Entomophagy (eating edible insects) could potentially address human deficiencies of iron, zinc and vitamin B12. This article aims to summarize available evidence about iron, zinc and vitamin B12 content of raw and processed edible insects and these contents compared with nutritional needs of different human life stages. A systematic literature search using specific key words (edible insects, iron content, zinc content, vitamin B12 content, and nutritional composition) in Web of Science and Scopus databases was performed. Forty six studies were reviewed. To ensure standardized comparisons, articles with nutrient-enriched edible insects were excluded. The quality of records was assessed using standardized protocols. Results indicate that edible insects are generally either “sources of” or “rich in” iron, zinc and vitamin B12 required for optimal nutrition and health of different human life stages. Moreover, iron, zinc and vitamin B12 content of edible insect species were generally either comparable to or higher than that of lean (beef, pork), poultry and kidney beans. Most insect species were oven processed with little/no species specific data for other processing methods. Variations in micronutrient content existed between processing methods and among oven processed edible insects. Data inaccuracies, poor data quality control and lack of insect-specific official analytical methods contributed to fairly high variations and made comparisons difficult. Based on available data, edible insects can potentially address human deficiencies of iron, zinc and vitamin B12, despite the observed variations, data gaps, lack of edible insect matrix-specific official methods in addition to limited human bioavailability and efficacy studies.

The clinical effectiveness of bariatric surgery has encouraged the use of bariatric procedures for the treatment of morbid obesity and its comorbidities, with sleeve gastrectomy and Roux-en-Y gastric bypass being the most common procedures. Notwithstanding its success, bariatric procedures are recognised to predispose the development of nutritional deficiencies. A framework is proposed that provides clarity regarding the immediate role of diet, the gastrointestinal tract and the medical state of the patient in the development of nutritional deficiencies after bariatric surgery, while highlighting different enabling resources that may contribute. Untreated, these nutritional deficiencies can progress in the short term into haematological, muscular and neurological complications and in the long term into skeletal complications. In this review, we explore the development of nutritional deficiencies after bariatric surgery through a newly developed conceptual framework. An in-depth understanding will enable the optimisation of the post-operative follow-up, including detecting clinical signs of complications, screening for laboratory abnormalities and treating nutritional deficiencies.

A major challenge in dietary assessment is the manual pre-processing of dietary data. Digital food registration via online platforms that are coupled to large food databases can automate this process. The accuracy of such platforms depends on the quality of the associated food database. In this study we validated the database of MyFitnessPal (MFP) versus the Belgian food composition database Nubel.

Fifty participants collected a 4-day dietary record using MFP at 2 time points, T1 and T2. Nutrient intake values extracted from MFP at T1 were used as training set to define a cut-off for each parameter (energy intake (EI), carbohydrates (CH), fat (F), protein (P), fibre (Fi), sugar (S), cholesterol (Ch) and sodium (So)) by optimising correlation with Nubel calculated values. Application of these criteria to the values extracted at T2 (n = 2826) resulted in rejection rate of 2.8%. The remaining values were correlated (Pearson or Spearman) with the Nubel calculated values. Fixed and proportional biases were traced using Bland-Altman analysis and impact on sample size was estimated from a power simulation.

MFP demonstrated strong correlation with the Nubel database for EI (r = 0.95), CH (r = 0.90), F (r = 0.90), P (r = 0.88), Fi (r = 0.80) and S (r = 0.77), but weak correlations for Ch (ρ = 0.51) and So (ρ = 0.53); all p < 0.001. Bland-Altman analysis showed no fixed bias between both methods, whereas a proportional bias was found for cholesterol. A practical implication is a loss of statistical power by 5–10% for EI and macronutrients compared to the Nubel database and the need to increase sample size accordingly.

We conclude that dietary analysis with MFP is accurate and efficient for total energy intake, macronutrients, fibre and sugar, but not for cholesterol and sodium

The increasing worldwide prevalence of obesity is a major public health concern, which has led to the development of surgical treatment strategies that achieve long-term sustainable weight loss and improvement of comorbidities and quality of life. However, nonsurgical complications can occur which sometimes necessitate hospital readmission depending on the severity. Current literature about hospital admission for nonsurgical complications after bariatric surgery is especially sparse. We performed a 5-year retrospective analysis of patients admitted for nonsurgical complications after bariatric surgery at the Department of Endocrinology, University Hospitals Leuven (Belgium). Patient and readmission characteristics were described by type of first bariatric surgery performed, time after first surgery, amount of bariatric surgeries in total, reason for hospitalization (nutritional, functional, psychological, metabolic and medical), need for parenteral and enteral feeding during hospitalization and duration of hospitalization. In a period of five years, there were 152 hospitalizations of 107 patients (86% females). The majority of patients (53%) underwent Roux-en-Y gastric bypass (RYGB) and had in total 1 (1–2) bariatric procedures. The median BMI before the first bariatric procedure was 40.7 (37.9–46.7) kg/m2. Patients were admitted 7.6 (3.4–13.1) years after surgery at an average age of 49 ± 12 years. Nutritional (66.4%), functional (37.5%) and co-presenting nutritional-functional (25.0%) problems were the most important reasons for hospitalization. In regard to the nutritional complications, the most important reasons for hospital admission were dumping syndrome (19.7%), macro- and micronutrient deficiencies (16.4%), bad compliance to prescribed nutritional guidelines (14.5%), anorexia (11.2%), extensive weight loss (10.5%) and failure to thrive (9.2%). During hospitalization, parenteral and enteral feeding was started in 19.1% and 9.9% of hospitalizations, respectively. The median duration of all hospitalizations was 8 (4–13) days. To conclude, the majority of hospitalized patients underwent RYGB and was female. Most patients were admitted late after surgery and nutritional problems were the most common complication. Nonsurgical complications after bariatric surgery are a clear illustration of the double-edged sword of surgical obesity management. The exact gastrointestinal anatomical and physiological changes provide the intended effect of weight loss, but may also elicit unintended imbalances of excessive losses of nutrients that compromise the outcome. Our findings demonstrate the need for lifelong multidisciplinary follow-up of lifestyle behavior and education on diet both before and after bariatric surgery.

Urban sub-Saharan Africa is in a nutrition transition shifting towards consumption of energy-dense nutrient-poor diets and decreasing physical activity. Determinants of nutrition transition in sub-Saharan Africa are presently not well understood. The objective of this review was to synthesise available data on determinants of dietary and physical activity behaviours among women of reproductive age in urban sub-Saharan Africa according to the socio-ecological framework. We searched MEDLINE, Embase, Scopus, Web of Science and bibliographies of included articles for qualitative, observational and randomised controlled studies published in English from January 2000 to September 2018. Studies conducted within general populations of women aged 18–49 years were included. Searches were according to a predefined protocol published on PROSPERO (ID = CRD42018108532). Two reviewers independently screened identified studies. From a total of 9853 unique references, twenty-three studies were retained and were mainly from South and West Africa. No rigorous designed quantitative study was identified. Hence, data synthesis was narrative. Notable determinants of dietary behaviour included: convenience, finances, social network, food skills and knowledge gaps, food deserts and culture. Cultural beliefs include strong relationship between high social status and weight gain, energy-dense confectionery, salt or fat-rich foods. Physical activity is influenced by the fast-changing transport environment and cultural beliefs which instigate unfavourable gender stereotypes. Studies with rigorous qualitative and quantitative designs are required to validate and develop the proposed frameworks further, especially within East Africa. Nevertheless, available insights suggest a need for comprehensive skill-based interventions focusing on socio-cultural misconceptions and financial limitations.

The growing prevalence of obesity explains the rising interest in bariatric surgery. Compared with non-surgical treatment options, bariatric surgery results in greater and sustained improvements in weight loss, obesity associated complications, all-cause mortality and quality of life. These encouraging metabolic and weight effects come with a downside, namely the risk of nutritional deficiencies. Particularly striking is the risk to develop iron deficiency. Postoperatively, the prevalence of iron deficiency varies between 18 and 53 % after Roux-en-Y gastric bypass and between 1 and 54 % after sleeve gastrectomy. Therefore, preventive strategies and effective treatment options for iron deficiency are crucial to successfully manage the iron status of patients after bariatric surgery. With this review, we discuss the risks and the contributing factors of developing iron deficiency after bariatric surgery. Furthermore, we highlight the discrepancy in the diagnosis of iron deficiency, iron deficiency anaemia and anaemia and highlight the evidence supporting the current nutritional recommendations in the field of bariatric research. In conclusion, we advocate for more nutrition-related research in patient populations in order to provide strong evidence-based guidelines after bariatric surgery.

The conduct of high-quality nutrition research requires the selection of appropriate markers as outcomes, for example as indicators of food or nutrient intake, nutritional status, health status or disease risk. Such selection requires detailed knowledge of the markers, and consideration of the factors that may influence their measurement, other than the effects of nutritional change. A framework to guide selection of markers within nutrition research studies would be a valuable tool for researchers. A multidisciplinary Expert Group set out to test criteria designed to aid the evaluation of candidate markers for their usefulness in nutrition research and subsequently to develop a scoring system for markers. The proposed criteria were tested using thirteen markers selected from a broad range of nutrition research fields. The result of this testing was a modified list of criteria and a template for evaluating a potential marker against the criteria. Subsequently, a semi-quantitative system for scoring a marker and an associated template were developed. This system will enable the evaluation and comparison of different candidate markers within the same field of nutrition research in order to identify their relative usefulness. The ranking criteria of proven, strong, medium or low are likely to vary according to research setting, research field and the type of tool used to assess the marker and therefore the considerations for scoring need to be determined in a setting-, field- and tool-specific manner. A database of such markers, their interpretation and range of possible values would be valuable to nutrition researchers.

The objective of the present study was to assess the intake of naturally occurring plant sterols and β-carotene via the overall diet of Belgian pre-school children and adults. Two different Belgian food consumption databases were used: (1) one with consumption data of pre-school children (2·5–6·5 years old) and (2) one with consumption data of adults ( ≥ 15 years old). These consumption data were combined with a newly developed database containing the plant sterol and β-carotene content in all relevant food items based on international food composition databases and scientific literature. The results show that Flemish pre-school children have a median plant sterol intake of 172 (interquartile range (IQR) = 47) and 184 (IQR = 52) mg/d for girls and boys, respectively. Their median β-carotene intake was 1857 (IQR = 1250) μg/d, without significant difference between girls and boys. Belgian women and men have a median plant sterol intake of 218 (IQR = 113) and 280 (IQR = 158) mg/d, respectively, and a median β-carotene intake of 2086 (IQR = 1254) μg/d (not significantly different between the sexes). The main food source of naturally occurring plant sterols was bread and other cereal products. For β-carotene, the main food source was vegetables.

The present study describes the consumption of foods enriched with plant sterols (PS) and supplements containing PS, and evaluates PS intakes via the current consumption and for specific consumption scenarios. A market inventory was performed to collate different PS-enriched food items and supplements available in Belgium. An FFQ was developed to investigate the consumption of PS-enriched foods and supplements. A total of 139 pre-school children (2·5–7 years old) and 569 adults (308 women and 261 men) living in Flanders (the northern, Dutch-speaking part of Belgium) participated in the study. Of these, 21 % (Flemish pre-school children) and 28·5 % (Flemish adults) consume PS-enriched food products, leading to a mean PS intake in the consumer group of 0·70 (sd 0·61) g/d for pre-school children and 1·51 (sd 1·42) g/d for adults. Of the adult PS consumers, 23·2 % did not suffer from elevated blood cholesterol levels; 50 % of them had a PS intake less than or equal to 1 g/d and 16·4 % had a PS intake above 3 g/d and 7·8 % even had an intake above 4 g/d. Scenario studies assessed the intake when all Belgian adults would consume PS-enriched margarines without (scenario 1) or with (scenario 2) a daily consumption of a PS-enriched yoghurt drink. This resulted in an intake above 3 g/d in 17 % (women) and 29 % (men) for scenario 1 and 40 % (women) and 53 % (men) for scenario 2. The results indicate that PS-enriched food products are also consumed by the non-target group. Efficient communication tools are needed to inform consumers better about the target group of PS-enriched products, the advised dose per day and alternative dietary strategies to lower the blood cholesterol level.

Relative validity and reproducibility of a semi-quantitative food-frequency questionnaire (FFQ) for measuring preschool children's usual Ca intake were assessed using parents or guardians as a proxy. Estimated diet records (EDR; 3d) were used as the reference method and reproducibility was measured by repeated FFQ administrations 5 weeks apart. From 2095 preschool children (2·5–6·5 years) randomly selected in Flanders (Flemish region of Belgium), 1052 returned a FFQ and EDR. Stringent exclusion procedures reduced the sample for validity analyses to 509 children. From a separate sample of 244 preschool children, 124 returned two FFQ, of whom sixty were included in the reproducibility analysis. Mean Ca intakes were 838 (sd 305) and 777 (sd 296) mg/d for EDR and FFQ respectively, indicating a mean difference of 60·9 (sd 294·4) mg/d (p<0·001). Pearson's correlation was 0·52. Cross-classification analysis of the FFQ and EDR classified 83%of the subjects in the same or adjacent category and 2·4% in extreme quartiles. Actual values for surrogate FFQ quartiles showed a progressive increase in Ca intake (p<0·001). The FFQ correctly identified 77% of the children consuming less Ca than the age-specific RDA (800mg/d). Correlation between repeated administrations was 0·79. No significant difference between mean Ca intakes was established by two administrations (23·8 (sd 161·2) mg/d). Cross-classification of repeated administrations classified 93·4% of the subjects in the same or adjacent category and no subjects in extreme categories. This FFQ tended to underestimate preschool children's Ca intake when administered by a proxy. However, it demonstrated good repeatability and fairly good ability to classify subjects into extremes of Ca intake.