Reference values for handgrip strength in among healthy young adults

Background: Isometric grip strength, evaluated with a handgrip dynamometer, is a marker of current nutritional status and cardiometabolic risk and future morbidity and mortality. We present reference values for handgrip strength in healthy young Colombian adults (aged 18 to 29 years). Methods: The sample comprised 5.647 (2.330 men and 3.317 women) apparently healthy young university students (mean age, 20.6±2.7 years) attending public and private institutions in the cities of Bogota and Cali (Colombia). Handgrip strength was measured two times with a TKK analogue dynamometer in both hands and the highest value used in the analysis. Sex- and age-specific normative values for handgrip strength were calculated using the LMS method and expressed as tabulated percentiles from 3 to 97 and as smoothed centile curves (P3, P10, P25, P50, P75, P90 and P97). Results: Mean values for right and left handgrip strength were 38.1±8.9 and 35.9±8.6 kg for men, and 25.1±8.7 and 23.3±8.2 kg for women, respectively. Handgrip strength increased with age in both sexes and was significantly higher in men in all age categories. The results were generally more homogeneous amongst men than women. Conclusions: Sex- and age-specific handgrip strength normative values among healthy young Colombian adults are defined. This information may be helpful in future studies of secular trends in handgrip strength and to identify clinically relevant cut points for poor nutritional and elevated cardiometabolic risk in a Latin American population. Evidence of decline in handgrip strength before the end of the third decade is of concern and warrants further investigation

Desempeño de las RISS en relación al acceso, coordinación y calidad de la atención en cáncer de mama y diabetes mellitus tipo 2 en Colombia

El objetivo de este capítulo es mostrar los resultados de investigación del desempeño de las redes de servicios de salud frente a diferentes dimensiones relacionadas al acceso, coordinación y calidad de la atención en dos enfermedades crónicas como es el cáncer de mama y la diabetes en Colombia, importantes patologías por su incidencia e impacto así como por la necesidad de la mecanismos efectivos de coordinación para la adecuada atención de los usuarios del sistema de salud. Por tanto, se realiza el análisis del desempeño de dos redes de servicios de salud en la atención de usuarias con diagnostico confirmado de cáncer de mama, vinculadas unas a redes pertenecientes al régimen contributivo y otras al régimen subsidiado. Redes que también fueron consideradas para el análisis del desempeño en la atención de usuarios con diagnostico confirmado de diabetes, en el que de manera adicional participó otra red perteneciente al régimen subsidiado con área de operación en el municipio de Soacha, puesto que las dos anteriores tiene influencia en la ciudad de Bogotá. La fuente primaria de los datos fue la historia clínica y éstos fueron extraídos de acuerdo a ciertos indicadores seleccionados por el equipo investigador a través de un previo proceso de validación y a partir de su importancia para evidenciar el desempeño de las redes de servicios de salud en las dimensiones enunciadas anteriormente. Se muestran los resultados del estudio, a partir de los cuales se propone una breve discusión y conclusiones.

Relação entre factores ambientais causadores de stress e doença renal felina

A Doença Renal Crónica (DRC) é de natureza insidiosa, progressiva e irreversível e uma grande causa de morbilidade e mortalidade em gatos. O comportamento natural da espécie felina fica comprometido no meio doméstico, originando situações de stress que desempenham um papel importante na patogénese da doença crónica. A literatura sugere que a activação contínua do sistema nervoso simpático desencadeia uma série de processos fisiológicos que se traduzem por último no aparecimento de fibrose renal, contribuindo assim para a progressão da DRC. Esta dissertação pretende avaliar essa relação. Para tal, foram analisados questionários que permitissem avaliar as condições em que viviam uma amostra de 139 gatos e realizados painéis hematológicos e bioquímicos a uma sub-amostra para verificar as correlações existentes. Ainda que não tenha sido possível concluir que a presença de um parâmetro individual possa ser apontada como causa directa do desenvolvimento de DRC, podemos identificar um conjunto de factores ambientais causadores de stress como prováveis factores de risco para a degradação desta doença e a sua transição para fases mais avançadas. Desta forma, a implementação de estratégias de enriquecimento ambiental MEMO (Multimodal Environmental Modification) não só visa melhorar a qualidade de vida destes animais como se pode revelar uma chave de sucesso na prevenção e maneio de doenças crónicas.

British Nutrition Foundation annual lecture: chips with everything? Nutritional genomics and the application of diet in disease prevention

The development of high throughput techniques ('chip' technology) for measurement of gene expression and gene polymorphisms (genomics), and techniques for measuring global protein expression (proteomics) and metabolite profile (metabolomics) are revolutionising life science research, including research in human nutrition. In particular, the ability to undertake large-scale genotyping and to identify gene polymorphisms that determine risk of chronic disease (candidate genes) could enable definition of an individual's risk at an early age. However, the search for candidate genes has proven to be more complex, and their identification more elusive, than previously thought. This is largely due to the fact that much of the variability in risk results from interactions between the genome and environmental exposures. Whilst the former is now very well defined via the Human Genome Project, the latter (e.g. diet, toxins, physical activity) are poorly characterised, resulting in inability to account for their confounding effects in most large-scale candidate gene studies. The polygenic nature of most chronic diseases offers further complexity, requiring very large studies to disentangle relatively weak impacts of large numbers of potential 'risk' genes. The efficacy of diet as a preventative strategy could also be considerably increased by better information concerning gene polymorphisms that determine variability in responsiveness to specific diet and nutrient changes. Much of the limited available data are based on retrospective genotyping using stored samples from previously conducted intervention trials. Prospective studies are now needed to provide data that can be used as the basis for provision of individualised dietary advice and development of food products that optimise disease prevention. Application of the new technologies in nutrition research offers considerable potential for development of new knowledge and could greatly advance the role of diet as a preventative disease strategy in the 21st century. Given the potential economic and social benefits offered, funding for research in this area needs greater recognition, and a stronger strategic focus, than is presently the case. Application of genomics in human health offers considerable ethical and societal as well as scientific challenges. Economic determinants of health care provision are more likely to resolve such issues than scientific developments or altruistic concerns for human health.

Young adults and the 5 a day campaign: perceived benefits and barriers of eating more fruits and vegetables

Although consuming adequate amounts of fruits and vegetables reduces the risk of developing chronic diseases, it is widely recognized that young adults’ intakes are currently well below the Department of Health’s recommended five portions a day, with men consuming even less than women. One approach in the UK has been to introduce health campaigns such as the 5 A DAY programme; however, little is currently known about how well their messages are understood amongst young adults. This study examined current knowledge of the 5 A DAY message in young adults, as well as the perceived benefits and remaining barriers towards consuming more fruits and vegetables. In total, four focus groups were conducted using male (n = 22) and female (n = 18) students at the University of Reading. Content analysis revealed that while participants were aware of the 5 A DAY recommendation, there was widespread confusion regarding the detail. In addition, men were less accepting of the message than women, reporting greater disbelief and a lack of motivation to increase intake. Finally, a range of barriers was reported by participants of both genders, despite the perceived beneficial effects for health and appearance. The results illustrate a considerable gap between awareness and knowledge of the 5 A DAY message, and underscore the challenge that changing behaviour in young adults represents. As well as stepping up education- and skill-based health campaigns, more targeted gender specific interventions will be needed to achieve sustained increases in fruit and vegetable intake.

Personalised nutrition: status and perspectives

Personalised, genotype-based nutrition is a concept that links genotyping with specific nutritional advice in order to improve the prevention of nutrition-associated, chronic diseases. This review describes the current scientific basis of the concept and discusses its problems. There is convincing evidence that variant genes may indeed determine the biological response to nutrients. The effects of single-gene variants on risk or risk factor levels of a complex disease are, however, usually small and sometimes inconsistent. Thus, information on the effects of combinations of relevant gene variants appears to be required in order to improve the predictive precision of the genetic information. Furthermore, very few associations between genotype and response have been tested for causality in human intervention studies, and little is known about potential adverse effects of a genotype-derived intervention. These issues need to be addressed before genotyping can become an acceptable method to guide nutritional recommendations.

Bioactive peptides from food proteins: new opportunities and challenges

Food proteins such as milk and soy are a rich source of bioactive peptides. In the last decade, research into this area has intensified and new bioactive peptide sequences have been discovered with a range of apparent biological functions; for example, antihypertensive, antioxidant, and antimicrobial effects and opiate-like qualities have been reported. These peptides could therefore lead to the development of important functional food products and ingredients for the prevention and even treatment of chronic diseases such as cardiovascular disease and cancer. Peptides can be produced by fermentation with dairy starters for instance, and by enzymatic hydrolysis with pancreatic and microbial enzymes. Further purification is typically carried out by membrane filtration and/or chromatographic methods. The production of novel bioactive peptides and their incorporation into functional food products poses several technological challenges as well as regulatory and marketing issues. Proof of efficacy is of paramount importance; this should be verified by conducting appropriate tests in vivo in animals and in humans. In addition, tests for cytotoxicity and allergenicity must be conducted. Despite all of these hurdles, scientific evidence is increasingly demonstrating the health benefits of diet-based disease prevention, and therefore new developments in this area are likely to continue both at the research and the commercialisation level.

Diet, immunity and functional foods

Functional foods (specific nutrient and/or food components) should beneficially affect one or more target functions in the body. The use of functional foods as a form of preventive medicine has been the subject of much research over the last two decades. It is well known that nutrition plays a vital role in chronic diseases, but it is only recently that data relating to the effects of specific nutrients or foods on the immune system have become available. This chapter aims to summarize the effects of some functional foods (e.g., prebiotics and micronutrients) on the immune system. It should be noted, however, that studies into the role of functional foods with regard to the human immune system are still in their infancy and a great deal of controversy surrounds the health claims attributed to some functional foods. Consequently, thorough studies are required in human and animal systems if we are to move towards developing a functional diet that provides maximal health benefits.

Molecular mechanisms by which dietary isoflavones potentially prevent atherosclerosis

Dietary isoflavones are currently receiving much attention because of their potential role in preventing coronary artery disease and other chronic diseases. Accumulating evidence from cell culture and laboratory animal experiments indicates that isoflavones have the potential to prevent or delay atherogenesis. Suggested mechanisms of action include: a reduction in low-density lipoprotein (LDL) cholesterol and a potential reduction in the susceptibility of the LDL particle to oxidation; (2) an improvement in vascular reactivity; (3) an inhibition of pro-inflammatory cytokines, cell adhesion proteins and nitric oxide (NO) production; and (4) an inhibition of platelet aggregation. These mechanisms are consistent with the epidemiological evidence that a high consumption of isoflavone-rich soy products is associated with a reduced incidence of coronary artery disease. Biological effects of isoflavones are dependent on many factors, including dose consumed, duration of use, protein-binding affinity, and an individual's metabolism or intrinsic oestrogenic state. Further clinical studies are necessary to determine the potential health effects of isoflavones in specific population groups as we currently know little about age-related differences in exposure to these compounds and there are few guidelines on optimal dose for cardiovascular health benefits.

Improving the nutritional quality of milk

Epidemiological evidence suggests high milk consumption protects against certain chronic diseases, and yet the high saturated fatty acid (SFA) concentration of milk fat has lead to research into reducing SFA and trans- fatty acid content, and enhancing conjugated linoleic acid (CLA) content. The most successful method of reducing SFA content is by feeding dairy cows supplemental oilseeds, although amount, type and form of oilseed influence the degree of effect. Also, the high unsaturated fatty acid content of oilseeds leads to increases in milk fat trans- fatty acids unless the oilseed is protected from rumen metabolism.

In vitro evaluation of the microbiota modulation abilities of different sized whole oat grain flakes.

Epidemiological studies and healthy eating guidelines suggest a positive correlation between ingestion of whole grain cereal and food rich in fibre with protection from chronic diseases. The prebiotic potential of whole grains may be related, however, little is known about the microbiota modulatory capability of oat grain or the impact processing has on this ability. In this study the fermentation profile of whole grain oat flakes, processed to produce two different sized flakes (small and large), by human faecal microbiota was investigated in vitro. Simulated digestion and subsequent fermentation by gut bacteria was investigated using pH controlled faecal batch cultures inoculated with human faecal slurry. The different sized oat flakes, Oat 23’s (0.53–0.63 mm) and Oat 25’s/26’s (0.85–1.0 mm) were compared to oligofructose, a confirmed prebiotic, and cellulose, a poorly fermented carbohydrate. Bacterial enumeration was carried out using the culture independent technique, fluorescent in situ hybridisation, and short chain fatty acid (SCFA) production monitored by gas chromatography. Significant changes in total bacterial populations were observed after 24 h incubation for all substrates except Oat 23’s and cellulose. Oats 23’s fermentation resulted in a significant increase in the Bacteroides–Prevotella group. Oligofructose and Oats 25’s/26’s produced significant increases in Bifidobacterium in the latter stages of fermentation while numbers declined for Oats 23’s between 5 h and 24 h. This is possibly due to the smaller surface area of the larger flakes inhibiting the simulated digestion, which may have resulted in increased levels of resistant starch (Bifidobacterium are known to ferment this dietary fibre). Fermentation of Oat 25’s/26’s resulted in a propionate rich SCFA profile and a significant increase in butyrate, which have both been linked to benefiting host health. The smaller sized oats did not produce a significant increase in butyrate concentration. This study shows for the first time the impact of oat grain on the microbial ecology of the human gut and its potential to beneficially modulate the gut microbiota through increasing Bifidobacterium population.

Milk and meat in our diet: good or bad for health?

Foods derived from animals are an important source of nutrients in the diet but there is considerable uncertainty about whether or not these foods contribute to increased risk of various chronic diseases. For milk in particular there appears to be an enormous mismatch between both the advice given on milk/dairy foods items by various authorities and public perceptions of harm from the consumption of milk and dairy products, and the evidence from long-term prospective cohort studies. Such studies provide convincing evidence that increased consumption of milk can lead to reductions in the risk of vascular disease and possibly some cancers and of an overall survival advantage from the consumption of milk, although the relative effect of milk products is unclear. Accordingly, simply reducing milk consumption in order to reduce saturated fatty acid (SFA) intake is not likely to produce benefits overall though the production of dairy products with reduced SFA contents is likely to be helpful. For red meat there is no evidence of increased risk of vascular diseases though processed meat appears to increase the risk substantially. There is still conflicting and inconsistent evidence on the relationship between consumption of red meat and the development of colorectal cancer, but this topic should not be ignored. Likewise, the role of poultry meat and its products as sources of dietary fat and fatty acids is not fully clear. There is concern about the likely increase in the prevalence of dementia but there are few data on the possible benefits or risks from milk and meat consumption. The future role of animal nutrition in creating foods closer to the optimum composition for long-term human health will be increasingly important. Overall, the case for increased milk consumption seems convincing, although the case for high-fat dairy products and red meat is not. Processed meat products do seem to have negative effects on long-term health and although more research is required, these effects do need to be put into the context of other risk factors to long-term health such as obesity, smoking and alcohol consumption.

Nutritional biomarkers for objective dietary assessment

The accurate assessment of dietary exposure is important in investigating associations between diet and disease. Research in nutritional epidemiology, which has resulted in a large amount of information on associations between diet and chronic diseases in the last decade, relies on accurate assessment methods to identify these associations. However, most dietary assessment instruments rely to some extent on self-reporting, which is prone to systematic bias affected by factors such as age, gender, social desirability and approval. Nutritional biomarkers are not affected by these and therefore provide an additional, alternative method to estimate intake. However, there are also some limitations in their application: they are affected by inter-individual variations in metabolism and other physiological factors, and they are often limited to estimating intake of specific compounds and not entire foods. It is therefore important to validate nutritional biomarkers to determine specific strengths and limitations. In this perspective paper, criteria for the validation of nutritional markers and future developments are discussed.

Carbon and nitrogen isotopic ratios of urine and faeces as novel nutritional biomarkers of meat and fish intake

Purpose Meat and fish consumption are associated with changes in the risk of chronic diseases. Intake is mainly assessed using self-reporting, as no true quantitative nutritional biomarker is available. The measurement of plasma fatty acids, often used as an alternative, is expensive and time-consuming. As meat and fish differ in their stable isotope ratios, δ13C and δ15N have been proposed as biomarkers. However, they have never been investigated in controlled human dietary intervention studies. Objective In a short-term feeding study, we investigated the suitability of δ13C and δ15N in blood, urine and faeces as biomarkers of meat and fish intake. Methods The dietary intervention study (n = 14) followed a randomised cross-over design with three eight-day dietary periods (meat, fish and half-meat–half-fish). In addition, 4 participants completed a vegetarian control period. At the end of each period, 24-h urine, fasting venous blood and faeces were collected and their δ13C and δ15N analysed. Results There was a significant difference between diets in isotope ratios in faeces and urine samples, but not in blood samples (Kruskal–Wallis test, p < 0.0001). In pairwise comparisons, δ13C and δ15N were significantly higher in urine and faecal samples following a fish diet when compared with all other diets, and significantly lower following a vegetarian diet. There was no significant difference in isotope ratio between meat and half-meat–half-fish diets for blood, urine or faecal samples. Conclusions The results of this study show that urinary and faecal δ13C and δ15N are suitable candidate biomarkers for short-term meat and fish intake.

Dietary intakes and food sources of phytoestrogens in the European Prospective Investigation into Cancer and Nutrition (EPIC) 24-hour dietary recall cohort

BACKGROUND/OBJECTIVES: Phytoestrogens are estradiol-like natural compounds found in plants that have been associated with protective effects against chronic diseases, including some cancers, cardiovascular diseases and osteoporosis. The purpose of this study was to estimate the dietary intake of phytoestrogens, identify their food sources and their association with lifestyle factors in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort. SUBJECTS/METHODS: Single 24-hour dietary recalls were collected from 36 037 individuals from 10 European countries, aged 35–74 years using a standardized computerized interview programe (EPIC-Soft). An ad hoc food composition database on phytoestrogens (isoflavones, lignans, coumestans, enterolignans and equol) was compiled using data from available databases, in order to obtain and describe phytoestrogen intakes and their food sources across 27 redefined EPIC centres. RESULTS: Mean total phytoestrogen intake was the highest in the UK health-conscious group (24.9 mg/day in men and 21.1 mg/day in women) whereas lowest in Greece (1.3 mg/day) in men and Spain-Granada (1.0 mg/day) in women. Northern European countries had higher intakes than southern countries. The main phytoestrogen contributors were isoflavones in both UK centres and lignans in the other EPIC cohorts. Age, body mass index, educational level, smoking status and physical activity were related to increased intakes of lignans, enterolignans and equol, but not to total phytoestrogen, isoflavone or coumestan intakes. In the UK cohorts, the major food sources of phytoestrogens were soy products. In the other EPIC cohorts the dietary sources were more distributed, among fruits, vegetables, soy products, cereal products, non-alcoholic and alcoholic beverages. CONCLUSIONS: There was a high variability in the dietary intake of total and phytoestrogen subclasses and their food sources across European regions.