Methods: The study was conducted at the pediatric unit of the university hospital of Treichville, one of the 3 main hospitals of Abidjan, the largest city of Ivory Coast. The medical records of 467 children from 5 to 14 years old were analyzed. The period from January 1st 2004 to December 31st 2006 was considered as pre-fortification period and the period from January 1st 2008 to December 31st 2010 was regarded as the post-fortification period. Data for anemia, hemoglobin, hematocrit, red blood cell count, and MCV were compared between pre- and post-fortification periods.

Results: The results showed that there were no statistically significant difference in prevalence of anemia and mean hemoglobin, hematocrit, red blood cells, and MCV between pre and post-fortification periods.

Conclusion: The double fortification of wheat flour with folic acid and iron had no significant impact on anemia in Ivorian children. This is perhaps due to the fact that wheat flour is not widely consumed as rice and rice products are more popular in Ivory Coast population. The Ivorian government perhaps should focus efforts on the fortification of these products.

THE RELATIONSHIP BETWEEN UNMETABOLIZED FOLIC ACID AND SERUM FOLATE CONCENTRATIONS AND CANCER RISK IN OLDER US ADULTS

by

Regine L. Baldauff

Importance Several studies have reported an increase in serum and unmetabolized folic acid levels since the implementation of folic acid fortification (January 1, 1998). However, the literature published during the post-folic acid fortification period is controversial with regards to the safety and potential risk for cancer in non-target populations.

Objective To study the association between unmetabolized folic acid and serum folate and cancer in older US adults.

Design, Setting, and Participants This is a cross sectional study using data from National Health and Nutrition Examination Surveys. Among 700 participants with identified unmetabolized folic acid, 147 cases were reported a history of having cancer from 1999-2002. Within the 7,981 subjects who had a recorded value for serum folate from 1999-2008; 1,459 reported a history of all cancer. Among the 4,007 women who had a recorded value for serum folate between 1999-2008; 288 reported a history of breast cancer.

Main Outcome Measures Associations of unmetabolized folic acid and serum folate with all cancer and breast cancer was evaluated using a multivariable logistic regression analysis controlling for demographic and dietary intakes.

Results Men and women without unmetabolized folic acid were 0.7 times less likely to develop cancer. Those over the age of sixty with the highest concentration of serum folate were 1.4 times more likely to have cancer than participants with lower serum folate concentrations. Women over the age of sixty with the highest concentration of serum folate were 1.8 times more likely to have breast cancer compared to women with lower serum folate concentrations.

Conclusions and Relevance The presence of unmetabolized folic acid and high serum folate concentrations were related to an increased prevalence of cancer. Further research is warranted to investigate the cause and effect relationship.

Introduction: AR results from an abnormally heightened immune response triggered by unharmful substances in the environment. Therefore, a therapy capable of regulating the overall immune function of the body should alleviate the discomfort caused by AR. The intestine is the largest immune organ of the body. And consumption of probiotics can induce positive changes in the composition of the microbiota that reside in the intestine within a short period of time. As a result, several trials have been conducted to investigate the therapeutic effects of probiotics on AR. However, because of the generally small sample size of these studies, it is difficult to reach a definite conclusion. Therefore, we performed a meta-analysis to assess if probiotics consumption leads to improvement of AR symptoms.

Method: Key words of “probiotics” and “seasonal allergy” were used to search PubMed, Cochrane and CINAHL to identify randomized controlled trials for the meta-analysis. Out of the 69 initially identified papers, 9 were eventually included in the analysis. Studies excluded were either duplicates, reported un-relevant outcomes, or provided insufficient data for further analysis. The meta-analysis was conducted through CMA 2.0, commercial comprehensive meta-analysis software. Standardized mean difference was calculated for subjective symptoms scores and serum biomarker levels for each study as the effect size, and the random effects model was applied to calculate the overall effect.

Results: In the Forest plot, the Hedges’ g value for overall symptom score was 0.451 with a p value of 0.02, indicating that probiotics consumption induced a moderate improvement in symptoms, and the improvement is statistically significant. On the other hand, the Hedges’ g value for blood biomarkers level was -0.15 with a p value of 0.127, meaning probiotics performed worse than placebo at decreasing the inflammation at cellular or molecular level, as measured by serum biomarkers, but this inferior effect was not statistically significant.

Conclusion: The use of probiotics is beneficial at relieving allergic symptoms for AR patients, but contradictory findings were discovered when it comes to the measurement of serum biomarkers levels. Future studies are needed to identify reliable biomarkers for AR, and studies with similar design but larger sample size would be helpful to further investigate the effectiveness of probiotics in the management of AR.

Objective: To investigate if the alterations in triglyceride accumulation in 3T3-L1 cells pretreated with oxidized soy oil are due to 1) a change in PPARg DNA interactions 2) changes in the expression of SREBP-1c, PPARg, and/or its target genes.

Main Methods: Confluent 3T3-L1 cells were pretreated for 24hours with 0.01% soy oil (SO) which was either unheated (unheated SO) or heated for 3, (3h-SO), 6 (6h-SO), or 9hours (9h-SO). The effect of 24hour soy oil exposure was assessed at several time points throughout the differentiation process. Alterations in PPARg DNA interaction was assessed using a PPARγ transcription factor assay kit while alterations in the expression of genes upstream and downstream of PPARγ was determined by RT-PCR. Primary and secondary products of oxidation within the SO were determined by spectrophotometry.

Results: The 6hr-SO contained the greatest concentration of peroxides whereas both the 6hr-SO and 9hr-SO contained a significantly higher concentration of conjugated dienes and aldehydes.Nuclear extracts from 3T3-L1 cells pretreated with 6h-SO demonstrated the greatest reduction in PPARγ DNA binding. Compared to the unheated SO and mildly oxidized 3h-SO, cells treated with the 6h-SO had a significant reduction in SREBP-1c, PPARg, LPL, and GLUT4 expression occurring early in the differentiation process. Variations in the gene expression of 6hr-SO pretreated cells persisted within partially differentiated and mature adipocytes.

Conclusions: Pre-treatment of preadipocytes with soy oil heated for ³ 6h greatly decreases the activity of PPARγ in the nucleus and adipogenic gene expression . These changes seen in early differentiation seem to correlate the best with the phenotype of reduced triglyceride accumulation seen in mature adipocytes.

Methods: Secondary analysis was done on 256 healthy 6-14 year old (54% male) Caucasian and African American (70%) children from Pittsburgh, PA. Participants completed a food frequency questionnaire (FFQ) and a Sun Exposure Questionnaire (SEQ) and provided anthropometric measures at 2 time points 6 months apart. Vitamin D intake was compared by BMI status (normal = <85^th percentile, overweight = 85^th to 95^th percentile, obese = >95^th percentile) as well as by change in BMI over 6 months. Statistical analysis included descriptive statistics, Kruskal-Wallis analysis of variance, Spearman’s correlation, Chi Square test, and regression analysis (vitamin D intake, gender, race, baseline BMI, total energy intake, sun exposure and sunscreen use).

Results: Median reported vitamin D intake was 245.85 IU at baseline and 382.51 IU at 6 month follow up. After subdividing children by BMI, at baseline the obese group reported lowest median intake (188 IU) and at 6 month follow up the normal group reported lowest median intake (374 IU) (P=0.03). Overall relation between vitamin D intake and BMI was significant (P=0.033) but weak (r=-0.015). Regression analysis revealed only baseline BMI status (P=<0.001) as a predictor of 6 month follow up BMI. No relation was observed between change in BMI and vitamin D intake.

Conclusion: The results of this study do not support a strong relationship between vitamin D intake and change in BMI status over a 6 month time period.

Objective: This study determined micro- and macronutrient intake in HIV-infected youth, and investigated relationships among nutrient intake, demographics, lipid profiles, and HIV-related factors.

Design: HIV-infected subjects and healthy controls 1-25 years old were prospectively enrolled. Concomitant demographic, clinical and laboratory data were collected. Nutrient intake was assessed via 24-hr dietary recalls performed every 3 months for one year, analyzed with NDS-R software, and compared to Dietary Reference Intakes (DRIs) and Acceptable Macronutrient Distribution Ranges (AMDRs).

Results: Subjects with ≥2 food recalls were analyzed (175 HIV+; 43 controls). Groups were similar in age, race, sex, body mass index, and kilocalorie intake. Both groups did not meet DRI for several micronutrients. HIV+ subjects had lower %DRI than controls for vitamins A, E, pantothenic acid, magnesium, calcium, folate and potassium. Percent kilocalories from fat was above normal and higher in HIV+ patients. Caloric intake was negatively correlated with current and nadir CD4 counts. Zinc, riboflavin, and magnesium %DRI were positively associated with current CD4+ count. In HIV+ subjects not on antiretroviral therapy, HIV-1 RNA levels were negatively correlated with protein intake.

Conclusions: HIV+ youth have inadequate intake of several essential nutrients and poorer dietary intake compared to controls. Intake of some nutrients was associated with HIV-related factors. Further investigation is warranted to determine the impact of nutrition on HIV progression and chronic complication risk in this population.

Objective: The objective of this study was to evaluate the associations between serum vitamin D status (deficiency and insufficiency) and distinct demographic, dietary, and lifestyle characteristics of adults in the United States using a large, nationally representative sample survey, the National Health and Nutrition Examination Survey (NHANES) 2005-2006.

Methods: The study sample consisted of 2340 adults aged 20-59 who had serum 25(OH)D measured and who had completed various questionnaires concerning dietary intake of vitamin D and other lifestyle factors. Multivariate logistic regression was used to estimate the odds ratio (OR) of vitamin D deficiency, insufficiency, and sufficiency in adults based on distinct demographic, dietary, and lifestyle characteristics. Statistical significance was set at α < 0.05.

Results: The prevalence of vitamin D deficiency was higher in obese adults than in underweight to normal weight adults (50.9% ± 4.57 vs. 29.3% ± 3.57), higher in adults who reported no sunburns than in adults who reported ≥ 3 sunburns (49.9% ± 3.82 vs. 18.0% ± 3.07), and higher in adults who use sun protective measures regularly than in adults who do not (48.4% ± 3.93 vs. 27.0% ± 3.75). The prevalence of vitamin D deficiency increased as dietary intake of vitamin D decreased. Non-Hispanic black adults were significantly more likely to be vitamin D deficient (OR = 45.27, 95% CI = 17.27-118.64) and insufficient (OR = 9.37, 95% CI = 3.43-25.61) than non-Hispanic white adults. Significant positive associations were found between vitamin D deficiency and several characteristics, namely obesity (OR = 7.43, 95% CI = 4.33-12.77), physical inactivity (OR = 1.63, 95% CI = 1.03-2.58) poor dietary vitamin D intake (OR = 2.34, 95% CI = 1.44-3.81), non-supplement use or supplement use with a low amount of vitamin D (OR = 1.75, 95% CI = 1.05-2.89), and activities that decrease exposure to sunlight (from OR = 2.97, 95% CI = 2.14-4.13 to OR = 5.30, 95% CI = 3.17-8.85).

Conclusion: The results of this nationally representative study demonstrate that obesity, physical inactivity, poor dietary intake of vitamin D, and low sunlight exposure increases the risk for vitamin D deficiency in U.S adults. Future studies are needed to investigate whether vitamin D supplementation, sunlight exposure, and vitamin D-fortified foods are efficient in correcting vitamin D deficiency and insufficiency among these groups.

Purpose: To determine the effect of a supplemental nutrition education on the knowledge and behaviors of urban school students.

Methods: Six nutrition lessons were provided to students attending the Boys and Girls Club of Metro Atlanta (BGCMA) in Atlanta, GA. A pre- and posttest was administered to assess differences in students’ nutrition knowledge and behaviors. Chi-square analysis compared the number of correct answers for the entire intervention population and after stratification by gender and number of classes missed. The Wilcoxon signed rank test compared the median number of correct answers in pre- vs. posttest responses for all participants and by the number of classes missed.

Results: 15 students enrolled in the study. 2 students did not complete the study. A significant but negative change in knowledge was found in 1 of 15 nutrition questions. A significant negative change in the median number of total answers correct on the pre- vs. posttest was also observed (p=0.049). Approximately 60% of the participants reported that they were more likely to make positive, nutrition-related behavior changes after the intervention.

Conclusion: We found a negative association between the nutrition education intervention and knowledge gain. This study suggests that nutrition education alone does not have a significant effect on nutrition knowledge of urban youth.

Objective: To examine how a point-of-selection intervention at The Freshman Dining Hall at Georgia State University (GSU) impacts student menu selections.

Methods: All subjects used an electronic menu at the entrance of the GSU Freshman dining hall. During the baseline period, students selected the foods that they intended to eat during the meal. During the intervention phase, the menu view included calculated food health scores for each food/beverage item. Upon exiting the dining hall, students entered the foods that they actually consumed.

Participants/setting: The study recruited freshmen students and student athletes who have an unlimited meal plan at the Freshman Dining Hall. Students under the age of 18 were excluded.

Statistical analysis: Frequency analysis was conducted to describe the demographic and anthropometric characteristics of the population. Median entry scores were compared by demographic and anthropometric characteristics using the Independent Samples Median Test. Median health scores were determined at baseline and during the intervention phase for each meal. Median scores were compared using the Wilcoxon sign rank test to determine if there was a difference before and after the intervention. All statistical analyses were performed using SPSS v18.0. Statistical significance was set at P<0.05.

Results: A total of 26 students participated in the study (46.7% female, 26.7% Caucasian). The mean age was 19 + 2.5 years and the mean BMI was 24.2 + 4.8 kg/m². During the baseline period, the median health scores at breakfast, lunch, and dinner were 55.41 and 76.10 and 77.53, respectively. During the intervention phase, the median entry health score for breakfast and lunch were 68.33 and 73.88, compared to exit scores of 67.24 and 63.24, respectively. No exit menu items were entered for dinner during the intervention. The mean difference between the entry and exit health scores at breakfast was -1.1, while the difference at lunch was 4.54. Neither of the differences was statistically significant.

Conclusion: The digital menu with point-of-selection health scores did not result in consumption of healthier foods, particularly at lunch. Additional point-of-selection nutrition interventions should be examined to determine what type of information is most effective with college students in the all-you-can-eat buffet style college dining hall.

Objective: The aim of this study was to determine whether serum 25(OH)D concentrations were associated with any specific dietary patterns in US children and adolescents using assay-adjusted serum 25(OH)D data from National Health and Nutrition Examination Survey (NHANES) 2003-2004 and 2005-2006.

Methods: Data from 2 cycles of the NHANES 2003-2004 and 2005-2006 for individuals aged 2 to ≤19 y, were used to study the association between dietary patterns and serum 25(OH)D. Dietary patterns were established using factor analysis based on food-frequency questionnaire data. Eigenvalues and Scree plot were used to derive 2 major principal factors. They were labeled as High Fat Low Vegetable (HFLV) and Prudent dietary patterns.

Results: Serum 25(OH)D was significantly lower in HFLV dietary pattern group compared to Prudent dietary pattern group (25.1 vs 27.0 ng/mL; P=0.001). The highest serum 25(OH)D concentrations for all subjects were in the low-intake HFLV group or medium and high-intake Prudent groups (P=0.003 and P=0.012, respectively). In multivariate adjusted analysis, children with higher Prudent dietary contribution scores to overall diet showed a significant positive relation with serum 25(OH)D (β=62.01, P=0.016). When data were stratified by sex, a significant positive relation was observed in girls who consumed the Prudent diet (β=86.34, P=0.014) and a significant negative relation was observed in girls who consumed the HFLV diet (β=-84.32, P=0.022).

Conclusion: Overall, serum 25(OH)D concentrations were associated with Prudent dietary pattern but not with HFLV dietary pattern in US children and adolescents. When stratified by sex, the relation between dietary patterns and serum 25(OH)D was confined to only girls. Children consuming HFLV pattern diet may benefit from vitamin D supplementation and sunlight exposure (outdoor activities), and should be encouraged to consume more vitamin D fortified foods.

Objective: The purpose of this study was to determine the amounts of oxidation products of a variety of PUFA containing foods over time, and to determine whether extracted fats from these foods act as ligands for PPAR-gamma.

Method: To study the effect of room-temperature storage on oxidation, 5 foods (walnuts, sunflower seeds, ground flax, fish oil capsules, and infant formula) were purchased and stored at room temperature for 1, 2, and 3 months. To determine oxidation levels in fried foods, French fries and chicken nuggets were used. Fat was extracted from each food and the levels of oxidation products were analyzed by spectrophotometry and kits designed to measure oxidation products. Using a fluorescence polarization-based ligand screening assay kit, fat extracted from foods was analyzed for its binding affinity for PPAR-gamma.

Results: Among foods stored at room temperature, the levels of oxidation products did not change significantly with time. Most foods exhibited the highest levels of oxidation at the purchase date. Infant formula and ground flax demonstrated higher levels of oxidation products than did other foods. In preliminary ligand binding assays, extracted fat from French fries showed the greatest binding affinity for PPAR-gamma; a select few other oils showed slight affinity.

Discussion: Surprisingly, storage time did not affect oxidation levels. The greatest amount of oxidation may occur during pre-purchase storage conditions. The processing of formula and ground flax may be the cause of the relatively higher oxidation levels in those foods. The binding affinity for PPAR-gamma demonstrated by French fries needs further investigation.

Conclusion: Certain oxidized lipids from foods may act as ligands for PPAR-gamma. Further research is required not only to determine which component of these PUFA-containing foods activates PPAR-gamma but also to determine whether that component acts as an agonist or antagonist for PPAR-gamma.

A LESSON FROM THE URBAN GARDEN

Jamie Hamblin

Purpose: In 2008 the world’s urban population surpassed the rural population; furthermore, the United Nations estimates by 2025 the world’s urban population will increase by about one billion people. Given recent population shifts and the interconnectedness between food and health, this research examines the role of agriculture in addressing urban food insecurity by reviewing urban interventions with a goal of food production.

Methods: Using the Sustainable Livelihoods Framework, an adjusted theoretical framework was developed which accounted for negative implications of these interventions as well as sustainability. Ultimately, the framework generated a food security score respective of each project. Using this score, statistical tests were conducted to confirm characteristics of more effective projects.

Results: Statistical analysis indicates food security score has a strong correlation with physical, future and social capital (0.72, 0.73 and 0.80 respectively). Food security score has a moderate correlation with duration of project and a strong correlation with number of project components (0.60 and 0.83). Furthermore, mean food security score of projects which used participatory methods was statistically different than mean food security score of projects which did not use participatory methods (p=0.01).

Conclusions: Participatory methods prove an important aspect of an urban agricultural intervention. Statistical results affirm urban food insecurity should be addressed through an integrated strategy which considers long-term viability of the project. Food security score, developed for this research, can help identify valuable components of interventions; however, this system is fairly subjective with some limitations.