Janet L. Weber

Iodine intake and status during pregnancy and lactation before and after government initiatives to improve iodine status, in Palmerston North, New Zealand: a pilot study

Iodine deficiency during pregnancy and lactation may adversely affect fetal and infant development. Two initiatives were introduced in New Zealand to prevent deficiency: (1) mandatory fortification of bread with iodised salt; and (2) provision of a subsidised iodine supplement (150 μg) for all pregnant and breastfeeding women. The aim of this study was to assess iodine intake and status among a self-selecting sample of pregnant and lactating women in Palmerston North, both before and after the two initiatives. Pregnant and breastfeeding women were recruited before (n = 25 and 32; 2009) and after (n = 34 and 36; 2011) the initiatives. Iodine concentration was determined in 24-h urine and breast milk samples using inductively-coupled plasma mass spectrometry. Use of supplements and salt, knowledge of iodine deficiency, and awareness of the initiatives were determined by questionnaire. Median urine iodine concentration (UIC) was higher in 2011 compared with 2009 for both pregnant (85 and 47 μg L(-1) ) and breastfeeding (74 and 34 μg L(-1) ) participants; median UIC were below the cut-offs for adequate iodine status. However, in 2011, the estimated daily iodine intake during pregnancy was 217 μg day(-1) ; 74% of women achieved the Estimated Average Requirement. Knowledge of the initiatives was low, only 28-56% were aware of the need for iodine supplements and only 15-22% were aware of the mandatory addition of iodised salt to bread. Despite initiatives, UIC of these women indicates iodine deficiency, however, dietary intakes appear adequate. Ongoing surveillance of supplement use and iodine status among pregnant and lactating women throughout New Zealand is needed to fully assess the efficacy of the initiatives. Alternative strategies may require evaluation to ensure all women have adequate iodine during pregnancy and breastfeeding.

Increased intake of selected vegetables, herbs and fruit may reduce bone turnover in post-menopausal women.

Increased consumption of vegetables/herbs/fruit may reduce bone turnover and urinary calcium loss in post-menopausal women because of increased intake of polyphenols and potassium, but comparative human studies are lacking. The main aim was to compare bone turnover markers and urinary calcium excretion in two randomised groups (n = 50) of healthy post-menopausal women consuming ≥9 servings of different vegetables/herbs/fruit combinations (three months). Group A emphasised a generic range of vegetables/herbs/fruit, whereas Group B emphasised specific vegetables/herbs/fruit with bone resorption-inhibiting properties (Scarborough Fair Diet), with both diets controlled for potential renal acid load (PRAL). Group C consumed their usual diet. Plasma bone markers, urinary electrolytes (24 h) and estimated dietary PRAL were assessed at baseline and 12 weeks. Procollagen type I N propeptide (PINP) decreased (−3.2 μg/L, p < 0.01) in the B group only, as did C-terminal telopeptide of type I collagen (CTX) (−0.065 μg/L, p < 0.01) in women with osteopenia compared to those with normal bone mineral density (BMD) within this group. Intervention Groups A and B had decreased PRAL, increased urine pH and significantly decreased urinary calcium loss. Urinary potassium increased in all groups, reflecting a dietary change. In conclusion, Group B demonstrated positive changes in both turnover markers and calcium conservation.

Complementary food blends and malnutrition among infants in Ghana: A review and a proposed solution

Widespread malnutrition among Ghanaian infants could be attributed to unfortified plant-based complementary foods commonly used at the household level. This review summarises the publications on the development of complementary food blends and intervention trials aimed at improving the nutritional status of Ghanaian infants. The complementary food blends are cereal-based which are developed from maize (in higher proportion) together with soyabean, cowpea and/or groundnut-an effort to improve protein and energy levels. The cereal-legume blends affect growth more positively than cereal-only formulations but not micronutrient status unless fortified with micronutrients. The low level of micronutrients (including vitamin A) and the high phytate content of cereal-legume blends partly account for micronutrient deficiencies. Phytate limits the bioavailability of nutrients such as iron, calcium and zinc. We propose an alternative complementary food blend which is based on sweet potato. This proposed formulation would be relatively high in endogenous β-carotene (vitamin A precursor) and low in phytate compared to household-level cereal-based complementary foods.

A household-level sweet potato-based infant food to complement vitamin A supplementation initiatives

Vitamin A deficiency (VAD) prevalence in Sub-Saharan Africa is high in spite of vitamin A supplementation programmes among children in most countries. Plant-based complementary foods remain the key source of nutrients in addition to breast milk for infants in lower income countries. Cereal-legume blends are superior in protein and energy densities compared with maize, millet or sorghum-only porridge. However, unfortified cereal-legume and cereal-only porridges are low in vitamin A. A household-level sweet potato-based infant food, rich in vitamin A, has been developed to complement vitamin A supplementation initiatives in Sub-Saharan Africa. A composite flour containing sweet potato, soybean, soybean oil and fishmeal was processed as complementary food by oven toasting (denoted oven-toasted ComFa). The oven-toasted ComFa and enriched Weanimix (processed from dehulled maize, dehulled soybean, groundnut and fishmeal) were assessed for suitability as complementary food based on the nutrient composition using specifications in the Codex Standard (CS) as a reference. The sweet potato-based formulation and enriched Weanimix met the energy, protein, fructose and fat specifications but barely met the amino acid score as indicated in the CS. However, only the oven-toasted ComFa met the calcium and almost half the vitamin A levels as specified in the CS. Oven-toasted ComFa was slightly lower in energy, protein and fat by a difference not greater than 4.0% but was higher by more than 100% in fructose and vitamin A levels. Therefore, the sweet potato-based complementary food is likely to support vitamin A supplementation initiatives in low-income countries better than the cereal-based formulation.

Carbohydrate composition, viscosity, solubility, and sensory acceptance of sweetpotato- and maize-based complementary foods

Background Cereal-based complementary foods from non-malted ingredients form a relatively high viscous porridge. Therefore, excessive dilution, usually with water, is required to reduce the viscosity to be appropriate for infant feeding. The dilution invariably leads to energy and nutrient thinning, that is, the reduction of energy and nutrient densities. Carbohydrate is the major constituent of food that significantly influences viscosity when heated in water. Objectives To compare the sweetpotato-based complementary foods (extrusion-cooked ComFa, roller-dried ComFa, and oven-toasted ComFa) and enriched Weanimix (maize-based formulation) regarding their 1) carbohydrate composition, 2) viscosity and water solubility index (WSI), and 3) sensory acceptance evaluated by sub-Sahara African women as model caregivers. Methods The level of simple sugars/carbohydrates was analysed by spectrophotometry, total dietary fibre by enzymatic-gravimetric method, and total carbohydrate and starch levels estimated by calculation. A Rapid Visco™ Analyser was used to measure viscosity. WSI was determined gravimetrically. A consumer sensory evaluation was used to evaluate the product acceptance of the roller-dried ComFa, oven-toasted ComFa, and enriched Weanimix. Results The sweetpotato-based complementary foods were, on average, significantly higher in maltose, sucrose, free glucose and fructose, and total dietary fibre, but they were markedly lower in starch content compared with the levels in the enriched Weanimix. Consequently, the sweetpotato-based complementary foods had relatively low apparent viscosity, and high WSI, than that of enriched Weanimix. The scores of sensory liking given by the caregivers were highest for the roller-dried ComFa, followed by the oven-toasted ComFa, and, finally, the enriched Weanimix. Conclusion The sweetpotato-based formulations have significant advantages as complementary food due to the high level of endogenous sugars and low starch content that reduce the viscosity, increase the solubility, impart desirable sensory characteristics, and potentially avoid excessive energy and nutrient thinning.

SWEET POTATO-BASED COMPLEMENTARY FOOD FOR INFANTS IN LOW-INCOME COUNTRIES

Background In low-income countries, most infants are given cereal-based complementary foods prepared at the household level. Such foods are high in phytate, which limits the bioavailability of nutrients, including iron, calcium, zinc, and in some cases proteins, which are crucial to the development of infants. Objective To compare the levels of macronutrients (protein, fat, and carbohydrate), gross energy, and fructose in sweet potato-based (denoted ComFa) formulations and enriched Weanimix (dehulled maize–dehulled soybean–groundnut blend with fish powder and sugar incorporated). The phytate level was also compared. Methods A composite flour of sweet potato and soybeans containing fish powder was processed by oven toasting as a home-based complementary food. Another blend containing skim milk powder was processed by extrusion cooking or roller drying as industrial-based prototypes. The macronutrient composition and the levels of fructose and phytate were determined in the ComFa formulations and enriched Weanimix. Results The ComFa formulations and the enriched Weanimix met the stipulated values in the Codex Alimentarius Commission standard for energy (400 kcal/100 g), protein (15 g/100 g), and fat (10 to 25 g/100 g) for complementary food, with the exception of the industrial-based ComFa formulations, which satisfied 83% of the protein requirement (15 g/100 g). The ComFa formulations had a quarter of the phytate level of enriched Weanimix. The fructose level in the sweet potato-based complementary foods was more than five times that in enriched Weanimix. Conclusions The sweet potato-based formulations were superior to enriched Weanimix as complementary foods for infants in low-income countries, based on the fructose (which makes the porridge naturally sweet) and phytate levels.

Diet, weight, cytokines and bone health in postmenopausal women

ObjectivesTo investigate diet and nutrition-related factors associated with bone loss in a group of postmenopausal (PM) women. Nutritional intake, inflammatory markers and body composition (weight, body mass index, fat/lean mass) were analysed for associations with bone mineral density (BMD).DesignA cross sectional study examining correlations between BMD (Duel-energy X ray absorptiometry; (DXA) and dietary intake (3-day diaries), body composition and plasma bone and inflammatory markers: C-terminal telopeptide of type I collagen (CTX) and procollagen type I N propeptide (P1NP), C- reactive protein (CRP), interleukin 6 and 10 (IL-6, IL-10), tumour necrosis factor (TNF) and osteoprotegerin (OPG).SettingCommunity dwelling women from the Auckland, Hawke’s Bay and Manawatu regions in New Zealand.Participants142 healthy, PM women aged 50–70 years.ResultsOPG (per kilogram fat mass) was increased in women with osteoporosis (p<0.001) compared to groups classified with normal BMD and osteopenia. Protein, vitamin B12, zinc, potassium and dairy intake were all positively correlated with higher BMD while dairy and potassium intakes also inversely correlated with CTX. Body composition (weight, BMI and fat/lean mass) had strong positive associations with BMD. Multiple regression analysis showed body weight, potassium and dairy intake were predictors of increased BMD in PM women and explained 39% (r2=0.39, p< 0.003) of variance.ConclusionBMD was negatively correlated with OPG and positively with weight, dairy and potassium intake. This study highlights the importance of maintaining adequate body weight and emphasising dairy and potassium predominantly sourced from fruit/vegetables to reduce bone loss at midlife.

Midlife women, bone health, vegetables, herbs and fruit study. The Scarborough Fair study protocol

BackgroundBone loss is accelerated in middle aged women but increased fruit/vegetable intake positively affects bone health by provision of micronutrients essential for bone formation, buffer precursors which reduce acid load and phytochemicals affecting inflammation and oxidative stress. Animal studies demonstrated bone resorption inhibiting properties of specific vegetables, fruit and herbs a decade ago.Objective: To increase fruit/vegetable intake in post menopausal women to 9 servings/day using a food specific approach to significantly reduce dietary acid load and include specific vegetables, fruit and herbs with bone resorbing inhibiting properties to assess effect on bone turnover, metabolic and inflammatory markers.Methods/DesignThe Scarborough Fair Study is a randomised active comparator controlled multi centre trial. It aimed to increase fruit and vegetable intake in 100 post menopausal women from ≤ 5 servings/day to ≥ 9 servings/day for 3 months. The women in the dietary intervention were randomly assigned to one of the two arms of the study. Both groups consumed ≥ 9 servings/day of fruit/vegetables and selected herbs but the diet of each group emphasised different fruit/vegetables/herbs with one group (B) selecting from a range of vegetables, fruit and culinary herbs with bone resorbing inhibiting properties. 50 women formed a negative control group (Group C usual diet).Primary outcome variables were plasma bone markers assessed at baseline, 6 weeks and 12 weeks. Secondary outcome variables were plasma inflammation and metabolic markers and urinary electrolytes (calcium, magnesium, potassium and sodium) assessed at baseline and 12 weeks. Dietary intake and urine pH change also were outcome variables. The dietary change was calculated with 3 day diet diaries and a 24 hour recall. Intervention participants kept a twice weekly record of fruit, vegetable and herb intake and urine pH.DiscussionThis study will provide information on midlife women’s bone health and how a dietary intervention increasing fruit and vegetable/herb intake affects bone, inflammatory and metabolic markers and urinary electrolyte excretion. It assesses changes in nutrient intake, estimated dietary acid load and sodium: potassium ratios. The study also explores whether specific fruit/vegetables and herbs with bone resorbing properties has an effect on bone markers.Trial registrationACTRN 12611000763943

Sweetpotato-based complementary food would be less inhibitory on mineral absorption than a maize-based infant food assessed by compositional analysis

The availability of micronutrients from sweetpotato-based complementary foods (CFs): oven-toasted and roller-dried ComFa, and from a maize-based infant food, enriched Weanimix, was compared using phytate/mineral molar ratios, polyphenols and β-carotene levels. The phytate/calcium, iron and zinc molar ratios of approximately 0.17, 1 and 15 predict better absorption of calcium, iron and zinc respectively. Generally, the sweetpotato-based CFs had at least half the phytate/mineral ratios of enriched Weanimix. The phytate/iron ratio in both the sweetpotato- and the maize-based CFs was greater than 1. Only the ComFa formulations had phytate/zinc ratio lower than 15. The level of polyphenol (iron inhibitor) was similar for the formulations. Only the sweetpotato-based CFs contained measurable levels of β-carotene, a possible iron enhancer. The lower phytate/mineral ratios and the β-carotene level of the sweetpotato-based CFs suggest that calcium, iron and zinc absorption could be better from them than from the maize-based infant food.

Iodine and Selenium Intakes of Postmenopausal Women in New Zealand

Iodine and selenium are required for thyroid function. This study investigated iodine and selenium intakes in healthy, women aged 50–70 years (n = 97) from three cities in the North Island of New Zealand, after mandatory fortification of bread with iodised salt. Iodine and selenium concentrations were determined in 24-h urine samples; daily intakes were extrapolated from amounts in urine (90% and 55% of daily intake, respectively). Three day diet diaries (3DDD) also estimated selenium and iodine (excluding iodised salt) intake. Median urinary iodine concentration (UIC) was 57 (41, 78) µg/L, indicating mild iodine deficiency. Estimated median iodine intake based on urine was 138 (100, 172) µg/day, below Recommended Dietary Intake (RDI) (150 µg/day) with 25% below Estimated Average Requirement (EAR) (100 µg/day). Estimated median selenium intake was 50 (36, 71) µg/day based on urine and 45 (36, 68) µg/day using 3DDD, below RDI (60 µg/day) with 49%–55% below EAR (50 µg/day). Median bread intakes were low at 1.8 (1.1, 2.7) serves/day; 25% consumed ≤1 serve/day. Although population iodine intakes improved following mandatory fortification, some had low intakes. Selenium intakes remain low. Further research should investigate thyroid function of low consumers of iodine fortified bread and/or selenium in New Zealand.