Protein supplementation represents an attractive strategy to prevent skeletal muscle mass loss and function with aging. However, it could be counterproductive in older adults, due to adverse effects on appetite and energy intake (EI). Understanding the effects of protein supplementation on appetite and energy intake is therefore key when investigating the potential efficacy for use in improving health outcomes. This systematic review aimed to assess the literature investigating the effects of protein supplementation on energy intake, and/or appetite in healthy older adults.

PubMed and The Cochrane Library, as well as MEDLINE, CINAHL, EBSCO, and Web of Science databases were searched up to 21 March 2019 for published studies and theses. The review was limited to randomized controlled trials and longitudinal studies in healthy adults over 60 years of age that reported effects of protein supplementation compared to control or pre-intervention on appetite and/or energy intake. The review was conducted according to PRISMA guidelines.

Out of 5,429 articles screened, 90 full-texts were reviewed and twenty-six studies (11 acute, 15 longitudinal) included. Studies involved a total of 1439 participants (502 male, 881 females). Of the acute studies, 3 reported conditions in which appetite was suppressed, 5 studies reported no effect and one study reported a condition in which appetite ratings increased following a protein load versus control. Three studies reported conditions in which ad libitum test meal EI was suppressed following protein preload and 7 reported no difference. When examining total EI (accounting for protein supplement and test meal), 2 studies reported no difference and 8 reported conditions where total EI was increased with protein supplement compared to control. Longitudinal studies ranged from 2–26 weeks duration. Two studies reported effects on appetite, one showing hunger to be suppressed on higher (1.0g/kg/d) compared to lower protein diet, and another showing hunger in response to whey consumption increased, but fullness also increased.14 studies reported effects on EI, most commonly assessed by food diary, and all showed no effect of increased protein intake compared to control on daily EI.

The systematic review indicates that while appetite may be suppressed under some conditions, the current literature supports protein supplementation in older adults, as it either has a positive effect or no effect on total EI in both short and longer-term studies. Therefore, protein supplementation may represent an effective solution to address protein deficiencies in older adults without compromising daily EI.

Selenium is an essential micronutrient with biochemical and cellular effects through activities of 25 selenocysteine-containing selenoproteins. Selenoproteins are anti-inflammatory and have antioxidant properties. Severe selenium deficiency causes muscle weakness and atrophy in humans however the effects of moderate selenium deficiency are unclear. The aims of this study are twofold: 1) to determine dietary selenium intakes and contributing food sources in very old adults and; 2) to determine whether dietary selenium intakes are associated with 5-year trajectories of muscle function: hand-grip strength (HGS) and Timed-Up-and-Go (TUG).

Cross-sectional (baseline) and prospective (1.5, 3 and 5-year follow-up) analyses of 845 participants aged 85 years from the Newcastle 85 + study were assessed for HGS and TUG performance using standardized protocols (Antoneta et al. 2016). Baseline dietary intakes were assessed using 24-hour multiple pass recall methods on two separate days (Mendonça et al. 2016). The top selenium food contributors (~90%) and the adequacy of intakes were determined i.e. those with intakes < LRNI, between the LRNI and RNI and > RNI. Linear mixed models explored the associations between selenium intake categories and time on the prospective, 5-year change in HGS and TUG in all participants, males and females.

Median intakes of selenium were 39, 48 and 35μg for all participants, males and females, respectively. Selenium intakes were below the LRNI in 51% of participants (median 27μg) whilst 15% had intakes ≥ the RNI (median 85μg). Only 13.3% of females and 16.9 % of males met the RNI. The top selenium contributors were cereals (46%), meat (22%), fish (10%), milk (6%), eggs (4%) and potatoes (3%) making up 91% of selenium intakes. Those with the lowest intakes had 2.72 kg lower HGS and 2.36s slower TUG compared to those with higher intakes (P < 0.005). There was no association between selenium intake in HGS or TUG, but time had a significant effect on the rate of change over 5-years in both parameters (P < 0.001).

Overall these results show that poor dietary selenium intakes are common in very old adults and that cereal and cereal products are major sources of selenium in this population. Whilst low selenium intakes are associated with worse HGS and TUG performance in the cross-sectional analysis, no significant associations were observed in the prospective analyses.

Eating behaviour refers to quantitative and qualitative features of the selection and decision on the foods to be consumed. Knowledge on determinants of eating behaviour increases the success of actions and interventions aiming to promote healthy eating habits and to prevent diseases. Several constructs facilitate the comprehension of health-related changes, among which the Locus of Control (LoC) and Stages of Change (SoC). Our aim was to study the relationships between several dimensions of eating behaviour with the health LoC and SoC towards healthy eating among Portuguese higher education students. Data from 267 higher education students (63.7% females) aged 18 to 27 years were assessed regarding health LoC (Health Locus of Control Scale; Ribeiro, 1994), SoC towards healthy eating (question and items from Kearney et al. (1999), adapted to refer specifically to the adoption of healthy eating) and eating behaviour. Emotional and external eating were measured using the Dutch Eating Behavior Questionnaire, flexible and rigid control of eating behaviour was measured with the Portuguese version of the subscales proposed by Westenhoefer et al. (1999), the Portuguese version of the Binge Eating Scale was used to assess binge eating severity, and eating self-efficacy was measured using the General Eating Self-Efficacy Scale. BMI was calculated using self-reported weight and height. No significant associations were found between BMI and health LoC. In the female subsample, i-LoC assessed through the factor “locus of control” was negatively associated with binge eating and positively with eating self-efficacy. However, we also found a negative association between eating self-efficacy and i-LoC assessed by the factor “other powerful”. Among men, none of the eating behaviour dimensions presented an association with health LoC. Regarding SoC, participants in the maintenance stage presented lower external eating and binge eating (both sexes), lower emotional eating and higher eating self-efficacy (women) and dietary restraint (higher rigid control among men but higher flexible control among women), when compared to those in the pre-contemplation/ contemplation stages. Our results suggest that SoC and LoC may be useful to achieve deeper knowledge on eating behaviour. Their assessement may also help designing early and sex-directed (namely regarding the different types of dietary restraint) programs and interventions focusing eating behaviour.

Cancer patients experience many diet and nutrition-related problems, which are often under-recognised and under-treated. Research suggests few healthcare professionals discuss dietary information with cancer patients. Consequently, patients may seek information from other sources. It is unknown what these information sources are or what types of advice patients obtain and follow. The aim of this study was to determine the source and type of diet information cancer patients obtain before their first dietetic assessment and the degree to which this is followed. This was a prospective, multi-center, cross-sectional observational study. Ethical approval was obtained for each centre. Consecutive cancer inpatients and outpatients were recruited for six months at seven tertiary centers. Patients were screened for eligibility. Inclusion criteria included solid tumour, over 18 years of age, new dietetic referral and ability to sign consent. Data collection was carried out by a dietitian during initial routine dietetic assessment. Participants were asked four questions about dietary advice since cancer diagnosis. To date, 74 participants (50% female) with a median age 60 (range 23–80) have been recruited. Forty percent reported weight loss of ≥ 5%. The median time from diagnosis to initial dietetic assessment was 3 months (range 0–242). Patients who obtained advice did so from several sources (median 2 sources per patient, range 0–6) prior to dietetic referral. In rank order these were; 1) family or friend (n = 31), 2) health professional (n = 24), 3) online forums or websites (n = 16) and 4) media (n = 14). Twenty-one (28%) had received no dietary advice. The most frequent advice obtained related to avoidance of certain foods; particularly dairy, meat and sugar. Fruit, vegetables, protein, juices and wholegrain were advised. Fifty-one percent followed the advice fully and 4% partially. Seven expressed disappointment at not having a dietetics referral earlier and identified the need for the hospital “to introduce good information early”. In conclusion, the majority of dietary and nutritional advice prior to dietetic referral came from friends, family, media and online forums and websites. Most advice related to the avoidance and/or promotion of particular foods. Cancer patients want dietary advice from dietitians at diagnosis to prevent unnecessary avoidance of certain foods and to reduce the risk of unintentional weight loss.

Beaumont Hospital Kidney Centre, Dublin is currently the largest provider of haemodialysis in Ireland. There is a dedicated renal dietetic team to address the nutritional needs of these patients. In order to provide an optimal service, a thorough understanding and insight of the service demands is needed. Currently there is no nutritional profile of these patients. Similarly the Renal dietetic team have not been in a position to identify if they are meeting current best practice guidelines, as outline by the National Kidney Foundation. E-Med, an online renal electronic notes system, was used to provide all dietetic notes during 2018. Using an audit template, an audit of these notes for outpatient haemodialysis patients was carried out to identify a number of nutritional issues. 75% (123/163) of outpatient haemodialysis patients received direct dietetic intervention in 2018. 76% of these patients demonstrated more than one nutritional issue and 16% displayed more than five nutritional issues. The most prevalent nutritional issues arising were hyperkalemia (41%) and hyperphosphatemia (33%). Currently guidelines, which recommend a dietetic review, every 3–4 months are not being met. 53% of patients received either none or only one direct dietetic intervention in this time period. The recommended ratio of 1:100 (dietitian: haemodialysis patient) is also not being met. Currently the ratio stands at 1:243 as the dietitian responsible for haemodialysis patients is also responsible for peritoneal dialysis patients. The average length of time recorded for each direct intervention was 1 hour. Beaumont Hospital haemodialysis outpatient cohort is a nutritionally complex group of patients, which require ongoing and frequent dietetic input. Beaumont Hospital renal dietitians are successfully providing at least one episode of direct intervention to the majority (75%) of the outpatient haemodialysis patients, suggesting efficient and effective use of available resources. An increase in dietetic staffing for the renal service could offer the potential to provide direct dietetic input to all haemodialysis patients within the hospital and to also provide an increased number of reviews to patients, as per guidelines. It is possible that the amount of time spent on dietetic patient assessments is being under-reported and further work is needed to cross-reference these figures using an alternative statistical package.

Malnutrition is associated to a progressive decline in health, reduced physical and cognitive functional status and mortality. However, the malnutrition prevalence differs across countries. Previous studies reported 19% of malnourished elderly in Turkey and 1.3% in Portugal.

We aimed to compare the nutritional status between between Portuguese and Turkish older adults using the Mini-Nutritional Assessment.

This is a cross-sectional study using data from the Pronutrisenior project, collected in Vila Nova de Gaia, Portugal (n = 430), and a study in Ankara, Turkey (n = 162). The sample consisted of older adults living at their homes. Socio-demographic data, clinical data from the medical records, the full form of Mini-Nutrititional Assessment, MNA-FF and anthropometry (weight, height, BMI, mid-arm circumference and calf circumference) were collected.

Turkish older adults lived more frequently with children, are more likely to be widow/widower, and have a higher probability of being housewife/househusband. A larger proportion of the Portuguese have tooth loss, diabetes, hypertension, oncologic diseases, kidney diseases, osteoarticular problems, or eye problems and a larger proportion of the Turkish have anemia. The BMI average is smaller in the Turkish sample, while the calf circumference average is larger. Turkish have a larger proportion of malnourished or at risk of malnutrition (4.9% and 31.5% vs. 1.2% and 24.0%, respectively). The average MNA-FF score is higher among the Portuguese, males and on people using denture, and without: toothloss, hypertension, CVD, anemia and oncological diseases. Moreover, higher MNA-FF scores were associated with younger ages, higher BMI and higher calf circumference.The effect size was larger for CVD and sex.

The prevalence of malnutrition in European and American populations ranges from 1% to 15% in ambulatory living elders, more common among females as in this work. Other studies showed that higher BMI is related with lower malnutrition prevalence and higher prevalence of obesity-related chronic diseases. Tooth loss was more frequent in the Portuguese, which may be due to a higher intake of sweets or packaged food. Portuguese elders had lower calf circumferences but higher BMI, which may be related to lower muscle mass and/or higher fat mass. The differences between the Portuguese and the Turkish may be related to the different per capita gross national product, positively correlated with BMI and the consumption of processed foods. Anemia in Turkish elders may be related with BMI and their lower consumption of meat and the higher tea intake that may reduce iron absorption, as reported by other studies.

Food portion sizes routinely consumed by children have increased over time and consumption of larger portion sizes is associated with higher weight status. Parents often have the critical role of deciding portion sizes of foods to serve their children. It is not well understood, however, how parents decide the amount of food to serve. This research aimed to investigate parental views on portion sizes of foods and beverages served to children.

A purposive sample of preschools and primary schools geographically located in either urban or rural areas of Northern Ireland and the Republic of Ireland, and classified as either high or low deprivation were recruited. Selected schools were invited to facilitate this research. Parents with at least one child aged 2–12 years attending a recruited school were then invited to participate in a focus group. A maximum of three groups were scheduled with interested parents at each school. One researcher moderated the focus groups, assisted by another researcher in all groups where possible. A semi-structured discussion guide was followed, using probes to stimulate discussion. The guide explored practices in portioning foods and beverages for children, factors influencing portioning and views on portion sizes of foods and beverages served to children. Discussions were audio-recorded, transcribed verbatim and data was analysed thematically. Nvivo software was used to manage the coded data.

Focus groups (n = 24) ranging in size from 3–12 parents were conducted across 19 schools. The response rate from parents at recruited schools ranged from 1–16%. A total of 144 parents (86% female, mean age 46y) participated, of which 60% had a child attending a high deprivation school and 64% had a child attending a rural school. Factors influencing parental portioning included seven themes comprised of sub-themes: parent knowledge (portion size knowledge, serving a learned amount), parent motivations (ensure child is fed, encourage healthier food), child-related factors (appetite, body size, food preferences, eating patterns), family influence (spouses and grandparents serving), food retail and other settings (restaurants, takeaways, special occasions), socio-cultural influences (parent childhood experiences, parents’ portion size norms) and portioning resources used (serve ware, utensils, hand sizes).

Parents’ main concern regarding the amount they feed their children was to ensure that they are fed a sufficient amount to feel full. Parents learned this amount through experience and felt it was specific to each child's appetite. These findings will inform future interventions and information campaigns to help parents understand child portion sizes.

Vitamin C is an essential nutrient which humans cańt produce. Vitamin C has many important functions in the body, such as immune-system stimulation, growth and repair of tissue, sustain cardiovascular and bone health and protecting cells from oxidative stress by neutralizing harmful free radicals.

To ensure adequate vitamin C levels intake recommendations are set.

A minimum of 10 mg/ day is needed to prevent scurvy, the clinical manifestation of vitamin C deficiency. Some countries like UK and Australia and the FAO/WHO* refer to this and set recommendations of 40–45 mg/day including a safety margin.

Later findings showed that vitamin C is essential for further functions, especially for the immune system. In addition, kinetic studies in healthy men showed that the saturation of neutrophil leukocytes and plasma needs higher vitamin C intakes. Based on the content parameters of plasma level, neutrophil saturation, and minimal urinary loss, the intake recommendations were increased in some countries. The IoM (US) increased the vitamin C recommendations (RDA) to 90 mg and 75 mg/ day and EFSA to 110 mg and 95 mg/ day for men and women, respectively.

It´s recommended to define intake recommendations based on functional parameters because vitamin C levels should be at a level that assures optimal functioning of all processes requiring vitamin C. Lack of overt deficiency does not necessarily indicate adequacy of intake. Up to now no sufficient evidence exists for a functional parameter.

Recent science from an in-vitro and a human intervention study in healthy men investigated the effects of vitamin C on the leukocyte function. The results support neutrophil motility as a suitable functional parameter. The observed effects indicate to increase the intake recommendation to 200 mg/ day for healthy persons. This is in line with established knowledge from pharmacokinetic, observational, and intervention studies. Plasma vitamin C saturation occurs at a daily intake of 200 mg/ day and a recent review showed that supplementation of at least 200 mg/ day reduced the duration of common cold significantly in children as well as in adults. Additionally, it could be shown that incidences of cardiovascular disease were lowest with vitamin C intakes of at least 200 mg/ day.

These findings indicate that an increase of current intake recommendations to 200 mg/ day would be beneficial for the function of the immune system, thus for human health.

It is recommended that infants are exclusively breastfed for the first six months. As the gold-standard in infant feeding, it is the safest and best way of ensuring infants achieve optimal health and development(1). Powdered Infant Formula (PIF) is not sterile and so, can be associated with bacteria such as Cronobacter spp(1–2). This bacterium can have an adverse effect on health in all age groups. However, the FAO/WHO have identified infants 0–12 months as a vulnerable group, with infants less than two months old and all immunocompromised infants regardless of age, being particularly at risk of infection(1).

Guidance set out by the Food Safety Authority of Ireland on the safe preparation of PIF states that it is essential to boil one litre of fresh tap water and let it cool to 70°C, to kill any bacteria in the powder and retain sufficient amounts of nutrients. By preparing, handling and storing PIF in line with the guidance, parents can reduce potential risks of contamination(1–2).

The aim of this study was to determine the current practice of reconstituting PIF in the domestic setting in Ireland. A sample of parents with a child aged 0–12 months (n = 228) completed a 30-item questionnaire online. Most respondents were first time parents (55%), female (89%), aged 25–44 years (99%) and educated to tertiary level (79%).

The results revealed that 64% (n = 146) of respondents reported to fill the kettle with one litre of fresh tap water, but less than half (45%) follow the guidance, to cool the boiled water to the required 70oC(1–2). The majority 91% (n = 208), stated that they discard any unused feed within two hours. Furthermore, 29% (n = 67) of respondents reported to use an automatic bottle preparation machine, 75% (n = 171) said they are aware of safety aspects/risks associated with preparing PIF and most (97%, n = 221) felt confident in their ability to safely prepare their infant's PIF feed.

It is evident that there is a need to highlight to all parents the importance of why and how PIF should be prepared and reconstituted at 70oC in accordance with the guidance(1–2), to minimise potential risks of contamination.

Activated hepatic stellate cells (HSCs) are a key contributor to liver fibrosis and drive the progression to advanced disease for many liver conditions, including non-alcoholic fatty liver disease. Previous studies suggest vitamin D may reduce inflammatory and pro-fibrogenic activity of HSCs in vitro. However, the mechanisms underpinning the effects of vitamin D in HSCs are not fully understood. The overall aim of these experiments was to mimic a lipid loading model on immortalised HSCs to test their responses to 1α,25-dihydroxyvitamin D3 (1α,25(OH)2D3). Two different human immortalised cell lines: HepG2, hepatocellular carcinoma cells, and LX-2, hepatic stellate cells; were cultured using standard methods. Cell viability in different treatment vehicles (2% DMSO and/or 0.1% ethanol) under serum free conditions was measured by MTT assay after 6 and 24 h. Cells were cultured with increasing concentrations of fatty acids (0–500μM, 1:1 oleic acid: palmitic acid) or vitamin D. Nile red, a neutral lipophilic fluorescent dye, was used to measure total intracellular lipid and quantified relative to vehicle. CYP24A1 mRNA expression was measured by qPCR in response to 1000nM 1α,25(OH)2D3 treatment in both cell lines for 24 h using TaqMan® gene expression assays and normalised to 18S rRNA. Cell viability in response to vehicle was examined at 6 h and 24 h to determine the optimal experimental time points. Whereas, HepG2 cells remained unaffected at 24 h in response to either or both vehicles combined (n = 4; combined vehicles, P = 0.3187), LX-2 cells showed reduced viability even at 6 h (n = 5; combined vehicles, P = 0.0050). Fatty acid treatment led to intracellular lipid accumulation in both cell lines. In response to 500μM fatty acid treatment, intracellular lipid increased by 1.7-fold in LX-2 cells at 6 h (n = 5, P = 0.00174) and 3.9-fold in HepG2 cells after 24 h (n = 4, P = 0.00184). Notably, CYP24A1 mRNA expression was markedly induced by vitamin D treatment in LX-2 cells (136 ± 7.64-fold, n = 3, P = 0.0010) in comparison to HepG2 cells (22 ± 0.78-fold, n = 3, P < 0.0001). In summary, the cell viability data suggested optimal time points for both fatty acid and vitamin D treatments may be 6 h for LX-2 cells, and 24 h for HepG2 cells. While intracellular lipid accumulation differed between the cell lines in response to fatty acid treatment, both cell lines produced a dose-dependent increase in intracellular lipid. Lastly, CYP24A1 mRNA expression confirmed the responsiveness of both cell types to vitamin D treatment. Ongoing experiments are examining microRNA expression in HSCs in response to both vitamin D and lipid loading.

Conjugated linoleic acids (CLAs) show a number of putative health-promoting activities including anti-carcinogenic, anti-adipogenic, anti-diabetogenic, anti-inflammatory and antioxidant actions. CLAs are naturally produced by ruminal bacteria and several studies demonstrate that various lactobacilli and bifidobacteria are also able to produce CLAs in vitro from linoleic acid (LA). However, the ability of the human gut microbiota to produce CLA is less extensively studied. Our hypothesis is that the human gut microbiota is able to convert LA to CLA, and that the readily fermentable fiber inulin would positively modulate the growth of CLA-producing bacteria and, consequently increase the CLA content in the intestine.

The capability of the faecal microbiota from five healthy donors to produce CLA was tested in anaerobic batch cultures for 48 hours at pH 5.5 and 6.5. Test treatments were linoleic acid (LA; 1 mg/mL) + bovine serum albumin (BSA; 0.2 mg/mL), and LA (1 mg/mL) + BSA (0.2 mg/mL) + inulin (1%, w/v) compared to a control BSA (0.2 mg/mL) fermentation. The microbial composition was analyzed 0, 24 and 48 hours after starting the fermentation by 16S rRNA gene Illumina MiSeq sequencing (V3-V4 region). CLAs were quantified by Ultra performance liquid chromatography - tandem mass spectrometer (UPLC-MS/MS) and bi-dimensional gas chromatography (GC x GC).

The inclusion of LA + BSA + inulin at pH 5.5 significantly increased the relative abundance of Collinsella aerofaciens (p < 0.05), and tended to increase the relative abundance of bifidobacteria. LA + BSA + inulin at both pH 5.5 and 6.5 reduced the relative abundance of Parabacteroides, Bilophila, Clostridia and Enterobacteriaceae (p < 0.05). The concentration of CLA, in particular the isomer cis9,trans11 C18:2, was significantly higher in the LA + BSA + inulin group at pH 5.5 after 24 and 48 hours fermentation.

The data show that the treatment LA + BSA + inulin at pH 5.5 induce substantial changes in microbiota composition, including bifidogenesis and CLA production in a human intestinal microbiota model. The changes of relative abundance detected are consistent with changes in gut bacteria previously linked to human health. Collinsella aerofaciens has been reported for reducing bloating, in particular in subjects suffering from irritable bowel syndrome, while Clostridia, Bilophila and Enterobacteriaceae causes human infections. In addition, the increase of bifidobacteria and LAB, which have previously been shown in vitro to produce CLA, may also be involved in CLA production under simulated cecal microbiome. These preclinical observations warrant confirmation in suitably designed animal and human mechanistic studies.