Parameters influencing vitamin D status in the adult Slovenian population

Vitamin D (VitD) je ključen za normalno delovanje telesa, sodeluje pri metabolizmu kalcija in fosforja ter je povezan z dejavniki tveganja za nastanek različnih bolezni. Endogena sinteza VitD v koži ob izpostavitvi ultravijoličnim žarkom tipa B je ključna, medtem ko postane v odsotnosti endogene sinteze glavni vir prehranski vnos. Le malo živil naravno vsebuje VitD, a še tam se pogosto nahaja v manjših koncentracijah. Prehranski vir VitD so tudi živila, obogatena z VitD, in prehranska dopolnila. Cilj doktorskega dela je bil na osnovi serumskih koncentracij 25-hidroksivitamina D (25(OH)D) oceniti preskrbljenost in dejavnike preskrbljenosti z VitD v Sloveniji. Sistematični pregled literature je pokazal visoko razširjenost pomanjkanja, sploh v zimskem času. Nacionalno reprezentativna raziskava Nutrihealth pa je potrdila zaskrbljujoče rezultate. V obdobju podaljšane zime je bilo pomanjkanje ugotovljeno pri 81,6 % odraslih in 78,8 % starejših odraslih, hudo pomanjkanje pri 40,8 % odraslih in 34,6 % starejših odraslih. Dodatno smo preučevali dejavnike, ki vplivajo na preskrbljenost z VitD. Pozimi je bila razširjenost pomanjkanja VitD pogostejša pri tistih z indeksom telesne mase (ITM) nad 30 in tistih s svetlejšo konstitutivno obarvanostjo kože, medtem ko je bila poleti podoptimalna preskrbljenost pogostejša pri tistih z ITM nad 30, tistih s svetlejšo konstitutivno obarvanostjo kože, nižjim prehranskim vnosom VitD, ter tistih ki se pokrivajo z oblačili z namenom zaščite kože pred soncem. Poleg tega je sistematični pregled literature prehranskega vnosa VitD razkril nizke vnose pri vseh populacijah. V sistematični pregled je bila vključena tudi nacionalno reprezentativna raziskava, v sklopu katere je bil vnos VitD 2,7 µg pri mladostnikih, 2,9 µg pri odraslih in 2,5 µg pri starejših odraslih. V okviru doktorskega dela smo ugotovili zaskrbljujočo nizko preskrbljenost z VitD, kar je posledica vpliva različnih dejavnikov, med katerimi izstopajo ITM, konstitutivna obarvanost kože in prehranski vnos. Pomanjkanje VitD pomeni velik javnozdravstveni problem, ki zahteva sistematičen pristop na več nivojih. Pomembno je zasnovati politike in javnozdravstvene ukrepe, ki bodo omejili razširjenost pomanjkanja VitD v Sloveniji.Vitamin D (VitD) is essential for the normal functioning of the body, as it participates in the metabolism of calcium and phosphorus, and the lack of it is associated with risk factors for developing various diseases. Endogenous synthesis of VitD in the skin—which happens upon exposure to ultraviolet B radiation—is a primary source of VitD, while in the absence of this process, the crucial source becomes dietary intake. Only a few foods naturally contain VitD, and even those often contain in smaller quantities. Therefore, fortified foods and dietary supplements can be an important source of VitD. The aim of the doctoral thesis was to assess the VitD status and factors influencing VitD status in Slovenia. A systematic literature review revealed a high prevalence of low VitD status, particularly during the wintertime. The nationally representative Nutrihealth study confirmed alarming results. During an extended winter period, insufficiency was observed in 81.6% of adults and 78.8% of older adults, while deficiency was observed in 40.8% of adults and 34.6% of older adults. Additionally, factors influencing VitD status were investigated. The Nutri-D study has indicated a higher prevalence of deficiency in winter among individuals with higher a body mass index and a lighter constitutive skin color. In contrast, suboptimal levels during summertime were more common in those with a higher body mass index, lighter constitutive skin color, lower dietary VitD intake, and those protecting themselves from the sun with clothing. Furthermore, a systematic review of the dietary VitD intake revealed low intakes across all populations. The SI.Menu research study which was included in the systematic review, reported VitD intake of 2.7 µg in adolescents, 2.9 µg in adults, and 2.5 µg in older adults. In the scope of the doctoral thesis, we identified highly prevalent low VitD status, which was influenced by various factors, especially body mass index, constitutive skin color, and dietary intake. VitD deficiency is a major public health risk, that requires a systematic approach on multiple levels. It is of the utmost importance to design conductive policies and take rigorous public health measures at both individual and national levels to reduce the prevalence of VitD deficiency in Slovenia

The Role of an Injured Party in the Slovenian Criminal Procedure

Doktorska disertacija preučuje vlogo oškodovanca v slovenskem kazenskem postopku. Osredotoča se predvsem na položaj »oškodovanca v ožjem smislu«, ki v kazenskem postopku sodeluje kot aktivni procesni subjekt poleg državnega tožilca, ki izvršuje funkcijo pregona po uradni dolžnosti. V ospredju raziskovanja, ki je umeščeno na področje kazenskega procesnega prava, je analiza oškodovančevih sodelovalnih pravic. Gre za vse tiste pravice, ki oškodovancu v kazenskem postopku omogočajo aktivno sodelovanje in s tem vplivanje na končni izid odločanja o obtožbi. Raziskovanje se dotika tudi podpornih pravic, ki oškodovancu zagotavljajo informiranost, pomoč in zaščito ter na ta način lajšajo njegovo izkušnjo znotraj (in zunaj) kazenskega postopka. Te pravice oškodovancu ne omogočajo neposrednega vplivanja na izid kazenskega postopka, vendar pa lahko po svoji naravi kljub temu posegajo v obdolženčev procesni položaj. Osrednji cilj doktorske disertacije je ugotoviti, kakšen je oškodovančev položaj v domačem kazenskem postopku. V ta namen je analizirana oškodovančeva vloga v zgodovinski, ustavnopravni, pozitivnopravni in primerjalnopravni dimenziji. Raziskava skuša ugotoviti, kako se je skozi čas spreminjalo razumevanje oškodovančeve vloge, kakšni so sodobni trendi v njenem razvoju in kakšen je oškodovančev položaj v veljavni pravni ureditvi kazenskega postopka po sprejemu novele Zakona o kazenskem postopku iz leta 2019 (ZKP-N). Pozitivnopravna analiza zajema oškodovančevo vlogo v rednem (klasičnem) kazenskem postopku, hkrati pa vključuje tudi preučevanje skrajšanih in poenostavljenih postopkov ter, obrobno, alternativnih načinov reševanja kazenskih zadev. Primerjalnopravna analiza je usmerjena v raziskovanje, kako je mogoče oškodovančev procesni položaj primerjati s položajem oškodovanih posameznikov v kazenskih postopkih Zvezne republike Nemčije, Republike Hrvaške in Kanade. Drugi cilj doktorske disertacije je ugotoviti, ali se zaradi okrepljene oškodovančeve vloge v našem pravnem prostoru spreminja tradicionalna koncepcija kazenskega postopka kot bipartitnega odnosa med državo in obdolžencem. Razprava naslavlja vprašanje, ali in kako se zaradi vključitve dodatnega procesnega subjekta v zasnovo domačega kazenskega postopka spreminja dinamika med glavnimi procesnimi subjekti. Hkrati so obravnavane tudi najbolj akutne dileme, s katerimi se sooča veljavna pravna ureditev, ter ponujeni konkretni predlogi za izboljšanje domačega kazenskega postopkovnika.This doctoral dissertation examines the role of the injured party in the Slovenian criminal procedure. It focuses primarily on the position of the injured party in the narrow sense, as someone who participates in criminal proceedings as an active procedural subject alongside the state prosecutor, who performs the prosecutorial function ex officio. The focus of the research, which is placed in the field of criminal procedural law, is on the analysis of the participatory rights of the injured party. These are all of the rights that enable the injured party to participate actively in the criminal proceedings and thus to influence the final outcome of the decision on the charges. The research also touches upon the service rights that ensure that the injured party is informed, assisted, and protected, thus facilitating his/her experience inside (and outside) the criminal proceedings. These rights do not allow the injured party to directly influence the outcome of the criminal proceedings, but by their nature may nevertheless prejudice the defendant\u27s procedural position. The main aim of the doctoral dissertation is to establish the position of the injured party in domestic criminal proceedings. To this end, the role of the injured party is analysed in historical, constitutional, positive and comparative law dimensions. The research seeks to establish how the understanding of the role of the injured party has changed over time, what the contemporary trends are in its development, and what the position is of the injured party in the current legal framework of criminal proceedings following the adoption of the amendment to the Criminal Procedure Act of 2019 (ZKP-N). The positive law analysis covers the role of the injured party in standard (traditional) criminal proceedings, but also includes an examination of summary and simplified procedures, and peripherally, alternative ways of resolving criminal cases. The comparative law analysis aims to explore how the injured party\u27s procedural role compares with that of injured individuals in the criminal proceedings of the Federal Republic of Germany, the Republic of Croatia, and Canada. The secondary objective of the doctoral dissertation is to determine whether the traditional conception of criminal procedure as a bipartite relationship between the state and the accused is changing in our legal system as a result of the enhanced role of the injured party. The discussion addresses the question of whether and how the dynamics between the main procedural subjects are changing due to the inclusion of an additional procedural subject in the design of domestic criminal proceedings. At the same time, the most acute dilemmas facing the current legal order are addressed, and concrete proposals for improving the domestic criminal procedural code are offered

Efficiency of Vitamin D Supplementation in Healthy Adults is Associated with Body Mass Index and Baseline Serum 25-Hydroxyvitamin D Level

Vitamin D (VitD) has a critical role in phosphorous–calcium metabolism as well as an important role in the immune system. In the human body, VitD is synthesized as cholecalciferol in the skin, but this process requires sunlight (UVB) radiation. Numerous reports showed high prevalence of VitD deficiency, particularly during the winter season, indicating the importance of VitD supplementation. Various factors can affect the absorption of VitD, including dosage and formulation. The primary study objective was to examine the efficiency of supplementation with three different formulations containing cholecalciferol in comparison with the control group. The secondary objective was to identify other factors affecting increase in serum 25-OH-VitD. A randomized controlled intervention study was conducted in Slovenia during wintertime (January– March) on 105 apparently healthy subjects (aged 18–65 years) with suboptimal VitD status (25-OH-VitD 30–50 nmol/L). Subjects were randomized into four groups: three treatment groups receiving (A) capsules with starch-adsorbed VitD, (B) oil-based Valens VitD oral spray, or (C) water-based Valens VitD oral spray and a control group (D) which did not receive supplemental VitD. Two months of supplementation with cholecalciferol (1000 IU; 25 µg daily) resulted in significant increase in serum 25-OH-VitD levels in comparison with control group (pooled Δc 32.8 nmol/L; 95% CI: 23.0, 42.5, p < 0.0001). While we did not observe any significant differences between the tested formulations, the efficiency of supplementation was associated with body mass index and baseline serum 25-OH-VitD level. Higher supplementation efficiency was observed in participants with normal body weight (BMI < 25) and in those with more pronounced VitD insufficiency. We also determined that tested dosage was not sufficient to achieve recommended 25-OH-VitD levels in all subjects

Free Sugar Content in Pre-Packaged Products: Does Voluntary Product Reformulation Work in Practice?

Ultra-processed, pre-packaged foods are becoming a growing part of our diet, while displacing whole and minimally processed foods. This results in an increased intake of free sugar, salt, and saturated fats, that have a profoundly negative effect on health. We aimed to assess the trend in free sugar content in pre-packaged foods in Slovenia and evaluate the efficacy of industry self-regulations designed to combat the excess consumption of free sugar. A nation-wide data collection of the Slovenian food supply was performed in 2015 and repeated in 2017. In 2017, 54.5% of all products (n = 21,115) contained free sugars (median: 0.26 g free sugar/100 g). Soft drinks became the main free sugar source among pre-packaged goods (28% of all free sugar sold on the market) in place of chocolates and sweets, of which relative share decreased by 4.4%. In the categories with the highest free sugar share, market-leading brands were often sweeter than the average free sugar value of the category. This indicates that changes in on-shelf availability towards a greater number of healthier, less sweet products are not necessarily reflected in healthier consumers’ choices. Relying solely on voluntary industrial commitments to reduce free sugar consumption will likely not be sufficient to considerably improve public health. While some further improvements might be expected over the longer term, voluntarily commitments are more successful in increasing the availability of healthier alternatives, rather than improving the nutritional composition of the market-leading products. Additional activities are, therefore, needed to stimulate reformulation of the existing market-leading foods and drinks, and to stimulate the consumption of healthier alternatives

Nutritional Composition of Gluten-Free Labelled Foods in the Slovenian Food Supply

The market of gluten-free (GF) foods has been expanding in recent years. GF foods are consumed not only by those with medical predispositions for avoiding gluten, but also by a specific segment of consumers, searching for “healthier” food choices. For these, such practices can present a serious limitation in the variability of food choices. Considering that GF foods are commonly perceived as healthier alternatives, there is a lack of knowledge on the nutritional profile and content of specific nutrients of GF-labelled foods compared to general food supply. A comparison of nutritional composition of GF/non-GF packed foods in the Slovenian food supply was conducted. The nutrient profiling scoring criterion (NPSC) and content of specific nutrients/energy was compared between GF-labelled and regular foods. The highest proportion of GF-labelled products were found in food categories, which typically do not contain gluten (Cheese imitates, Milk imitates, Yoghurt imitates, Canned fish and seafood and Processed meat). Significant differences in the nutrient profile between GF-labelled and regular products were found in Cakes, muffins and pastry, Crisps and snacks, Desserts and Milk imitates. GF-labelled foods often had lower protein and sugar content. Energy value was comparable in most categories and no significant differences in salt content were found, compared to non-GF products. In conclusion, GF-labelled foods will unlikely bring health benefits to those who are not medically required to follow GF diet. Public health initiatives should aim towards promotion of consuming non-processed foods and provision of reliable information about who is required to consume GF foods

How effective are health messages/warnings in improving knowledge and awareness of alcohol-related harm? The Slovenian case on using a mobile app

Abstract Background Consumers generally lack access to information on alcoholic beverages, in spite of it being readily available for food and non-alcoholic beverages. Given the rights of consumers, and as with other products harmful to the population, there have been increasing calls for health warnings to be placed on alcoholic beverages, similar to those implemented on tobacco products. The aim of our research was to assess whether knowledge and awareness of the risks and harms associated with alcohol can be improved with a mobile app. Methods Intervention was conducted using VKJ mobile app, which enables users to scan the barcode of an alcoholic beverage and receive feedback on its labelled alcohol content and estimated energy value. At each search, eleven different health messages/warnings about the risks and harms of alcohol are also displayed randomly, rotating on the screen. A survey was conducted before and after the intervention, to assess the knowledge and awareness of the risks and harms associated with drinking alcohol. Results Significant differences were found for eight of the twelve tested statements. The improvement was seen to a greater extent in the group of high-risk drinkers. The results also showed that the vast majority of participants (78%) who were exposed to the health messages supported mandatory labelling of alcoholic beverages with information on ingredient listing and energy value, and 72% would like to have health warnings on alcohol products. Conclusions The use of a mobile app can be an option to improve knowledge and raise awareness of the risks and harms related to alcohol

Facilitating consumers choice of healthier foods

Summary indicator front-of-package nutrition labelling schemes are gaining momentum. In Europe, an example of such a scheme is Nutri-Score, which was first introduced in France. Supported by additional research, the scheme has the potential to expand into other countries. Such a scenario opens a series of questions related to the use of Nutri-Score in the territories with pre-existing food labelling schemes. A key question is whether different nutrition labelling schemes would provide conflicting information for consumers when applied to same foods. The goal of our study was, therefore, to evaluate the alignment of different front-of-package nutrition labelling schemes. The study was conducted using cross-sectional data on the composition of selected categories of prepacked foods with high penetration nutrition/health claims and symbols in the Slovenian food supply. We evaluated a variety of existing front-of-package nutrition labelling schemes: three interpretive nutrition rating systems (Nutri-Score, Health Star Rating (HSR), Traffic light system), four health symbols (Protective Food symbol, Choices, Finnish heart, and Keyhole symbol), and also three nutrient profile models developed for other purposes (Office of Communications (United Kingdom, Ofcom), World Health Organization Regional office for Europe (WHOE) and Food Standards Australia New Zealand (FSANZ)). Overall, our results indicate that interpretive nutrition rating systems (i.e., Nutri-Score) are mostly less strict than the nutrient profiles of tested health symbols. A risk of conflicting information would happen in a scenario where food is eligible to carry a health symbol, but is at the same time rated to have lower nutritional quality by an accompanying interpretive nutrition rating system. When Protective Food symbol and Nutri-Score are used together, this would occur for 5% of foods in our sample. To avoid such risks, schemes for health symbols could be adapted to be stricter than interpretive nutrition rating systems used in the same territory/market, but such adaptations are challenging and should be well planned. While our study showed that, in most cases, Nutri-Score is a less strict model than tested health symbols, the rating-system approach might offer useful support and incentive for food producers towards gradual food reformulation

Table_1_Validation of the food frequency questionnaire for the assessment of dietary vitamin D intake.DOCX

Vitamin D and its adequate status are related to many aspects of human health; therefore, an appropriate tool is needed for the valid assessment of vitamin D status. The main contributor to vitamin D status is endogenous synthesis after cutaneous exposure to ultraviolet B light (UVB), but in the absence of UVB radiation, vitamin D intake becomes an important source of vitamin D. Various tools are available for vitamin D intake assessments, with the Food Frequency Questionnaire (FFQ) being among the fastest, cheapest, and most convenient; however, until now, these tools have not been adapted for the Slovenia (SI). To enable valid vitamin D intake estimation, we developed a simple one-page semi-quantitative FFQ (sqFFQ/SI) and tested its validity using a 5-day dietary record (DR) as a reference method. The reproducibility was tested with the second sqFFQ/SI (sqFFQ/SI2) 6 weeks after the first (sqFFQ/SI1). The validity and reproducibility of this method were tested on 54 participants using Bland–Altman plots, Spearman’s correlation, and Kappa analyses of tertiles. The mean daily vitamin D intake was 3.50 ± 1.91 μg according to the 5-day DR, and 2.99 ± 1.35 and 3.31 ± 1.67 μg according to the sqFFQ/SI1 and repeated sqFFQ/SI (sqFFQ/SI2), respectively. When analyzing for validity, the sqFFQ/SI1 was found to be significantly correlated (p < 0.05) with the 5-day DR, with an acceptable correlation coefficient of 0.268 and a Bland–Altman index of 3.7%. For reproducibility, the correlation between the sqFFQ/SI1 and sqFFQ/SI2 was highly significant (p < 0.001), with a good correlation coefficient of 0.689 and a Bland–Altman index of 3.7%. Kappa analyses of tertiles showed a poor validity and acceptable reproducibility. Overall, we observed a higher reproducibility than validity. Validation and reproducibility analyses demonstrated that the proposed sqFFQ/SI is acceptable and is, therefore, an appropriate tool for the effective assessment of habitual vitamin D intake on an individual level. With this consideration, this tool will be used in further population studies to assess vitamin D intake and for the development of a screening tool for the assessment of the risk for vitamin D deficiency, which will be used as a foundation for evidence-based policy-making decisions.</p