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dr Emma derbyshire Phd RNutr (Public Health) Nutritional Insight ltd

FooD FoR THouGHT

In the US, new dietary guidelines are required under the 1990 National Nutrition Monitoring and Related Research Act, which specifies that every five years, the US Departments of Health and Human Services (HHS) and of Agriculture (USDA) must publish a joint report containing nutritional and dietary information and guidelines for the lay public. This report itself must be based on current scientific and medical evidence.

Based on these requirements, the new 2015-2020 Dietary Guidelines for Americans were released this January. These have been developed for policymakers and health professionals and relate to how the general public, aged two years and older, can improve their overall eating patterns.

The guidelines provide five main overarching points developed with the intention of helping to encourage individuals make shifts in their food and beverage patterns. These are to: 1) Follow a healthy eating pattern across the lifespan; 2) Focus on variety, nutrient density, and amount; 3) Limit calories from added sugars and saturated fats and reduce sodium intake; 4) Shift to healthier food and beverage choices, and 5) Support healthy eating patterns for all. Within these, it is also specified that a healthy eating pattern both ‘includes’ and ‘limits’ the inclusion of certain foods. These recommendations are shown below.

A HEAlTHy EATinG PATTERn

incluDES limiTS

A variety of vegetables from all of the subgroups: dark green, red and orange, legumes (beans and peas), starchy, and other. fruits, especially whole fruits. Grains, at least half of which are wholegrains. fat-free or low-fat dairy, including milk, yoghurt, cheese, and/or fortified soy beverages. A variety of protein foods, including seafood, lean meats and poultry, eggs, legumes (beans and peas), and nuts, seeds and soy products. Oils. saturated fats and trans fats, added sugars, and sodium. key recommendations that are quantitative are provided for several components of the diet that should be limited. These are to: consume less than 10% of calories per day from added sugars; consume less than 10% of calories per day from saturated fats; consume less than 2,300 milligrams (mg) per day of sodium; if alcohol is consumed, consume in moderation - up to one drink per day for women and up to two drinks per day for men and only by adults of legal drinking age.

Dr Emma Derbyshire is a freelance nutritionist and former senior academic. Her interests include pregnancy and public health. www.nutritionalinsight.co.uk hello@nutritionalinsight.co.uk

Overall, most of these guidelines make good common sense. However, we can already see some discrepancies with new UK alcohol guidelines which further advise to spread alcohol intake over three days or more if as much as 14 units per week are being consumed.

The new report also highlights the need for global consistency when it comes to referring to sugars. We see the term ‘added sugars’ used here, whilst the latest UK Scientific Advisory Committee on Nutrition Carbohydrates and Health report replaces this with ‘free sugars’.

For more information • US Department of Health and Human Services and US Department of Agriculture (2016). 2015-2020 Dietary

Guidelines for Americans. 8th Edition. Available at http://health.gov/dietaryguidelines/2015/guidelines/ • Department of Health (2016). UK Chief Medical Officers’ Alcohol Guidelines Review Summary of the

• SACN (2015). Carbohydrates and Health. TSO: London https://www.gov.uk/government/uploads/system/ uploads/attachment_data/file/445503/SACN_Carbohydrates_and_Health.pdf

proposed new guidelines. Available at: www.gov.uk/government/uploads/system/uploads/attachment_data/ file/489795/summary.pdf

lATEST on PREGnAncy WEiGHT GAin

Excess pregnancy weight gain is a growing problem. In turn, this has been linked to more challenging deliveries, with more C-sections being required due to the larger birth size of infants. Now, a new systematic review has looked into the role that macronutrients play in this.

After searching eight different scientific databases, 56 articles (46 observational studies and 10 trials) were found, although only 11 (20%) were regarded to be ‘high quality’.

Twelve studies suggested that higher energy intakes could be associated with higher levels of pregnancy weight gain. Some trends were seen for fat, although more work is needed to look into the specific roles of individual types of fat and no trends were found for carbohydrate or protein.

Overall, these findings indicate that energy intakes appear to be associated with levels of pregnancy weight gain, although better quality trials now need to feed into future pooled analyses.

For more information, see: Tielemans MJ et al (2016). Am J Clin Nutr Vol 103, No 1, pg 83-99.

FATTy AciD DiScREPAnciES

A wealth of research has measured levels of fatty acids in relation to disease biomarkers. Now it has come to light that different approaches in doing this affects association patterns.

Using data from two human cohorts, new work examined relationships between blood lipids (TAG, and LDL, HDL or total cholesterol) and circulating fatty acids expressed either as a percentage of total, or as concentration in serum.

Overall, it was found that correlations between stearic acid, linoleic acid, dihomo-γ-linolenic acid, arachidonic acid, docosahexaenoic acid and circulating TAG reversed when fatty acids were expressed as concentrations compared with a percentage of total. This reversal pattern was also seen in blood serum samples from both human cohorts.

In summary, it seems that different methods of expressing fatty acids can lead to dissimilar correlations between blood lipids and certain fatty acids. Worryingly, this study raises important questions about how reversals in association patterns could affect the interpretation of findings from such studies.

For more information, see: Sergeant S et al (2016). Br J Nutr Vol 115, No 2, pg 251-61.

SuGAR REDucTion - A PlEASAnT SuRPRiSE

There was much in the public domain last year about sugar, with interest about how to put sugar reduction guidelines into practice. Now, new work has looked into whether we can get used to having less sugar in our diets, in a similar way to how we become used to using less salt.

A sample of healthy adults (n=29) aged 21-54 years were studied for one month and matched across groups for their baseline sugar intake and weight. They were then randomly allocated to: 1) eat a low sugar diet for three months (40% of calories from simple sugars were replaced with fat, protein or complex carbohydrate), or 2) no change in sugar intake. For the last month of the study they ate as they wished.

Overall, results showed that reducing dietary intakes of simple sugars altered perceived ‘sweet taste intensity’. Interestingly, even when sugar intakes were reduced, perceived ‘pleasantness’ was unaffected. Sweetness variations in beverages, however, were not as well identified.

These results indicate that sugar reduction does appear to influence perceived sweet taste intensity. More work is needed to determine how this may affect long-term consumption habits.

GSE FoR HiGH blooD PRESSuRE?

Grape seed extract (GSE) is a rich source of proanthocyanidins (a class of polyphenols with antioxidant properties), but until recently, their potential health benefits has not necessarily been reinforced with scientific evidence. Now, a new study has looked at potential effects on blood pressure.

A 12-week randomised controlled trial allocated 36 middle-aged adults with early stages of hypertension to drink a juice containing 150mg GSE twice daily for six weeks, or a placebo juice (no GSE). This included a two-week placebo run-in period and a four-week no beverage follow-up period.

Results showed that after six weeks, GSE significantly lowered systolic blood pressure by 5.6% and diastolic blood pressure by 4.7%. Unfortunately, blood pressure returned to normal four weeks after the beverage was discontinued.

Overall, these results indicate that GSE could help to lower blood pressure in high risk individuals. Further trials are now needed to see if other population groups could also benefit.

For more information, see: Park E et al (2016). Br J Nutr Vol 115, No 2, pg 226-38.

iRon inTAkES oF ToDDlERS

Iron deficiency is common amongst toddlers and children and is regarded as the most common nutritional deficiency worldwide. Now, new work in Australia has measured habitual iron intakes amongst those aged two years and under - a population group that is often overlooked from dietary surveys.

Data from the Melbourne Infant Feeding, Activity and Nutrition Trial Program was analysed from 485 infants (mean age 9.1 months) and 423 toddlers (mean age 19.6 months) and their mums.

Interestingly, mean iron intakes were found to be 9.1mg/day for infants, declining to 6.6mg/ day for toddlers. Subsequently 32.6% of infants and 18.6% of toddlers had inadequate daily iron intakes. The main sources of iron were fortified infant formula and cereals.

This data emphasises the need to support families in helping to maintain and improve children’s iron intakes. The decline in formula use as children get older appears to correlate with the decline in habitual intakes.

imPoRTAnT nEWS FoR ViTASAVouRyTm 200

Vitaflo® International Ltd wishes to inform you that Vitasavoury 200 has been discontinued from our nutrition support product range. Vitasavoury 300 is available as an alternative in all four flavours. For more information please contact your local Vitaflo representative or call the nutrition helpline on 0151 702 4937. www.vitaflo.co.uk

mAkinG liFE TASTE GooD - WiTH imPRoVED AlTHéRA®

In November 2015, Nestlé Health Science reformulated Althéra®, for the dietary management of mild to moderate cows’ milk allergy. Improved Althéra® has preferred taste and palatability for increased acceptance of the formula.1

The 100% extensively hydrolysed whey protein source provides a more palatable option compared to casein based eHF.2 • Enhanced level of calcium which is needed for normal growth and development of bone.3 • Contains lactose which significantly increases the absorption of calcium and improves palatability.4,5 • Hypoallergenic for better tolerance - the most extensively hydrolysed formula in the UK.2 • 100% extensively hydrolysed whey protein source facilitates faster gastric emptying.6,7 and provides a more palatable option compared to casein based eHF.2,5 Careline: 0800 0 81 81 80 ROI: 1800 931 832 Email: SMA.Information@uk.nestle.com Website: www.smahcp.co.uk

References: 1. EFsA Journal scientific opinion. 2014. scientific Opinion on the essential composition of infant and follow-on formulae. EFsA Panel on Dietetic Products, Nutrition and Allergies page 40. 2. Abrams sA et al, Am J Clin Nutr. 2002;76(2):442-6. 3. Niggemann b et al. Pediatr Allergy Immunol 2008; 194(4):348-54. 4. Rapp et al. Clin transl Allergy 2013; 3 (suppl 3):132. 5. Fried MD et al. JPediatr 1992; 120:569-572. 6. Khoshoo V et al. Eur J Clin Nutr 2002; 56:656-658. 7. Althéra versus Nutramigen competitive benchmarking test – sweden 2012 (internal data).