Breastfeeding as an issue of significance in the world of public health and nutrition has gained considerable traction in recent months. With globally publicized opposition by the US to the World Health Assembly Resolution on Infant and Young Child Feeding (triggered by severe restrictions on milk products for older infants and young children) and reports of coercion to further corporate interests, the issue is of great pertinence in today’s times. It being World Breastfeeding Week, this blog will delve into the science of breastfeeding, a nutrition-focused behavior that has amassed a tremendous body of evidence in its favor when concerning infant and young child health [1].

The Lancet series published in 2016 describes both the micro and macro level benefits of breastfeeding for infants in countries of all economic strata. One paper [2] from the series estimates that approximately 823,000 annual deaths among children <5 years of age and 20,000 annual deaths of women from breast cancer can be avoided through the promotion of improved breastfeeding practices. Additionally, breastfeeding has long lasting impacts on morbidity and improves the cognitive capacity and educational potential of children, with economic benefits including higher wages in adulthood [2]. Greater benefits are achieved with longer durations of breastfeeding, and this behavior has impact on morbidity with evidence showing protective benefits against diarrhea, respiratory infections, and asthma [3].

Additionally, a growing body of evidence shows overwhelming support for breastfeeding as protective behavior against long-term health outcomes related to non-communicable diseases including obesity [3]. An analysis of 113 studies shows that longer durations of breastfeeding are associated with a 26% reduction (95% CI: 22-30) in the odds of obesity across income groups. Another pooled analysis of 11 studies showed a 35% reduction (95% CI: 14-51) in the incidence of type 2 diabetes [3]. Prior work has shown that breastfeeding confers protection against obesity later in life, with lower prevalence rates after adjusting for confounders such as socioeconomic status, birthweight and sex [4].

Recent papers published in the American Journal of Clinical Nutrition highlight the nuanced impact of breastfeeding on child growth trajectories. A study by Kramer et al. (2018) showed, using various different statistical analyses, a causal effect of randomization to a breastfeeding promotion intervention on growth during the first 2-3 months of life [5]. Additionally, these authors noted that children in a breastfeeding intervention group and those who were breastfed for ≥12 months experienced faster growth when compared to those in the control group or those breastfed for <12 months, particularly during the first 2-3 months. The differences in growth velocity between groups was lower in subsequent months and almost equalized by 12 months of age.

A study by Eny et al. conducted in Canada found that maternal BMI was positively correlated to infant BMI [6]. These authors note that maternal BMI has been shown to modify BMI growth rates among children beginning at birth up to 12 years of age [7]. These authors note that the trajectories for growth differed by breastfeeding duration, maternal BMI and birth weight from 1-3 months of age.

Results from these studies and others highlight the need for more prospective research to assess how, when and whether breastfeeding practices influence infant weight gain, and what factors within breastmilk impact lean and fat mass growth [8]. Overall, the case for early initiation, exclusivity of breastfeeding for the first 6 months and continued breastfeeding up to 2 years remain strong and programs, policies and incentives to encourage and promote adequate breastfeeding behaviors remain the need of the hour. So this World Breastfeeding Week, may mothers’ across the world be motivated, encouraged and supported to continue gifting their young one of the most valuable gifts nature has accorded us!

References:
[1] Jacobs, A. (2018). Opposition to breast-feeding resolution by the US stuns world health officials. Retrieved from: https://www.nytimes.com/2018/07/08/health/world-health-breastfeeding-ecuador-trump.html
[2] Rollins, N.C., Bhandari, N., Hajeebhoy, N., Horton, S., Lutter, C.K., Martines, J.C., Piwoz, E.G., Richter, L.M., Victora, C.G. (2016). Why invest, and what it will take to improve breastfeeding practices? Lancet, 387, 491-504.
[3] Victora, C.G., Bahl, R., Barros, A.J., Franca, G.V.A., Horton, S., Krasevec, J., Murch, S., Sankar, M.J., Walker, N., Rollins, N.C. (2016). Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect. Lancet, 287, 475-490.
[4] Armstrong, J., Reilly, J.J., & Child Health Information Team. (2002). Breastfeeding and lowering the risk of childhood obesity. Lancet, 359 (9322), 2003-2004.
[5] Kramer, M.S., Davies, N., Oken, E., Martin, R.M., Dahhou, M., Zhang, X., & Yang, S. (2018). Infant feeding and growth: putting the horse before the cart. American Journal of Clinical Nutrition, 107, 635-639.
[6] Eny, K.M., Anderson, L.N., Chen, Y., Lebovic, G., Pullenayegum, E., Parkin, P.C., Maguire, J.L., Birken, C.S. (2018). Breastfeeding duration, maternal body mass index, and birth weight are associated with differences in body mass index growth trajectories in early childhood. American Journal of Clinical Nutrition, 107, 584-592.
[7] Bornhorst, C., Siani, A., Russo, P., Kourides, Y., Sion, I., Molnar, D., Moreno, L.A., Rodrigues, G., Ben-Shlomo, Y., Howe, L., et al. (2016). Early life factors and inter-country heterogeneity in BMI growth trajectories of European children: the IDEFICS study. PLoS One, 2016:11:e0149268.
[8] Hay, W.W. Jr. (2018). Breastfeeding newborns and infants: some new food for thought about an old practice. American Journal of Clinical Nutrition, 107, 499-500.

Breastfeeding: Foundation of Life

World Breastfeeding Week is celebrated every year from August 1 – 7 across the globe to encourage breastfeeding and promote healthy practices from the earliest stages of life. This campaign is led by the World Alliance for Breastfeeding Action (WABA), a global network of organizations and individuals who work to promote and support breastfeeding practices worldwide. The 2018 slogan is “Breastfeeding: Foundation for Life”.

“In a world filled with inequality, crises and poverty, breastfeeding is the foundation of lifelong good health for babies and mothers.”

Latest Research on Breastfeeding

ASN’s four nutrition science journals often publish new research on breastfeeding, and there were many sessions on the topic at ASN’s annual meeting, Nutrition 2018. ASN also ensures the representation and support of breastfeeding research within our membership and scientific programs through a dedicated research interest section, Maternal, Perinatal, and Pediatric Nutrition. Members who belong to this group focus on the biology of nutrition as it impacts human development, and the role of nutrition on both short-and long-term outcomes in the mother, fetus, infant, and child.

New Research on Breastfeeding from American Journal of Clinical Nutrition

Breastfeeding newborns and infants: some new food for thought about an old practice

“Feeding newborns and infants is hardly a new topic, but these 2 articles provide some important new food for thought, and hopefully might stimulate appetite for studying how breastfeeding and human milk confer unique advantages on infant growth and development, as well as prevention of later life diseases such as obesity, which are programmed early in life.”

Breastfeeding duration, maternal body mass index, and birth weight are associated with differences in body mass index growth trajectories in early childhood

Infant feeding and growth: putting the horse before the cart

Current Knowledge on Micronutrients in Human Milk: Adequacy, Analysis, and Need for Research

This free supplement was published with the May 2018 issue of Advances in Nutrition. Articles included are:

Introduction to Current Knowledge on Micronutrients in Human Milk: Adequacy, Analysis, and Need for Research

Overview of Nutrients in Human Milk

Limitations of the Evidence Base Used to Set Recommended Nutrient Intakes for Infants and Lactating Women

Micronutrients in Human Milk: Analytical Methods

Retinol-to-Fat Ratio and Retinol Concentration in Human Milk Show Similar Time Trends and Associations with Maternal Factors at the Population Level: A Systematic Review and Meta-Analysis

Iodine in Human Milk: A Systematic Review

Vitamin B-12 in Human Milk: A Systematic Review

Breastfeeding and the Microbiome

ASN Fellow Dr. David Heber recently published a video Microbiome #3: Getting it Started. This is what he says:

“The Microbiome is established in the gut during breast feeding. While some bacteria enter the body during delivery and from the mother’s skin, the majority are formed from a special group of complex carbohydrates called Human Milk Oligosaccharides (HMO’s). There are about 150 HMO’s and they feed a single bacterial species called Bacteroides Infantilis which has a series of pumps on its surface bringing these sugars called oligosaccharides inside the cell to be digested. This bacteria is called an “inside” eater and does not share the HMO’s with other bacteria so it becomes the dominant bacteria in the gut Microbiome setting up the baby’s immune system. The breast milk has protein, fat, and lactose (the same sugar in cow’s milk) but is unique in having the 150 HMO’s. This is another reason why it is so important for women to breast feed their babies. Breastfeeding also removes 500 Calories per day from the Mom’s body helping with reducing pregnancy weight gain. During breast feeding women need to get extra protein, Calcium, vitamin D and B vitamins to replace what is being put out in breast milk!!”

Video shared with Dr. David Heber’s permission.

Calcium is traditionally considered the bone-health nutrient. This is because 99% of calcium is contained within the bone, in which calcium creates a mineral complex with phosphate (hydroxyapatite), giving bone its characteristic strength and function. However, besides forming part of bone, calcium is also involved in other functions, such as muscle function, nerve transmission, intracellular signaling, and others.

Bone is a very dynamic organ in which the rate of formation and resorption (or destruction) is different throughout the lifespan. During childhood and adolescence, the rate of formation is higher than the rate of resorption, leading to maximum bone gain. In older adults these rates are switched, causing loss of bone. This bone loss may lead to osteopenia, osteoporosis, and an increased risk of bone fractures.

Is an increased intake of calcium associated with reduced risk of fractures?

As a way to prevent bone loss and fractures in middle-aged and older adults, there is usually a push from public health initiatives and healthcare professionals to increase the intake of calcium. However, an increased intake of calcium (dietary + supplements) may not necessarily lead to fewer fractures. Two of the most recent systematic reviews and meta-analyses showed that increasing dietary calcium and the supplementation of calcium (and vitamin D) did not reduce the risk of fractures. However, this remains controversial as a previous meta-analysis showed that the supplementation of calcium and vitamin D was associated with a 15% risk reduction in middle-aged and older adults (community-dwelling and institutionalized).

 The use of calcium supplements may lead to a higher risk of cardiovascular disease

The hypothesis is that an increased intake of calcium may lead to a positive calcium balance (intake lower than output in urine + feces), in the absence of increased bone formation. This positive calcium balance may lead to the calcification of tissues other than the bone, such as the vasculature, increasing the risk of cardiovascular disease. However, this association remains controversial. A sub-analysis of the Multi‐Ethnic Study of Atherosclerosis (MESA), showed that those that had higher dietary calcium intake (without supplements) had a lower risk of coronary artery calcification, while those that were taking supplements had a higher risk. However, the National Osteoporosis Foundation and the American Society for Preventive Cardiology suggested that calcium intake (diet + supplements) that does not exceed the tolerable upper level of intake of 2000 to 2500mg/d is not associated with cardiovascular outcomes, and should be considered safe.

Special caution of high intake of calcium in subjects with reduced kidney function

A high intake of calcium, particularly those that use calcium supplements, may represent a problem for those with reduced kidney function, as they may not be able to excrete the extra calcium. In a study by Hill and collaborators, a calcium intake of 2500mg (1000 mg through diet + 1500mg from calcium carbonate), compared with a dietary calcium intake of 1000mg, led to 500mg of calcium retention in patients with reduced kidney function. Similarly, Spiegel and collaborators compared a diet with 800mg vs. 2000mg of calcium in subjects with normal and reduced kidney function. In those on the 2000mg calcium diet, there was a positive calcium balance, which was more marked in those with reduced kidney function. With these results, a calcium intake higher than 800-1000mg (diet + supplements) should be avoided in those patients with a reduced kidney function to prevent calcifications of tissues other than the bone.

Should health care professionals recommend a high intake of calcium?

The current evidence, in middle-aged and older adults, does not seem to support high calcium intakes (above the tolerable upper level) for the prevention of fractures. Additionally, high calcium intakes achieved with the use of supplements may be associated with increased risk of cardiovascular disease. However, the use of supplements may be useful for patients that have low calcium intake. Finally, special attention should be taken in patients with reduced kidney function, as a high intake (diet + supplements) may lead to an increased risk of cardiovascular disease.

 

What do I eat? That is a question most people ask themselves at least once a day. Imagine getting a prescription from your physician and vetted by a nutritionist to cook certain foods at home. The prescription is tailored to your personal needs, and your care team has received training as health coaches to help you successfully implement this new plan. This is culinary medicine.

Read more

Which consumer are you?

The astute academic or health professional: You have a degree (one or more) in nutrition, you have PubMed bookmarked on your internet browser, and you spend your days dispelling nutrition myths and/or researching the next nutrition breakthrough.

The health foodie. You scour wholesome recipes online, you already know the nutrition trends for 2019, you make detailed grocery lists like it’s your job, you’re a #mealprepsunday veteran, and always know where to find the best deals for natural/organic/raw/fresh eats.

The bachelor/broke student: Is it cheap? Edible? Delicious? Easy to prepare? If yes, it goes in the cart.

The athlete with phenomenal sport skills, and (developing) culinary know-how: You know that the foods you eat influence your athletic performance. You are game for eating better, under one condition: you need quick/easy foods that pack a nutritional punch.

The busy parent: There are lunches to make, picky eaters to feed, and you can’t remember the last time you enjoyed a calm, healthy mealtime at home. Grocery shopping is typically a stressful battle between your healthy intentions, and the little ones’ demands for sugary cereals and flashy marketing.

Photo Credit: Lifehacker

Whether you identify with one or multiple distinct categories listed here, each one is unified by a few common underlying themes:

We all eat.

We crave amazing flavors.

There are never enough hours in the day.

We really do have good intentions; We want to eat well.

Assuming we don’t grow/hunt/gather our own food, we cross paths with one another for a common purpose: Food Shopping! On that note, we’ve been exposed to the same rules of thumb for healthy grocery shopping:

-Shop the perimeter!

-Steer clear of the middle aisles!

The way I see it, there are two types of people in this world: Those who love the center aisles (but could use a little strategy for picking the best options), and those who openly shun those aisles (but are secretly curious to explore the forbidden foods within).

As a health professional, it’s my duty to pass along this tried-and-true advice. But as a real-life RD on a budget, I hear you: Those middle aisles are mighty tempting, so what’s a guy/girl to do?

Take a deep breath, direct that grocery cart towards those center aisles, keep your eye on the prize and walk with intention because you have a fool-proof plan. Healthy shoppers, unite! Today, you’ll conquer those middle aisles like the savvy consumer you are.

Photo Credit: The Sports Nutrition Coach

Your strategy: Divide and conquer by food group like so:

Whole grains, legumes, and pseudograins: Instant oatmeal, frozen brown rice or quinoa (that’s a pseudograin), ready-to-serve plain cooked rice, Grape Nuts (for impressive iron and fiber content), popcorn, Vaccuum packed pre-cooked lentils (that’s a legume), whole grain bread (can you find bread with 0-1g sugar per serving? Can you find fiber above 2g per serving?)

Fruits and vegetables: Frozen is your friend! These items are picked at peak ripeness and flash-frozen immediately afterwards. Canned items are fine as well (in light syrup or water). Can you get all colors of the rainbow?

Protein: Canned beans, canned tuna, canned chicken, canned salmon, frozen chicken strips (no breading), hummus

Dairy: single serve plain Greek yogurt (Ok, you’ll find this in the perishables, but this is too versatile not to include), string cheese

Fats: Olives, frozen Cool Whip, prepared guacamole

Snacks: Dark chocolate (Pro-tip: Pick one with single-digit grams sugar per serving), nuts (try pistachios, almonds, or walnuts), dried fruit, jerky, whole grain chips, hummus

Drinks: Chocolate milk

Spreads/flavorings: Sriracha, olive oil, balsamic vinegar, mustard, pesto

Photo credit: Smile Sandwich

 Once you return home from this über successful grocery trip, you’ll want to assemble some stellar meals using your new bounty. Try this one-day sample plan:

Breakfast: Yogurt cup topped with frozen fruit, Grape Nuts, nut butter (purchase single serve packets in a pinch!) Feeling extra hungry? Prepare a side of instant oatmeal

Lunch: Tuna sandwich (canned tuna mixed w/ mustard, Ezekiel bread). Side of green salad (found in deli section)

Snack: Handful of nuts, handful chips, and hummus

Post Workout: Classic PB&J, or chocolate milk

Dinner: Defrost that frozen rice, quinoa, or lentils, frozen veggies of choice, top w/ beans (and/or thawed ready-to-eat chicken), salsa, pre-made guacamole, and Sriracha

Dessert: 2-3 squares of dark chocolate, alongside frozen blueberries w/ a dollop of cream

Not everyone has a nutrition coach by their side, but you, ASN reader, have an edge. Use this guide to confidently navigate the previously forbidden center aisles. Print it, internalize it, share it. No nonsense, no gimmicks. Blasphemy? Hardly. Creative and backed in science? Absolutely.

The popularity of the essential polyunsaturated omega-3 fatty acids (O3FA) is on the rise. In 2017, O3FA achieved a spot on the top 20 foods and ingredients list that Americans are adding to their diets (The Hartman Group). In addition, the global fish oil market is expected to reach a whopping 4.08 billion dollars in the next four years!  The proposed health benefits are likely the driving force behind the increasing demand.

Despite their booming popularity, a large percentage of adults are not meeting the O3FA recommended intake. There are three primary O3FAs with distinct characteristics: alpha-linolenic acid (ALA), eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). Although commonly grouped under the umbrella term O3FAs, are all O3FAs created equal?

Unique Characteristics of O3FAs

Omega-3 fatty acids cannot be sufficiently produced in the body earning them the title of “essential fatty acids.” The plant-derived omega-3, ALA, is the parent precursor to EPA and DHA. Unfortunately, the conversion rate in our bodies is very low.  It is important to realize that in the process of metabolizing ALA to EPA and DHA, a series of anti-inflammatory markers are produced (leukotrienes, prostaglandins and thromboxane). As these anti-inflammatory metabolites are beneficial, direct EPA and DHA consumption is needed to meet bodily requirements.

Independent and Complementary Health Benefits

The majority of current research focuses on the health benefits of marine fatty acids.  DHA and EPA consumption portray an array of shared and complementary benefits related to the treatment of cardiovascular disease, depression diabetes, sleep disorders and more. DHA is more significantly associated with decreases in resting heart rate, blood pressure and with improvements in cellular membrane health due to its additional double bond and longer carbon chain. Increased cellular levels of EPA have been shown to benefit coronary heart disease, hypertension and to decrease inflammation. EPA and DHA are both associated with reduced gene expression related to fatty acid metabolism, reduced inflammation and oxidative stress.

Specific supplementation of ALA is not consistently associated with cardiovascular health. Although plant-derived ALA can be easily substituted in for excess omega-6 fatty acids (O6FAs). Research has shown that by reducing the O3FA:O6FA ratio, you can decrease bodily inflammation, increase anti-inflammatory markers and more efficiently utilize EPA and DHA.

An ALA, EPA and DHA-Rich Diet

The 2015-2020 Dietary Guidelines for Americans recommends that healthy adults consume at least 8 ounces of a variety of non-fried fatty seafood per week. For EPA and DHA requirements, the American Heart Association recommends fatty marine sources containing 500 mg or more of EPA and DHA per 3oz cooked serving (e.g., salmon and tuna).   ALA is the most commonly consumed O3FA in the Western diet as it is found in plant-based foods (e.g., dark green leafy vegetables, walnuts, canola oil, flax seed). Unlike EPA and DHA, an Adequate Intake (AI) level is established at 1.6 g/day and 1.1 g/day for men and women respectively.

The Final Verdict 

The wide range of benefits stemming from marine O3FAs indicates the importance of regular consumption of fatty seafood and EPA and DHA-containing products.  The incorporation of plant-derived ALA may serve more importantly as a substitute for omega-6 fatty acids to reduce bodily inflammation, decrease the high O3FA:O6FA ratio typically observed in the Western diet, and to help elevate EPA and DHA levels in the body. EPA and DHA may be featured as the health promoting “dynamic duo,” but ALA is still invited to the party!

 

References

1.         Yanni Papanikolaou JB, Carroll Reider and Victor L Fulgoni. U.S. adults are not meeting recommended levels for fish and omega-3 fatty acid intake: results of an analysis using observational data from NHANES 2003–2008. Nutrition Journal 2014.

2.         Harris WS, Mozaffarian D, Lefevre M, Toner CD, Colombo J, Cunnane SC, Holden JM, Klurfeld DM, Morris MC, Whelan J. Towards establishing dietary reference intakes for eicosapentaenoic and docosahexaenoic acids. J Nutr 2009;139(4):804S-19S. doi: 10.3945/jn.108.101329.

3.         Frits A. J. Muskiet MRF, Anne Schaafsma, E. Rudy Boersma and Michael A. Crawford. Is Docosahexaenoic Acid (DHA) Essential? Lessons from DHA Status Regulation, Our Ancient Diet, Epidemiology and Randomized Controlled Trials. Journal of nutrition 2004;134.

4.         Mozaffarian D, Wu JH. (n-3) fatty acids and cardiovascular health: are effects of EPA and DHA shared or complementary? J Nutr 2012;142(3):614S-25S. doi: 10.3945/jn.111.149633.

5.         Bork CS, Veno SK, Lundbye-Christensen S, Jakobsen MU, Tjonneland A, Schmidt EB, Overvad K. Dietary Intake of Alpha-Linolenic Acid Is Not Appreciably Associated with the Risk of Ischemic Stroke among Middle-Aged Danish Men and Women. J Nutr 2018. doi: 10.1093/jn/nxy056.

6.         Evangeline Mantzioris MJJ, Robert A Gibson and Leslie G Cleland Differences exist in the relationships between dietary linoleic and alpha-linolenic acids and their respective long-chain metabolites. Am J Clin Nutr 1995;61:320-4.

7.         Agriculture. USDoHaHSaUSDo. 2015 – 2020 Dietary Guidelines for Americans. 8th Edition. December 2015.

With more than 20 featured sessions, 2,000 presentations of new, original research, 5 award lectures, numerous workshops and non-stop networking opportunities, we think it’s safe to say that there is something for everyone at Nutrition 2018.

Be sure to check out the Nutrition 2018 Schedule Planner before you go.  This interactive, online platform will help you navigate all of Nutrition 2018’s offerings.  Click here for tips on planning your conference experience to get the most out of Nutrition 2018.

Here’s a preview of just a few of the offerings you will find in Boston:

Scientific and Statistical Principles, A Workshop based on the Best (but Oft-Forgotten) Practices Article Series in the American Journal of Clinical Nutrition
Saturday, 1:00 – 3:00 PM

The American Journal of Clinical Nutrition has published a series of articles to help reinforce important scientific and statistical principles that should be useful for researchers in general and for those in nutrition in particular. The conduct and analysis of scientific endeavors are constantly changing, and much like there is continuing medical education, the AJCN editors intend for this series to serve in a way as “continuing scientific education.”  Join Associate Editor David Allison, PhD and Editor-in-Chief Dennis Bier, MD for a refresher course on topics related to statistical design and analysis.

Nutrition and Natural Disasters, a featured presentation in the Japan Society of Nutrition and Food Science Forum
Saturday, 1:30 – 3:00 PM

From major earthquakes to tsunamis, Japan has endured its share of catastrophic natural disasters.  Nobuyo Kasaoka, PhD, RD, will discuss how Japan addresses nutrition challenges following natural disasters.

Ensuring Trust in Nutrition Science
Saturday, 1:30 – 3:00 PM  AND Monday, 1:00 PM  (ASN Live! in The Hub)

ASN commissioned a Blue Ribbon Panel on “Ensuring Trust in Nutrition Science” to develop best practices regarding how to work collaboratively with various stakeholders across sectors and disciplines while maintaining transparency and scientific rigor in nutrition science to uphold the trust of all stakeholders.  Join panel member, Patrick Stover, PhD, to learn more about the recommendations coming out of this effort.

Is a Calorie a Calorie:  Reframing the Question
Sunday, 8:00 – 10:00 AM

Does obesity result from consuming more calories than you burn or might the body’s hormonal and metabolic regulation systems also play a role?  What are the right research questions we should be asking to advance our understanding of this topic? Esteemed researchers share their views and advance the discussion on this long-debated topic.

NIH CSR Grant Review
Sunday, 12:15 – 12:45 PM at Science Stage in The Hub

Interested in learning more and becoming involved with the NIH grant review process?  Join Fungai Chanetsa, PhD, MPH, Scientific Review Officer for NIH’s Center for Scientific Review for an interactive discussion. Dr. Chanestsa will also highlight the Early Stage Career Reviewer Program.

 How Can Dietary Assessment be Improved?  Budding Entrepreneurs Propose New Ideas in Sight and Life’s Elevator Pitch Contest
Sunday, 3:00 – 5:00 PM

Seven finalists from around the world will pitch their ideas for new technologies and methods to improve the measurement of dietary intake. Paired with mentors from the Harvard School of Business, these young professionals aim to impress an esteemed panel of judges for a cash prize. Sit back and enjoy Nutrition 2018’s version of Shark Tank.

Altmetrics:  Real Time Measurement of Your Scholarly Impact
Sunday, 3:00 – 4:00 PM and Monday, 10:30 – 11:30 AM

Online tools allow researchers to broaden the impact of their published work in an ever increasing way.  What are alternative metrics, when should you use them and why should you care?  Join us for this workshop to learn about the major trends in the development of new metrics to measure the impact of your publications.

Recent Advances in Nutritional Modulation of the Immune System
Monday, 8:00 – 10:00 AM

Recent years have brought a new understanding of the role of the immune system in health and disease.  In this session, researchers will present intriguing new findings suggesting how foods, nutrients and conditions such as obesity interact with the immune system and inflammation.

New Technologies in the Food System:  How Do they Fit and Who Decides?  (Food Evolution Movie Screening and Discussion)
Monday, 10:30 AM – 12:30 PM

What are the decision-making processes that bring changes to the food system? What is the role of government, consumers, producers and scientists in these discussions? How do new technologies such as GMOs fit into the hierarchy of needs for the food system?  Join us for a viewing of the Food Evolution movie followed by a panel discussion moderated by The Washington Post’s Tamar Haspel.

Nutrition and Health in an Accelerating Pace of Life
Tuesday, 8:00 – 10:00 AM

There is no single metric to quantify the pace of life, but many indices indicate that it is fast and accelerating nationally and globally.  Since World War II, there has been an increasing demand for a food supply that is not only safe, palatable, and affordable, but also convenient. This has been driven to a large extent by substantive shifts in where people live, the types of jobs they have, the increasing hours worked, dual-income families, food preparation methods and other behaviors. This has all driven the desire for, indeed the necessity of, options that emphasize convenience. The consequence of this for food availability and choice, nutrient composition and health are still largely unknown, but widely speculated upon.  Consumer expectations and claims by some clinicians and policy makers have far outpaced the science leading to confusion and increased risk of poor food choices.  The magnitude and duration of this shift in ingestive behaviors elevates it beyond a “fad” to a reality that must be better understood. This session will explore the historic, current and future consequences of changing lifestyles on diet quality and health.

Tasting Outside the Oral Cavity
Monday, 10:30 AM – 12:30 PM

Recent evidence documents the presence of taste receptors throughout the GI tract as well as in many other peripheral sites. The nature of these receptors and the ligands they bind are often the same as those in the oral cavity. These discoveries raise new questions with important health implications. To what extent is there a continuity of sensory and nutrient information flowing from the oral cavity through the extent of the GI tract and what are the implications of activating or disrupting this information flow?  Are compounds once thought to be biologically inert in the GI tract actually modulating processes such as digestion, appetite and nutrient absorption? This session will review the evidence for extra oral “taste” sensing and its potential health implications.  Evidence from cell culture, animal models and human trials will be presented.

Prevention of Food Allergies & Atopic Disease: The Atopic March – Can it Be Halted?
Tuesday, 10:30 AM – 12:30 PM

Food allergy occurs in up to 12% of American children and adults, and as many as 5% of infants have eczema. Rates of food allergy have been steadily increasing over the past 2 decades.  Past infant feeding guidelines have emphasized breastfeeding, delaying the introduction of complementary foods, and extended delay in exposure of the most allergenic foods such as peanuts, eggs, fish, soy and wheat.  On the basis of randomized controlled trials, these guidelines have recently been revised to recommend early exposure to allergens. Controversy remains regarding potential protective effects of hydrolyzed formulas (are they as hypoallergenic as breast milk?); optimal timing of introduction, especially in relation to recommendations for exclusive breastfeeding for 6 months; and potential benefit of breastfeeding at time of introduction of peanut, gluten, egg.  Also, who should be targeted for these recommendations?   Those deemed high risk or the general population?

To attend these sessions, please click here to register for Nutrition 2018!

 

By: Nafisa M. Jadavji, PhD

 

A stroke occurs when there is reduced blood flow to the brain. Blood carries oxygen and glucose to cells in the brain. When there are reduced levels of blood, these cells start to die. Since the brain controls behavior, this cell death leads to impairments in function. The impairments are dependent on where the stroke happens in the brain. There are two main types of stroke: hemorrhagic and ischemic. For this blog, I will be focusing on ischemic stroke which is a result of blockage in a blood vessel. Currently, stroke typically affects older individuals and the global population is aging according to the United Nations. Additionally, older individuals also lose their ability to absorb all the vitamins and nutrients they require from their diet as they age.

Nutrition is a modifiable risk factor for diseases of aging. For example, B-vitamin absorption decreases as individuals age. B-vitamins play a major role in reducing levels of homocysteine, a non-protein amino acid. High levels of homocysteine have been associated with increased risk to develop cardiovascular diseases, such as stroke. Supplementation with B-vitamins has been reported to have positive effects on brain health.

A study by researchers in Oxford University and University of Oslo has shown that B-vitamin supplementation in the elderly within the United Kingdom reduced age-related brain atrophy after 2 years of supplementation. Furthermore, another study by the same group reported that B-vitamin supplementation reduced cerebral atrophy in areas vulnerable to Alzheimer’s disease.

More recently, a group from China reported that folic acid supplementation in combination with Enalapril, used to treat heart disease, reduced the risk of stroke by 21% in patients that were hypertensive.

Within the aging population, B-vitamin supplementation has been reported to have positive effects on brain health. The elderly are more prone to ischemic stroke, but the mechanisms through which this benefit is accomplished are not well understood.

A recent study investigating the role of B-vitamin supplementation on ischemic stroke was published in the Neurobiology of Disease. This study tried to examine the mechanisms of how supplementation improved brain function. A group of wildtype males were put on a folic acid deficient diet (0.2 mg/kg) prior to ischemic damage to increase levels of homocysteine and another group of mice were put on a control diet (2mg/kg folic acid). After ischemic damage to the sensorimotor cortex, FADD mice were put on a supplemented diet, where levels of folic acid, riboflavin, vitamin B12, and choline were increased. Animals were maintained on the diets for 4-weeks after which motor function was assessed.  Researchers found that supplemented diet mice performed better on motor tasks compared to CD mice with ischemic damage. In the brain tissue, increased levels of plasticity and antioxidant activity were reported.

Combination therapies for stroke-affected patients are thought to be most effective. A pharmaceutical in combination with a lifestyle change, such as increased exercise may be beneficial for stroke-affected patients. This data suggests that nutrition may also be a viable option to prevent or attenuate ischemic damage.

 

 

The renal diet is commonly recommended for those with late stages of chronic kidney disease and end-stage kidney disease. The renal diet is characterized by the reduction of dietary sodium, potassium, and phosphorus. The rationale behind these restrictions is to prevent the buildup of these micronutrients in the blood and to reduce complications, such as hypertension, fluid overload, arrhythmias, bone disorders, and vascular calcifications. However, this diet is considered restrictive, hard to prescribe and follow.

A consequence of the renal diet is the reduction in the consumption of some food groups, such as fruits, vegetables, whole grains, legumes, and nuts. These food groups, besides being good sources of the aforementioned nutrients, are also good sources of vitamins, other minerals, polyphenols, and dietary fiber. Indeed, when researchers have looked into the nutrient intake of patients with late stages of chronic kidney disease and end-stage kidney disease undergoing renal replacement therapy (i.e., hemodialysis), patient consumption of some vitamins and dietary fiber is below the recommendations.

Moreover, when dietary patterns have been explored, a predominance of a Western-type dietary pattern with a high consumption of red meat, salt, and refined sugars, and a lower consumption of fruits, vegetables, legumes, whole grains, and nuts has been reported. A Western-type diet may seem counterintuitive as patients with chronic kidney disease have a higher prevalence of cardiovascular disease and mortality than the general population, as well as other comorbidities, such as obesity and diabetes.

The renal diet is restrictive and hard to follow 

But why are patients with chronic kidney disease and end-stage kidney disease consuming a Western-type diet? If you are a registered dietitian, you know that the renal diet is one of the hardest to prescribe. Additionally, often times a patient with kidney disease has other comorbidities, such as diabetes and hypertension, which adds a layer of difficulty to the medical nutrition therapy. Some dietitians provide a list of foods that are high in potassium, phosphorus, and sodium. If you look into the lists of foods, you quickly realize that your options are reduced. Also, some of the cooking methods to reduce these nutrients may require extra time and resources, which could be a barrier for patients and a burden for their care givers. This may lead patients to disregard the recommendations altogether and may be reflected in the nutrient intake and dietary patterns reported. 

The traditional approach to the renal diet is evolving 

The traditional approach to the renal diet is beginning to change. Recently, the European Renal Association-European Dialysis and Transplantation Association recommended the Mediterranean diet as the dietary pattern of choice for chronic kidney disease patients. Additionally, modified and “liberalized” dietary recommendations based on easy-to-follow guidelines have been proposed for hemodialysis patients. However, there may be some healthcare and nutrition professionals who may disagree with these recommendations. One reason is that potassium intake may be increased and a risk of high concentrations of potassium in blood, or hyperkalemia, may outweigh the benefits of the diet overall. However, the association of dietary potassium and serum potassium in end-stage kidney disease patients undergoing hemodialysis treatment is very weak. Moreover, with these dietary patterns most of the phosphorus comes from plant-based foods, as the consumption of animal-based products is limited, which confers a benefit as the bioavailability of phosphorus is lower than the animal sources and the consumption of ultra-processed foods is also limited.

The Mediterranean and DASH-style diet have been associated with reduced cardiovascular and all-cause mortality in the general population. In kidney disease, a dietary pattern that resembles these diets has been associated with a 27% reduction in mortality risk. However, recent results from the DIET-HD multinational cohort of over 8,000 hemodialysis patients showed that a high adherence to the Mediterranean or DASH-type diet was not associated with reduced cardiovascular mortality or all-cause mortality. This study, however, was an observational prospective multinational cohort from European countries using a food frequency questionnaire that uses the British Food Composition Table and, therefore, there is a limited generalizability of the results.  

The nutrition guidelines for patients with chronic kidney disease are being updated

An update for the major nutrition guidelines for kidney disease patients (the Kidney Disease Outcomes Quality Initiative [K/DOQI] guidelines by the National Kidney Foundation) is expected later this year. Even though an overall focus of nutrient recommendations is still expected, it is not known if a particular dietary pattern will be recommended following the recommendations of the European Renal Association-European Dialysis Transplantation Association. Despite this, without a doubt there is a need for prospective, randomized-clinical trials  to provide proof of the benefit on outcomes and quality of life with focusing on dietary patterns rather than mere nutrient restrictions. nd

March is National Nutrition Month. The campaign promotes healthy eating habits and nutrition education, and it celebrates the people who promote these healthy habits. In 2018, the theme is “Go Further with Food”, highlighting that food decisions make an impact on your overall health.

Members of the American Society for Nutrition (ASN) are diverse. We study nutrition as a science, reporting on the physiological and biological aspects of foods and nutrients. We are also the nutrition educators and practitioners who get the latest nutrition science into the hands of those who need it: policymakers, dietitians, medical doctors, nurses and allied health professionals, and consumers. To celebrate National Nutrition Month and ASN’s impact on enhancing the knowledge of nutrition and quality of life, we will be highlighting some of our programs and activities that ultimately influence public health and how we can “go further with food.”

NUTRITION 2018 – American Society for Nutrition’s Annual Meeting

Nutrition 2018 LogoThis year ASN kicks off a new annual meeting that will focus on the multidisciplinary field of nutrition science. The meeting will bring together basic, translational, clinical, and population scientists and practitioners. The meeting will be held in Boston June 9-12 and registration is open now!

Some hot nutrition topics at the meeting:

  • Role of Anti-inflammatory Nutrition Strategies
  • Pediatric Nutrition
  • Nutrition and the Environment
  • Precision Nutrition
  • Science of Breastfeeding
  • Food Allergies

These are only a few topics that are included in the 4-day nutrition meeting. Our NUTRITION 2018 schedule is now open so please refer to it for the latest sessions.

Stay tuned for more news and a special membership offer for dietitians and nutritionists during National Nutrition Month.