Voeding wat is er mis?

De basis suppletie is op wetenschappelijke publicaties ontwikkeld. Hierbij is gebruik gemaakt van de National Library of Medicine. Daar waar mogelijk werden studies die opgezet zijn volgens het "placebo controlled cross-over" principe gebruikt. Andere vormen die vaak werden gebruik zijn reviews en epidemiologisch onderzoek. Publicaties uit bladen als The Lancet, American Journal of Cardiology, The New England Journal of Medicine etc. hadden de voorkeur.

Alle artikelen en behandelingsprotocollen zijn volgens het zelfzorg principe geschreven. Bij zelfzorg is niet de arts of specialist maar de patiënt verantwoordelijk voor het correct uitvoeren van de behandeling. Toch adviseer ik patiënten om bij gezondheidsklachten eerst een arts te raadplegen. Een juiste diagnose is ook bij een zelfzorgtraject van onschatbare waarde. Als u reeds onder behandeling bent van een arts overleg dan met uw arts voordat u voedingssupplementen gaat gebruiken.

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Voeding wat is er mis mee

Zonnebloemolie waarschuwing

linoleic acid = linolzuur = zonnebloemolie
  1. High-energy diets, fatty acids and endothelial cell function: implications for atherosclerosis
    Our studies suggest that omega-6 fatty acids, and especially linoleic acid, cause endothelial cell dysfunction most markedly as well as can potentiate TNF-mediated endothelial cell injury. We propose that high-energy diets, and especially diets rich in linoleic acid, are atherogenic by contributing to an imbalance in cellular oxidative stress/antioxidant status of the endothelium, which can lead to activation of oxidative stress-responsive transcription factors, inflammatory cytokine production and the expression of adhesion molecules.
  2. Linoleic acid induces MCP-1 gene expression in human microvascular endothelial cells through an oxidative mechanism
    Linoleic acid is a dietary fatty acid that appears to play an important role in activation of the vascular endothelium under a variety of pathological conditions, including development of atherosclerosis or cancer metastasis. Evidence indicates that inflammatory responses may be an underlying cause of endothelial cell pathology induced by linoleic acid.
  3. The role of linoleic acid in endothelial cell gene expression. Relationship to atherosclerosis
    There is evidence that linoleic acid plays a critical role in gene expression and vascular function as it relates to the pathogenesis of atherosclerosis.
  4. Linoleic acid increases lectin-like oxidized LDL receptor-1 (LOX-1) expression in human aortic endothelial cells
    Results from in vitro studies suggest that selected fatty acids, and especially linoleic acid (LA), can elicit endothelial dysfunction (ED).
  5. Linoleic acid activates nuclear transcription factor-kappa B (NF-kappa B) and induces NF-kappa B-dependent transcription in cultured endothelial cells
    High dietary intakes of unsaturated fats may be atherogenic by disrupting normal functions of the vascular endothelium, due in part to the ability of linoleic acid (18:2n-6) to contribute to an increase in cellular oxidative stress and related injurious events. Exposing endothelial cells to 90 micromol linoleic acid/L for 6 h resulted in a significant increase in lipid hydroperoxides that coincided wih an increase in intracellular calcium concentrations.
  6. Unsaturated fatty acids selectively induce an inflammatory environment in human endothelial cells
    Specific unsaturated dietary fatty acids, particularly linoleic acid, can selectively stimulate the development of a proinflammatory environment within the vascular endothelium.
  7. Involvement of CYP 2C9 in mediating the proinflammatory effects of linoleic acid in vascular endothelial cells
    Polyunsaturated fatty acids such as linoleic acid are well known dietary lipids that may be atherogenic by activating vascular endothelial cells.

Lijnzaadolie waarschuwing

Lijnzaadolie wordt uit vlaszaad gewonnen en is rijk aan alfa-linoleenzuur, een essentieel omega-3 vetzuur. Alfa-linoleenzuur is een meervoudig onverzadigde olie en naar de maatstaven van het Voedingscentrum dus een gezonde olie. Dat is niet helemaal waar. Alfa-linoleenzuur is heel geschikt bij de behandeling en de preventie van borstkanker, daar zijn de wetenschappers het wel over eens.

Maar alfa-linoleenzuur verhoogt bij mannen de kans op het krijgen van prostaatkanker. Bovendien versnelt alfa-linoleenzuur de progressie van prostaatkanker bij mannen die deze ziekte al hebben. Dat kan men dus nauwelijks gezond noemen. Daarom adviseer ik mannen geen lijnzaadolie te gebruiken.
  1. Dietary intake of n-3 and n-6 fatty acids and the risk of prostate cancer.
    Increased dietary intakes of ALA may increase the risk of advanced prostate cancer. In contrast, EPA and DHA intakes may reduce the risk of total and advanced prostate cancer.
  2. Alpha-linolenic acid and risk of prostate cancer: a case-control study in Uruguay
    Including this report, five of six studies that have examined the relationship between alpha-linolenic acid and prostate cancer yielded a positive association, which was significant in four studies. Thus, there appears to be evidence of a role of alpha-linolenic acid in prostate carcinogenesis
  3. The inhibitory effect of flaxseed on the growth and metastasisof estrogen receptor negative human breast cancer xenograftsis attributed to both its lignan and oil components
    In conclusion, FS reduced the growth and metastasis of established ER- human breast cancer in part due to its lignan and FO components, and not to lipid peroxidation. (c) 2005 Wiley-Liss, Inc.

Soja waarschuwing

  1. Implications of antinutritional components in soybean foods
    There are a number of components present in soybeans that exert a negative impact on the nutritional quality of the protein. Among those factors that are destroyed by heat treatment are the protease inhibitors and lectins. Protease inhibitors exert their antinutritional effect by causing pancreatic hypertrophy/hyperplasia, which ultimately results in an inhibition of growth. The lectin, by virtue of its ability to bind to glycoprotein receptors on the epithelial cells lining the intestinal mucosa, inhibits growth by interfering with the absorption of nutrients. Of lesser significance are the antinutritional effects produced by relatively heat stable factors, such as goitrogens, tannins, phytoestrogens, flatus-producing oligosaccharides, phytate, and saponins. Other diverse but ill-defined factors appear to increase the requirements for vitamins A, B12, D, and E. The processing of soybeans under severe alkaline conditions leads to the formation of lysinoalanine, which has been shown to damage the kidneys of rats. This is not generally true, however, for edible soy protein that has been produced under milder alkaline conditions. Also meriting consideration is the allergenic response that may sometimes occur in humans, as well as calves and piglets, on dietary exposure to soybeans.
  2. Brain aging and midlife tofu consumption
    Poor cognitive test performance, enlargement of ventricles and low brain weight were each significantly and independently associated with higher midlife tofu consumption.. In this population, higher midlife tofu consumption was independently associated with indicators of cognitive impairment and brain atrophy in late life.
  3. Zinc bioavailability in soybean meal
    The phytate contained in the SPC (soy protein concentrate) basal diet therefore markedly reduced the efficiency of utilizing the supplemental inorganic Zn from ZnSO4 x 7H2O.

Verkeerde balans essentiële vetzuren

  1. The importance of the ratio of omega-6/omega-3 essential fatty acids
    Several sources of information suggest that human beings evolved on a diet with a ratio of omega-6 to omega-3 essential fatty acids (EFA) of approximately 1 whereas in Western diets the ratio is 15/1-16.7/1. Western diets are deficient in omega-3 fatty acids, and have excessive amounts of omega-6 fatty acids compared with the diet on which human beings evolved and their genetic patterns were established. Excessive amounts of omega-6 polyunsaturated fatty acids (PUFA) and a very high omega-6/omega-3 ratio, as is found in today's Western diets, promote the pathogenesis of many diseases, including cardiovascular disease, cancer, and inflammatory and autoimmune diseases, whereas increased levels of omega-3 PUFA (a low omega-6/omega-3 ratio) exert suppressive effects.
  2. n-3 fatty acids and human health: defining strategies for public policy
    Human beings evolved on a diet that was balanced in n-6 and n-3 essential fatty acid intake, whereas Western diets have a ratio of n-6/n-3 of 16.74. The scientific evidence is strong for decreasing the n-6 and increasing the n-3 intake to improve health throughout the life cycle.
  3. Essential fatty acids in health and chronic disease
    Human beings evolved consuming a diet that contained about equal amounts of n-3 and n-6 essential fatty acids. Over the past 100-150 y there has been an enormous increase in the consumption of n-6 fatty acids due to the increased intake of vegetable oils from corn, sunflower seeds, safflower seeds, cottonseed, and soybeans. Today, in Western diets, the ratio of n-6 to n-3 fatty acids ranges from approximately 20-30:1 instead of the traditional range of 1-2:1. Studies indicate that a high intake of n-6 fatty acids shifts the physiologic state to one that is prothrombotic and proaggregatory, characterized by increases in blood viscosity, vasospasm, and vasoconstriction and decreases in bleeding time.
  4. Dietary fatty acids and prevention of hormone-responsive cancer
    The results from some, but not all, epidemiological studies indicate that the level of dietary fat intake and the nature of the constituent fatty acids influence both breast and prostate cancer risk, and disease progression. These observations derive support from the use of animal models, which demonstrate that polyunsaturated omega-6 fatty acids stimulate mammary carcinogenesis and tumor growth and metastasis, whereas long-chain omega-3 fatty acids exhibit inhibitory effects.

Te weinig selenium in de bodem

  1. Are there functional consequences of a reduction in selenium intake in UK subjects?
    Dietary Se levels in the UK have fallen over the last 20 years and recent surveys indicate that average Se intakes are 30-40 microg/d, which is well below the current UK reference nutrient intake for adult men (75 microg/d) or women (60 microg/d). Functional consequences of this decline have not been recognised, although epidemiological data suggest it may contribute to increased risk of infections and incidence of some cancers. Previous data have indicated that biochemical changes in Se-dependent proteins occur in otherwise healthy UK subjects given small Se supplements. The current studies have focused on the effect of small Se supplements on the immune response since there is evidence of specific interactions between Se intake and viral replication, and since the potential anti-cancer effects of Se may be mediated by non-antioxidant effects of Se such as changes in immune function. Data indicate that subjects given small Se supplements (50 or 100 microg Se/d) have changes in the activity of Se-dependent enzymes and evidence of improved immune function and clearance of an administered live attenuated virus in the form of poliovirus vaccine. Responses of individual subjects to Se supplements are variable, and current work is evaluating potential explanations for this variability, including genetic variability and pre-existing Se status.
  2. Selenium status of low-selenium area residents: Polish experience
    The results obtained confirm our thesis that Se concentration in the blood of the inhabitants of Poland depends on the region of the country. In recent years, in a considerable number of Polish inhabitants, the concentration of Se in blood plasma has been relatively low-about 50-55 microg/l, and the calculated daily dietary intake about 30-40 microg/day. The low levels of the element in the blood and urine are probably due to its deficiency in the diet.
  3. Selenium deficiency in Yugoslavia
    Data on selenium (Se) deficiency in Yugoslavia are presented. The results include Se content of soil, cereal crops, and garlic grown in these soils, and human serum and scalp hair from several towns and regions. All data indicate a serious Se deficiency: soil (n = 140), the mean value of 200 +/- 69.6 micrograms/kg Se; wheat, (58) mean = 20.5 +/- 12.4 micrograms/kg; corn, (79) mean = 13.7 +/- 13.6 micrograms/kg; and garlic, (66) mean = 13.7 +/- 17.1 micrograms/kg Se. Analyses of human tissue show a very low Se status of the Yugoslav population: serum, (n = 875) mean = 50.0 +/- 18.0 micrograms/L and scalp hair, (388) mean = 94 +/- 16 micrograms/kg Se. In some regions, Se contents of grain, garlic, and human serum and hair are approaching those in the low-Se belt in China. It is assumed that very low Se status of a human population could be a risk factor in the development of Balkan Endemic Nephropathy (BEN) and in a high incidence of urinary tract tumors (UTT) in endemic areas.
  4. The argument for increasing selenium intake
    While Se-deficiency diseases have been recognised for some time, evidence is mounting that less-overt deficiency can also cause adverse health effects and furthermore, that supra-nutritional levels of Se may give additional protection from disease. In the context of these effects, low or diminishing Se status in some parts of the world, notably in some European countries such as the UK, is giving cause for concern. While deficiency has an adverse effect on immunocompetence, Se supplementation appears to enhance the immune response. Se appears to be a key nutrient in counteracting certain viral infections; thus, in a Se-deficient host the benign coxsackie virus becomes virulent, causing heart damage, the influenza virus causes more serious lung pathology and HIV infection progresses more rapidly to AIDS. Long recognised as essential for successful animal reproduction, Se is required for human sperm maturation and sperm motility and may reduce the risk of miscarriage. Deficiency has been linked to adverse mood states. Findings have been equivocal in linking Se to cardiovascular disease risk, although other conditions involving oxidative stress and inflammation have shown some association with Se status. There is growing evidence that higher Se intakes are associated with reduced cancer risk. While persuasive evidence already exists to suggest that additional Se would be beneficial in some health conditions, results from intervention trials underway or planned have the potential to reinforce or refute the argument for increasing Se intake.
  5. Biofortification of UK food crops with selenium
    Se is an essential element for animals. In man low dietary Se intakes are associated with health disorders including oxidative stress-related conditions, reduced fertility and immune functions and an increased risk of cancers. Although the reference nutrient intakes for adult females and males in the UK are 60 and 75 microg Se/d respectively, dietary Se intakes in the UK have declined from >60 microg Se/d in the 1970s to 35 microg Se/d in the 1990s, with a concomitant decline in human Se status. This decline in Se intake and status has been attributed primarily to the replacement of milling wheat having high levels of grain Se and grown on high-Se soils in North America with UK-sourced wheat having low levels of grain Se and grown on low-Se soils. An immediate solution to low dietary Se intake and status is to enrich UK-grown food crops using Se fertilisers (agronomic biofortification). Such a strategy has been adopted with success in Finland. It may also be possible to enrich food crops in the longer term by selecting or breeding crop varieties with enhanced Se-accumulation characteristics (genetic biofortification). The present paper will review the potential for biofortification of UK food crops with Se.
  6. Selenium supplementation: does soil supplementation help and why?
    There are now concerns that dietary Se intake is inadequate for the population in the UK and parts of Europe. Many different methods can be proposed to deal with this problem. Experience from Finland suggests that the addition of Se to fertiliser is a safe and effective means of increasing the intake of the micronutrient in the human population. However, careful consideration needs to be given to the potential consequences of increasing Se intake. It is important to understand the biochemical and physiological changes that may occur with any increase in Se intake within the UK population. Se is an essential component of at least twenty functional proteins within mammals. These proteins are essential for a range of metabolic functions, including antioxidant activity, thyroid hormone synthesis and immune function. Thus, any increase in Se intake has the potential to influence in a wide range of factors that may impinge on the incidence of chronic disease. Treatment of soil with Se-supplemented fertiliser will certainly increase total Se in food products derived from areas where this treatment is in place. Consumption of such foods will increase Se status in many populations where the existing intake does not meet requirements. If the increases in Se intake are not toxic the overall consequences have the potential to be beneficial.

Te weinig magnesium in de voeding

  1. Environmental magnesium deficiency as a cardiovascular risk factor
    Magnesium is abundant in nature and the major routes of intake are through food and water. Through changes in the treatment of foodstuffs and altered diets, as well as increased use of surface water with low magnesium content, magnesium deficiency is present in modern society. Magnesium deficiency causes cardiac arrhythmia and several studies suggest that a low level of magnesium in drinking water is a risk factor for myocardial infarction, particularly among men. Before general prevention programmes can be recommended, risk groups must be defined and experimental intervention programmes performed.
  2. Magnesium content of the food supply in the modern-day world
    A large-scale US survey has shown that the dietary magnesium intake tends to be lower than recommended. The suboptimal intake prevalent among US adults is consistent with the pattern observed in other North American and European surveys. Several factors are discussed, including the waterborne magnesium factor, the loss of magnesium during food refining and the magnesium content of vegetarian diets, as well as various metabolic situations, e.g., hypertension, pregnancy, osteoporosis, drug therapy, alcoholism, stress and cardiac trauma. The benefits of magnesium supplementation among those with sub-RDA intakes are illustrated..
  3. Magnesium and diabetes mellitus: their relation
    Epidemiological studies had shown low levels of magnesium ingestion in the general population, as well as a relation between the ingestion of food rich in magnesium and the reduction of diabetes installation and its complications. Based on this, the supplementation with magnesium has been suggested in patients with diabetes mellitus who have proven hypomagnesemia and the presence of its complications.
  4. A review of magnesium intake in the elderly. A cause for concern?
    Elderly people in the United States represent an emerging high risk group for nutritional deficiencies. A magnesium deficit in the elderly can occur due to inadequate nutrient intakes, multiple drug use, or altered gastrointestinal function. Magnesium has been targeted as a risk factor for elderly people and has been implicated in the aging process. Data presented in this review confirm decreased availability of magnesium in the food supply, lower intakes of magnesium by elderly people, and widespread supplementation practices. Conflicting data exist regarding levels of magnesium in the blood and magnesium status in the elderly. It is not known to what extent suboptimal intakes may affect the aging process; however, magnesium-deficient conditions have been associated with neuromuscular and cardiovascular disorders, endocrine disturbances, insulin resistance and Alzheimer's disease.

Te weinig chroom in de voeding

  1. Dietary chromium intake. Freely chosen diets, institutional diet, and individual foods
    Chromium content of 22 daily diets, designed by nutritionists to be well-balanced, ranged from 8.4 to 23.7 micrograms/1000 cal with a mean +/- SEM chromium content of 13.4 +/- 1.1 micrograms/1000 cal. Most diary products are low in chromium and provide less than 0.6 micrograms/serving. Meats, poultry, and fish are also low in chromium, providing 2 micrograms of chromium or less per serving. Chromium contents of grain products, fruits, and vegetables vary widely, with some foods providing greater than 20 micrograms/serving. In summary, chromium content of individual foods varies, and is dependent upon chromium introduced in the growing, transport, processing, and fortification of the food. Even well-balanced diets may contain suboptimal levels of dietary chromium.
  2. Chromium content of foods and diets
    In many developing countries, such as Brazil, the Sudan, and Iran, the dietary intake is high, from 50-100 micrograms/d, whereas in certain developed countries, such as Finland, Sweden, Switzerland, and the US, the intake is 50 micrograms/d or lower and, consequently, at or below the estimated safe and adequate daily dietary intake range of 50-200 micrograms/d established by the US National Academy of Sciences. The average Cr content of human milk is below 0.5 micrograms/L, thus resulting in a very low average intake of 0.3 microgram Cr/d by exclusively breast-fed infants in the US and Finland.
  3. Chromium content in foods and dietary intake estimation in the Northwest of Mexico
    The daily chromium intake was 30.43 +/- 1.6 micrograms/d. Chromium values obtained in the food analyzed are considered low. Moreover, chromium intake obtained from the diet is not enough to meet the safety and adequate daily chromium intake. Therefore, the population from the Northwestern Mexico has a suboptimal dietary chromium intake.
  4. Chromium intake, absorption and excretion of subjects consuming self-selected diets
    Chromium (Cr) content of the self-selected diets of 10 adult males and 22 females was determined. Each subject collected duplicate food and beverage samples on a daily basis for seven consecutive days. The 7-day average intake for males was 33 +/- 3 micrograms (mean +/- SEM), range 22-48 micrograms, and intake for females was 25 +/- 1, range 13-36. Mean Cr intake per 1000 cal was approximately 15 micrograms. Approximately 90% of the diets analyzed were below the minimum suggested safe and adequate daily intake for Cr of 50 micrograms. Chromium absorption was inversely related to dietary intake; absorption at a dietary Cr intake of 10 micrograms was approximately 2% and, with increasing intake to 40 micrograms, Cr absorption decreased to 0.5%. These data demonstrate that the average daily intake of chromium from self-selected diets is well below the minimum suggested safe and adequate intake and that Cr absorption, at levels found in typical US diets, is inversely related to dietary intake.

Te weinig vitamine A in de voeding

  1. Vitamin A intake and status
    OBJECTIVE: To review the methodology for vitamin A intake and status assessment and to discuss available data on vitamin A intake and status in the Netherlands. CONCLUSIONS: For diagnosis of a deficient vitamin A status, a number of valid biochemical and functional tests and criteria for interpretation are available. However, the sensitivity and specificity of most tests for assessment of the vitamin A status in the suboptimal and/or marginal range seem troublesome. The average vitamin A intake in the Netherlands (adult men 830 RE; adult women 650 RE) is slightly below the Dutch RDA (men 1000 RE; women 800 RE. In particular, individuals avoiding liver and liver products have lower intakes and might have limited stores. The functional significance of these findings remains to be established.
  2. The WHO programme of prevention and control of vitamin A deficiency, xerophthalmia and nutritional blindness
    The vast extent and the world wide distribution of vitamin A deficiency is discussed. Its epidemiology is reviewed and sources of vitamin A in diets recorded, along with the high requirements of children. Strategy for prevention is described under three headings--short, medium and long term steps. Strategies in many countries received notice.

    PIP: Conservative estimates project over 500,000 cases/year of new active corneal lesions and 6-7 million cases of noncorneal xerophthalmia attributable to vitamin A deficiency on a worldwide basis. Vitamin A deficiency affects growth, the differentiation of epithelial tissues, and immune competence. The most dramatic impact, however, is on the eye and includes night blindness, xerosis of the conjunctiva and cornea, and ultimately corneal ulceration and necrosis of the cornea. Vitamin A deficiency occurs when body stores are exhausted and supply fails to meet the body's requirements, either because there is a dietary insufficiency, requirements are increased, or intestinal absorption, transport and metabolism are impaired as a result of conditions such as diarrhea. Vitamin A deficiency is the single most frequent cause of blindness among preschool children in developing countries. The younger the child, the more severe is the disease and the higher the risk that corneal destruction will be followed by death. The most important step in preventing vitamin A deficiency is ensuring that children's diets include adequate amounts of carotene containing cereals, tubers, vegetables, and fruits. An overall strategy designed to prevent and control vitamin A deficiency, xerophthalmia, and nutritional blindness may be defined in terms of action taken in the short, medium, and long term. A short-term, emergency measure includes the administration to vulnerable groups of single, large doses of vitamin A on a periodic basis. In the medium-term, the fortification of a dietary vehicle (e.g., sugar or monosodium glutamate) with vitamin A can be initiated. Increased dietary intake of vitamin A through home gardening and nutrition education programs comprises the longterm solution to this problem. The World Health Organization plans to launch a 10-year program of support to countries where vitamin A deficiency is a significant public health problem.
  3. Vitamin A deficiency disorders: international efforts to control a preventable "pox".
    Visual symptoms (night blindness) of vitamin A deficiency (VAD) were among the earliest diet-related deficiencies documented. Knowledge of vitamin A chemistry, metabolism and deficiency consequences accrued rapidly during the first eight decades of the 20th century. A series of disorders were described in animals, including impaired growth, reproduction, epithelial integrity, and disease resistance that were relieved by consumption of both animal and plant sources of the vitamin. Identification of the intestinal beta-carotene cleavage enzyme in the laboratory of James Allen Olson was seminal to understanding the mechanism for formation of vitamin A from ingested carotenoids. WHO's 1990 estimate of about 40 million children annually with clinical eye signs of VAD was revised upward to 140-250 million at risk of vitamin A deficiency disorders (VADD) when epidemiological and clinical trials demonstrated morbidity and mortality risk even in the absence of ocular signs. Alternative methods for VAD status assessment and more reliable analytical techniques were developed, several in Dr. Olson's laboratory. The last decade has seen global progress in VADD control by expanding distribution of medicinal supplements, fortification of foods and dietary diversification through horticulture and education programs. Experience shows that achievements gained through narrowly focused interventions are fragile and vulnerable to national political and economic instability. Contextually relevant, community-centered strategies that improve household food and nutrition security and self-reliance are critical to sustaining international efforts to control the VADD "pox."
  4. A 2-year longitudinal nutritional survey of 405 Northumberland children initially aged 11.5 years
    Children (405), initially of average age 11.5 years, recorded all food and drinks consumed for three consecutive days (with an interview on the fourth day) on five separate occasions over a 2-year period. Food tables (Paul & Southgate, 1978) enabled nutrient intakes to be calculated. The data collected were found to be of high reliability (Hackett et al. 1983). The mean energy intakes showed broad agreement with other recent British dietary surveys but were well below those recorded in the prewar study by Widdowson (1947) and the FAO/WHO (1973) recommended levels. They were slightly below the current Department of Health and Social Security (DHSS; 1979) recommended intakes. Over the 2-year period, the energy intake of the boys increased by 13% compared with an increase of only 7% in the girls. The iron and vitamin A intakes of all groups of children were low compared with current recommendations (DHSS, 1979). This seems to be a result of falling energy intake. Mean calcium intakes were also only marginally in excess of the recommended intake, and those of most of the girls would fall below the recommendation if the proposal to end the fortification of flour (DHSS, 1981) is implemented
  5. Fortification strategies to meet micronutrient needs: successes and failures
    Food fortification is likely to have played an important role in the current nutritional health and well-being of populations in industrialized countries. Starting in the early part of the 20th century, fortification was used to target specific health conditions: goitre with iodized salt; rickets with vitamin D-fortified milk; beriberi, pellagra and anaemia with B-vitamins and Fe-enriched cereals; more recently, in the USA, risk of pregnancy affected by neural-tube defects with folic acid-fortified cereals. Considerable progress has been made in reducing vitamin A and I deficiencies, although less so with Fe, even as Zn and folic acid deficiencies are emerging as important public health problems. Food fortification based on sound principles and supported by clear policies and regulations can play an increasingly large role in this progress towards prevention and control of micronutrient malnutrition.
  6. Vitamin A deficiency disorders
    The major cause of blindness in children worldwide is xerophthalmia caused by vitamin A deficiency. In addition it has other adverse effects, including increased mortality and the term vitamin A deficiency disorders (VADD) has been introduced to cover the whole clinical spectrum of disease. The ocular manifestations of xerophthalmia have been classified and a set of prevalence criteria for the detection of a problem of public health magnitude has been in use for more than two decades. The global prevalence of VADD is now well documented and World Health Organisation (WHO) receives information continuously for updating its data base on the subject. The pathogenesis of the disease is still imperfectly understood, it is not at all clear precisely why certain subjects in vulnerable communities develop xerophthalmia, while the majority are spared. A schedule for treatment of the established case has been available for a long time, but at both clinic and hospital level concentrated sources of vitamin A for treatment are frequently not available. More emphasis needs to be laid on prevention and a choice of methods consisting of large dose supplementation, fortification of food, control of precipitating infections and dietary improvement. The advantages and drawbacks of each are discussed.

    PIP: This article focuses on xerophthalmia, caused by vitamin A deficiency, which is the major cause of blindness among children worldwide. The term "vitamin A deficiency disorders" (VADD) has been introduced to cover the whole clinical spectrum of disease. The global prevalence of VADD is now well documented and WHO has evidence that the number of young children suffering from subclinical vitamin A deficiency is steadily increasing. Moreover, the pathogenesis of the disease is still imperfectly understood. It is not clear why certain subjects in vulnerable communities develop xerophthalmia, while the majority are spared. Oral preparations of vitamin A are well absorbed and utilized in even severely malnourished patients. A schedule of treatment is given to serve as a guide in the full treatment process. Control of VADD involves a massive dose supplementation, fortification of common foodstuffs with vitamin A, immunization, and dietary improvement. However, each of these methods has drawbacks and advantages.
  7. Subclinical vitamin A deficiency: a potentially unrecognized problem in the United States
    Vitamin A deficiency in its subclinical form is a world health problem in young children. The problem is probably under recognized in the United States and other developed countries who do not normally consider their citizens to be malnourished. Lack of a simple screening test to measure subclinical deficiency adds to this problem. Consequently, focused dietary assessment of vitamin A intake by a Food Frequency Questionnaire (FFQ) is a necessary component of health care maintenance, especially for toddlers and preschool age children. Dietary counseling and vitamin supplementation for high risk children is a necessary health promotion intervention.

Te weinig ijzer in de voeding

  1. Iron intake and iron status among adults in the Netherlands
    Women aged 20-49 are the adult sex-age group with the greatest risk of developing (an early stage of) iron depletion. The most important dietary factors influencing the iron status are the type of iron (haem/non-haem) and factors affecting the bioavailability of iron.
  2. Iron deficiency in Europe
    In Europe, iron deficiency is considered to be one of the main nutritional deficiency disorders affecting large fractions of the population, particularly such physiological groups as children, menstruating women and pregnant women. Some factors such as type of contraception in women, blood donation or minor pathological blood loss (haemorrhoids, gynaecological bleeding...) considerably increase the difficulty of covering iron needs. Moreover, women, especially adolescents consuming low-energy diets, vegetarians and vegans are at high risk of iron deficiency.
  3. Iron deficiency--United States, 1999-2000
    Iron deficiency, the most common nutritional deficiency worldwide, has negative effects on work capacity and on motor and mental development in infants, children, and adolescents, and maternal iron deficiency anemia might cause low birthweight and preterm delivery. Although iron deficiency is more common in developing countries, a significant prevalence was observed in the United States during the early 1990s among certain populations, such as toddlers and females of childbearing age.
  4. Recommendations to prevent and control iron deficiency in the United States. Centers for Disease Control and Prevention
    Iron deficiency is the most common known form of nutritional deficiency. Its prevalence is highest among young children and women of childbearing age (particularly pregnant women). In children, iron deficiency causes developmental delays and behavioral disturbances, and in pregnant women, it increases the risk for a preterm delivery and delivering a low-birthweight baby.
  5. Iron deficiency anaemia--an old enemy
    Anaemia has remained a widespread public health problem in countries of the Eastern Mediterranean Region. Prevalence figures vary from a low of 17% to a high of over 70% among preschool children; from 14% to 42% among adolescents and from 11% to over 40% among women of childbearing age. Although the prevalence of anaemia has often been used as a proxy indicator for iron deficiency anaemia, this approach is not valid in settings where the etiology of anaemia is complex or unknown or where other micronutrient deficiencies of folate, vitamin B12 and vitamin A can co-exist. An integrated, multifactorial and multisectoral approach has to be adopted comprising targeted interventions to provide iron supplements to especially vulnerable segments of the population, in particular pregnant women; food-based approaches to increase iron intake through food fortification and dietary diversification; and other measures combined with iron interventions where other causes of anaemia are prevalent.
  6. Overweight children and adolescents: a risk group for iron deficiency
    In this national sample, overweight children demonstrated an increased prevalence of iron deficiency. Given the increasing numbers of overweight children and the known morbidities of iron deficiency, these findings suggest that guidelines for screening for iron deficiency may need to be modified to include children with elevated BMI.
  7. Anaemia and iron deficiency disease in children
    Iron deficiency is the single most common nutritional disorder world-wide and the main cause of anaemia in infancy, childhood and pregnancy. It is prevalent in most of the developing world and it is probably the only nutritional deficiency of consideration in industrialised countries. In the developing world the prevalence of iron deficiency is high, and is due mainly to a low intake of bioavailable iron. However, in this setting, iron deficiency often co-exists with other conditions such as, malnutrition, vitamin A deficiency, folate deficiency, and infection. In tropical regions, parasitic infestation and haemoglobinopathies are also a common cause of anaemia. In the developed world iron deficiency is mainly a single nutritional problem. The conditions previously mentioned might contribute to the development of iron deficiency or they present difficulties in the laboratory diagnosis of iron deficiency.

Te weinig B-vitamines in de voeding

  1. Folate intake and status among adults in the Netherlands
    The folate intake among adult men and women was adequate in view of recommended daily intakes. However, the folate intake among women did not meet the recommendation for those who want to become pregnant. According to criteria derived from homocysteine metabolism as related to cardiovascular disease, folate status may not be adequate in 60-79% of adult age-sex groups.
  2. Dietary intake among adults with special reference to vitamin B6
    It is concluded that a low vitamin B6 intake is the result of both the quantity (energy) and quality (nutrient density) of the food consumed. The effects of this are not restricted to vitamin B6 and therefore, the low vitamin B6 groups have a combination of relatively low intakes.
  3. Micronutrient status, with special reference to vitamin B6
    Direct biomarkers of vitamin B6 intake confirmed the preselection of a group with a low vitamin B6 intake. The results suggest that the sensitivity of vitamin B6 status parameters for low vitamin B6 intake was highest for the direct vitamin B6 status parameters and lowest for handgripstrength and homocysteine excretion after a methionin load; results for enzyme stimulation coefficients were intermediate. The prevalence of below adequate status parameters for vitamin B2, B6, B12 and C was not more than 7% among the different age-gender groups, with the exception of a value of 16% for plasma PLP levels below 19 nmol/l among men aged 50-79.
  4. Combinations of low thiamin, riboflavin, vitamin B6 and vitamin C intake among Dutch adults. (Dutch Nutrition Surveillance System)
    OBJECTIVE: Clustering of low vitamin intake may entail a greater functional and/or health risk than the summation of separate low intakes may suggest. Therefore, the prevalence of combined low thiamin, riboflavin, vitamin B6 and vitamin C intake in various adult sex-age groups in The Netherlands was estimated. METHODS: Nutritional risks were evaluated by comparing the calculated intakes with the recommendations for each vitamin. For this purpose the data of a subsample of 3353 adults of a nationwide food consumption survey were used, which had been collected in 1987-88 within the framework of the Dutch Nutrition Surveillance System. Food consumption data were obtained through 2-day dietary records. Respondents were segmented into tertiles based on their vitamin intake per 1000 kcal (4.2 MJ) to adjust for energy intake. RESULTS: As compared with the RDAs, mean overall intake was lowest for vitamin B6. Based on tertile analyses, the risk for inadequate intake was relatively high for vitamin C, small for riboflavin and intermediate for thiamin and vitamin B6. Low vitamin densities clustered somewhat since the prevalence of combined low intakes for all four vitamins was higher than expected from probability calculations. This interdependence was mainly the result of a higher consumption of alcoholic beverages and of other food products with a low vitamin density. CONCLUSION: In affluent societies nutritional risk assessment should not be based solely on single vitamins but should also be oriented at combined low intake levels.

Te weinig zink in de voeding

  1. Use of national food balance data to estimate the adequacy of zinc in national food supplies: methodology and regional estimates
    OBJECTIVES: Adequate zinc nutriture is critically important for human health, but the development of programmes to control zinc deficiency is limited by the lack of reliable information on population zinc status. The present analyses were conducted to: (1) estimate the absorbable zinc content of national food supplies; (2) compare this information with theoretical population requirements for zinc; and (3) use these results to predict national risks of inadequate zinc intake. SETTING AND DESIGN: National food balance data were obtained for 176 countries from the Food and Agriculture Organization of the United Nations. The amount of absorbable zinc in these foods was estimated from food composition data, and zinc absorption was predicted using a model developed by the International Zinc Nutrition Consultative Group (IZiNCG). Demographic data were obtained from United Nations estimates, and age- and sex-specific physiological requirements for absorbable zinc were estimated using IZiNCG recommendations. RESULTS AND CONCLUSIONS: The mean per capita absorbable zinc content of national food supplies ranged from 2.98-3.01 mg day(-1) in Western Europe and USA & Canada to 2.09 mg day(-1) in Southeast Asia. The estimated percentage of individuals at risk of inadequate zinc intake ranged from 9.3-9.5% in the regions of North Africa & Eastern Mediterranean and USA & Canada to 33.1% in Southeast Asia. Overall, approximately 20.5% of the world's population is estimated to be at risk of inadequate zinc intake. Data on the absorbable zinc content of national food supplies can be used to determine whether further assessments of population zinc status and development of intervention programmes are warranted.
  2. Clinical and laboratory assessment of zinc deficiency in Dutch children. A review
    From the comparison of the results of three conventional tests of samples taken concurrently (serum, urine, and hair) in groups of Dutch children with symptoms common in Zn deficiency (diarrhea, recurrent infection, or growth retardation), it is estimated that +/- 1% of Dutch children with minor complaints suffer from either acute or subacute Zn deficiency.
  3. Clinical pictures of malnutrition in ill elderly subjects
    The most important deficits affecting ill elderly subjects are those relating to proteins, iron, zinc, selenium, and vitamins B12, B1, B6 and D.
  4. Nutrition and immunity in the elderly: modification of immune responses with nutritional treatments
    Micronutrient deficits, namely of zinc, selenium, and vitamin B-6, all of which are prevalent in aged populations, have the same influence on immune responses. Because aging and malnutrition exert cumulative influences on immune responses, many elderly people have poor cell-mediated immune responses and are therefore at a high risk of infection. Supplementation with high pharmacologic doses of a single nutrient (zinc or vitamin E) may be useful for improving immune responses of self-sufficient elderly people living at home.
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