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Nutritional Strategies for Managing Iron Deficiency in Adolescents: Approaches to a Challenging but Common Problem

2024-09-09T07:50:03Z

Title: Nutritional Strategies for Managing Iron Deficiency in Adolescents: Approaches to a Challenging but Common Problem Authors: T Cohen, Clay; M Powers, Jacquelyn Abstract: Nutritional Strategies for Managing Iron Deficiency in Adolescents: Approaches to a Challenging but Common Problem Clay T Cohen, Jacquelyn M Powers * Division of Hematology/Oncology, Department of Pediatrics, Baylor College of Medicine and Texas Children’s Cancer and Hematology Center, Texas Children’s Hospital, Houston, TX, United States ABSTRACT Iron deficiency (ID) is a common and challenging problem in adolescence. In order to prevent, recognize, and treat ID in this age range, it is critical to understand the recommended daily intake of iron in relation to an adolescent’s activity, dietary habits, and basal iron losses. Adolescents following vegetarian or vegan diets exclusively rely on plant-based, nonheme iron, which has decreased bioavailability compared with heme iron and requires increased total iron intake. Individuals with disordered eating habits, excessive menstrual blood loss, and certain chronic health conditions (including inflammatory bowel disease and heart failure) are at high risk of ID and the development of symptomatic iron deficiency anemia (IDA). Adolescent athletes and those with sleep and movement disorders may also be more sensitive to changes in iron status. Iron deficiency is typically treated with oral iron supplementation. To maximize iron absorption, oral iron should be administered no more than once daily, ideally in the morning, while avoiding foods and drinks that inhibit iron absorption. Oral iron therapy should be provided for 3 mo in the setting of ID to reach a ferritin of 20 ng/mL before discontinuation. Intravenous iron is being increasingly used in this population and has demonstrated efficacy and safety in adolescents. It should be considered in those with persistent ID despite a course of oral iron, severe and/or symptomatic IDA, and chronic inflammatory conditions characterized by decreased gastrointestinal iron absorption. Keywords: Iron deficiency, adolescent medicine, iron, anemia

Diet, Food, and Nutritional Exposures and Inflammatory Bowel Disease or Progression of Disease: an Umbrella Review

2024-09-09T07:46:42Z

Title: Diet, Food, and Nutritional Exposures and Inflammatory Bowel Disease or Progression of Disease: an Umbrella Review Authors: Christensen, Camilla; Knudsen, Andrea; K Arnesen, Erik Abstract: Diet, Food, and Nutritional Exposures and Inflammatory Bowel Disease or Progression of Disease: an Umbrella Review Camilla Christensen 1,y , Andrea Knudsen 1,*,y , Erik K Arnesen 2 , Jan Gunnar Hatlebakk 3,4 , Ida Sofie Sletten 5 , Lars T Fadnes 1,6 1 Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway; 2 Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway; 3 Department of Clinical Medicine, University of Bergen, Bergen, Norway; 4 Norwegian Centre of Competence in Functional Gastrointestinal Disorders, Haukeland University Hospital, Bergen, Norway; 5 The Medical Library, University of Bergen, Bergen, Norway; 6 Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway ABSTRACT Inflammatory bowel disease (IBD), including Crohn’s disease (CD) and ulcerative colitis (UC), contributes to substantial morbidity. Un derstanding the intricate interplay between dietary factors and the incidence and progression of IBD is essential for developing effective preventative and therapeutic strategies. This umbrella review comprehensively synthesizes evidence from systematic reviews and meta analyses to evaluate these complex associations. Dietary factors associated with an increased incidence and/or progression of IBD include a high intake of red and processed meat, other processed foods, and refined sugars, together with a low intake of vegetables, fruits, and fiber. For most other food groups, the results are mixed or indicate no clear associations with IBD, CD, and UC. Some differences seem to exist between UC and CD and their risk factors, with increased intake of dietary fiber being inversely associated with CD incidence but not clearly associated with UC. Dietary fiber may contribute to maintaining the gut epithelial barrier and reduce inflammation, often through interactions with the gut microbiota. This seems to play an important role in inflammatory mechanisms in the gut and in IBD incidence and progression. Diets low in fermentable saccharides and polyols can alleviate symptom burden, but there are concerns regarding their impact on the gut microbiota and their nutritional adequacy. Mediterranean diets, vegetarian diets, and a diet low in grains, sugars, and lactose (specific carbohydrate diet) are also associated with lower incidence and/or progression of IBD. The associations of dietary patterns are mirrored by inflammatory biomarkers. IBD is typically treated pharmaceutically; however, many patients have a suboptimal response to medical treatments. The findings from this umbrella review could provide evidence for nutritional counseling and be a valuable addition to traditional treatment plans for IBD. This systematic review was registered at PROSPERO as CRD440252. Keywords: dietary patterns, food groups, inflammatory bowel disease, Crohn’s disease, ulcerative colitis

Infant Formulas With Partially or Extensively Hydrolyzed Milk Proteins for the Prevention of Allergic Diseases: A Systematic Review and Meta-Analysis of Clinical Trials

2024-09-09T07:40:53Z

Title: Infant Formulas With Partially or Extensively Hydrolyzed Milk Proteins for the Prevention of Allergic Diseases: A Systematic Review and Meta-Analysis of Clinical Trials Authors: Li, Xiaoxu; He, Tingchao; Sufang Duan Abstract: Infant Formulas With Partially or Extensively Hydrolyzed Milk Proteins for the Prevention of Allergic Diseases: A Systematic Review and Meta-Analysis of Clinical Trials Xiaoxu Li 1 , Tingchao He 2,3 , Sufang Duan 2,3 , Jinghong Liang 1 , Gang Feng 3,4 , Fang Li 2,3 , Zhenyu Shen 6 , Wenhui Ye 5 , Biao Liu 5 , Bibo Jiang 1 , Yujing Chen 1 , Nan Liu 1 , Ignatius Man-Yau Szeto 3,4,* , Li Cai 1,7,** 1 Department of Maternal and Child Health, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong Province, China; 2 Inner Mongolia Dairy Technology Research Institute, Hohhot, China; 3 Inner Mongolia Yili Industrial Group, Yili Maternal and Infant Nutrition Institute (YMINI), Beijing, China; 4 National Center of Technology Innovation for Dairy, Hohhot, China; 5 Inner Mongolia Yili Industrial Group, Hohhot, China; 6 The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong Province, China; 7 Guangdong Provincial Key Laboratory of Food, Nutrition and Health, School of Public Health, Sun Yat-sen University, Guangzhou, China ABSTRACT Despite the widely recommended usage of partially hydrolyzed formula (PHF) or extensively hydrolyzed formula (EHF) of milk protein for preventing allergic diseases (ADs), clinical studies have been inconclusive regarding their efficacy compared with that of cow's milk formula (CMF) or breast milk (BM). We aimed to systematically evaluate the effects of PHF or EHF compared with those of CMF or BM on risk of ADs (cow's milk allergy, allergic rhinitis, eczema, asthma, wheeze, food allergy, and sensitization) in children. We searched PubMed, Embase, Cochrane Library, and Web of Science for clinical trials published from inception to 21 October, 2022. We used the Grading of Recom mendations Assessment, Development, and Evaluation (GRADE) approach to grade the strength of evidence. Overall, 24 trials (10,950 infants) were included, 17 of which specifically included high-risk infants. GRADE was low for the evidence that, compared with CMF, infants early fed with EHF had lower risk of cow's milk allergy at age 0–2 y [relative risk (RR): 0.62; 95% CI: 0.39, 0.99]. Moderate evidence supported that PHF and EHF reduced risk of eczema in children aged younger or older than 2 y, respectively (RR: 0.71; 95% CI: 0.52, 0.96; and RR: 0.79; 95% CI: 0.67, 0.94, respectively). We also identified moderate systematic evidence indicating that PHF reduced risk of wheeze at age 0–2 y compared with CMF (RR: 0.50; 95% CI: 0.29, 0.85), but PHF and EHF increased the risk compared with BM (RR: 1.61; 95% CI: 1.11, 2.31; and RR: 1.64; 95% CI: 1.26, 2.14). Neither PHF nor EHF had significant effects on other ADs in children of any age. In conclusion, compared with CMF, PHF, or EHF had different preventive effect on cow's milk allergy, eczema, and wheeze. Compared with BM, both PHF and EHF may increase risk of wheeze but not other ADs. Given that most trials included only high-risk infants, more research on non–high risk infants is warranted before any generalization is attempted. This protocol was registered at PROSPERO as CRD42022320787. Keywords: allergy, prevention, partially hydrolyzed milk protein formula, extensively hydrolyzed milk protein formula, meta-analysis

Observational Dose-Response Meta-Analysis Methods May Bias Risk Estimates at Low Consumption Levels: The Case of Meat and Colorectal Cancer

2024-09-09T07:34:58Z

Title: Observational Dose-Response Meta-Analysis Methods May Bias Risk Estimates at Low Consumption Levels: The Case of Meat and Colorectal Cancer Authors: G Pouzou, Jane; J Zagmutt, Francisco Abstract: Observational Dose-Response Meta-Analysis Methods May Bias Risk Estimates at Low Consumption Levels: The Case of Meat and Colorectal Cancer Jane G Pouzou, Francisco J Zagmutt * EpiX Analytics, LLC. Fort Collins, CO, United States ABSTRACT Observational studies of foods and health are susceptible to bias, particularly from confounding between diet and other lifestyle factors. Common methods for deriving dose-response meta-analysis (DRMA) may contribute to biased or overly certain risk estimates. We used DRMA models to evaluate the empirical evidence for colorectal cancer (CRC) association with unprocessed red meat (RM) and processed meats (PM), and the consistency of this association for low and high consumers under different modeling assumptions. Using the Global Burden of Disease project’s systematic reviews as a start, we compiled a data set of studies of PM with 29 cohorts contributing 23,522,676 person-years and of 23 cohorts for RM totaling 17,259,839 person-years. We fitted DRMA models to lower consumers only [consumption < United States median of PM (21 g/d) or RM (56 g/d)] and compared them with DRMA models using all consumers. To investigate impacts of model selection, we compared classical DRMA models against an empirical model for both lower consumers only and for all consumers. Finally, we assessed if the type of reference consumer (nonconsumer or mixed consumer/nonconsumer) influenced a meta-analysis of the lowest consumption arm. We found no significant association with consumption of 50 g/d RM using an empirical fit with lower consumption (relative risk [RR] 0.93 (0.8–1.02) or all consumption levels (1.04 (0.99–1.10)), while classical models showed RRs as high as 1.09 (1.00–1.18) at 50g/day. PM consumption of 20 g/d was not associated with CRC (1.01 (0.87–1.18)) when using lower consumer data, regardless of model choice. Using all consumption data resulted in association with CRC at 20g/day of PM for the empirical models (1.07 (1.02–1.12)) and with as little as 1g/day for classical models. The empirical DRMA showed nonlinear, nonmonotonic relationships for PM and RM. Nonconsumer reference groups did not affect RM (P ¼ 0.056) or PM (P ¼ 0.937) association with CRC in lowest consumption arms. In conclusion, classical DRMA model assumptions and inclusion of higher consumption levels influence the association between CRC and low RM and PM consumption. Furthermore, a no-risk limit of 0 g/d consumption of RM and PM is inconsistent with the evidence. Keywords: model uncertainty, red and processed meat, carcinogenicity, confounding and bias in dose-response models, model assumptions in nutrition