Book: Nutritional Composition of Food Products

This book delves into the complex and dynamic nature of different food products, offering a comprehensive estimation of macronutrients, micronutrients, and other vital elements that make these foods invaluable to human health. With advances in scientific research, our understanding of food composition has evolved, revealing both its nutritional benefits and its potential therapeutic applications in addressing various health conditions. 

Evidence and Ethics in Food Fortification Policy Development

The primary objective of food fortification policy and programs is generally the “protection of public health and safety”. The ‘protection’ indicates the benefits associated with mandatory food fortification. On the other hand, ‘public health and safety’ refers to the risk of harm resulting from excessive nutrient intake. These two dimensions create ambiguity for the decision makers. The exposure to the raised level of nutrients can also have ethical consequences. The decision on fortification policy should be based both on the evidence and ethics.

The food fortification policy must be informed by sound scientific evidence. We generally use a term: evidence-informed-policy-making decision. There should be two types of evidence: evidence of food fortification to ‘promote’ public health; and evidence to ‘protect’ public health.

The evidence hierarchy method is used to evaluate the quality of evidence. For example, evidence based on randomized controlled trials (RCTs) is considered high quality. The process for developing evidence-informed guidelines was developed by WHO (2009). It consists of a nine step procedure as shown in figure below. 

Excess iodine intake and its relation with thyroid dysfunction

 

For the control of Iodine Deficiency Disorder (IDD), Universal salt Iodization (USI) was implemented. As a result of it, Nepal is heading towards iodine sufficiency however the prevalence of clinical and sub-clinical hypothyroidism is still higher.The increased prevalence of thyroid disorders can be result of iodine deficiency or excess of iodine intake. The prevalence of excess iodine intake is hiking all over the world including Nepal. A study done in 1000 patients (with 270 clinical hypothyroidism patients) showed anti-TPO (Thyroid Peroxidase) antibody positive. The study also stated that the cause of hypothyroidism in present day Nepal was chronic autoimmune thyroiditis (Hashimoto's thyroiditis). As stated earlier, the status of iodine consumption in Nepal is moving from iodine deficiency to adequate or excess, there might be higher burden of thyroid disorders in Nepal due to the increased prevalence of autoimmune thyroiditis (Pokharel, S., 2019). 

A community based cross sectional study done in Udaypur (Nepal) in primary school aged children (6 years to 12 years) showed 10% (n=20) prevalence of thyroid dysfunction (sub-clinical hypothyroidism). Majority of the participants were reported to have excess urinary iodine concentration (UIC). The sensitive marker of recent dietary iodine intake is Urinary iodine rather than thyroid dysfunction. The analysis of thyroid hormones showed 1.6% of school age children had sub-clinical hyperthyroidism.

Although any apparent clinical consequences are not resulted by excess iodine exposure, thyroid dysfunction can occur in sensitive patients with specific risk factors, including those with pre-existing thyroid disease, the elderly, fetuses and neonates. The iodine-induced hypothyroidism or hyperthyroidism could be either sub-clinical or overt, hence excess iodine exposure should be suspected. The aeitology of thyroid dysfunction in not discernible.

Besides, Iodine Global Network (IGN) has highlighted several countries around the world to be categorized as having excess iodine status in population. As per study done in school age children in 6-9 years of age, IGN has listed Nepal in excessive iodine intake country. So, this could necessitate for the revisit of iodine standard in Nepal.

Is it time to revisit the standard of "Iodised salt"?

A paragraph from the recently published article: 

"WHO/UNICEF/IGN recommends that the iodine status of populations be based on the mUIC. It has been further designated that an optimal iodine intake is where a mUIC in school aged children (SAC) is in the range of 100–299 ug/L and excessive if the mUIC >300 ug/L (UNICEF, 2015). These levels are not as well defined for women of reproductive age, but for pregnant women, the optimal range is 150–249 ug/L, whereas the iodine intake is considered to be above requirements when the mUIC is between 250 and 499 ug/L and excessive >500 ug/L (WHO, 2013). With these criteria in mind, the 2016 survey shows that at the national level, SAC are currently classified in the “excessive” range, whereas pregnant women and women of child bearing age would be classified as “adequate” and “more than adequate,” respectively. Looking at the stratified results for several subgroups in the population, among the 34 strata listed, 19 (56%) were classified as excessive for SAC. Iodine intake was high in the central and western regions, in the Terai, and among a number of ethnic groups including the poorer Terai Janajati. For pregnant women, there were no strata with mUIC >500, but again, the sample size was small rendering these estimates imprecise. In addition, the assessment of iodine content of salt showed that mean iodine content for all salt samples was 44.1 ppm, and that 67.5% were >40 ppm—well above the expected level at the retail (30 ppm) and household (15 ppm) levels. The standards are based on an average per capita consumption of 10-g salt per day, so an iodine content this high will provide more than three times the daily requirement. These findings suggest that the current standard, combined with marked increase in use of a refined packaged product, may require an adjustment of the standard. "

Vitamin and mineral requirements in human nutrition

PDF Document: "WHO (2004): Vitamin and mineral requirements in human nutrition"

 

 

Compilation of nutrition and health claims evaluated by EFSA

The following is a list of nutrition and health claims evaluated by European Food Safety Authority (EFSA). The authorized claims are shown with green text and the rejected claims are shown in red text.

EFSA evaluation of health claims related to COPPER

The following is a list of claims related to the copper. The claim explaining “ copper contributes to the cholesterol and glucose” was not authorized by European Food Safety Authority (EFSA).

Claims	EFSA opinion reference	Status
Copper contributes to maintenance of normal connective tissues	2009;7(9):1211	Authorised
Copper contributes to normal energy-yielding metabolism	2009;7(9):1211 2011;9(4):2079	Authorised
Copper contributes to normal functioning of the nervous system	2009;7(9):1211 2011;9(4):2079	Authorised
Copper contributes to normal hair pigmentation	2009;7(9):1211	Authorised
Copper contributes to normal iron transport in the body	2009;7(9):1211	Authorised
Copper contributes to normal skin pigmentation	2009;7(9):1211	Authorised
Copper contributes to the normal function of the immune system	2009;7(9):1211 2011;9(4):2079	Authorised
Copper contributes to the protection of cells from oxidative stress	2009;7(9):1211	Authorised
Copper contributes to the cholesterol and glucose	2009;7(9):1211	Non-authorised

Non-Authorized (Rejected) Health Claims related to Calcium

The following claims were rejected by the EFSA (European Food Safety Authority).

Rejected Claims	EFSA opinion Reference
Calcium contributes to normal functioning of cells.	2010;8(10):1725
Calcium helps manage your weight	2010;8(10):1725
Calcium contributes to weight control. Calcium modulates energy metabolism
Calcium helps to keep a healthy blood pressure.	2009;7(9):1210
Calcium naturally present in dairy products is important for weight management	2010;8(10):1725
Dairy calcium has been shown to stimulate lipolysis.
Consumption of dairy calcium aids weight loss.
Dairy calcium modulates fat metabolism.
Dairy calcium helps promote fat loss.
Calcium promotes a healthy heart. Calcium maintains a healthy heart. Calcium helps build a healthy heart. Calcium helps promote a healthy heart	2009;7(9):1210
Oyster shells are rich source of calcium that contributes to healthy blood cholesterol level/ Oyster shells are a rich source of calcium that helps to maintain normal cholesterol level/Oyster shells are a rich source of calcium that decreases LDL cholesterol and increase HDL cholesterol.	2010;8(10):1725
Diet which includes several daily servings of low-fat milk products (about 1200 mg of calcium/day) helps to control blood pressure.	2009;7(9):1210
Supplementation with B-vitamins, iron, magnesium as well as vitamin C can reduce fatigue and tiredness in situations of inadequate micro-nutrient status.	2010;8(10):1725
Water-soluble vitamins, calcium, magnesium and zinc are essential for mental function and performance	2010;8(10):1725
In situations of inadequate micronutrient status, supplementation with water-soluble vitamins, minerals and zinc can sustain mental performance (e.g. concentration, learning, memory, reasoning).
Calcium supports the regulation of the acid base balance	2011;9(6):2201
Calcium strengthens the nails.	2010;8(10):1725
Calcium phosphoryl oligosaccharide  restores tooth enamel after meals, increases tooth surface hardness, helps strengthen teeth.	2011;9(6):2267
Calcium-containing fruit juices:  Reduced risk for dental erosion	Q-2009-00501

List of EFSA approved Health Claims for Calcium

The following claims were rejected by the EFSA (European Food Safety Authority).

Approved Claims	EFSA opinion Reference
Calcium contributes to normal blood clotting	2009;7(9):1210
Calcium contributes to normal energy-yielding metabolism	2009;7(9):1210
Calcium contributes to normal muscle function	2009;7(9):1210
Calcium contributes to normal neurotransmission	2009;7(9):1210
Calcium contributes to the normal function of digestive enzymes	2009;7(9):1210
Calcium has a role in the process of cell division and specialisation	2010;8(10):1725
Calcium is needed for the maintenance of normal bones	2009;7(9):1210 2009;7(9):1272 2010;8(10):1725 2011;9(6):2203
Calcium is needed for the maintenance of normal teeth	2009;7(9):1210 2010;8(10):1725 2011;9(6):2203

Conditions of use of the claim: The claim may be used only for food which is at least a source of calcium as referred to in the claim SOURCE OF [NAME OF VITAMIN/S] AND/OR [NAME OF MINERAL/S] as listed in the Annex to Regulation (EC) No 1924/2006.

Food Composition Table For Nepal

PDF Document: "Food Composition Table For Nepal"

Vitamin D & COVID-19

Evidence that Vitamin D Supplementation Could Reduce Risk of Influenza and COVID-19 Infections and Deaths

William B. Grant ^1,*,Henry Lahore ²,Sharon L. McDonnell ³,Carole A. Baggerly ³,Christine B. French ³,Jennifer L. Aliano ³ andHarjit P. Bhattoa ⁴

Abstract

The world is in the grip of the COVID-19 pandemic. Public health measures that can reduce the risk of infection and death in addition to quarantines are desperately needed. This article reviews the roles of vitamin D in reducing the risk of respiratory tract infections, knowledge about the epidemiology of influenza and COVID-19, and how vitamin D supplementation might be a useful measure to reduce risk. Through several mechanisms, vitamin D can reduce risk of infections. Those mechanisms include inducing cathelicidins and defensins that can lower viral replication rates and reducing concentrations of pro-inflammatory cytokines that produce the inflammation that injures the lining of the lungs, leading to pneumonia, as well as increasing concentrations of anti-inflammatory cytokines. Several observational studies and clinical trials reported that vitamin D supplementation reduced the risk of influenza, whereas others did not. Evidence supporting the role of vitamin D in reducing risk of COVID-19 includes that the outbreak occurred in winter, a time when 25-hydroxyvitamin D (25(OH)D) concentrations are lowest; that the number of cases in the Southern Hemisphere near the end of summer are low; that vitamin D deficiency has been found to contribute to acute respiratory distress syndrome; and that case-fatality rates increase with age and with chronic disease comorbidity, both of which are associated with lower 25(OH)D concentration. To reduce the risk of infection, it is recommended that people at risk of influenza and/or COVID-19 consider taking 10,000 IU/d of vitamin D₃ for a few weeks to rapidly raise 25(OH)D concentrations, followed by 5000 IU/d. The goal should be to raise 25(OH)D concentrations above 40–60 ng/mL (100–150 nmol/L). For treatment of people who become infected with COVID-19, higher vitamin D₃ doses might be useful. Randomized controlled trials and large population studies should be conducted to evaluate these recommendations. 
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Nutrients 2020, 12(4), 988; https://doi.org/10.3390/nu12040988