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- Herausgeber: John Wiley & Sons
- Kategorie: Fachliteratur
- Serie: Bioprocessing in Food Science
- Sprache: Englisch
NUTRITIONAL SCIENCE AND TECHNOLOGY Food science is a rapidly changing and complicated subject. This new series addresses the current state-of-the-art concepts and technologies associated with the industry and will cover new ideas and emerging novel technologies and processes. The book Nutritional Science and Technology: Concept to Application in the series, "Bioprocessing in Food Science," is an excellent resource for any scientist, engineer, student, or other industry professional interested in this topic. It covers a wide range of topics, including human nutrition, technological processes, the health benefits of fermented foods, and food safety concerns. The content contributors and editors are experts in the field, and their primary goal is to provide extensive knowledge about recent technologies in nutritional science and technology to students, researchers, and industry professionals. Manufacturers are looking for new possibilities to occupy a growing share of the rapidly changing food market, and this book will enable them to make informed decisions about adopting appropriate processing technology, implementation, economics, and constraints of different technologies. The book also provides insights on advances in nutritional science and technology for healthy and safe nutrition, with maximum illustrations of how to ensure public health safety and adequate nutrition. Overall, this book is a comprehensive overview of this study area and a valuable resource for anyone interested in this field.
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Veröffentlichungsjahr: 2023
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Table of Contents
Cover
Table of Contents
Series Page
Title Page
Copyright Page
Preface
1 Human Nutrition and Supplements
1.1 Dietary Supplements – Introduction
1.2 Global History of Dietary Supplements
1.3 Usage of Dietary Supplements
1.4 Types of Dietary Supplements
1.5 Nutritional Adequacy and Dietary Diversity
1.6 Calcium and Vitamin D Supplements
1.7 Omega-3 Fatty Acid and Health Benefits
1.8 Zinc Supplementation and Health Benefits
1.9 Iron Supplementation and Health Benefits
1.10 Dietary Supplements and Sports
1.11 Dietary Supplements and FDA
1.12 Dietary Supplements and Toxicity
References
2 Prebiotics, Probiotics and Synbiotics
2.1 Introduction
2.2 Prebiotics and Its Types
2.3 Probiotics
2.4 Synbiotics
2.5 Encapsulation of Probiotics
2.6 Probiotic Foods Developed
References
3 Mechanistic Insights of Dietary Modulation on Gut Microflora and Associated Physiological Changes
3.1 Introduction to Flora in the GIT Tract of Humans-Genus Metabolites
3.2 Association of Gut Flora and its Impact on Human Health and Associated Diseases
3.3 Dietary Modulation of Gut Flora for Therapeutic Usage
3.4 Data from Human and Animal Studies
3.5 Future Prospects and Conclusion
References
4 Nutritional Profile, Functional Characteristics, Health Benefits, and Potential Application of Edible Gum (
Gond
)
4.1 Introduction
4.2 Nutritional Facts of Gond
4.3 Properties of
Gond
4.4 Biological Sources of Gond
4.5 Geographical Sources of Gond
4.6 Benefits of Gond
4.7 Other Uses of Gond
Conclusion
References
5 Omega-3 Fatty Acids: Nutritional Aspects and Their Role in Health and Diseases
5.1 Introduction
5.2 Nomenclature and Types of Omega-3 Fatty Acids
5.3 Food Sources and Supplements
5.4 Intake and Safety of Fatty Acids
5.5 Health Benefits
5.6 Conclusion
References
6 Role of Fermented Dairy Products in Enhancing the Immunity
6.1 Introduction
6.2 Immune Enhancing Potential of Fermented Foods: Mechanism
6.3 Fermented Dairy Products Modulators of Intestinal Microbiota
6.4 Fermented Dairy Products Modulate Immune System
6.5 Future Trends
6.6 Conclusion
References
7 Potential Applications of Nanotechnology in Food Systems: An Overview
7.1 Introduction
7.2 Natural Self-Assembled Food Nanostructures
7.3 Classification of Nanoparticles Applied in Food Industry
7.4 Potential Applications: Nanotechnology in Food Industry
7.5 Nanotoxicity and Health Hazards
7.6 Nanotechnology in Food Industry: Regulatory Issues and Challenges
7.7 Food Nanotech: Future Prospects and Conclusion
References
8 Nutritional Biomarkers in Metabolic Disorders
8.1 Introduction
8.2 Metabolic Syndrome
8.3 Nutritional Biomarkers (NB)
8.4 Factors Affecting the Specificity and Utility of Nutritional Biomarkers
8.5 Role of Different Nutritional Biomarkers (Serum Biomarkers) in Different Metabolic Syndromes
8.6 Novel Biomarkers
8.7 Various Analytical Techniques Related to Different Nutritional Biomarkers
8.8 Level of Biomarkers in Extreme Coronavirus Infection
8.9 Health Biomarkers
8.10 Concept of Omics in Development of New and Integrative Nutritional Biomarkers
8.11 Limitations and Challenges in the Field of Nutritional Biomarkers
8.12 Future Directions and Perspectives
8.13 Conclusions
References
9 Food Safety and Quality Assurance in the Food Chain: Focus on Foodborne Outbreaks
9.1 Introduction
9.2 Classification of Foodborne Diseases by Symptomatology
9.3 The EFSA-ECDC Reports on Zoonoses and Foodborne Outbreaks
9.4 The Notifications from the Rapid Alert System for Food and Feed Portal
9.5 Conclusions
References
10 Emerging Techniques in Food Preservation
10.1 Introduction
10.2 High-Pressure Processing (HPP)
10.3 Pulsed Electric Field (PEF) Processing
10.4 Pulsed Light Technology (PLT)
10.5 Ultrasound Food Processing
10.6 Ohmic Heating of Food
10.7 Cold Plasma
10.8 Oscillating Magnetic Field (OMF)
10.9 Higher Pressure Thermal (HPT) Processing
10.10 Bacteriocins
10.11 Dielectric Heating Using Radio Waves
10.12 Microwaves
10.13 Irradiation
10.14 Conclusion
References
11 Food Omics and Its Implications in Nutritional Sciences
11.1 Food Omics: An Overview
11.2 Techniques in Food Omics
11.3 Food Omics Studies & Their Challenges
11.4 Food Omics: A Platform to Investigate Health Benefits
Conclusions
12 Consumer Viewpoints Regarding Food and Risk Assessment
12.1 Introduction
12.2 Food Safety
12.3 Food Standards and Regulations in India
12.4 The Key Terms Involved in Risk Management
12.5 The Fundamental Principles of Food Safety Risk Management
12.6 Types of Food Risks
12.7 Factors that Modulate Consumers’ Perception of Risk
12.8 Conclusion
References
13 Application of Nanomaterials in Detection of Food Contaminants: A Food Safety Perspective
13.1 Introduction
13.2 Global Scenario from Food Safety Perspective
13.3 Current Food Safety Strategies and Food Safety
13.4 Application of Nanotechnology in Detection of Food Contaminants
13.5 Advancements in Nano-Biosensing of Food Contaminants
13.6 Potential Risks and Future Prospects of Nanomaterials in Food Safety
13.7 Conclusions
References
14 Food Allergy and Food Intolerance
14.1 Introduction
14.2 Food Allergy and Food Intolerance
14.3 Food Allergens
14.4 Types of Food Allergy
14.5 Mechanism of Food Allergy
14.6 Risk Factors Involved in Food Allergy
14.7 Symptoms of Food Allergy
14.8 Diagnosis of Food Allergy
14.9 Treatment of Food Allergy
14.10 Food Intolerance
14.11 Conclusion
References
15 Molecular Nutrition and Nutrient–Gene Interactions
15.1 Introduction
15.2 Molecular Nutrition: Understanding Basic Mechanisms
15.3 Nutrigenetics
15.4 Nutrigenomics
15.5 Nutriepigenomics
15.6 Nutrimetabolomics
15.7 Conclusion and Future Perspectives
References
16 Food Metabolism and Chronic Diseases
16.1 Introduction
16.2 Food Metabolism and Associated Diseases
16.3 Nutrient Intake Goals for Preventing Diet‑Related Chronic Disease
16.4 Conclusion and Future Prospects
References
17 Nanomaterials in Food System
17.1 Introduction
17.2 Nanomaterials as an Emerging Tool
17.3 Nanomaterials in Food Industry
17.4 Conclusion
References
About the Editors
Index
Also of Interest
End User License Agreement
List of Tables
Chapter 1
Table 1.1 Zinc physiological requirement in regard to age group and gender.
Table 1.2 Iron requirement by World Health Organization.
Table 1.3 Types of sports supplements.
Chapter 2
Table 2.1 Principal methods for encapsulating probiotic microorganisms [117].
Table 2.2 Different encapsulating materials used to encapsulate probiotic bact...
Chapter 3
Table 3.1 Different types of diets.
Table 3.2 Effects of modulating gut microbiome: Probiotics [48, 52, 53].
Chapter 4
Table 4.1 Nutritional value of
Gond
.
Table 4.2 Properties of
Gond
.
Table 4.3 Applications of different gums [1, 3, 4, 6, 8–17].
Chapter 5
Table 5.1 Food sources and supplements of omega-3 fatty acids.
Chapter 6
Table 6.1 Listed the fermented dairy product and their role in immune enhancem...
Chapter 8
Table 8.1 Different classes of dietary biomarkers and their intended uses in t...
Table 8.2 Interrelationship between leptin and MeS.
Table 8.3 Adiponectin and MeS interrelationship.
Table 8.4 LAR and the metabolic syndrome.
Table 8.5 Nutritional biomarkers and their corresponding analytical techniques...
Table 8.6 Change in biomarker levels during extreme infection of COVID-19 [87]...
Chapter 9
Table 9.1
Salmonella
foodborne outbreaks data collected from the EFSA-ECDC Rep...
Table 9.2
Campylobacter
foodborne outbreaks data collected from the EFSA-ECDC ...
Table 9.3 Bacterial toxins including
Bacillus
,
Clostridium
and staphylococcal ...
Table 9.4
Listeria monocytogenes
foodborne outbreaks data collected from the E...
Table 9.5 Number of notifications distinguished for pathogens and food categor...
Table 9.6 Classification of notifications for the most represented pathogens b...
Table 9.7 Number of notifications for pathogens from the RASFF Portal in the y...
Chapter 10
Table 10.1 Merits and limitations of various advanced process techniques.
Chapter 13
Table 13.1 Utilization of different nanomaterials in nano-sensing of food path...
Chapter 14
Table 14.1 Difference between food allergy and food intolerance.
Table 14.2 Symptoms of food allergy.
Chapter 15
Table 15.1 Role and diseases caused due to deficiency of vitamins.
Table 15.2 Reports of some nutrigenetics studies conducted for understanding g...
Chapter 16
Table 16.1 Few metabolic disorders associated with carbohydrate metabolism.
Table 16.2 Common food metabolic pathways and associated chronic diseases.
Table 16.3 Dietary intake to maintain a healthy lifestyle.
Chapter 17
Table 17.1 List of different nanomaterials used in nanosensors exploited in th...
Table 17.2 List of products manufactured by different companies integrating na...
List of Illustrations
Chapter 2
Figure 2.1 Guidelines for the safety evaluation of human probiotics.
Figure 2.2 Probiotics as functional foods in enhancing gut immunity.
Figure 2.3 Characteristics of probiotics.
Figure 2.4 Schematic representation of spray-drying mechanism.
Figure 2.5 Encapsulation by spray chilling.
Figure 2.6 Classification and types of probiotic foods.
Chapter 3
Figure 3.1 Composition of microflora in healthy gut.
Figure 3.2 Determinants for the gut microbiota.
Figure 3.3 Potential contributors to the pathogenesis of IBS/IBD [48]. IBS: Ir...
Figure 3.4 Alterations in metabolome and dysregulation of the brain-gut axis [...
Figure 3.5 Alterations in gut microbiota phyla: IBD and NAFLD [49, 51]. IBD: I...
Figure 3.6 Different probiotics species to treat IBS and liver diseases [55]. ...
Chapter 4
Figure 4.1 In butter, deep-fried edible gum (
Gond
) for sweet preparations.
Figure 4.2 Astragalus gummifer.
Figure 4.3 Procedure for making some of the traditional gond sweets.
Figure 4.4 Various types of sweets prepared from gond (a) Gond ke ladoo, (b) G...
Chapter 6
Figure 6.1 The potential role of fermented dairy product in immunomodulation.
Chapter 7
Figure 7.1 Schematic diagram illustrating nanoparticles of relative dimensions...
Figure 7.2 Flowchart demonstrating potential applications of nanotechnology.
Figure 7.3 The general process to obtain kinetically stable nanoemulsion.
Chapter 8
Figure 8.1 Interaction of adipokines, cytokines, and inflammatory markers that...
Figure 8.2 Factors affecting the specificity and utility of nutritional biomar...
Figure 8.3 Factor that regulates level of leptin in the plasma [1].
Figure 8.4 Metabolic balance connected with adiponectin [1].
Figure 8.5 Products formed during oxidation of LDL [1] (Created with BioRender...
Figure 8.6 Involvement of integrative nutritional biomarkers and omics technol...
Chapter 9
Figure 9.1 Potential transmission pathways of foodborne illnesses.
Figure 9.2 Analysis of relevant keywords for foodborne diseases and symptoms f...
Figure 9.3 Number of confirmed human cases of major zoonoses in the EFSA-ECDC ...
Figure 9.4 Countries of origin and number of notifications (equal or major tha...
Figure 9.5 Notifying countries and number of notifications (equal or major tha...
Figure 9.6 Number of notifications for countries resulting both countries of o...
Figure 9.7 Number of notifications for countries resulting both countries of o...
Figure 9.8 Notifications and outbreaks caused by
Salmonella
spp. and different...
Figure 9.9 Classification of food categories causing foodborne outbreaks by
Sa
...
Figure 9.10 Number of notifications for
L. monocytogenes
from the RASFF Portal...
Figure 9.11 Number of notifications for the parasitic infestation with
Anisaki
...
Chapter 10
Figure 10.1 High-pressure processing technology for food preservation.
Figure 10.2 Pulsed electric field processing.
Figure 10.3 Effect of radiations on microbial cells.
Chapter 13
Figure 13.1 Nano materials used in designing nano biosensing detection systems...
Figure 13.2 Strategies used for nano-sensing of pathogens.
Chapter 14
Figure 14.1 Major food allergens.
Figure 14.2 Mechanism of allergic reaction – (a) Sensitization phase (b) Effec...
Figure 14.3 Skin prick test to diagnose food allergy.
Figure 14.4 Blood tests (a) RIST (b) RAST.
Chapter 17
Figure 17.1 Time taken by the food packaging material to get degraded.
Figure 17.2 Processes involved in food industry and integration of nanotechnol...
Figure 17.3 Applications of different nanomaterials in the fields of food indu...
Guide
Cover Page
Series Page
Title Page
Copyright Page
Preface
Table of Contents
Begin Reading
About the Editors
Index
Also of Interest
WILEY END USER LICENSE AGREEMENT
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Scrivener Publishing100 Cummings Center, Suite 541JBeverly, MA 01915-6106
Bioprocessing in Food Science
Series Editor: Anil Panghal, PhD
Scope: Bioprocessing in Food Science a series of volumes covering the entirety of food science, unit operations in food processing, nutrition, food chemistry, microbiology, biotechnology, physics and engineering during harvesting, processing, packaging, food safety, and storage and supply chain of food. The main objectives of this series are to disseminate knowledge pertaining to recent technologies developed in the field of food science and food process engineering to students, researchers and industry people. This will enable them to make crucial decisions regarding adoption, implementation, economics and constraints of the different technologies. Bioprocessing has revolutionised the food industry by allowing for more efficient and sustainable production methods. This comprehensive series focused on microbial fermentation, enzyme technology, genetic engineering, microbial transformations, and bioreactor design. As we continue to face challenges such as population growth and climate change, bioprocessing will play an increasingly important role in ensuring a sustainable food supply for future generations.
Manufacturers are looking for new opportunities to take a significant position in a food market that is continually changing as demand for healthy food rises in the current global environment. In the current scenario, academia, researchers and food industries are working in a scattered manner and different technologies developed at each level are not implemented for the benefits of different stake holders. Compiled reports and knowledge on bioprocessing and food products is a must for industry people. However, the advancements in bioprocesses are required at all levels for betterment of food industries and consumers.
The volumes in this series are comprehensive compilations of all the research that has been carried out so far, their practical applications and the future scope of research and development in the food bioprocessing industry. The novel technologies employed for processing different types of foods, encompassing the background, principles, classification, applications, equipment, effect on foods, legislative issue, technology implementation, constraints, and food and human safety concerns are covered in this series in an orderly fashion. These volumes are comprehensively meeting the knowledge requirements for the curriculum of undergraduate, postgraduate and research students for learning the concepts of bioprocessing in food engineering. Undergraduate, post graduate students and academicians, researchers in academics and in the industry, large- and small-scale manufacturers, national research laboratories, all working in the field of food science, agri-processing and food biotechnology will be benefitted.
Publishers at ScrivenerMartin Scrivener ([email protected])Phillip Carmical ([email protected])
Nutritional Science and Technology
Concept to Application
Edited by
Tejpal DhewaAnil Kumar Puniya
and
Anil Panghal
This edition first published 2023 by John Wiley & Sons, Inc., 111 River Street, Hoboken, NJ 07030, USA and Scrivener Publishing LLC, 100 Cummings Center, Suite 541J, Beverly, MA 01915, USA© 2023 Scrivener Publishing LLCFor more information about Scrivener publications please visit www.scrivenerpublishing.com.
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Library of Congress Cataloging-in-Publication Data
ISBN 9781119808961
Cover images: Dermcidin, Molekuul | Dreamstime.com, Doctor with Microscope, Kurhan | Dreamstime.com, Probiotic Bacteria, Kateryna Kon | Dreamstime.comCover design by Kris Hackerott
Preface
The book, Nutritional Science and Technology: Concept to Application, in the “Bioprocessing in Food Science” series is an up-to-date and comprehensive overview of this area. Written and edited by a team of experts in the field, this book covers topics such as human nutrition, technological processes, the health benefits of fermented foods, and food safety concerns. The book’s primary goal is to provide extensive knowledge about recent technologies in nutritional science and technology to students, researchers, and industry professionals. It will enable them to make informed decisions regarding adopting appropriate processing technology, implementation, economics, and constraints of different technologies. As the demand for healthy, nutritious, and safe food increases, manufacturers are looking for new possibilities to occupy a growing share of the rapidly changing food market.
The book covers a range of emerging topics, from concepts to applications of human nutrition, supplements, gut microbiota, mechanistic aspects of dietary modulation, food metabolism, chronic diseases, health benefits of fermented dairy products, advances in nutritional biomarkers in the detection of metabolic disorders, food omics, their implications in nutritional sciences, nanotechnology in food systems, applications of nanomaterials in the food system, emerging techniques in food preservation, molecular nutrition, nutrient-gene interactions, food allergy and intolerance, and food safety and quality assurance in the food chain. The book also provides insights on advances in nutritional science and technology for healthy and safe nutrition with illustrations of how to ensure public health safety and adequate nutrition. The authors and editors discussed the need for innovative food products, contamination in the food chain, risk assessment, regulatory frameworks, and their challenges within the context of the nutritional sciences in the global food market.
Editors
Tejpal Dhewa
Anil Kumar Puniya
Anil Panghal
1Human Nutrition and Supplements
Mahak Sharma*, Divya Sanghi and Ankita Sharma
Department of Nutrition and Dietetics, Faculty of Allied Health Sciences, Manav Rachna International Institute of Research and Studies, Faridabad, Haryana, India
Abstract
Dietary supplements are isolated or bound nutrients consumed by individuals to improve their nutritional status. They are usually consumed when an individual is deficient in a particular nutrient or wants to increase his/her muscle mass. The ingredients usually used as supplement are amino acid, herbs, minerals, vitamins and enzymes. Dietary supplements are used in the form of softgels, powder, capsules, liquid, and gelcaps. There are many health benefits of dietary supplements like Iron, Zinc, Protein supplements, Vitamin D, Calcium, Omega–3 fatty acids and many more. To maintain optimal growth and development while prevent deficiency, adequate intake is advisable but excess use or high dose cause the possibility of toxicity. This chapter emphasizes various health benefits of dietary supplements and their uses.
Keywords: Food supplements, sports supplements, nutrition, health
1.1 Dietary Supplements – Introduction
There is a broad variety of dietary supplements in the market. More than 56,000 distinct dietary supplements are available, according to the US Food and Drug Administration (FDA), with thousands of new products/ supplements being introduced to customers each year [1].
Dietary supplements, by definition, are formula that can supplement our regular diet with nutrients and reduce the risk of deficiency diseases and health problems like Protein Energy Malnutrition (PEM) and osteoporosis. Dietary supplements can be used as remedy in case of nutrient deficiencies either due to any chronic disease course or lower intake of nutrients but it cannot replace a normal/regular diet and daily nutrients of a meal, which are necessary for a healthy life. Many ingredients, such as herbs/medicinal plants and hormones, are used to make dietary supplements that have not been identified as nutrients or as having any nutritional functions [2]. It was explained that, when labeled correctly, these compounds should be called supplement ingredients rather than drug ingredients.
Along with natural supplements, many synthetic supplements are also in trend. Dietary supplements [3] are presumed healthy, when taken as directed dosages, they do not pose a serious or unreasonable risk of injury or illness. The FDA now regulates the dosage limit, marketing, advertising, and most importantly the labeling of these dietary supplements.
Dietary supplements come in many forms such as pills, capsules, powders, gels and extracts, although the most popular form of consumption is in powder form. They contain many nutrients which are difficult to get from daily normal diet like amino acids, vitamins, minerals, fiber and enzymes.
1.2 Global History of Dietary Supplements
In most countries, supplements are not regulated as a whole. Instead, they are covered under a collection of already existing laws and regulations [4, 5]. That is, they are “hanging from the hook” of pre-existing law. Previously, the dilemma was whether these goods should be classified as medications or foods; however, a third alternative is to classify them as bio-logics under existing rules. The Dietary Supplement Health and Education Act (DSHEA) of 1994 established supplement control in the United States. In the US, the FDA regulates dietary supplements as foods rather than drugs as a result of DSHEA; however, they are treated differently from traditional foods. Even if the ingredients used in supplement preparation can have nutritional benefits or occasionally adverse consequences, they are not tested for protection or effectiveness before being released into the market, unlike drugs. When a nutritional supplement is launched/ available in the market, the FDA has the duty of demonstrating that it is having adverse consequences in order to limit its use or withdraw it from the market. The FDA bases its decision on a “MedWatch” programme in which healthcare professionals have reported supplement-related complications and side effects. Consumers, on the other hand, were expected to notify the FDA of any potential supplement-related side effects. Some nutritional supplements, particularly botanical formulations, and pharmaceuticals were regulated. In most of the countries only those supplements got permitted that met recommended criteria.
1.3 Usage of Dietary Supplements
The usage of dietary supplement is popular in all age groups to get the perfect body image or according to disease course to prevent chronic nutrient deficiencies. Usage of supplements is much more common in Western countries or developed countries in comparison to underdeveloped countries. Ethnographic studies revealed that cultural factors and family rather than individuals also have the impact on potential usage of supplements [6]. Many misconceptions exist in society about the use of iron tablets. Honduran women believe that using iron tablets will result in larger infants, and they are also concerned about gaining too much weight and creating deformities in their children. Due to the low cost of iron tablets, it has little social standing. Tiredness, fatigue, and dizziness were considered common symptoms of pregnancy in India, so women did not seek treatment [7].
There are several research studies that show that various forms of perceiving or responding to public health messages or initiatives may have a substantial effect on their success or failure.
There are also other factors which act as a barrier for usage and selection of different supplements.
1.4 Types of Dietary Supplements
Supplements can be classified in three categories according to ingredients selected for their preparation: 1. Natural Dietary Supplements, 2. Semi-Synthetic Supplements, 3. Synthetic Dietary Supplements.
1.4.1 Natural Dietary Supplements
Natural supplements are made up with original extract of the natural ingredients or botanicals (herbs, fruits, vegetables, etc). No added chemicals are used in preparation of these supplements. These supplements are more expensive in comparison to synthetic supplements.
1.4.2 Semi-Synthetic Supplements
These types of supplements contain some amount of natural ingredients but their nutrient density will depend on the synthetic chemicals also, which are easily prepared in vitro and easily added to natural ingredients to increase the nutrient density of the product. These are a cheaper source of nutrients and sometimes have low bioavailability.
1.4.3 Synthetic Supplements
These types of products are prepared by using all synthetic ingredients in vitro. No natural ingredients are required to prepare these products. Mostly these products contain predigested or simple monomers which can easily be digested and absorbed by the human body. Many differences were reported between certain natural and synthetic vitamins in regard to physiochemical properties, proven clinical advantages of natural vitamins. Recent studies also proved the fact that natural vitamins are nutritionally better than synthetic vitamins [8].
To prove the difference between natural and synthetic supplements, many randomized control trials were conducted. Meinrad Lindschinger [9] in 2019 conducted a trail for effect of B complex vitamins on Homocysteine, Oxidative Stress, and Antioxidant Level and found no statistically noticeable difference between both the groups but some favorable tendencies like more sustainability, and less oxidative stress and homocysteine levels were observed in natural vitamins, which have more sustainability in comparison to synthetic ones.
Apart from this, supplements can also be classified in another way by number of nutrients present in one entity such as single nutrient mineral/ vitamin (high protein, caloric dense, etc.) and multiple micronutrients or having multiple nutrients in single tablet/capsules. Many supplements are available in the market which is targeting organ-specific disease such as kidney disease or liver disease.
The quality of supplement is a challenge; either it is botanical or synthetic, and many adulterants or misidentifications are related to this. Certain categories of supplements, like supplements related to sport and sexual performance, particularly use some unlabeled prohibited substances to deliver “spiking” and even sometimes the addition of active synthetic drugs.
1.5 Nutritional Adequacy and Dietary Diversity
Nutritional Adequacy is defined as a diet providing all the nutrients in balanced form, thus providing adequacy.
A diet is called a diverse diet when it includes various food groups (cereals, pulses, milk products, vegetables, fruits, meat product, etc.), which is important for attaining sufficient nutrient adequacy and sufficient development and body expansion [10, 11, 14].
Dietary diversity is defined as “the number of different foods or food groups consumed over a given reference period” [12, 14]. A diet covering all the food groups in balanced amount will provide adequate macronutri-ents and micronutrients, which could improve overall health especially in schoolchildren and decrease the prevalence of many chronic diseases such as cardiovascular diseases (CVDs), diabetes mellitus, metabolic syndrome and cancers, etc. [13, 14].
The best indicator used for assessing diet quality is Dietary diversity score (DDS), which is linked inversely with risk of chronic diseases [14].
Thus, it is important to focus on dietary diversity as it can help in improving the health status, especially in relation to abdominal obesity and its related diseases [15]. Generally, there is poor dietary diversity leading to poor nutritional adequacy, making it necessary to provide dietary supplements to treat some of the chronic diseases.
1.6 Calcium and Vitamin D Supplements
As the population ages, osteoporosis remains a major public health issue. Calcium and vitamin D have long been identified as essential nutrients for bone health and its maintenance. Adequate doses of calcium and vitamin D are important for patients with bone loss. Unfortunately, around 90% of women are not getting adequate calcium and more than 50% of women getting treatment for bone loss may have inadequate levels of vitamin D [16, 17].
The most important element in the body is Calcium, which is essential for many cell functions. Apart from bone health, Calcium plays an essential role in blood coagulation, neuromuscular activity and normal cardiac function apart from bone function.
It is an important part of the architecture of bone and is required for bone mineral deposition for the entire life. The majority of the calcium (99%) is in the bones and teeth plasma and extracellular fluid (ECF) also contains some amount of calcium. High or low levels of plasma calcium indicate positive or negative calcium balance. Bone resorption increases to restore plasma levels, if the plasma level decreases. Sufficient calcium intake is important to maintain the balance. With the help of vitamin D, calcium is adequately absorbed in small intestines [18, 19].
At around the age of 30, the peak bone mass is adequately achieved; therefore, sufficient physical activity and taking the recommended doses of vitamin D and calcium in adolescence and young adulthood helps in ensuring adequate bone mass development [19]. Therefore, to ensure adequate intake of calcium, a lot of calcium supplements are readily available for all age groups.
The Calcium Carbonate and Calcium Citrate are the two most popular calcium supplements. These supplements have been observed to be adequately utilized when taken with any food [19, 20].
Among the calcium salts, Calcium carbonate supplements provide maximum percentage of elemental calcium. Calcium carbonate has composition of 40% of elemental calcium in comparison to 21% of elemental calcium present in calcium citrate. Around 13% of it is found in calcium lactate, and around 9% is found in calcium gluconate [19, 21].
Vitamin D is another necessary nutrient required for maintaining bone health. The most important function of vitamin D is intestinal calcium absorption regulation along with the stimulation of bone resorption leading to the serum calcium concentration maintenance [19, 22]. The main sources of vitamin D are sunlight, diet, and supplements. Some studies have shown that around 90% of people between the ages of 50 to 70 years do not receive adequate vitamin D from the diet they consume [19, 23].
Calcium intake influences optimal intake of vitamin D. High intake of dietary calcium along with vitamin D is required for optimum bone health [19, 24]. Patients can be counseled regarding intake of calcium supplements, which also contain vitamin D, and through this adequate supplementation can be achieved.
Therefore, proper nutrition education about healthy lifestyle, with intake of adequate vitamin D and calcium along with proper physical activity can prevent bone loss and osteoporosis. This nutrition education can be given from time to time to all age groups since bone loss increases as the age progresses [19].
Proper bone health is not maintained by many people as they do not receive an adequate amount of nutrition, although there are a variety of dietary sources of the two nutrients. Also, a very limited amount of vitamin D is synthesized from the skin since people have been made more aware of the damaging effects of sunlight. Therefore, people have to depend on the supplements to meet the amounts necessary for bone health [19].
1.7 Omega-3 Fatty Acid and Health Benefits
Since the 1900s, cardiovascular diseases (CVDs) are the main reason behind morbidity along with mortality worldwide.
The most used dietary supplements are probiotics, which are the fastest-growing supplements along with fish oil (Omega-3 fatty acids), multivitamins, Vitamin D, and coenzyme Q10 (CoQ10), in that order.
Providing multi-vitamin supplementation helps in reducing cardiovascular events; occurrence of coronary artery disease, a trial fibrillation and heart failure is directly linked with Vitamin D levels; CoQ10 deficiency is linked to myocardial dysfunction and with statin myopathy. It is recommended to take probiotics for lowering blood pressure and circulating lipids. However, studies done on the effects of dietary supplementations are not adequately quoted, as people believe that dietary supplements have a beneficial effect in maintaining a healthier diet and lifestyle, but rare randomized studies performed could not prove this [25].
Consumption of two fatty acids per week, i.e., 0.3-0.5 grams of eicos-apentaenoic acid and docosahexaenoic acid per day is recommended since omega-3 fatty acids intake is found beneficial in decreasing the levels of triglyceride, blood pressure, platelet aggregation, arrhythmia, and athero-genesis [26].
Recent studies have shown that increased intake of LCn3 can slightly reduce the risk of coronary heart disease mortality, and reduce serum triglycerides. Increasing ALA reduces the risk of cardiovascular events and arrhythmia slightly [27].
1.8 Zinc Supplementation and Health Benefits
The biological growth of the human body, immune function, cell proliferation, enzyme functioning, gene expressions, genome stability, reproductive functions, and stabilization of DNA are some of the vital functions of a trace element called Zinc. Zinc plays a very important role in maintaining the homeostasis of the human being. In categorical pattern, the role of this trace element is grouped into three major functions – Zinc acts like a catalyst, it has structural functions and regulatory functions [28]. The effective absorption is less of the Zinc present in solid food and varies depending on the diet composition; therefore Zinc supplement administered is done in aqueous solutions and has great absorption of around 60-70% [29].
To estimate the average physiological requirement of Zinc, a factorial method was used, keeping in mind the absorption of zinc and losses through both intestinal and non-intestinal pathways as represented in Table 1.1.
The “Zinc deficiency” is more prevalent in young children, as required for their growth and development, in adolescents for pubertal growth spurt, and during pregnancy and lactation period, as Zinc is essential for infant growth. The elderly population also take insufficient amount of Zinc required by the body. The statistics states that 13% of mortality and 4% of global child morbidity is prevalent because of the deficiency of Zinc.
Table 1.1 Zinc physiological requirement in regard to age group and gender.
Variables age
Who
Variables age
FNB
IZINCG
Reference wt. (kg)
Requirement (mg/day)
Reference wt. (kg)
Requirement (mg/day)
Reference wt. (kg)
Requirement (mg/day)
6-12 mo
9
0.84
6-12 mo
9
0.84
9
0.84
1-3 year
12
0.83
1-3 year
13
0.74
12
0.53
3-6 year
17
0.97
4-8 year
22
1.20
21
0.83
6-10 year
25
1.12
10-12 year
35
1.40
8-13 year
40
2.12
38
1.53
12-15 year
48
1.82
15-18 year M
64
1.97
14-18 year M
64
3.37
64
2.52
15-18 year F
55
1.54
14-18 year F
57
3.02
56
1.98
Pregnancy
-
2.27
Pregnancy*
-
4.1-5.0
-
2.68
Lactation
-
2.89
Lactation*
-
3.8-4.5
-
2.98
*Different stages of pregnancy/lactation. WHO=World Health Organization; FNB=Food and Nutrition Board;
IZiNCG=International Zinc Nutrition Consultative Group
International Zinc Nutrition Consultative Group (IZiNCG) [30].
Ota E. et al. (2015) conducted a review that includes data from 21 randomized controlled trials (RCTs) with a sample size of 17,000 women and their infants. The data revealed that the supplementation of Zinc during pregnancy leads to a relative reduction of 14% in birth of preterm infants with placebo, but no other beneficial evidence was discovered regarding intake of zinc supplementation during pregnancy [31].
The deficiency of Zinc can lead to growth retardation, hypo-gonadism, hepato-megaly, spleno-megaly, wrinkled and dried skin, and severe iron deficiency anemia [32]. Severe immune deficiency can also develop and can cause many fatal infections before 25 years of age [33]. Recent studies also indicated that a decrease in cell–mediated and humoral immune response and increased susceptibility to infections like diarrheic diseases is observed in Zinc deficient patients. Administration of zinc in acute diarrhea conditions was found to be a beneficial therapeutic remedy in children [34, 35]. A recent research [36] stated a positive impact of Zinc supplementation in conditions like pneumonia and acute diarrhea. The mortality rate in children due to diarrhea has been reduced by supplementation of Zinc in developing countries over a period of less than five years. Zinc supplementation also has a beneficial effect on conditions like “enteropathicacroder-matitis, Wilson’s, chronic hepatitis C, shigellosis, leprosy, leishmaniasis” and the common cold [37, 38].
Recent studies indicated the increased risk of neuro-degenerative disorders, affecting “neurogenesis” and increasing “neuronal apoptosis” due to the deficiency of Zinc, which further can lead to difficulty in understanding and increasing forgetfulness. This further links zinc deficiency with cerebral-aging, depression, anxiety, Alzheimer’s disease and Parkinson’s disease [39–41].
1.9 Iron Supplementation and Health Benefits
As compared to zinc, an abundance of iron is present on earth [42, 43], and every living organism requires iron biologically for proper development, growth and functioning of the human body [44, 45]. Even if it is present in abundant amounts, Iron in the environment act like a growth-limiting [43]. Iron in the presence of oxygen forms oxides, becomes insoluble in nature, and is thus unavailable for uptake by living organisms [42]. In the human body, Hemoglobin contains iron, and is present in bound form. Iron is bound to a protein called hemoprotein as heme compounds [46]. Iron is essential for formation of hemo-globin and myo-globin, which carries oxygen and transport throughout the human body. Almost 2/3rds of the human body’s Iron is used for circulating erythrocytes in the living organism and 15% of iron is bound to myoglobin in muscle tissue. The presence of Iron is required even for the synthesis of heme-enzymes and many other iron containing enzymes [46, 47]. Around 25% of Iron is present in mobilizable iron store [48].
Breast milk contains very little amount of Iron, which is sufficient in early infancy. 0.7 – 0.9 mg/day iron is required by the infant from 4-6 months after birth till the remaining part of the first year as represented in the Table 1.2. A double amount of Iron is required between the age of 1 and 6 years. During the period of growth spurts in adolescents, there is an increase in demand for Iron by the human body [49].
1 to 3 gms of iron is stored in the body of an average adult. The intake by diet and loss of iron needs to be balanced by the human body. The shedding of cells from the mucosal surface and skin leads to a loss of about 1 mg of iron [50]. Among premenopausal female adults, an average loss of 2 mg per day of Iron takes place due to menstruation [51]. The enhancement of human body mass during the neonatal stage and for growth and development in the childhood stage transiently boosts iron requirements [52].
When the supply of Iron is compromised, including the erythron, the medical condition is defined as Iron deficiency. Iron deficiency also takes place due to no mobilizable iron stores [53]. Iron deficiency can be present in human beings with or without anemia. The development of Anemia can cause many functional defects which include cerebral development, immune system, and work capacity [42, 54–56]. Deficiency of Iron during the different stages of pregnancy is correlated with negative outcomes for both maternal health and neonatal health, including high risk of infection, maternal-mortality, low birth weight infants and peri-natal mortality [57].
The depletion of Iron stores, and the body not being able to supply enough iron as compared to the metabolic demands to replenish the iron loss and to sustain development of the human being, become the major cause of iron deficiency [42]. Lack of consumption of bio-available iron and impaired absorption of Iron are also considered to be one of the primary causes of Iron deficiency [58, 59].
Iron supplementation is one of the major strategies which is used to treat Iron deficiency among populations with different age groups. “Ferrous iron salts (ferrous sulfate and ferrous gluconate)” are used for oral iron supplementation, due to their high bioavailability and low cost [60]. The best way to take an iron supplement is to take it on an empty stomach as the iron absorption is higher during that stage but can cause nausea and epi-gastric pain due to the high iron dosage (usually 60 mg Fe/day) [61]. In developing countries, during pregnancy, Iron supplementation is advisable due to the low iron stores in the human body [62].
Table 1.2 Iron requirement by World Health Organization.
Age/sex
mg/day
b
4-12 months
0.96
12-24 months
0.61
2-5 years
0.70
6-11 years
1.17
12-16 years (girls)
2.02
12-16 years (boys)
1.82
Adult males
Pregnant women
c
1.14
First trimester
0.8
Second and third trimester
6.3
Lactating women
1.31
Menstruating women
2.38
Postmenopausal women
0.96
Iron requirements of 97.5% of individuals in terms of absorbed irona, by age group and sex (World Health Organization, 1989).
aAbsorbed iron is the fraction that passes from the gastrointestinal tract into the body for further use. bCalculated on the basis of median weight for age. cRequirements during pregnancy depend on the woman’s iron status prior to pregnancy [49].
1.10 Dietary Supplements and Sports
Dietary supplements are isolated or bound nutrients consumed by the individuals to improve their nutritional status. They are usually consumed when an individual is deficient in a particular nutrient or wants to increase his/her muscle mass. The ingredients usually used as supplement are amino acid, herbs, minerals, vitamins and enzymes. Dietary supplements are used in the form of “softgels, powder, capsules, liquid, and gelcaps”.
In today’s era of sports competition and zeal, it is a common false belief of athletes that supplement consumption will magically improve their performance. But experts on sports nutrition still emphasize a well-balanced diet. The human body’s requirement for vitamins and minerals can be met easily by consumption of fruits and vegetables (yellow orange, red, deep green, and blue). Moreover, they contribute to the body’s antioxidant pool and reduce oxidative stress. Scientific studies have revealed that taking extra vitamins and minerals supplements has no role in increase of muscle mass, strength or VO2 max. An athlete should consume five to nine servings of fruit and vegetables in a day. Egg, meat, milk and milk products are wholesome foods containing both vitamins and minerals in good amount. It is good nutrition and sound training techniques that yield improvements and better performance rather than supplements. Intense training and balanced nutrition and diet should be the first priority in an athlete’s nutrition program.
As per the DSHEA, dietary supplements should be well labelled as per the guidelines and should be identified as “Dietary supplement and not drug”. Among the various forms of supplements, proteins are the commonest choice for athletes. Here are three common forms of protein supplements:
1.10.1 Protein Concentrates
They are the product of protein extraction by heat and acid or enzymes. They have 60-80% protein; the other 20-40% is fats and carbohydrates.
1.10.2 Protein Isolates
Further filtration of concentrates separates large amount of fats and carbohydrates, and concentrates the amount of protein. Protein-isolate powders have around 90–95% protein.
1.10.3 Protein Hydrolysates
Further by the use of acid or enzyme and by heating of isolates detached the amino acids bonding which produces hydrolysates. They are absorbed more quickly by the body [63].
Protein supplements can also be classified on the basis of their source. Some of most available in the market are given in Table 1.3 below.
Table 1.3 Types of sports supplements.
Type of supplements
Benefits
Limitations
Milk Protein
Contains both slow and fast proteins
Has 80% casein (slow) and 20% whey (fast) protein
Less expensive
Other nutrients are also there
Contain fats and cholesterol
Shelf life is less
Not suitable for lactose intolerant person
Whey protein
Contains fast proteins
They are rapidly digested
Highest amount of BCAA, increase muscle growth and repair
Less muscle fatigue and wasting
Protein powder needs to be mixed with water
Soy Protein
Comparable to animal protein
Also a fast protein
Some forms may contain isoflavones
May not build muscles as that of whey and casein
Taste may be unfamiliar to athlete
Egg protein
Perfect protein due to essential amino acid profile
Contains all 13 essential nutrients
Cholestrol and fat is not present in egg whites
Half of the protein is present in egg yolk but its also high in cholesterol. Salmonella bacteria can develop easily in raw eggs.
May be allergic for some
1.11 Dietary Supplements and FDA
The formulation and regulation of dietary supplements is taken care of by FDA. The regulations are applied by FDA in different sets, covering “conventional” foods and “drug products”. Under the Dietary Supplement Health and Education Act (DSHEA) of 1994:
1.11.1 Manufacturers and distributors of adulterated or misbranded dietary supplements and dietary ingredients – market products are prohibited. This means that the responsibility of a particular company for evaluating and testing the product for safety and correct product labelling has to be done before marketing to make sure that the product satisfies all the requirements of DSHEA and FDA regulations.
1.11.2 Any adulterated or misbranded dietary supplement product that reaches the market is the responsibility of the FDA to take action on it.
Dietary supplements includes both liquid and solid external substances. So before jumping to supplement types, it is important for sports nutrition students to understand fluid and its importance.
1.12 Dietary Supplements and Toxicity
In today’s scenario, it has been observed that there is a growing trend of increased intake of multi-vitamin/multi-mineral supplements in developed countries [64, 65]. As reported by the study, 33% of US adults consume multi-vitamin and multi-mineral supplements [66] and intake is high among “male military personnel” (32–47%) and among “military women” 32–47%) [67]. About 64-81% of “long-term cancer survivors”, consume large amounts of multi-vitamin and mineral supplements [66]. To maintain optimal growth and development and prevent deficiency, adequate intake is advisable but excess use or high dose cause the possibility of toxicity [68]. The dosage of pyridoxine (vitamin B6) higher than 500 mg/d reported the conditions of Photo-sensitivity and neuro-toxicity. Vitamin E doses of 800–1200 mg/d can cause bleeding which is further associated with anti-platelet action, and dosage more than 1200 mg/d give the symptoms of acute diarrhea, muscle cramping, cloudy vision, and gonadal dysfunction [69]. Excess intake of vitamin A is also linked with toxicity. In two large clinical trials, the “Retinol Efficacy Trial” [70] and the “ATBC study” [71], the increased risk of lung cancer is associated with male smokers consuming β-carotene supplements. The ABTC study reported the increased mortality and incidence of prostate cancer in male alcohol users consuming the β-carotene supplement. The consumption of “fish liver oils” having vitamin A and multi-vitamin supplements in them can cause hypervitaminosis A [72, 73].
References
1. A. Sarubin,
The Health Professional's Guide to Popular Dietary Supplements
. Chicago, IL: American Dietetic Association, 2000.
2. M.C. Nesheim, What is the research base for the use of dietary supplements?
Public Health Nutr,
2:35–38, 1999.
3. L.S. Balluz, S.M. Kieszak, R.M. Philen, J. Mulinare, Vitamin and mineral supplement use in the United States: Results from the Third National Health and Nutrition Examination Survey,
Arch Fam Med,
9,258–262, 2000.
4. A. Dickinson, History and overview of DSHEA.
Fitoterapia
, 82, 5–10, 2011.
5. C.L. Taylor, Regulatory frameworks for functional foods and dietary supplements.
Nutr. Rev
, 62, 55–59, 2004.
6. L. Williams, L. Semu, D. Behague, C. Sibale, C.France, A qualitative study of constraints to reducing iron deficiency and anaemia in women of reproductive age in Thyolo district, Malawi MotherCare. John Snow Inc. Arlington, VA, 1996.
7. M.B. Bentley, A. Parekh, Perceptions of anemia and health seeking behavior among women in four Indian states (Technical Working Paper #9) MotherCare, John Snow Inc. Arlington, VA, 1998.
8. R. J. Thiel, Natural vitamins may be superior to synthetic ones,
Med Hypotheses,
55(6), pp. 461-9, 2000.
9. M. Lindschinger, F.Tatzber, W. Schimetta, I. Schmid, B. Lindschinger, G. Cvirn, O. Stanger, E. Lamont, W. Wonisch, A Randomized Pilot Trial to Evaluate the Bioavailability of Natural versus Synthetic Vitamin B Complexes in Healthy Humans and their Effects on Homocysteine, Oxidative Stress, and Antioxidant Levels,
Oxidative Medicine and Cellular Longevity
, 2019
.
10. L.Azadbakht, A.Esmaillzadeh, Diet variety: a measure of nutritional adequacy and health,
J Qazvin Univ Med Sci
, 13, pp. 88–97, 2009.
11. M.Vakili, P.Abedi, M.Sharifi, M.Hosseini, Dietary diversity and its related factors among adolescents: a survey in Ahvaz-Iran,
Glob J Health Sci
, 5, pp. 181–186, 2013.
12. E.H. Pangaribowo, N. Gerber, M. Torero, Food and nutrition security indicators: a review. Bonn: Center for Development Research, 2013.
13. P. Mirmiran, L. Azadbakh, A.Esmaillzadeh, F.Azizi, Dietary diversity score in adolescents - a good indicator of the nutritional adequacy of diets: Tehran lipid and glucose study,
Asia Pac J Clin Nutr
,13, pp. 56–60, 2004.
14. K.F. Tiew, Y.M. Chan, M.S. Lye, S.C. Loke , Factors associated with dietary diversity score among individuals with type 2 diabetes mellitus,
J Health Popul Nutr
, 32, pp. 665–676, 2014.
15. S. M. Nachvak, H. Abdollahzad, R. Mostafai, S. Moradi, Y. Pasdar, M. Rezaei, and S. Esksndari, Dietary Diversity Score and Its Related Factors among Employees of Kermanshah University of Medical Sciences,
Clinical Nutrition Research
, 6(4), pp. 247–255, 2017.
16. (NDC) National Dairy Council, USDA’s Continuing survey of food intakes by individuals, 1994–1996 (online), Accessed on March 22, 2008.
17. M.F. Holick, E.S. Siris, N. Binkley, M.K. Beard, A. Khan, J.T. Katzer, R.A. Petruschke, E. Chen, A.E. de Papp, Prevalence of Vitamin D inadequacy among postmenopausal North American women receiving osteoporosis therapy, J Clin Endocrinol Metab, Jun, 90(6), pp. 3215-24, 2005.
18. F.R. Bringhurst, M.B. Demay,
et al. Harrison’s Principles of Internal Medicine
, 16th ed. II. New York: McGraw Medical Publishing Division, Bone and mineral metabolism in health and disease, pp. 2246–9, 2005.
19. J. A. Sunyecz, The use of calcium and vitamin D in the management of osteoporosis. Therapeutics and
Clinical Risk Management
, 4(4), pp. 827–836, 2008.
20. R.P. Heaney, S.D. Dowell, J. Bierman,
et al.
, Absorbability and cost effectiveness in calcium supplementation,
J Am Coll Nutr
, 20, pp. 239–46, 2001.
21. S.M. Weisman, Calcium connection to bone health across a woman’s lifespan – A roundtable,
J Reprod Med
, 50(11 Suppl), pp. 879–84, 2005.
22. I.R.Reid, Clinical aspects of the use of vitamin D and its metabolites, In: E.S. Orwoll, M. Bliziotes, eds.
Osteoporosis: Pathophysiology and Clinical Management
, Totowa, NJ: Humana Press, pp. 293–307, 2003.
23. C. Moore, M.M. Murphy, D.R. Keast,
et al.
, Vitamin D intake in the United States,
J Am Diet Assoc
,104, pp. 9980–3, 2004.
24. C.M. Weaver, J.C. Fleet, Vitamin D requirements: current and future,
Am J ClinNutr
, 0(suppl), pp. 1735S–9S, 2004.
25. S. Bronzato, A. Durante, Dietary Supplements and Cardiovascular Diseases,
Int J Prev Med
, Sep 17, 9:80, 2018.
26. A. Saremi, R. Arora, The utility of omega-3 fatty acids in cardiovascular disease,
Am J Ther
, Sep-Oct,16(5), pp. 421-36, 2009.
27. A.S. Abdelhamid, T.J. Brown, J.S. Brainard, P. Biswas, G.C. Thorpe, H.J. Moore, K.H. Deane, C.D. Summerbell, H.V. Worthington, F. Song, L. Hooper, Omega-3 fatty acids for the primary and secondary prevention of cardiovascular disease,
Cochrane Database Syst Rev
, Feb 29, 3(2), 2020.
28. R.J.Cousins, Zinc,
Present Knowledge in Nutrition,
7th ed., Washington DC: International Life Science Institute Nutrition Foundation, pp. 293–306, 1996.
29. FAO/WHO, Expert Consultation on Human Vitamin and Mineral Requirements, Vitamin and mineral requirements in human nutrition: Report of joint FAO/WHO expert consolation, 2nd ed. Bangkok, Thailand, pp. 341, 2004.
30. K.H. Brown, J.A. Rivera, Z. Bhutta, R.S. Gibson, J.C. King, B. Lönnerdal, M.T. Ruel, B. Sandtröm, E. Wasantwisut, C. Hotz, International Zinc Nutrition Consultative Group
(IZiNCG)
,
Food Nutr Bull
, 25(1 Suppl 2), pp. S99-203, 2004.
31. E. Ota, R. Mori, P. Middleton, R. Tobe-Gai, K. Mahomed. Zinc supplementation for improving pregnancy and infant outcome. Cochrane Database Syst Rev, 2015 Feb, DOI: 10.1002/14651858.CD000230.pub5
32. A.S. Prasad, Clinical, immunological, anti-inflammatory and antioxidant roles of zinc,
Exp Gerontol,
43(5), pp. 370–7, 2008.
33. A.S. Prasad, Zinc in human health: effect of zinc on immune cells,
Mol Med,
14(5–6), pp. 353–7, 2008.
34. M.J. Tuerk, N. Fazel, Zinc deficiency,
CurrOpin Gastroenterol,
25(2), pp. 136– 43, 2009.
35. A.S. Prasad, Discovery of human zinc deficiency: its impact on human health and disease
Adv Nut,
4(2), pp. 176–90, 2003.
36. M.Y. Yakoob, E. Theodoratou, A. Jabeen, A. Imdab, T.P. Eisele, J. Ferguson, Preventive zinc supplementation in developing countries: impact on mortality and morbidity due to diarrhea, pneumonia and malaria,
BMC Public Health,
11 (Suppl 3), pp. 3–23, 2011.
37. A.S. Prasad, Impact of the discovery of human zinc deficiency on health,
J Am CollNutr,
28(3), pp. 257–65, 2009.
38. J. Hui, N.L. Tang, Wilson’s disease: a review of treatment options with a focus on zinc therapy
, Orphan Drugs ,
2, pp. 35–45, 2012.
39. B. Szewczyk, Zinc homeostasis and neurodegenerative disorders,
Front Ageing Neurosci,
5, pp. 33, 2013. doi: 10.3389/fnagi2013.00033.
40. M.L. Plum, L. Rink, H. Haase, The essential toxin: impact of zinc on human health,
Int J Environ Res Public Health,
7(4), pp. 1342–65, 2010.
41. G.L. Brewer, S.H. Kanzer, E.A. Zimmerman, E.S. Molho, D.F. Celmins, S.M. Heckman, Subclinical zinc deficiency in Alzheimer’s disease and Parkinson’s disease,
Am J Alzheimers Dis Other Demen,
25(7), pp. 572–5, 2010.
42. R.J. Wood, A, Ronnenberg. Iron, Shils ME, Shike M, Ross AC, Caballero B, Cousins RJ, editors,
Modern Nutrition in Health and Disease,
10th edition, Baltimore: Lippincott Williams & Wilkins, pp. 248–70, 2005.
43. A.G. Quintero-Gutiérrez, G. González-Rosendo, J. Sánchez-Muñoz, J. Polo-Pozo, J.J. Rodríguez-Jerez, Bioavailability of heme iron in biscuit filling using piglets as an animal model for humans,
Int J Biol Sc,
4, pp. 58–62, 2008.
44. P. Aisen, C. Enns, M. Wessling-Resnick, Chemistry and biology of eukaryotic iron metabolism,
Int J Biochem Cell Biol,
33, pp. 940–59, 2001.
45. P.T. Lieu, M. Heiskala, P.A. Peterson, Y. Yang
,
The roles of iron in health and disease,
Mol Aspects Med,
2, pp. 1–87, 2001.
46. L.R. McDowell, Amsterdam: Elsevier Science,
Minerals in Animal And Human Nutrition
, 2nd edition, pp. 660, 2003.
47. R.F. Hurrell, Bioavailability of iron,
Eur J ClinNutr,
51, pp. S4–8, 1997.
48. Institute of Medicine, Iron, In:
Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc, Washington, DC
: National Academy Press, pp. 290–393, 2001.
49. FAO/WHO. Expert Consultation on Human Vitamin and Mineral Requirements, Vitamin and mineral requirements in human nutrition: Report of joint FAO/WHO expert consolation, 2nd ed. Bangkok, pp. 341, 2004.
50. J.D. Cook, B.S. Skikne, S.R. Lynch, M.E. Reusser, Estimates of iron sufficiency in the US population,
Blood,
68, pp. 726–31, 1986.
51. T.H. Bothwell, R.W. Charlton, A general approach of the problems of iron deficiency and iron overload in the population at large,
SeminHematol,
19, pp. 54–67, 1982.
52. R.S. Gibson, A.C. MacDonald, P.D. Smit-Vanderkooy, Serum ferritin and dietary iron parameters in a sample of Canadian preschool children,
J Can Dietetic Assoc,
49, pp. 23–8, 1988.
53. WHO/UNICEF/UNU,
Iron Deficiency Anemia Assessment, Prevention, and Control
, p. 114, 2001.
54. J.L. Beard, J.R. Connor, Iron status and neural functioning,
Annu Rev Nutr
, 23, pp. 41–58, 2003.
55. M.L. Failla, Trace elements and host defense: Recent advances and continuing challenges,
JNutr,
133, S1443–7, 2003.
56. F.E. Viteri, B. Torun, Anemia and physical work capacity, In: Garby L, editor,
Clinics in Hematology,
Vol. 3. London: WB Saunders, pp. 609–26, 1974.
57. CDC, Breastfeeding Report Card, United States: Outcome Indicators Publication, from Centers for Disease Control and Prevention, National Immunization Survey, 2010.
58. E.S. Cooper, D.A. Bundy, Trichuriasis.
Ballieres, Clin Trop Med Commun Dis,
2, 629–43, 1987.
59. R. Larocque, M. Casapia, E. Gotuzzo, T.W. Gyorkos, Relationship between intensity of soil-transmitted helminth infections and anemia during pregnancy,
Am J Trop Med Hyg,
73, pp. 783–9, 2005.
60. M.B. Zimmermann, R.F. Hurrell, Nutritional iron deficiency,
Lancet,
370, pp. 115–20, 2007.
