Dietary protein restriction is one major therapy in chronic kidney disease (CKD), and ketoacids have been evaluated in CKD patients during restricted-protein diets. The objective of the present study was to compare the efficacy of a low-protein diet supplemented with ketoacids (LPD+KA) and a low-protein diet alone (LPD) in halting the development of renal lesions in CKD. 5/6 Nephrectomy Sprague–Dawley rats were randomly divided into three groups, and fed with either 22 % protein (normal-protein diet; NPD), 6 % protein (LPD) or 5 % protein plus 1 % ketoacids (LPD+KA) for 24 weeks. Sham-operated rats were used as controls. Each 5/6 nephrectomy group included fifteen rats and the control group included twelve rats. Proteinuria, decreased renal function, glomerular sclerosis and tubulointerstitial fibrosis were found in the remnant kidneys of the NPD group. Protein restriction ameliorated these changes, and the effect was more obvious in the LPD+KA group after 5/6 nephrectomy. Lower body weight and serum albumin levels were found in the LPD group, indicating protein malnutrition. Lipid and protein oxidative products were significantly increased in the LPD group compared with the LPD+KA group. These findings indicate that a LPD supplemented with ketoacids is more effective than a LPD alone in protecting the function of remnant kidneys from progressive injury, which may be mediated by ketoacids ameliorating protein malnutrition and oxidative stress injury in remnant kidney tissue.

There is controversy whether children should have a dietary supply of preformed long-chain polyunsaturated n-3 fatty acids EPA and DHA. The aims of the workshop were to review evidence for a possible benefit of a preformed EPA and/or DHA supply, of data required to set desirable intakes for children aged 2–12 years, and of research priorities. The authors concluded that EPA and DHA intakes per kg body weight may often be low in 2- to 12-year-old children, relative to intakes per kg body weight of breast-fed infants and adult intakes, but reliable data are scarce. Little information is available that increasing dietary intakes of EPA or DHA in children has benefits to physical or mental function or other health endpoints. Studies addressing EPA and DHA intakes and tissue status among groups of children with different dietary habits, and measures of relevant development and health endpoints, are needed for developing potential advice on desirable intakes of EPA and/or DHA in children. At this time it appears prudent to advise that dietary intakes in childhood are consistent with future eating patterns supporting adult health, such as prevention of metabolic disorders and CVD, supporting immune function, and reproductive health. In conclusion, the available information relating dietary EPA and DHA intakes in children aged 2–12 years to growth, development and health is insufficient to derive dietary intake recommendations for EPA and DHA. Adequately designed studies addressing dietary intakes, measures of status and relevant functional or health effects across this age group are needed.

Although anthropometric parameters have been extensively studied regarding their relationship to physical function status, the association between these parameters and the activity of daily living (ADL) function remains controversial. We investigated whether BMI or mid-upper arm circumference (AC) is an indication of variation in the physical functioning of the frail elderly. The present study was a prospective cohort analysis of 543 community-dwelling frail elderly. Data included the participants' demographic characteristics, basic ADL, comorbidity and anthropometric measurements at baseline and at 2-year follow-up. Logistic regression models were used to investigate the association between ADL status and anthropometric measurements during the study period. Among the 543 participants, 418 maintained or improved their ADL status, while 125 showed an ADL decline during the study period. Multivariate logistic regression analysis showed that BMI and AC levels or ADL status at baseline were not independent predictors of the loss of ADL function or the decline in these anthropometric measurements during the study period, respectively. However, the decline in BMI and AC levels and the loss of ADL function were associated with each other during the study period. There is an association between the negative changes in anthropometric measurements during the follow-up period and the decline in ADL function during a 2-year follow-up in community-dwelling frail elderly.

Knowledge about metabolisable energy (ME) intake is crucial for various experimental settings in rodent studies. ME considers faecal and renal energy losses. In particular, faecal energy excretion can vary considerably between differentially composed diets. Thus determination of faecal energy losses, i.e. apparent energy digestibility, is the most important experimental approach to determine ME. Predictive equations for ME such as Atwater factors or an equation for pigs, which are frequently employed for rodent feed, consider an average energy digestibility for nutrients and average renal losses for protein. Both equations, however, were never validated for rat feed. We therefore determined experimentally the digestibility of energy (experimentally determined digestible energy − 5·2 kJ/g digestible protein) and nutrients of eleven natural and five purified rat diets and compared the present results with the predicted values. Compared with natural diets, digestibility of gross energy (GE) and nutrients was higher by about 20 % in the purified diets (P < 0·0001). Mean GE digestibility in natural diets amounted to 71·4 % (range 53·3–83·5 %; n 11). Atwater factors predicted ME with satisfactory accuracy in purified diets. In contrast, for natural diets, only the equation for pig feed gave acceptable estimates of ME. Choosing an inappropriate predictive equation for ME resulted in considerable error. For prediction of ME in mixed rat feed, we propose to use the equation for pig feed for natural diets and Atwater factors for purified diets. If the equation for pig feed cannot be applied we suggest using the lower modified Atwater factors instead of the ‘original’ Atwater factors to estimate the ME of a diet.

Folate deficiency during embryogenesis is an established risk factor for neural tube defects in the fetus. An adequate folate nutritional status is also important for normal fetal growth and brain development. The aim of the present research was to study the association between folic acid use of the mother during pregnancy and child behavioural development. Within a population-based cohort, we prospectively assessed folic acid supplement use during the first trimester by questionnaire. Child behavioural and emotional problems were assessed with the Child Behaviour Checklist at the age of 18 months in 4214 toddlers. Results showed that children of mothers who did not use folic acid supplements in the first trimester had a higher risk of total problems (OR 1·44; 95 % CI 1·12, 1·86). Folic acid supplement use protected both from internalising (OR of no supplement use 1·65; 95 % CI 1·24, 2·19) and externalising problems (OR 1·45; 95 % CI 1·17, 1·80), even when adjusted for maternal characteristics. Birth weight and size of the fetal head did not mediate the association between folic acid use and child behaviour. In conclusion, inadequate use of folic acid supplements during early pregnancy may be associated with a higher risk of behavioural problems in the offspring. Folic acid supplementation in early pregnancy, aimed to prevent neural tube defects, may also reduce mental health problems in children.

Glycaemic responses to foods reflect the balance between glucose loading into, and its clearance from, the blood. Current in vitro methods for glycaemic analysis do not take into account the key role of glucose disposal. The present study aimed to develop a food intake-sensitive method for measuring the glycaemic impact of food quantities usually consumed, as the difference between release of glucose equivalents (GGE) from food during in vitro digestion and a corresponding estimate of clearance of them from the blood. Five foods – white bread, fruit bread, muesli bar, mashed potato and chickpeas – were consumed on three occasions by twenty volunteers to provide blood glucose response (BGR) curves. GGE release during in vitro digestion of the foods was also plotted. Glucose disposal rates estimated from downward slopes of the BGR curves allowed GGE dose-dependent cumulative glucose disposal to be calculated. By subtracting cumulative glucose disposal from cumulative in vitro GGE release, accuracy in predicting the in vivo glycaemic effect from in vitro GGE values was greatly improved. GGEin vivo = 0·99GGEin vitro+0·75 (R2 0·88). Furthermore, the difference between the curves of cumulative GGE release and disposal closely mimicked in vivo incremental BGR curves. We conclude that valid measurement of the glycaemic impact of foods may be obtained in vitro, and expressed as grams of glucose equivalents per food quantity, by taking account not only of GGE release from food during in vitro digestion, but also of blood glucose clearance in response to the food quantity.

This report summarises a workshop convened by the UK Food Standards Agency (FSA) on 14 October 2008 to discuss current FSA-funded research on carbohydrates and cardiovascular health. The objective of this workshop was to discuss the results of recent research and to identify any areas which could inform future FSA research calls. This workshop highlighted that the FSA is currently funding some of the largest, well-powered intervention trials investigating the type of fat and carbohydrate, whole grains and fruit and vegetables, on various CVD risk factors. Results of these trials will make a substantive contribution to the evidence on diet and cardiovascular risk.

To ascertain the association of BMI and obesity with short stature, a cross-sectional telephone survey was conducted in 2006, using a multilevel approach, adjusting for individual- and city-level measures of socio-economic status. The study probabilistic sample consisted of 54 369 adults (>18 years) living in households with access to telephone lines in each urban area of the twenty-six Brazilian state capitals and federal district. Odds of being currently obese and obese at age 20 years were compared between short stature individuals (5th percentile) and those with normal stature. After controlling for individual- and city-level sociodemographic characteristics and behaviours, high BMI was strongly associated with short stature individuals (P = 0·001). Among short stature women the adjusted OR of being obese was 3·0 (95 % CI 2·2, 4·2) compared with those with stature greater than the 5th percentile. Among men this adjusted OR was 2·0 (95 % CI 1·5, 2·6). When comparisons were made for BMI at age 20 years the OR were even larger (6 for men and 8 for women). Despite the growing body of evidence that environmental factors such as poor food choices and physical inactivity are the main determinants of the worldwide obesity epidemic, the greater difference in BMI and prevalence of obesity in the Brazilian capitals was explained mainly by individual factors. We found a strong association between obesity and short stature after adjustment for diet, physical activity, and many environmental factors. Intra- and inter-generational consequences of undernutrition are an alternative explanation for the regional disparities in obesity in Brazil.

Optimal foraging predicts that animals should be able to assess the content of important nutrients in food. Ungulates discriminate salt and P, but discrimination of other minerals is controversial even though they are also essential and often limiting. Animal scientists have explained this taste through palatability, which predicts the same pattern of discrimination for calves and hinds and greater consumption by the latter. Social learning may also be involved, predicting a correlation between mother and calf and less consumption by the latter. The present study examines the consumption behaviour of free-choice supplemented minerals by hinds and calves of Iberian red deer (Cervus elaphus hispanicus) to discern between these hypotheses. Behavioural indices of intake correlated with actual mineral consumption (P < 0·001). Mother and calf behavioural indices correlated only for salt-mixed minerals. Calves showed overall behavioural indices of consumption greater than hinds (P < 0·01 and P < 0·001), and also for all single supplements except NaCl, as expected from growth needs and in contrast to the palatability hypothesis. Calves showed a greater consumption of CuSO4 and lower of Na2SeO3 than pure salt. Hinds showed a different pattern, ingesting lower amounts of all minerals except CuSO4 and salt. Additional analyses also showed discrimination between minerals unmixed with salt, such as CaHPO4 and CaCO3 (P = 0·012 and P = 0·020). The greater intake of growing calves and the different consumption patterns for hinds and calves suggest that deer can discriminate among minerals, and that they do not consume minerals for their palatability or driven by social learning. Therefore, deer may be selecting minerals according to nutritional requirements.

The objective was to quantify the vitamin A equivalency of β-carotene in two diets using a dual-isotope dilution technique and the apparent β-carotene absorption as measured by the oral–faecal balance technique. Seventeen healthy adults with an ileostomy completed the 4-week diet-controlled, cross-over intervention study. Each subject followed both diets for 2 weeks: a diet containing vegetables low in β-carotene content with supplemental β-carotene in salad dressing oil (‘oil diet’; mean β-carotene intake 3·1 mg/d) and a diet containing vegetables and fruits high in β-carotene content (‘mixed diet’; mean β-carotene intake 7·6 mg/d). Daily each subject consumed a mean of 190 μg [13C10]β-carotene and 195 μg [13C10]retinyl palmitate in oil capsules. The vitamin A equivalency of β-carotene was calculated as the dose-corrected ratio of [13C5]retinol to [13C10]retinol in serum. Apparent absorption of β-carotene was determined with oral–faecal balance. Isotopic data quantified a vitamin A equivalency of [13C10]β-carotene in oil of 3·6:1 (95 % CI 2·8, 4·6) regardless of dietary matrices differences. The apparent absorption of (labelled and dietary) β-carotene from the ‘oil diet’ (30 %) was 1·9-fold higher than from the ‘mixed diet’ (16 %). This extrinsic labelling technique can measure precisely the vitamin A equivalency of β-carotene in oil capsules, but it does not represent the effect of different dietary matrices.

Although the inverse association between coffee consumption and risk of diabetes has been reported numerous times, the role of caffeine intake in this association has remained unclear. We evaluated the consumption of coffee and other beverages and food containing caffeine in relation to the incidence of diabetes. The study participants were 5897 men and 7643 women in a community-based cohort in Takayama, Japan. Consumption of coffee, green tea, oolong tea, black tea and chocolate snacks were measured with a semi-quantitative FFQ in 1992. At the follow-up survey in 2002, the development of diabetes and the time of diagnosis were reported. To assess the association, age, smoking status, BMI, physical activity, education in years, alcohol consumption, total energy intake, fat intake and women's menopausal status were adjusted. Among men who consumed one cup per month to six cups per week and among those who consumed one cup per d or more, the associated hazard ratios were 0·69 (95 % CI 0·50, 0·97) and 0·69 (95 % CI 0·49, 0·98) compared with those who drank little to no coffee, with a P value for trend of 0·32. The hazard ratios for women with the same coffee consumption patterns were 1·08 (95 % CI 0·74, 1·60) and 0·70 (95 % CI 0·44, 1·12), with a P value for trend of 0·03. The association between estimated total caffeine intake and risk of diabetes was insignificant both among men and among women. The results imply that coffee consumption decreased the risk of developing diabetes. The protective effect may exist aside from the influence of caffeine intake.

There is an urgent need to develop and validate a series of biomarkers, which accurately measure and inform on how the human gut microbiota can affect human health. The human gut hosts a complex community of micro-organisms, with unique features in each individual. The functional role of this gut microbiota in health and disease is increasingly evident, but poorly understood. Comprehension of this ecosystem implies a significant challenge in the elucidation of interactions between all of its components, but promises a paradigm shift in preventive nutrition and medicine. ‘Omics’ technologies for the first time offer tools of sufficient subtlety to tackle this challenge. However, these techniques must be allied with traditional skills of the microbial physiologist, which are in danger of being lost. Targeting these efforts at the identification of biomarkers associated with gut health will require access to a ‘biobank’ from a pan-European or worldwide observation study, which would include samples taken with appropriate frequency from healthy individuals of different ages. This offers a pragmatic opportunity for a unique food and pharmaceutical industry collaboration.