August 14, 2007

     Volume 2007, No. 7

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IN THIS EDITION

LARGE ENTRÉE PORTION SIZE AND INCREASED ENTRÉE ENERGY DENSITY INDEPENDENTLY BUT ADDITIVELY PROMOTE HIGHER ENERGY CONSUMPTION IN YOUNG CHILDREN

REVIEW OF THE EFFECTS OF VITAMIN D DEFICIENCY

LARGE ENTRÉE PORTION SIZE AND INCREASED ENTRÉE ENERGY DENSITY INDEPENDENTLY BUT ADDITIVELY PROMOTE HIGHER ENERGY CONSUMPTION IN YOUNG CHILDREN

Portion sizes have increased over the years not only for adults but their children too. Many researchers believe increased portion sizes are a major contributor to the growing obesity epidemic. Infants are born with the ability to self-regulate their caloric intake and studies have shown young children also possess that ability. As children age, they become less sensitive to body signals. Numerous studies with both populations (adults and children) have shown that satiety does not change when the energy density (ED) of the food is decreased. Energy density does appear to have an affect on children who drink an ED drink 1 hour prior to a meal. However, no research appears to address the question of ED and entrée portion size on satiation in young children.

The study took 53 ethnically diverse 5 - 6 year-old children (28 girls, 25 boys) living in Houston, Texas. The children were fed 4 meals which included Stouffer’s macaroni and cheese dinner, applesauce, 2% milk, carrots, corn, and cookies. The macaroni and cheese served as the entrée and was altered either by adding butter to increase ED or water to increase the volume to match the ED version. The entrée portion size was either 250 g or 500g with one of the 250g and 500g meals having increased ED.  The type and volume of side dishes remained consistent for all meals. 

Evaluation of the data showed a 33% increase in total meal intake when the entrée portion size was doubled. This increased total calorie meal consumption by 15%. There was no difference in the volume consumed between the reference meals and the high ED meals and also no difference between the amounts of sides consumed between either of the meals. However, though volume was not affected, children served a 40% higher ED entrée had a 33% increase in energy consumption from the entrée. Children fed both the larger and high ED meal consumed 76% more total entrée calories and 34% more total meal calories.   This research study indicates that increased portion size and higher energy density additively increase caloric intake in young children.

Citation:

Effect of portion size and energy density on young children’s intake at a meal. Fisher JO, Liu Y, Birch LL, and Rolls BJ.  American Journal of Clinical Nutrition 2007: 86:174-9.

To read the abstract, go to http://www.ajcn.org/cgi/content/abstract/86/1/174

REVIEW OF THE EFFECTS OF VITAMIN D DEFICIENCY

A review article in The New England Journal of Medicine outlines the numerous effects of vitamin D deficiency.  Recent research has shown that most tissues and cells in the body have a vitamin D receptor which, in turn, gives vitamin D a role in the prevention of many chronic illnesses. Vitamin D is available to humans through exposure to sunlight, diet, and dietary supplements. Using the definition of vitamin D deficiency held by most experts (25-hydroxyvitamin D level <20 ng per milliliter measured in serum), it can be estimated that 1 billion people worldwide are either vitamin D deficient or insufficient. Several studies have shown that 40% to 100% elderly men and women living in European and U.S. communities are deficient in vitamin D. Other studies have also shown a high potential risk for children and young adults. Even in sunny climates, vitamin D deficiency is common when most of the skin is shielded from the sun's rays. Repercussions of vitamin D deficiency and effects of increased vitamin D intake include:

• Only 10% to 15% of dietary calcium and about 60% of phosphorus is absorbed without vitamin D. Even at levels 50% higher than the deficiency marker, intestinal calcium absorption can be significantly decreased. Calcium and vitamin D deficiencies in utero and in childhood may prevent optimal calcium deposition in the skeleton.

• As they age, women are at an increased risk of osteoporosis. Approximately, 60% to 70% of women between 60 and 70 years have osteoporosis. Trials providing 700 to 800 IU of vitamin D3 per day in patients whose baseline concentration of 25-hydroxyvitamin D was less than 17 ng per milliliter showed optimal prevention of nonvertebral and hip fractures as well as an increase of the mean concentration of 25-hydroxyvitamin D to 40 ng per milliliter.

• Skeletal muscles have a vitamin D receptor and deficiency causes muscle weakness. A meta-analysis of five randomized clinical trials showed a 22% reduction in falls for patients with increased vitamin D intake versus patients receiving calcium or a placebo.

• Other tissues with a vitamin D receptor include brain, prostate, breast, and colon tissues as well as immune cells. The active form of vitamin D, 1,25-hydroxyvitamin D controls the genes responsible for cellular proliferation, differentiation, apoptosis, and angiogenesis. The proliferation of normal cells and cancer cells is decreased by 1,25-hydroxyvitamin D. As an immunomodulator, 1,25-hydroxyvitamin D can destroy cells causing tuberculosis and other infections.  It also increases insulin production and myocardial contractility.

• Studies indicate that deficient levels of vitamin D are associated with a 30% to 50% increased risk of incident colon, prostate, and breast cancer and an increased risk of mortality from these cancers. A vitamin D intake of 233 to 652 IU per day showed a 0.53 relative risk for colorectal cancer in 1954 men compared to a 1.0 relative risk with an intake of 6 to 94 IU per day. In the Women's Health Initiative, in an 8-year follow-up, a 253% increased risk of colorectal cancer was seen in women with a 25-hydroxyvitamin D concentration of less than 12 ng per milliliter. Women in the highest quartile of vitamin D intake had a 50% lower risk of breast cancer compared to those in the lowest quartile. A suggested explanation for these results is the ability of 1,25-hydroxyvitamin D to reduce the potential for malignant cells to survive.

• Higher levels of 25-hydroxyvitamin D concentration have also been shown to decrease the risk of multiple sclerosis, rheumatoid arthritis and osteoarthritis. In children, vitamin D3 supplementation has been associated with an 80% reduction in the risk for type 1 diabetes. Vitamin D deficiency has also been associated with increased insulin resistance, decreased insulin production and metabolic syndrome.

• Vitamin D deficiency is associated with congestive heart failure and high blood levels of heart disease risk factors such as C-reactive protein and interleukin-10.

• Other disorders associated with vitamin D deficiency are schizophrenia, depression, decreased mental function, and wheezing illnesses.

Most experts suggest that children and adults getting inadequate sun exposure require 800 to 1,000 IU of vitamin D per day. Lactating women require 4,000 IU per day to ensure adequate vitamin D3 levels in their milk. A moderate amount of sun exposure, 5 to 30 minutes between 10:00 am and 3:00 pm, twice a week, can provide sufficient vitamin D.  Even in the elderly, the skin can make enough vitamin D to reduce the risk of fracture. In conclusion, the authors suggest that the recommended adequate intakes of vitamin D are inadequate and should be set at 800 IU of vitamin D3 per day.

Citation:

Vitamin D Deficiency. Holick MF. The New England Journal of Medicine, 2007 Jul;357;3:266-281..

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