Michael B. Krawinkel

Relating dietary diversity and food variety scores to vegetable production and socio-economic status of women in rural Tanzania

The objective of the present study was to measure diversity in nutrition with dietary scores, and to assess their relationship to vegetable production and the socio-economic status of women in rural Tanzania. A dietary diversity score (DDS) and a food variety score (FVS) were created from data gathered with three semi-quantitative 24-h recalls performed during three non-consecutive seasons during 2006/2007. Data on vegetable production, selling and buying and socio-economic data was gathered with a semi-quantitative questionnaire. A total of 252 randomly selected women from three districts of north-eastern and central Tanzania participated. The median DDS of 6 and the mean FVS of 8.3 were low, suggesting an overall poor dietary quality, with about one third of participants having an alarmingly low DDS of only two to four food groups per day. These women consumed a very basic diet consisting mainly of cereals and vegetables. Differences among districts were pronounced while those among seasons were less distinct. The DDS and FVS were both significantly associated with ethnicity, occupation and status within the household of participants. As a more varied diet is not necessarily healthier, integration of both quantity and quality in the scores is proposed for future studies. This can be achieved, for example, by weighing food types according to their importance in the diet. As both scores are linked to the production, selling and buying of vegetables, the promotion of homestead food production may be a good way to improve dietary diversity.

Antidiabetic effects of bitter gourd extracts in insulin-resistant db/db mice.

Bitter gourd (BG, Momordica charantia) exerts proven blood glucose- and body weight-lowering effects. To develop an effective and safe application, it is necessary to identify the bioactive compounds and biochemical mechanisms responsible for these effects in type 2 diabetes. A total of forty-five 4-week-old male db/db mice were assigned to five groups of nine each. The mice were given sterile tap water as a control, a whole fruit powder, the lipid fraction, the saponin fraction or the hydrophilic residue of BG at a daily oral dosage of 150 mg/kg body weight for 5 weeks, respectively. Weight gain was significantly decreased in all the BG-treated groups (P ≤ 0.05). Glycated Hb levels were the highest in the control mice compared with all the four BG-treated mice (P = 0.02). The lipid fraction had the strongest effect, and it tended (P = 0.075) to reduce glycated Hb levels from 9.3 % (control mice) to 8.0 % (lipid fraction-treated mice). The lipid and saponin fractions reduced lipid peroxidation of adipose tissue significantly (P ≤ 0.01). Additionally, the saponin fraction and the lipid fraction reduced protein tyrosine phosphatase 1B (PTP 1B) activity in skeletal muscle cytosol by 25 % (P = 0.05) and 23 % (P = 0.07), respectively. PTP 1B is the physiological antagonist of the insulin signalling pathway. Inhibition of PTP 1B increases insulin sensitivity. This is the first study to demonstrate that BG is involved in PTP 1B regulation, and thus explains one possible biochemical mechanism underlying the antidiabetic effects of BG in insulin resistance and type 2 diabetes.

Fruit and vegetable consumption in a sample of 11-year-old children in ten European countries : the PRO GREENS cross-sectional survey

OBJECTIVE To describe fruit and vegetable intake of 11-year-old children in ten European countries and compare it with current dietary guidelines. DESIGN Cross-sectional survey. Intake was assessed using a previously validated questionnaire containing a pre-coded 24 h recall and an FFQ which were completed in the classroom. Portion sizes were calculated using a standardized protocol. SETTING Surveys were performed in schools regionally selected in eight countries and nationally representative in two countries. SUBJECTS A total of 8158 children from 236 schools across Europe participating in the PRO GREENS project. RESULTS The total mean consumption of fruit and vegetables was between 220 and 345 g/d in the ten participating countries. Mean intakes did not reach the WHO population goal of ≥400 g/d in any of the participating countries. Girls had a significantly higher intake of total fruit and vegetables than boys in five of the countries (Sweden, Finland, Iceland, Bulgaria and Slovenia). Mean total fruit intake ranged between 114 and 240 g/d and vegetable intake between 73 and 141 g/d. When using the level ≥400 g/d as a cut-off, only 23·5 % (13·8-37·0 %) of the studied children, depending on country and gender, met the WHO recommendation (fruit juice excluded). CONCLUSIONS Fruit and vegetable consumption was below recommended levels among the schoolchildren in all countries and vegetable intake was lower than fruit intake. The survey shows that there is a need for promotional activities to improve fruit and vegetable consumption in this age group.

German National Consensus Recommendations on Nutrition and Lifestyle in Pregnancy by the 'Healthy Start - Young Family Network'

Diet and physical activity before and during pregnancy affect short- and long-term health of mother and child. The energy needs at the end of pregnancy increase only by about 10% compared to nonpregnant women. An excessive energy intake is undesirable since maternal overweight and excessive weight gain can increase the risks for a high birth weight and later child overweight and diabetes. Maternal weight at the beginning of pregnancy is especially important for pregnancy outcome and child health. Women should strive to achieve normal weight already before pregnancy. Regular physical activity can contribute to a healthy weight and to the health of pregnant women. The need for certain nutrients increases more than energy requirements. Before and during pregnancy, foods with a high content of essential nutrients should be preferentially selected. Supplements should include folic acid and iodine, iron (in case of suboptimal iron stores), the ω-3 fatty acid docosahexaenoic acid (in case of infrequent consumption of ocean fish) and vitamin D (in case of decreased sun exposure and decreased endogenous vitamin D synthesis). Pregnant women should not smoke and not stay in rooms where others smoke or have smoked before (passive smoking). Alcohol consumption should be avoided, since alcohol can harm unborn children.

Dietary Patterns and Nutritional Health of Women: The Nutrition Transition in Rural Tanzania

Background Many developing countries are experiencing a rapid nutrition transition in urban areas. Objective To investigate whether a nutrition transition was occurring in a rural area by examining the dietary patterns of women in rural Tanzania. Methods A total of 252 women aged 16 to 45 years from three districts of northeastern and central Tanzania participated. During three different seasons in 2006–2007, the women were interviewed with the use of a structured, interviewer-administered questionnaire, including a 24-hour dietary recall. From these recalls, the mean intakes of 12 main food groups were calculated and used to establish five dietary patterns by principal component analysis. Data were also obtained on attitudes toward obesity, body mass index (BMI), hemoglobin level, and measures of socioeconomic status and analyzed for associations with dietary patterns. Results The five dietary patterns were “traditional-coast,” characterized by fruits, nuts, starchy plants, and fish; “traditional-inland,” characterized by cereals, oils and fats, and vegetables; “purchase,” characterized by bread and cakes (usually fried in oil), sugar, and black tea; “pulses,” characterized mainly by pulses, with few or no vegetables; and “animal products,” characterized by a high consumption of meat, eggs, and/or milk. Significant positive associations were found, among others, between the purchase pattern and BMI (ρ = 0.192, p = .005) and between the animal products pattern and wealth (ρ = 0.168, p = .002). Conclusions Differences between traditional and modern nutritional food patterns were evident. This study found the “traditional-inland” pattern to be the most healthy, while the “purchase” food pattern was the most prevalent. The purchase pattern, in particular, may provide some evidence for early stages of the nutrition transition in rural Tanzania.

Säuglingsernährung und Ernährung der stillenden Mutter

ZusammenfassungDas sich derzeit im Aufbau befindliche Netzwerk Gesund ins Leben – Netzwerk Junge Familie wurde initiiert, um eine Basis für eine effektive Kommunikation zu schaffen. Es stellt ein bundesweites Kommunikationsnetzwerk dar, in dem sich Akteure, Institutionen und Medien zusammenschließen, die Eltern rund um die Geburt begleiten und unterstützen wollen. Die Empfehlungen verschiedener relevanter Fachorganisationen und Institutionen wurden zusammengetragen, mit den Mitgliedern des Wissenschaftlichen Beirats des Netzwerks diskutiert und einheitliche Kernaussagen (Handlungsempfehlungen) formuliert. Diese werden zum einen als anwendungsorientierte, alltagsbezogene Botschaften an junge Familien weitergegeben, zum anderen in der Schulung der Multiplikatoren/-innen ergänzt durch Hintergrundinformationen eingesetzt. Sie umfassen Kernaussagen zum Stillen, zur Säuglingsmilchnahrung, zur Beikost, zu Getränken (ergänzenden Flüssigkeitszufuhr), zu Nährstoffsupplementen sowie zur Ernährung der stillenden Mutter, zu Genussmitteln in der Stillzeit, zu Medikamenten und Nährstoffsupplementen in der Stillzeit und zur nicht die Ernährung und das Rauchen betreffenden Allergieprävention beim Kind.AbstractThe German network“Healthy Start – Young Families’ Network” (Gesund ins Leben – Netzwerk Junge Familie), was set up to form a basis for an effective, nationwide communication network between actors, institutions and media wishing to accompany and support parents through pregnancy and birth. The recommendations of various relevant professional organisations and institutions have been compiled, discussed among the members of the scientific advisory board and formulated into standardized key messages (recommendations for action). These recommendations will be passed on to young families on the one hand in the form of application-oriented messages for everyday life, and on the other as an integral part of disseminator training in the form of background information. They include key messages on breastfeeding, infant formula, baby foods, drinks (complementary fluids intake), nutritional supplements, nutrition for breastfeeding mothers, stimulants while breastfeeding, medication and food supplements while breastfeeding, as well as advice on non-nutrition- and non-smoking-related allergies in children.

Revised D-A-CH intake recommendations for folate: how much is needed?

The D-A-CH reference value (D-A-CH arises from the initial letters of the common country identification for the countries Germany (D), Austria (A) and Switzerland (CH)) for folate equivalents had been set at 400 μg/d for adults in the year 2000. By that time, the prevention of cardiovascular diseases through reduction of homocysteine was considered an important target of the reference value. Since that time a number of research papers revealed that in spite of an inverse association between folate-rich diet and chronic diseases, a preventive effect of folic acid intake on cardiovascular events was not supported by randomized controlled trials, and the reduction of plasma homocysteine levels to around 10–12 μmol/l did not reduce the risk for thromboembolic and cardiovascular diseases in persons already affected by these diseases. These results together with the observation that folate intakes below 400 μg/d result in a sufficient folate status justified a review of the current literature and—consequently—a reduction of the reference value to 300 μg/d for adults. This reference value is expressed as dietary folate equivalents that take into account the difference in bioavailability between folic acid and all types of folates in food. The recommendation to take a daily supplement of 400 μg of synthetic folic acid for women who intend to get pregnant and until the end of the first trimester of pregnancy is maintained.

Interaction of Nutrition and Infections Globally: An Overview

The interaction of nutrition and infections is known by experience by generations of medical doctors. Before the era of antibiotics, diet was an integral part of the management of infections. Now, it is necessary to take a fresh look at this interaction as the understanding of immune response has expanded considerably. Comparatively little research has addressed the impact of nutrition interventions on the management of infectious diseases. Most observations of the interaction between nutrition and infections are epidemiological in character. This holds especially true for measles as well as for tuberculosis. In AIDS, the deterioration of the nutritional status is an indicator of disease progression. Infections in undernourished children are a common cause of death, and taking this finding into account helps to reduce the case fatality rate in severely malnourished patients. Regarding the immune response, cellular as well as soluble components are affected by deficiencies of single nutrients or general undernutrition. The immunosuppressive effect of undernutrition starts during intrauterine life already: maternal nutrition status has been shown to impact on immune function in adult animals. Recent research suggests that not only undernutrition but also caloric overnutrition impacts on immune response to infections and immunization. This is partly due to the chronic inflammatory activity of the adipose tissue and partly due to neuroendocrine alterations. Infectious diseases also impact on the nutritional status, either specifically or through unspecific mechanisms, such as anorexia, tachypnea, and vomiting.

Neonatology/paediatrics - guidelines on parenteral nutrition, chapter 13.

There are special challenges in implementing parenteral nutrition (PN) in paediatric patients, which arises from the wide range of patients, ranging from extremely premature infants up to teenagers weighing up to and over 100 kg, and their varying substrate requirements. Age and maturity-related changes of the metabolism and fluid and nutrient requirements must be taken into consideration along with the clinical situation during which PN is applied. The indication, the procedure as well as the intake of fluid and substrates are very different to that known in PN-practice in adult patients, e.g. the fluid, nutrient and energy needs of premature infants and newborns per kg body weight are markedly higher than of older paediatric and adult patients. Premature infants <35 weeks of pregnancy and most sick term infants usually require full or partial PN. In neonates the actual amount of PN administered must be calculated (not estimated). Enteral nutrition should be gradually introduced and should replace PN as quickly as possible in order to minimise any side-effects from exposure to PN. Inadequate substrate intake in early infancy can cause long-term detrimental effects in terms of metabolic programming of the risk of illness in later life. If energy and nutrient demands in children and adolescents cannot be met through enteral nutrition, partial or total PN should be considered within 7 days or less depending on the nutritional state and clinical conditions.

Momordica charantia and Type 2 Diabetes: From in vitro to Human Studies

Type 2 diabetes is a growing health problem worldwide that is particularly severe in India and China. In these areas, bitter gourd (Momordica charantia) is a popular vegetable which is traditionally known to have health beneficial effects not only, but mainly, on diabetes. Bitter gourd could be a cheap possibility to help the poor in these and other countries to control their blood glucose levels. This review describes anti-diabetic effects of bitter gourd reported in the literature and discusses what still needs to be clarified for developing an evidence-based and safe use of the bitter gourd for diabetes. Analyses of bioactive compounds have shown that bitter gourd is rich in nutrients and phytochemicals of which some have anti-diabetic effects. Juices, powders, extracts, and isolated compounds have been tested in vitro and in vivo. Bitter gourd increases insulin secretion of the pancreas, decreases intestinal glucose uptake, and increases uptake and utilization of glucose in peripheral tissues. Although human studies with type 2 diabetics are weak in their design and/or results, some of the studies do indicate anti-diabetic effects in patients and safety for bitter gourd treatment in humans. In the future, well designed studies with rodents will help to understand what kind of bitter gourd variety, dosage, preparation, and duration of administration is optimal. Such results will help to design human studies which are necessary to prove the effectiveness of bitter gourd in patients.