Vitamin D deficiency is prevalent in patients with chronic spinal cord injury (SCI) and has been implicated as an aetiologic factor of osteoporosis and various skeletal and extra-skeletal issues in SCI patients. Few data were available regarding vitamin D status in patients with acute SCI or immediately assessed at hospital admission. This retrospective cross-sectional study evaluated vitamin D status in SCI patients at admission to a UK SCI centre in January–December 2017. A total of 196 eligible patients with serum 25(OH)D concentration records at admission were recruited. The results found that 24 % were vitamin D deficient (serum 25(OH)D < 25 nmol/l), 57 % of the patients had serum 25(OH)D < 50 nmol/l. The male patients, patients admitted in the winter–spring time (December–May), and patients with serum sodium < 135 mmol/l or with non-traumatic causes had a significant higher prevalence of vitamin D deficiency than their counterparts (28 % males v. 11⋅8 % females, P = 0⋅02; 30⋅2 % in winter–spring v. 12⋅9 % in summer–autumn, P = 0⋅007; 32⋅1 % non-traumatic v. 17⋅6 % traumatic SCI, P = 0⋅03; 38⋅9 % low serum sodium v. 18⋅8 % normal serum sodium, P = 0⋅010). There was a significant inverse association of serum 25(OH)D concentration with body mass index (BMI) (r = −0⋅311, P = 0⋅002), serum total cholesterol (r = −0⋅168, P = 0⋅04) and creatinine concentrations (r = −0⋅162, P = 0⋅02) that were also significant predictors of serum 25(OH)D concentration. Strategies for systematic screening and efficacy of vitamin D supplementation in SCI patients need to be implemented and further investigated to prevent the vitamin D deficiency-related chronic complications.

Homocysteine (Hcy) is an intermediary sulphur amino acid recognised for pro-oxidative properties in several species which may weaken immune competence in piglets. In this species, there is an acute 10-fold increase of concentrations of plasma Hcy (pHcy) during the first 2 weeks of life. The present experiment aimed to determine if pHcy in piglets can be regulated by oral supplementations of betaine as a methyl group supplier, creatine for reducing the demand for methyl groups, choline with both previous functions and vitamin B6 as enzymic co-factor for Hcy catabolism. A total of seventeen sows (second parity) were fed gestation and lactation diets supplemented with folic acid (10 mg/kg) and vitamin B12 (150 µg/kg). Eight piglets in each litter received daily one of the eight following oral treatments (mg/kg body weight): (1) control (saline); (2) betaine (50); (3) choline (70); (4) creatine (300); (5) pyridoxine (0·2); (6) treatments 2 and 5; (7) treatments 3 and 4; and (8) treatments 2, 3, 4 and 5. According to age, pHcy increased sharply from 2·48 µm at birth to 17·96 µm at 21 d of age (P < 0·01). Concentrations of pHcy tended to be lower (P = 0·09) in treated than in control piglets but the highest and sole pairwise significant decrease (23 %) was observed between treatments 1 and 8 (P = 0·03). Growth from birth to 21 d of age was not influenced by treatments (P > 0·70). Therefore, it appears possible to reduce pHcy concentrations in suckling piglets but a combination of all chosen nutrients is required.

Periconceptional folic acid supplementation is effective in the prevention of neural tube defects (NTDs). The aim of the present study was to determine the level of knowledge about the benefits of preconceptional folic acid supplementation in a sample of women of childbearing age and its associated factors. A cross-sectional community-based study design was carried out on a total of 441 women of childbearing age. Questionnaires included knowledge of preconception of folic acid supplements and socio-demographic characteristics. The χ2 was used to compare categorical data. Multivariate logistic regression was used to isolate the predictive variables and examined individually by calculating the adjusted odds ratio. Statistical significance is declared as P < 0·05. We found that 35·1 % (n 155) knew preconceptional folic acid supplementation could prevent NTDs, and 3·8 % (n 17) knew the right time to take preconceptional folic acid supplementation and only 1·7 % (n 7) who had a history of NTDs. Attended secondary education (OR 2·7; 95 % CI 1·1, 6·0, P = 0·017), governmental employee (OR 3·5; 95 % CI 2·3, 17·8, P < 0·001), current pregnancy status (OR 3·0; 95 % CI 2·1, 4·2, P = 0·043), history of visiting the antenatal care service during pregnancy (OR 2·9; 95 % CI 1·07, 7·8, P = 0·03), history of taking folic acid supplement (OR 4·5; 95 % CI 2·9, 7·1, P < 0·001) were associated. More than half of the participant women did not know about preconception of folic acid supplements that reduce the risk of NTDs. Identification of the level of knowledge on preconception of folic acid may allow for targeted educational or other interventions to further encourage folic acid use.

Objective: To characterise perceptions of the Philadelphia Beverage Tax among low-income parents. Design: We conducted semi-structured interviews and administered demographic questions via telephone. We based the interview guide and initial codebook on a conceptual model illustrating perceived fairness and effectiveness as essential for successfully adopting food policies. We performed thematic analysis using NVivo 12. Setting: We recruited from a primary care paediatrics clinic in Philadelphia, Pennsylvania from July to August 2020. Participants: Philadelphia parents/caregivers of 2- to 11-year-old children with Medicaid insurance. Results: Participants were predominantly African American (97 %), female (100 %), and had annual household incomes <$50 000 (80 %). Participants were 26- to 72-years old, with an average aged child of 5 years (range 7 months to 20 years). Themes emerged regarding tax perceptions, revenue use and behaviour change due to the tax. Using revenue for highly valued programmes and accountability of city government to use revenue as promised were critical elements in perceptions of tax fairness. Some parents avoided the tax through cross-border shopping and buying drink powders or concentrates, influencing perceptions of tax effectiveness. The tax signalled the health dangers of sweetened beverage consumption to most parents. Conclusion: Our findings bring to light four key takeaways for policymakers designing sweetened beverage taxes. (1) Dedication of tax revenue to programmes highly valued by parents and (2) transparency in revenue spending may improve acceptability. (3) State or national taxes may be more effective at decreasing consumption due to cross-border shopping. (4) Pairing taxes with health promotion campaigns may enhance behaviour change.

The aim of the present study was to develop and validate a test to evaluate dietitian's clinical competence (CC) about nutritional care in patients with early chronic kidney disease (CKD). The study was conducted through five steps: (1) CC and its dimensions were defined; (2) test items were elaborated, and choice of response format and scoring system was selected; (3) content and face validity were established; (4) test was subjected to a pilot test and those items with inadequate performance were removed; (5) criterion validity and internal consistency for final validation were established. A 120-items test was developed and applied to 207 dietitians for validation. Dietitians with previous CKD training obtained higher scores than those with no training, confirming the test validity criterion. According to item analysis, Cronbach's α was 0⋅85, difficulty index 0⋅61 ± 0⋅22, discrimination index 0⋅26 ± 0⋅15 and inter-item correlation 0⋅19 ± 0⋅11, displaying adequate internal consistency.

This scoping review aimed to identify questionnaire-based dietary assessment methods for use in the National Health and Nutrition Survey (NHNS) in Japan. The search was conducted in three databases (PubMed, Web of Science, and Ichushi) to identify questionnaire such as food frequency questionnaire and dietary history questionnaire validated against dietary recalls or food records for the intakes of both food groups and nutrients among Japanese adults. Study quality was assessed based on previously developed criteria. We extracted the questionnaire characteristics and the design and results of the validation studies. We identified 11 questionnaires, with the number of food items ranging from 40 to 196, from 32 articles of good quality. In the validation studies, participants were aged 30–76 years and 90% of the articles used ≥3 d dietary records as reference. The number of nutrients and food groups with a group-level intake difference within 20% against the reference method ranged from 1 to 30 and 1 to 11, respectively. The range of mean correlation coefficients between questionnaire and reference methods were 0.35–0.57 for nutrients and 0.28–0.52 for food groups. When selecting a survey instrument in the NHNS from the 11 existing questionnaires identified in this study, it is important to select one with high group-level comparison and correlation coefficient values on the intended assessment items after scrutinizing the design and results of the validation study. This review may serve as a reference for future studies that explore dietary assessment tools used for assessing dietary intake in specific representative populations.

EPA and DHA are often used in veterinary medicine due to their beneficial effects for several medical conditions such as osteoarthritis. EPA and DHA are administered to dogs through different matrices. The aim of the present study was to determine the effects on the plasma levels in dogs caused by various matrices for EPA and DHA administration. In this study, three different n-3 PUFA formulations were used: soft chew tablet (CCx); liquid fish oil (LFO); and enriched kibbles (EK). The formulations were administered single-dose and compared in a randomised, cross-over designed study with a 1-week wash-out period. Several variables were observed after the administration of these formulations in thirteen dogs: the NEFA plasma concentration, the AUC for 1 d (AUC0–24 h), and maximum plasma concentration for both EPA and DHA. All plasma fatty acid levels reached baseline levels within 72 h. CCx (median = 2·987) had a significantly lower AUC0–24 h for EPA compared with LFO (median = 5·647, P = 0·043) and EK (median = 5·119, P = 0·032) (F2,22 = 4·637, P = 0·021). CCx (median = 2·471) AUC0–24 h for DHA was significantly lower compared with LFO (median = 4·837, Z = −2·56, P = 0·011) and EK (median = 4·413, Z = −2·59, P = 0·01). EPA and DHA plasma levels were affected by matrix, as with the CCx, the AUC0–24 h of EPA and DHA were both lower compared with LFO and EK. The effect of matrix on bioavailability is important for product development as well as for clinical trials studying effects of EPA and DHA.

Arachidonic acid (ARA) is essential in felines because conversion of dietary linoleic acid (LA) to ARA is rate-limited by low Δ6-desaturase. Dietary γ-linolenic acid (GLA) may serve as an ARA precursor by-passing this initial rate-limiting step. This possibility was investigated using twenty-six adult female domestic shorthair cats divided into three groups and fed on complete and balanced diets containing high GLA (GL), high LA (HL) or low LA (LL, control) diets, for 300 d prior to ovariohysterectomy. Plasma was obtained 1–2 d before surgery and uterine, ovarian and associated adipose tissues were reserved for lipid analysis. Fatty acid profiles of the plasma phospholipid (PL) fractions and adipose lipids were performed. In the GL group, plasma and uterine tissue PL were significantly enriched in GLA, di-homo GLA (DGLA) and ARA compared with control. However, ovarian and adipose tissue PL were only enriched in DGLA. Enrichment of uterine tissues with DGLA and ARA probably supplies the essential eicosanoid precursors for reproduction when GLA is fed consistently with an active Δ5-desaturase in uterus. By contrast, this enzyme appears less active in ovary because ARA was not higher compared with control. Earlier reports concluded that ARA was not necessary for fertilisation (an ovarian function), but required for successful pregnancy and reproduction (a uterine function). Adipose tissue DGLA may be a reservoir for ARA synthesis by other tissues upon mobilisation. Dietary GLA may meet feline ARA requirements in the absence of an animal-based preformed source of ARA.

Reduced absorption capacity in patients with intestinal resections (IR) could result in malabsorption of fat-soluble components like carotenoids, which are of clinical interest in relation to visual health. In this case cohort, we investigated the association between IR and serum lutein, zeaxanthin, β-carotene and macular pigment optical density, when compared with healthy controls. Ten patients with IR and twelve healthy controls were included in the study. Baseline characteristics were comparable between groups, except for higher serum TAG (P < 0·05) and shorter bowel length (P < 0·0001) in the group with IR. Serum lutein, zeaxanthin, β-carotene and macular pigment optical density were >15 % lower in the patient group compared with healthy controls (P < 0·05, adjusted for age) and, in the case of serum lutein and zeaxanthin, also for dietary intake of carotenoids. Results suggest that for a test of macular carotenoid supplementation, subjects with a potentially clinically significant carotenoid deficit could be recruited among patients with IR.

The recent exponential increase in caesarean section (CS) rates in many countries including Ghana requires an understanding of the potential long-term consequences on child health. The present study investigated the relationship between CS delivery and risk of childhood overweight/obesity. A retrospective cohort study was conducted from October 2019 to March 2020 in Ghana. Using multi-stage sampling, 553 mother–child pairs aged 6–23 months were selected from ten health facilities during child welfare clinic (CWC) services. We assessed the association between delivery mode (caesarean v. vaginal) and subsequent body mass index for age (BMI/age Z-score) using hierarchical multivariable linear regression analysis. The prevalence of overweight/obesity (BMI/age Z-score > +2 sd) in children was 3⋅6 %. After adjusting for maternal gestational weight gain, macrosomia and child feeding practices, children who were born through CS had mean BAZ which was 0⋅105 standard units significantly higher than their colleagues who were delivered through normal vaginal [beta coefficient (β) 0⋅105, (95 % CI 0⋅03, 0⋅55)]. CS birth was also associated with 3⋅2 times higher odds of overweight/obesity than vaginal delivery (AOR 3⋅23; 95 % CI 1⋅14, 9⋅13). Consequently, CS delivery was associated positively with increased body mass (adiposity) in the study sample. The association between CS delivery and risk of childhood obesity was attenuated after adjusting for macrosomia. These results would be important for informing clinicians and expectant mothers in considering CS delivery.

In cats, the incidence of obesity and diabetes is increasing, and little is known about specific aspects of the endocrine control of food intake in this species. Recent data suggest that ghrelin has an important role in the control of insulin secretion and vice versa, but this role has never been demonstrated in cats. Here we aimed to improve our understanding about the relationship between insulin, amylin and ghrelin secretion in response to a nutrient load in overweight cats. After a 16 h fast, weekly, six overweight male cats underwent randomly one of the four testing sessions: saline, glucose, arginine and TAG. All solutions were isoenergetic and isovolumic, and were injected intravenously as a bolus. Glucose, insulin, acylated ghrelin (AG), amylin and prolactin were assayed in plasma before and 10, 20, 40, 60, 80 and 100 min after the nutrient load. A linear mixed-effects model was used to assess the effect of bolus and time on the parameters. A parenteral bolus of glucose or arginine increased insulin and ghrelin concentrations in cats. Except for with the TAG bolus, no suppression of ghrelin was observed. The absence of AG suppression after the intravenous load of arginine and glucose may suggest: (1) that some nutrients do not promote satiation in overweight cats; or that (2) AG may be involved in non-homeostatic consumption mechanisms. However, the role of ghrelin in food reward remains to be assessed in cats.

The present study explored nursing and medical students’ perceptions of food security, their access to healthy food and the circumstances that affect their access to healthy food in Qatar. The photovoice method was adopted in the present study. Students submitted their photos pertaining to food security and their access to healthy food in Qatar. Afterwards, the students completed an online synchronous semi-structured interview. The interviews were transcribed verbatim and thematically analysed. After the data analysis, a focus group discussion was conducted for member checking. The present study is a collaborative project between two universities in Qatar: The University of Calgary in Qatar (UCQ) and Qatar University (QU). Undergraduate students (seven nursing students and nine medical students) were recruited, asked to collect photos and interviewed. Four themes emerged from the data. First, food retail environments promoted unhealthy eating. Second, fast food under stressful circumstances: a sense of comfort. Third, food as a symbol of culture and socialisation. Finally, the paradox of access to affordable and healthy food in Qatar. Undergraduate students highlighted various circumstances that affect their perceptions of food security and their access to healthy food in Qatar. Future research that aims at understanding the facilitators and barriers to access healthy food at the university campus may help to improve nutrition interventions targeting those students. Future initiatives should focus on leveraging various resources to assist universities in tailoring their food initiatives to suit their students’ local needs.

Constipation can greatly impact the quality of life (QoL), which can be relieved by dietary fibres; however, preserving a higher fibre intake remains a challenge. We investigated the effects of a personalised dietary advice (PDA) on fibre intake and mild constipation complaints. A total number of twenty-five adults with mild constipation complaints were included in a 4-week observation period followed by a 4-week personalised intervention. The PDA provided high-fibre alternatives via a web tool. In weeks 1, 4 and 8, dietary intake, constipation complaints and QoL were assessed. Furthermore, participants collected a faecal sample at weeks 1, 4 and 8 to determine microbiota diversity and composition, and short-chain fatty acids (SCFA). Participants completed questions daily for 8 weeks regarding abdominal complaints, stool frequency and stool consistency. Fibre intake in week 8 was significantly higher compared to week 1 (Δ = 5·7 ± 6·7 g, P < 0·001) and week 4 (Δ = 5·2 ± 6·4 g, P < 0·001). Constipation severity and QoL significantly improved at week 8 compared to the observation period (P < 0·001). A higher fibre intake significantly reduced constipation severity (β = −0·031 (−0·05; −0·01), P = 0·001) and the QoL (β = −0·022 (−0·04; −0·01), P = 0·009). Stool consistency (P = 0·040) and abdominal pain (P = 0·030) improved significantly during the intervention period (P = 0·040), but stool frequency did not. Average microbial alpha diversity and composition and SCFA concentrations did not change over time, but indicated individual-specific dynamics. Several SCFAs were associated with constipation complaints. To conclude, a PDA effectively increased fibre intake and subsequently reduced constipation complaints, indicating that guided dietary adjustments are important and feasible in the treatment of mild constipation complaints.

The considerable amount of original and generic types of skinfold calipers available is a source of systematic measurement error. This study is a brief report that critically examines the original and illustrated structural configuration of the three main types of skinfold calipers. For more than half a century, the Harpenden®, Lange® and Slim Guide® skinfolds calipers have been widely used in clinical and research settings. It is well established that the physical, mechanical and functional specificity of each type of skinfold caliper makes its interchangeable use impossible. Our report suggests that commercially available technical specifications are insufficient to judiciously choose a skinfold caliper. The area of the jaws, the coefficient of spring and the static and dynamic downward pressure of each type of skinfold caliper must be determined in the metrological laboratory and added to the technical user manual. Choosing a type of skinfold caliper for regular use, without conflict of commercial interest, requires a critical understanding of the physical, mechanical and functional characteristics that configure it. Therefore, a new downward static calibration test and the first eligibility flowchart for a skinfold caliper have been proposed. Finally, the information gathered in this report may be useful for manufacturers of anthropometric instruments and health professionals who use the skinfold technique as a tool for diagnosis and nutritional control.

The combined burden of stunting and wasting in children under five years is a serious public health concern. The present study aimed to estimate the joint burden of stunting and wasting among children aged 6–59 months and explore its spatial variation across Nepal. The 2016 Nepal Demographic and Health Survey data was used to study acute and chronic childhood malnutrition. A Bayesian distributional bivariate probit geoadditive model was designed to study the linear association and geographical variation of stunting and wasting among 6–59 months, children. Child-related factors such as low birth weight, fever in the last 2 weeks preceding the survey and fourth or greater birth order were associated with a higher likelihood of stunting. The likelihood of a child being stunted was significantly less in the wealthiest households, having improved toilet facilities, and if mothers were overweight. Children from severely food insecure households were significantly more likely, and children from poorer households were significantly less likely to suffer both acute and chronic malnutrition simultaneously. Results from spatial effect showed that children from Lumbini and Karnali had a higher burden of stunting, and the likelihood that achild would have been wasted was significantly higher in Madhesh and Province 1. Immediate nutritional efforts are vital in low-income and severely food insecure households to lessen the risk of stunting and wasting in under children. Disproportionate geographic variations in stunting and wasting warrant sub-regional-specific nutrition intervention to achieve nutrition targets and reduce the burden of childhood malnutrition across the country.

Low concentrations of elements in food can be measured with various techniques, mostly in small samples (mg). These techniques provide only reliable data when the element is distributed homogeneously in the material to be analysed either naturally or after a homogenisation procedure. When this is not the case or homogenisation fails, a technique should be applied that is able to measure in samples up to grams and even kilograms and regardless of the distribution of the element. An adaptation of neutron activation analysis (NAA), called large-sample NAA, has been developed and proven accurate and may be an attractive alternative in food research and mass balance studies. Like standard NAA, large-sample NAA can be used to measure both toxic and trace elements relevant for nutrition.

Chylomicron particles are continually synthesised and secreted from the intestine even in the absence of ingested fat. It is possible that following consumption of low doses of fat the basal level of chylomicron secretion and subsequent metabolism are sufficient to metabolise this fat without an increase in postprandial chylomicron concentrations. To test this hypothesis, healthy male subjects were randomised to receive, on three separate occasions, meals containing a range of doses of fat (average 8·1–19 g) and effects on postprandial lipaemia and chylomicron concentration were determined. Furthermore, to delineate the effect on lipid-rich v. lipid-poor (remnant) forms lipid levels were also determined in a density <1·006 g/ml fraction. Following consumption of the very low dose of fat the postprandial concentration of chylomicrons was unaltered, whereas following the medium dose postprandial chylomicron concentrations were significantly increased. Interestingly, this increase was only detected in the lipid-rich chylomicron fraction, with postprandial levels of chylomicron remnants remaining unchanged. In conclusion, it appears that consumption of what would be considered low to medium doses of fat are not associated with transient postprandial increases in chylomicron remnants in healthy male subjects.

Children with cerebral palsy (CP) typically suffer from congenital deformities, such as scoliosis and contractures, therefore, it is a challenge to measure the stature of CP children. Studies have suggested that predictive equations based on tibia length (TL) may be used as an alternative method in measuring the actual height or stature. The present study aimed to develop and validate predictive equations based on TL for CP children in Malaysia across all five levels of gross motor functions (GMFCS I to V) through a cross-sectional study. All subjects were recruited from Hospitals and Community-Based Rehabilitation (CBR) in the central and southern regions of Malaysia. Two predictive equation models were developed using multiple linear regression. For Model 1, the predictive equation was developed based on TL. On the other hand, Model 2 was developed based on TL with age was included. A flexible Seca measuring tape was used to measure the stature and TL. CP children aged 2–18 years were classified into the equation development group (EDG), n 177 and the validation group (VG), n 139. Model 1, Height = 32⋅3 + 3⋅14 (TL), demonstrated a strong correlation with the actual height (R2 0⋅834), small SEE (1⋅42), and high intra correlation coefficient (0⋅929). The findings suggested that Model 1 was more accurate in estimating the height of CP children aged 2–18 years. This model was shown to suit the Malaysian population and applicable across all GMFCS levels.

The poor assessment of child malnutrition impacts both national-level trends and prioritisation of regions and vulnerable groups based on malnutrition burden. Namibia has reported a high prevalence of malnutrition among children younger than 5 years of age. The present study's aim was to identify the optimal methods for estimating child stunting and wasting prevalence in Namibia using two datasets with suspected poor data quality: Namibia Demographic and Health Surveys (NDHS) (1992–2013) and Namibia Household Income and Expenditure Survey (NHIES), 2015/16. This comparative secondary data analysis used two prevalence estimation methods: WHO flags and PROBIT. WHO flags is the standard analysis method for most national household surveys, while the PROBIT method is recommended for poor quality anthropometry. In NHIES (n 4960), the prevalence of stunting (n 4780) was 30·3 and 20·9 % for the WHO flags and PROBIT estimates, respectively, and the national wasting prevalence (n 4637) was 11·2 and 4·2 %, respectively. The trends in nutritional status from NDHS and NHIES showed improvement across WHO flags and PROBIT until 2013; however, from 2013 to 2016, PROBIT showed smaller increases in stunting and wasting prevalence (2·5 and 0·6 percentage points) than WHO flags (6·6 and 5·0 percentage points). PROBIT identified the Khoisan ethnic group and Northern geographical regions with the highest stunting and wasting prevalence, while WHO flags identified similar prevalence across most groups and regions. The present study supports the recommendation to use PROBIT when poor data quality is suspected for constructing trends, and for targeting regions and vulnerable groups.