The Diet of Preschool Children in the Mediterranean Countries of the European Union: A Systematic Review

This systematic review discusses data on the dietary intake of preschool children living in the Mediterranean countries of the European Union, including the comparison with a Mediterranean-like diet and the association with nutritional status. Specifically, data from the multinational European Identification and Prevention on Dietary and life style induced health effects in children and infants (IDEFICS) study and national studies, such as the Estudo do Padrão Alimentar e de Crescimento Infantil (EPACI) study and Geração XXI cohort in Portugal, ALimentando la SAlud del MAñana (ALSALMA) study in Spain, Étude des Déterminants pré-et postnatals précoces du développement et de la santé de l'ENfant (EDEN) cohort in France, Nutrintake 636 study in Italy, and Growth, Exercise and Nutrition Epidemiological Study in preSchoolers (GENESIS) cohort in Greece, were analyzed. In the majority of countries, young children consumed fruit and vegetables quite frequently, but also consumed sugared beverages and snacks. High energy and high protein intakes mainly from dairy products were found in the majority of countries. The majority of children also consumed excessive sodium intake. Early high prevalence of overweight and obesity was found, and both early consumption of energy-dense foods and overweight seemed to track across toddler and preschool ages. Most children living in the analyzed countries showed low adherence to a Mediterranean-like diet, which in turn was associated with being overweight/obese. Unhealthier diets were associated with lower maternal educational level and parental unemployment. Programs promoting adherence of young children to the traditional Mediterranean diet should be part of a multi-intervention strategy for the prevention and treatment of pediatric overweight and obesity.

Outcome of the Public Consultation on the Draft Opinion of the Scientific Panel on Dietetic Products, Nutrition, and Allergies (NDA) on Dietary Reference Values for Fats, Including Saturated Fatty Acids, Polyunsaturated Fatty Acids, Monounsaturated Fatty Acids, Trans Fatty Acids, and Cholesterol

On 2 July 2009, the EFSA Panel on Dietetic products, Nutrition and Allergies (NDA) endorsed a draft Opinion on Dietary Reference Values for fats to be released for public consultation. This Scientific Report summarises the comments received through the public consultation and outlines how these were taken into account in the final opinion. EFSA had received contributions from 40 interested parties (individuals, non-governmental organisations, industry organisations, academia and national assessment bodies). The main comments which were received during the public consultation related to: the availability of more recent data, the nomenclature used, the use of a non-European food composition data base, the impact of genetic factors in modulating the absorption, metabolism and health effects of different fatty acids, the definition of “nutritionally adequate diet”, the use of Dietary Reference Values in the labelling of foods, the translation of advice into food-based dietary guidelines, nutrient goals and recommendations, certain risk management issues, and to Dietary Reference Values of fats, individual fatty acids, and cholesterol. All the public comments received that related to the remit of EFSA were assessed and the Opinion on Dietary Reference Values for fats has been revised taking relevant comments into consideration.

Mobilisation des dépôts ectopiques de tissu adipeux : ses implications dans la résolution des comorbidités associées à l'obésité sévère suivant une chirurgie bariatrique

La prévalence de l’obésité sévère ne cesse d’augmenter. La problématique associée à l’obésité sévère est la présence possible de nombreuses comorbidités qui peuvent coexister et altérer le système cardiovasculaire, pulmonaire, endocrinien, articulaire et même favoriser le développement de certains cancers. L’excès de poids, plus particulièrement l’excès de tissu adipeux, sont tous deux liés au développement de ces comorbidités. Aucune donnée n’est disponible quant au rôle de la déposition ectopique du tissu adipeux. Considérant le caractère morbide de l’obésité sévère, la mortalité de toute cause augmentée et l’espérance de vie réduite, à ce jour le seul traitement dit efficace à long terme pour le traitement de l’obésité sévère est la chirurgie bariatrique. L’efficacité est définie par la perte de poids, le maintien à long terme de cette perte de poids ainsi que par l’amélioration ou la résolution des comorbidités. L’intérêt clinique et scientifique pour la chirurgie bariatrique est grandissant. Un nombre important d’études s’intéresse aux mécanismes sous-jacents de la résolution des comorbidités. Le diabète de type 2 est la comorbidité la plus étudiée et peu d’études se sont intéressées aux déterm meil.inants de la résolution de l’hypertension artérielle et de l’apnée obstructive du som Comme premier objectif, cette thèse visait à caractériser les différences de la composition corporelle et de la distribution du tissu adipeux de patients obèses sévères avec ou sans diagnostic de diabète de type 2, d’hypertension artérielle et d’apnée obstructive du sommeil. Le deuxième objectif de cette thèse visait à comparer l’évolution postopératoire suite à une chirurgie bariatrique sur les changements de la composition corporelle et de la distribution du tissu adipeux selon le statut de résolution du diabète de type 2, de l’hypertension artérielle et de l’apnée obstructive du sommeil. De plus, considérant le peu d’évidences dans la littérature au sujet des déterminants de la résolution de l’hypertension artérielle et de l’apnée obstructive du sommeil, l’évaluation du profil inflammatoire, des adipokines et de l’activité du système nerveux autonome ont aussi été caractérisés. Premièrement, nous avons documenté qu’en présence d’obésité sévère, la déposition ectopique du tissu adipeux était plus importante chez les patients avec un diabète de type 2, une hypertension artérielle et une apnée obstructive du sommeil comparativement à ceux n’ayant pas ces comorbidités. Nous avons par la suite montré que la résolution du diabète de type 2 et de l’hypertension artérielle était caractérisée par une réduction plus importante du tissu adipeux viscéral. Au contraire, la résolution de l’apnée obstructive du sommeil était plutôt caractérisée par une réduction plus importante du tissu adipeux sous-cutané à la mi-cuisse et par une tendance à une perte de poids plus élevée. De plus, nous avons observé que chez les patients qui n’avaient pas résolu leur diabète de type 2, leur hypertension artérielle et leur apnée obstructive du sommeil, la quantité de tissu adipeux viscéral, à 12 mois suivant la chirurgie bariatrique, était plus importante comparativement à celle mesurée chez les patients n’ayant pas résolu ces comorbidités. Spécifiquement à l’évaluation du profil inflammatoire et des adipokines, nous avons observé que chez les patients obèses sévères, la présence de l’hypertension artérielle et de l’apnée obstructive du sommeil n’était pas caractérisée par un profil altéré au niveau des marqueurs inflammatoires et des adipokines. Également, nous n’avons pas observé de changements majeurs qui pouvaient expliquer, en partie, la résolution de l’hypertension artérielle et de l’apnée obstructive du sommeil. Quant à l’activité du système nerveux autonome, nous avons observé une faible activité du système nerveux parasympathique chez les patients obèses sévères avec hypertension artérielle et apnée obstructive du sommeil. Nous avons également documenté que la résolution de l’hypertension artérielle et de l’apnée obstructive du sommeil était associée à une tendance à une augmentation plus importante de l’activité parasympathique du système nerveux autonome. Les résultats obtenus au cours de ce doctorat supportent l’importance de la déposition ectopique du tissu adipeux en situation d’obésité sévère, particulièrement le rôle du tissu adipeux viscéral, dans le développement du diabète de type 2, de l’hypertension artérielle et de l’apnée obstructive du sommeil ainsi que dans la résolution de ces comorbidités suivant une chirurgie bariatrique. D’autres recherches devront davantage s’intéresser à la mobilisation des dépôts ectopiques de tissu adipeux comme un déterminant important dans la résolution à plus long terme de ces comorbidités.

Objective Methods for Characterizing Physical Exposures which may contribute to Work-related Musculoskeletal Disorders in Agricultural Workers

Thesis (Ph.D.)--University of Washington, 2016-08

Occupational exposure to fungi and particles in animal feed industry

Background: Very few studies regarding fungal and particulate matter (PM) exposure in feed industry have been reported, although such contaminants are likely to be a significant contributing factor to several symptoms reported among workers. The purpose of this study has been to characterize fungal and dust exposure in one Portuguese feed industry. Material and Methods: Air and surface samples were collected and subject to further macro- and microscopic observations. In addition we collected other air samples in order to perform real-time quantitative polymerase chain reaction (PCR) amplification of genes from Aspergillus fumigatus and Aspergillus flavus complexes as well as Stachybotrys chartarum. Additionally, two exposure metrics were considered – particle mass concentration (PMC), measured in 5 different sizes (PM0.5, PM1, PM2.5, PM5, PM10), and particle number concentration (PNC) based on results given in 6 different sizes in terms of diameter (0.3 μm, 0.5 μm, 1 μm, 2.5 μm, 5 μm and 10 μm). Results: Species from the Aspergillus fumigatus complex were the most abundant in air (46.6%) and in surfaces, Penicillium genus was the most frequently found (32%). The only DNA was detected from A. fumigatus complex. The most prevalent in dust samples were smaller particles which may reach deep into the respiratory system and trigger not only local effects but also the systemic ones. Conclusions: Future research work must be developed aiming at assessing the real health effects of these co-exposures.

How to deal with uncertainties regarding the occupational exposure to antineoplastic mixtures: additive effect should always be considered?

Risk assessment considerations - The concept that “safe levels of exposure” for humans can be identified for individual chemicals is central to the risk assessment of compounds with known toxicological profiles. Selection of agents for combination chemotherapy regimens involves minimize overlapping of mechanisms of action, antitumor activity and toxicity profile. Although the toxicological profile and mechanism of action of each individual drug is well characterized, the toxicological interactions between drugs are likely, but poorly established at occupational exposure context. The synergistic nature of interactions may help in understanding the adverse health effects observed in healthcare workers, where exposure situations are characterized by complex mixtures of chemical agents, and the levels of individual exposing agents are often not sufficiently high to explain the health complaints. However, if a substance is a genotoxic carcinogen, this would be the “lead effect”; normally, no OEL based on a NOEL would be derived and the level would be set so low that it would be unlikely that other effects would be expected. Aim of the study - Recently research project developed in Portuguese Hospitals characterize the occupational exposure to antineoplastic agents and the health effects related. The project aimed to assess exposure of the different risk groups that handle antineoplastic agents in the hospital setting, namely during preparation and administration of these drugs. Here it is presented and discussed the results in a study developed in two hospitals from Lisbon.

Co-exposure to mycotoxins: the case of waste management workers

Introduction - Occupational exposures are characterized by being complex and associated to co-exposure to several contaminants by different exposure routes. Even if exposure occurs to only a chemical agent, it can have different exposure routes and can result in different health effects. The waste management setting is recognized by the presence of several chemical and biologic agents in the workplaces. Recently, it was reported occupational exposure to Aflatoxin B1 (AFB1) in one Portuguese waste management industry. However, data regarding to fungal burden showed that exposure to other mycotoxins should be expected. Aim of the study - The aim of the present work was to know if workers from this waste management industry were exposed to other mycotoxins besides AFB1.

Importance of size-selective particle measuring for assessing occupational exposures: a case study “from field to fork”

Sampling the total air concentration of particulate matter (PM) only provides a basic estimate of exposure that normally not allows correlating with the observed health effects. Therefore is of great importance to recognize the particles size distribution and, particularly, the exposure to fine particles (≤ 2.5 μm). This particles dimension corresponds to the respirable fraction, the one that can implicate local and systemic effects due to particle deposition and clearance from the lungs and transport within the organism. This study intended to describe occupational exposure to PM2.5 in three units related with swine production and consumption, namely: feed production, swine production and swine slaughterhouse. A size-selective particle measuring in five to six workplaces of each unit was performed. Measurements of PM were done using a portable direct-reading hand-held equipment (Lighthouse, model 3016 IAQ). Data showed slaughterhouse unit with higher values, with values ranging from 0.030 to 0.142 mg/m3 (0.073 + 0.043), being the cutting room the workplace with higher values. In feed production unit, values were between 0.026 and 0.033 mg/m3 (0.028 + 0.003) with the warehouse of pharmacy products as the workplace with higher values. Finally, in swine unit values ranged from 0.006 to 0.048 mg/m3 (0.023 + 0.017) with the batteries area presenting the higher values. PM can be rich in fungi and bacteria and their metabolites, such as endotoxins and mycotoxins. Previous publications already showed high contamination in these occupational settings and particles can have an important role in exposure since can easily act as carrier of these agents. Data acquired allow not only a better prediction of particle penetration into respiratory regions of the respiratory tract, but also a better estimation of PM health effects. Moreover, data permit to identify the workplaces where investment should be made to prevent and reduce exposure.

BPA occupational exposure assessment in Europe: a scientific gap

Bisphenol A (BPA), 2,2-bis(4-hydroxyphenyl) propane one is of the greatest volume industrial chemicals utilized in the world with increased production every year. Environmental exposure to this xenoestrogen is considered a generalized phenomenon with a Tolerable Daily Intake (TDI) of4 µg/kg body weight/day established by the European Food Safety Authority. Several studies have focused in estimate human daily intake and potential associated health effects of environmental exposures, however despite of the massive BPA production and consumption in European countries, with policarbonate and epoxy resins as the major applications, occupational exposure to BPA have been overlooked and considered safe by the European authorities.

Climate changes influence in occupational exposure to fungi and mycotoxins

Climate changes and their effects on fungal distribution and activity are aspects of concern regarding the human exposure to mycotoxins. An exhaustive search was made for papers available in scientific databases reposrting the influence that climate cchange has on fungi and mycotoxins. Also a review regarding fungal burden, collected between 2010 and 2015 in different settings, was done to support the discussion about future fungi and mycotoxins ocuupational exposure. A. flavus complex, E. graminerarum complex and F. verticilliodes were the most reported to be influenced by climate changes. We noted also that the analyzed Portuguese settings presented already an occupational problem due to their fungal burden. It will be important to know future climate changes to select what complexes/species and strains, and consequently the mycotoxins, we should consider as indicators of an occupational problem. In addition, epidemiologic studies are needed to increase knowledge about potential health effects related with the exposure to both risk factors.

Occupational exposure to particles during hotel´s rooms cleaning

Background: The majority of studies investigated ambient particles, although in most industrialized countries people spend most of their time indoors and significant emissions of fine and ultrafine particles leading to human exposure are caused by various indoor tasks, including cleaning tasks. Objective: To characterize the occupational exposure to particles during cleaning of hotel's rooms. Methodology: Measurements of mass concentration and particle number concentration were performed before and during cleaning tasks in two rooms with different floor types (wood and carpet) with the equipment Lighthouse, model 3016 IAQ. Results: Considering mass concentration, particles with higher were responsable for higher leves of contamination, particularly PM5.0 and PM10.0. However, considering the particle number concentration, the smaller particle size obtained the higher values. Conclusion: It was observed higher number of particles of the smaller size in all tasks, which is associated with worse health effects. It was observed that the room with wood in the floor has lower values when compared to the room with carpet. The tasks with greater exposure were the 'vacuuming' and 'clean up powder'.

Importância do polimorfismo OGG1 Ser326Cys no estudo dos efeitos para a saúde que resultam da exposição ocupacional a genotóxicos: o caso da exposição a antioneoplásicos

O ensaio cometa é um dos ensaios de avaliação de genotoxicidade mais promissores de avaliação do risco humano, sendo recomendado para a monitorização de populações com exposição crónica a agentes genotóxicos. Os laboratórios são ambientes profissionais em que os trabalhadores podem encontrar-se expostos a agentes químicos. As drogas antineoplásicas são agentes químicos que são considerados carcinogénicos e, desta forma, medidas de protecção especiais devem ser adoptadas. O objectivo desta comunicação é contribuir para o desenvolvimento de um programa de biomonitorização que inclui a avaliação de genotoxicidade relacionada com biomarcadores de susceptibilidade genética.

Fungal contamination in one hotel room: does carpet coating in the floor enhance fungal contamination?

Interest in bioaerosol exposure has increased significantly because it is now recognized that exposure to fungal agents is associated with a wide range of adverse health effects with a major impact on public health. Fungi are able to grow on almost all natural and synthetic materials, especially if they are hygroscopic or wet. Aim of the study: Several materials used indoors can contribute to enhance fungal contamination indoors. This study intended to understand the carpet influence on fungal contamination when used in the floor of a hotel room.

Importance of size-selective particle sampling for assessing occupational exposures: results from three different occupational settings

Sampling the total air concentration of particulate matter (PM) only provides a basic estimate of exposure that normally not allows correlating with the observed health effects. Therefore is of extreme importance to know the particles size distribution and, in more detail, the exposure to fine particles (≤ 2.5 µm). This particles dimension corresponds to the respirable fraction. This particle fraction can result, besides local effects, in systemic effects due to particle deposition and clearance from the lungs and transport within the organism. This study intended to describe occupational exposure to PM2.5 in three different units located near Lisbon and related with occupational exposure to organic dust, namely: swine and poultry feed production and waste management.

Factors affecting gut metabolism and bioavailabilty of orange juice flavanones in humans

Several studies have supported a beneficial role of dietary flavonoids in reducing the risk/progression of chronic diseases (including hypertension, cardiovascular disease, certain cancers, type-2-diabetes, cognitive dysfunction, age-related bone disease). Their beneficial properties are likely to be affected by their structure, distribution in foods, food matrix, life habits (physical activity). Most dietary polyphenols reach the colon where they are metabolized to phenolic acids by gut bacteria. Lack of knowledge of the factors affecting flavonoid metabolism and bioavailability hinders understanding of their health effects. Therefore, this thesis aimed to investigate the effect of factors on bioavailability and metabolism of dietary polyphenols from orange juices (OJ) in in vitro and in vivo studies. In chapter 3, the variability of orange juice polyphenolic content was assessed using in vitro models of the human gastrointestinal tract. Chapter 4 investigated the reduced urinary phenolic acids after OJ and yoghurt (Y) in humans compared to OJ alone using in vitro models of the human gut. In chapter 5, raftiline and glucose were tested for effects on metabolism of hesperidin (flavanone not OJ). In chapter 6, an intervention study of 4 weeks moderate intensity exercise determined whether exercise affected bioavailability and metabolism of OJ flavanones in healthy sedentary females. The studies in this thesis showed that food sources, food matrix and physical exercise may determine the significant variations in bioavailability and metabolism of flavonoids, seen in a number of studies. These factors could result in differences in bioactivity and bioefficacy of polyphenols, and need to be taken into account in further studies of the effects of flavanones on disease risk.