Systematic review of metrics used to characterize dietary nutrient supply from household consumption and expenditure surveys

Objective: To review existing publications using Household Consumption & Expenditure Survey (HCES) data to estimate household dietary nutrient supply to (1) describe scope of available literature, (2) identify the metrics reported and parameters used to construct these metrics, (3) summarize comparisons between estimates derived from HCES and individual dietary assessment data, and (4) explore the demographic and socioeconomic sub-groups used to characterize risks of nutrient inadequacy. Design: This study is a systematic review of publications identified from online databases published between 2000 to 2019 that used HCES food consumption data to estimate household dietary nutrient supply. Further publications were identified by “snowballing” the references of included database-identified publications. Setting: Publications using data from low- and lower middle income countries Results: In total, 58 publications were included. Three metrics were reported that characterized household dietary nutrient supply: apparent nutrient intake per adult-male equivalent per day (n=35), apparent nutrient intake per capita per day (n=24), and nutrient density (n=5). Nutrient intakes were generally overestimated using HCES food consumption data, with several studies finding sizeable discrepancies compared to intake estimates based on individual dietary assessment methods. Sub-group analyses predominantly focused on measuring variation in household dietary nutrient supply according to socioeconomic position and geography. Conclusion: HCES data are increasingly being used to assess diets across populations. More research is needed to inform the development of a framework to guide the use of and qualified interpretation of dietary assessments based on these data.

Caloric adequacy of parenteral nutrition and its influence on the clinical outcome of hospitalised patients

Background: The adaptation of Parenteral Nutrition (PN) to actual energy requirements of hospitalised patients is essential, since excessive and insufficient nutritional intake have been associated with poor clinical outcomes. Aim: To evaluate the adaptation of prescribed PN to the estimated nutritional requirements using three predictive equations and the influence of excessive/insufficient nutrient intake on patient clinical outcomes (nutritional parameters, metabolic and infectious complications). Methods: Prospective, observational study in hospitalised patients nutritionally assessed. Data was collected the first and fifth/sixth day of PN with clinical (infection, length of hospital stay), biochemical (visceral proteins, cholesterol, glucose, triglycerides, lymphocytes, CRP) and anthropometric parameters (skin folds, height, weight). Theoretical requirements were calculated using Harris-Benedict (HB), Mifflin-St Jeor (MF) and 25 Kcal/Kg/day formulas. The HB formula was used to compare estimated and provided requirements. Results: A total of 94 patients (mean: 72 ± 13.7 years old) were included with initial mean weight and height of 69.2 Kg and 162.8 cm, respectively (mean BMI: 26.1 Kg/m2). No statistically significant differences were found between the actual (1620 Kcal/day) and estimated caloric mean calculated with HB (1643 Kcal/day) and MF (1628 Kcal/day). When comparing with the caloric estimation, 31.9% of patients were underfed, while 14.9% were overfed. Intergroup analysis demonstrated significant variations in albumin, prealbumin, glucose, cholesterol, triglycerides and MUAC, with a significant increase of hyperglycaemia (+37.86; p < 0.05) and hypertriglyceridemia (+63.10; p < 0.05), being higher in overfed patients. Conclusion: In our study, inadequate nutrient intake was associated with a higher degree of hyperglycaemia and hypertriglyceridemia, without positive impact on anthropometric parameters.

Validity and Reliability of Semiquantitative Food Frequency Questionnaires for Assessing Nutrient Intake among Preschool Children in Northwest China

Background. Considering the lack of valid and reliable food frequency questionnaires (FFQs) for nutritional epidemiological studies in China, it is necessary to develop an effective one for assessing nutrient intake among preschool children. The aim of this study was to evaluate the validity and reliability of newly developed FFQs for assessing food and nutrient intakes among preschool children in Northwest China. Methods. Semiquantitative 67-item FFQs were developed and validated. In total, 326 children (aged 2–6 years) were recruited from three different cities in Northwest China. All subjects were asked to complete the FFQs twice with a six-month interval period for test-retest reliability. Apart from the FFQs, a 3-day food record (3-DFR) was also carried out to evaluate the validity of the FFQs. Results. There was no significant difference in the nutrient intakes of preschool children between the two FFQs ( P > 0.05 ), and these two FFQs demonstrated a positive correlation ( P < 0.05 ). Spearman’s coefficient correlation values ranged from 0.222 (“Selenium”) to 0.832 (“Energy”). The intraclass correlation coefficient values ranged from 0.282 (“Selenium”) to 0.882 (“Energy”). With regards to the validity of FFQs, nutrient intakes from FFQs were greater than 3DR dietary recalls ( P < 0.05 ). After adjusting for total energy and intraindividual variation, all nutrient intakes showed a positive correlation ( P < 0.05 ), and these correlations became stronger. According to the quartiles of nutrient intakes, the exact agreement between the FFQs and 3DR dietary recalls ranged between 40% (“Selenium”) and 70% (“Energy”), and grossly misclassified was low (12.5%). Conclusions. The findings of this study indicate that the designed FFQs exhibit good test-retest reliability and moderate relative validity. Hence, the FFQs can serve as an important tool for the large-scale assessment of food and nutrient intakes among preschool children (in the mentioned areas of China).

Nutritional quality of some non-alcoholic beverages from the Romanian market

In the recent years, young consumers choose to consume from the category of soft drinks, without acknowledging that their health may be endangered. To this end, we aim to contribute to the real scientific estimation of the nutrient intake from a number of 20 waters with vitamins and minerals having a reduced addition of fruit extract (1-3%), compared to juices that have 10-30 % fruits extract, from those sold in Romania. We analyzed the presentation of the nutritional declaration, the quality of the additives and the profiling of nutrients through the SENS system. The obtained results classify the products in the category of those with low energy value and in the category “significant sources of vitamins and minerals”; there are from food classes 2 and 4, as a nutritional profile

Uncommon sublingual ulceration in an infant

Sir, An eight-month-old girl was referred to our department with an extensive lingual ulceration. The parents noted that she had habitually bitten her tongue since the release of her first teeth at the age of six months. She was a poor feeder and did not sleep well because of the painful lingual ulceration. There was no family history of developmental disorders or congenital syndromes. Intraoral examination revealed a deep, circular, and extensive ulceration of the whole ventral surface of the tongue with intermittent bleeding in the tongue (Figs. 1a – c). An examination of the rest of the intraoral mucosa revealed that the lower central incisors had recently erupted. However, there were two other ulcerations of the palmar surface of the second and third fingers caused by nocturnal finger biting. Neurological examination noted a lack of pain sensitivity related to peripheral neuropathy diagnosed as congenital insensitivity to pain. Based on the clinical features and the particular site on the ventral surface of the tongue against the lower central incisors and ulcerative lesions of the fingers due to self-biting, the lesion was diagnosed as Riga–Fede disease. Because of the size of the ulceration, significant pain during feeding led to inadequate nutrient intake associated with permanent sleep disturbances. Radical treatment was chosen and the lower central incisors were extracted. Topical corticosteroids were prescribed to help with healing. The term Riga–Fede disease has been used to describe a traumatic ulceration that has occurred on the ventral surface of the tongue in newborn babies and infants. It is most commonly related to neonatal or natal teeth but may also occur in infants after the eruption of the primary lower incisors [1]. This benign ulceration occurs as a result of repetitive mechanical trauma caused to the oral mucosal surfaces by the teeth and is most commonly located on the ventral surface of the tongue against the teeth [1,2]. Riga–Fede disease may reveal an underlying developmental or neurologic disorder, including congenital insensitivities to pain [3]. The case of our patient was associated with congenital insensitivity to pain. Failure to diagnose may lead to dehydration and inadequate nutrient intake in the infant because of the significant pain during feeding. No biopsy is needed. The diagnosis of Riga–Fede disease is based on clinical characteristics [1,2]. Treatment should focus on eliminating the source of trauma. Conservative treatment is attempted at first by grinding the sharp edges of the teeth and placing composite resin in a dome shape or by placing a protective ring. If conservative treatment fails to heal the wounds, radical treatment may be necessary, such as extraction of the teeth [2,3]. We believe that Riga–Fede disease must be recognized by clinicians to avoid misdiagnosis and delayed treatment.