Mary M Murphy

Fortification: new findings and implications

This article reviews the current landscape regarding food fortification in the United States; the content is based on a workshop sponsored by the North American Branch of the International Life Sciences Institute. Fortification of the food supply with vitamins and minerals is a public health strategy to enhance nutrient intakes of the population without increasing caloric intake. Many individuals in the United States would not achieve recommended micronutrient intakes without fortification of the food supply. The achievement and maintenance of a desirable level of nutritional quality in the nations food supply is, thus, an important public health objective. While the addition of nutrients to foods can help maintain and improve the overall nutritional quality of diets, indiscriminate fortification of foods could result in overfortification or underfortification in the food supply and nutrient imbalances in the diets of individuals. Any changes in food fortification policy for micronutrients must be considered within the context of the impact they will have on all segments of the population and of food technology and safety applications and their limitations. This article discusses and evaluates the value of fortification, the success of current fortification efforts, and the future role of fortification in preventing or reversing nutrient inadequacies.

Associations of consumption of fruits and vegetables during pregnancy with infant birth weight or small for gestational age births: a systematic review of the literature

Maternal nutrition is recognized as one of the determinants of fetal growth. Consumption of fruits and vegetables is promoted as part of a healthful diet; however, intakes are typically lower than recommended levels. The purpose of this study was to systematically review results from studies examining the relationship between maternal consumption of fruits and vegetables during pregnancy with infant birth weight or risk for delivering a small for gestational age baby. A comprehensive search of PubMed and EMBASE was conducted and abstracts were screened using predefined criteria. Eleven relevant studies were identified and systematically reviewed, including six prospective cohort studies, three retrospective cohort studies, and two case–control studies. Seven studies were conducted in cohorts from highly developed countries. One prospective study from a highly developed area reported increased risk for small for gestational age birth by women with low vegetable intakes (odds ratio 3.1; 95% confidence interval 1.4–6.9; P=0.01); another large prospective study reported a 10.4 g increase in birth weight per quintile increase in fruit intake (95% confidence interval 6.9–3.9; P<0.0001) and increases of 8.4 or 7.7 g per quintile intake of fruits and vegetables (combined) or fruits, vegetables, and juice (combined), respectively. One retrospective study reported an association between low fruit intake and birth weight. In less developed countries, increased vegetable or fruit intake was associated with increased birth weight in two prospective studies. Overall, limited inconclusive evidence of a protective effect of increased consumption of vegetables and risk for small for gestational age birth, and increased consumption of fruits and vegetables and increased birth weight among women from highly developed countries was identified. Among women in less developed countries, limited inconclusive evidence suggests that increased consumption of vegetables or fruits may be associated with higher infant birth weight. The available evidence supports maternal consumption of a variety of fruits and vegetables as part of a balanced diet throughout pregnancy.

Consumption of grapefruit is associated with higher nutrient intakes and diet quality among adults, and more favorable anthropometrics in women, NHANES 2003-2008

Background Dietary guidance recommends consumption of a nutrient-dense diet containing a variety of fruits. The purpose of this study was to estimate usual nutrient intakes and adequacy of nutrient intakes among adult grapefruit consumers and non-consumers, and to examine associations between grapefruit consumption and select health parameters. Methods The analysis was conducted with data collected in the National Health and Nutrition Examination Survey (NHANES) 2003–2008. Respondents reporting consumption of any amount of grapefruit or 100% grapefruit juice at least once during the 2 days of dietary recall were classified as grapefruit consumers. Results Among adults aged 19+ years with 2 days of dietary recall (n=12,789), 2.5% of males and 2.7% of females reported consumption of 100% grapefruit juice or fresh, canned, or frozen grapefruit during the recalls. Grapefruit consumers were less likely to have usual intakes of vitamin C (males: 0% vs. 47%; females: 0% vs. 43%; P<0.001) and magnesium (P<0.05) below the estimated average requirement (EAR) compared to non-consumers, and they were more likely to meet adequate intake levels for dietary fiber (P<0.05). Potassium and β-carotene intakes were significantly higher among grapefruit consumers (P<0.001). Diet quality as assessed by the Healthy Eating Index-2005 (HEI-2005) was higher in grapefruit consumers (males: 66.2 [95% CI: 61.0–71.5] vs. 55.4 [95% CI: 54.4–56.4]; females: 71.4 [95% CI: 65.1–77.6] vs. 61.2 [95% CI: 59.8–62.6]). Among women, grapefruit consumption was associated with lower body weight, waist circumference, body mass index (BMI), triglycerides, C-reactive protein (CRP), and higher high-density lipoprotein (HDL) cholesterol (P<0.05), However, risk of being overweight/obese was not associated with grapefruit consumption. Conclusion Consumption of grapefruit was associated with higher intakes of vitamin C, magnesium, potassium, dietary fiber, and improved diet quality. Grapefruit may provide a healthful option for adults striving to meet fruit recommendations.

Daily intake of dairy products in Brazil and contributions to nutrient intakes: a cross-sectional study

OBJECTIVE Dairy products are sources of protein and micronutrients important in a healthy diet. The purpose of the present analysis was to estimate consumption of dairy products by Brazilians and identify contributions of dairy products to nutrient intakes. DESIGN Dairy consumption data were obtained from 24 h dietary records. Dairy products were defined as milk (including flavoured), cheese and yoghurt. Estimates of dairy product intakes were generated for all individuals, individuals in urban and rural households and for age groups 10-18 years, 19-59 years and ≥60 years. Contributions to nutrient intakes were estimated for the total sample and sub-populations. SETTING Nationwide cross-sectional survey, 2008-2009. SUBJECTS Nationally representative sample of individuals aged ≥10 years in the Individual Food Intake survey, a component of the Brazilian Household Budget Survey (n 34 003). RESULTS Among individuals aged ≥10 years, per capita intake of dairy products was 142 (se 2.1) g/d. Dairy product intake was higher among individuals in urban compared with rural areas and among groups 10-18 years and ≥60 years compared with adults aged 19-59 years. Dairy products accounted for 6.1% of daily energy intake, 7.3% of protein, 16.9% of saturated fat, 11.1% and 4.3% of total and added sugars, respectively, and 10.2-37.9% of daily Ca, vitamin D, P, vitamin A and K. CONCLUSIONS Dairy products were substantial contributors to daily intakes of selected nutrients of concern in Brazil, although mean daily dairy product consumption was less than a typical portion. Education efforts in Brazil to raise awareness about the nutritional role of dairy foods may serve to improve overall diet quality.

Greater weight loss among men participating in a commercial weight loss program: a pooled analysis of 2 randomized controlled trials.

Being overweight and obese are significant health concerns for men and women, yet despite comparable needs for effective weight loss and maintenance strategies, little is known about the success of commercial weight loss programs in men. This study tests the hypothesis that men participating in a commercial weight loss program (Weight Watchers) had significantly greater weight loss than men receiving limited support from health professionals for weight loss (controls). A pooled analysis of weight loss and related physiologic parameter data from 2 randomized clinical trials was conducted. After 12 months, analysis of covariance tests showed that men in the commercial program group (n = 85) lost significantly more weight (P < .01) than men in the control group (n = 84); similar significant differences were observed for body mass index and waist circumference. These results suggest that participation in a commercial weight loss program may be a more effective means to lose weight and maintain weight loss.

Systematic review of clinical studies related to pork intake and metabolic syndrome or its components.

Globally, both the incidence of type 2 diabetes and the consumption of meat, in particular pork meat, have increased, concurrently. Processed meats have been associated with an increased risk for diabetes in observational studies. Therefore, it is important to understand the possible mechanisms of this association and the impact of meats from different species. The goal of this systematic review was to assess experimental human studies of the impact of pork intake compared with other protein sources on early markers for the development of diabetes, ie, insulin resistance, glucose intolerance, and the components of the metabolic syndrome. A systematic review was conducted searching PubMed and EMBASE and using the Cochrane and PRISMA guidelines. Eight studies were eligible and critically reviewed. Five studies were based on a single meal or single day exposure to pork, as compared with other sources of protein. The glucose-insulin response following the pork meals did not differ compared with beef, shrimp, or mixed sources of proteins. However, compared with eggs, ham (processed meat) led to a larger insulin response in nonobese subjects. Compared with whey, ham led to a smaller insulin response and a larger glucose response. These findings suggest possible mechanisms for the association between processed meat and the development of diabetes. Nonprocessed pork meats were not compared with eggs or whey. The three longer interventions (11 days to 6 months) did not show a significant impact of pork on the components of the metabolic syndrome, with the exception of a possible benefit on waist circumference and high-density lipoprotein cholesterol (one study each with significant limitations). Most of the findings are weak and there is a lack of solid evidence. The literature on the topic is limited and important research gaps are identified. Considering recent trends and projections for diabetes and pork intake, this is an important global public health question that requires more attention in order to provide improved evidence-based dietary recommendations.

Chemistry, manufacturing and exposure assessments to support generally recognized as safe (GRAS) determinations

Identity, stability, purity, intended use levels in what foods and technical effects, and probable intake are among the key components in an assessment to support GRAS determinations. The specifications of identity of a food substance are an important component of the safety assessment as changes in the physical and chemical properties of a food substance can influence its technical effect in food and can influence its nutritional or toxicological properties of the food substance. Estimating exposure is a key determining step in the safety evaluation of a food substance. Intake assessment in GRAS determination is necessarily comprehensive based on cumulative exposure, i.e. proposed new uses plus background dietary exposure. Intake estimates for safety assurance in a GRAS determination also represent conservative overestimate of chronic exposure as they are based on 2-day average daily intake and the upper percentile (90th) intake among consumers. In contrast, in a nutrient assessment where realistic intake estimates are of interest, usual intake estimates are relied upon. It should also be noted that intake estimates for GRAS determinations are also more conservative than estimate of dietary exposure by EPA (FIFRA), where mean per capita are used to assess chronic exposure. Overall, for safety assurance, intake assessments in GRAS determinations are comprehensively cumulative and typically conservative overestimate of exposures.