The Role of Nutrition in Active and Healthy Ageing: For prevention and treatment of age-related diseases: evidence so far

Europe is facing an ageing population. Life expectancy is at its highest and many European populations are going through major demographic changes and transition towards a much older population structure. However, despite living longer many people suffer ill-health or disability in the last 15 to 20 years of life. To encourage active healthy ageing and to help increase healthy life expectancy, the European Commission has launched the European Innovation Partnership on Active and Healthy Ageing (the Partnership), which aims to add an average of two healthy life years in Europe by 2020. This report aims to support the Partnership and to review the contribution of diet and nutrition in increasing healthy life years and promoting active healthy ageing (AHA). The report gives a description of the key determinants of AHA including economic, social and behavioural contributions and how they can relate to diet. It focusses on the issue of undernutrition in older people – both a cause and consequence of functional decline. Given the importance of undernutrition and that micronutrient deficiency is a common problem in older adults, this report summarises the evidence on key micronutrient supplementations on prevention and treatment of age-related diseases and conditions. At this stage, the current evidence is not sufficient or strong enough to support the use of vitamin and mineral supplementation to improve health in the elderly. It does not follow that supplementation is not effective; there are many possible explanations for the lack of effects seen in the studies reviewed. However, as it stands, a better approach to ensure proper nutrition in the elderly is to improve their diet, to maximise their intake of essential vitamins and minerals from natural food sources. Indeed, the evidence from Mediterranean diet as a whole diet approach to promote health, increase longevity, and reduce the risks of a range age-related diseases risks supports this in a number of observational studies. A number of research gaps are also highlighted in this report. Further research is needed on the wider determinants of AHA e.g. social, economic and environmental aspects and their interrelationships with dietary behaviours in older people; to identify the most effective strategies to promote public health messages to the older population; further evidence on life-course approach to ageing; and to develop a set of validated, agreeable, cost-effective and non-invasive measures and tools to quantify AHA outcomes including the quality of diet, fitness, and well-being in older people. Above all, there is a need to provide better guidance on diet and nutrition for older population and a set of age-specific, up-to-date dietary recommendations is essential to achieve this.JRC.I.2-Public Health Policy Suppor

Feasibility study on dietary recommendations for older adults in the European Union

Despite mounting scientific evidence to support healthy and balanced diet in promoting active and healthy ageing, targeted, age-specific, and up-to-date dietary recommendations for older adults in Europe are not easy to find. On the 23-24 October 2014, the JRC organised an expert workshop "Feasibility study on dietary recommendations for older adults in the European Union" to discuss the need for dietary recommendations targeting older adults in Europe, and to identify strategies to promote better diet to prevent malnutrition in the older population. Twenty four experts from multiple disciplines related to nutrition and ageing from various European countries participated in the one and half day workshop. The overall consensus was that older adults, who are healthy may not need additional specific dietary recommendations as the current general adult population recommendations are likely to be sufficient, although some argued that even in healthy older adults, attention should still be paid to vitamin D and protein intakes. Participants identified and developed points for action for three main strategies/ working areas to promote better diet and reduce malnutrition in older adults. The strategies were 1) to develop targeted dietary guidelines for specific groups of older adults, 2) to implement general screening with a multi-disciplinary approach, and 3) to carry out additional research in a number of areas related to diet and ageing.JRC.I.2-Public Health Policy Suppor

Radiographic image quality criteria for osteoarthritis of the knee

The femorotibial joint is the most affected in osteoarthritis (OA) and the main symptom is pain. Weight-bearing plain radiographs of the knees are the most reliable diagnostic tool for evaluating and grading the severity of this disease. The joint space width (JSW) has been increasingly used to assess the severity of OA from radiographs. To present a reliable method for visual image quality assessment of weight-bearing knee radiographs and proposes guidelines for diagnostic measurements predictors of OA.info:eu-repo/semantics/publishedVersio

A organização didática patente nos manuais escolares de matemática do 2.º ano do 1.º ciclo do Ensino Básico, sobre a temática dos números e operações

O presente estudo enquadra-se no trabalho final do mestrado em Educação Préescolar e Ensino do 1º Ciclo do Ensino Básico e tem como propósito analisar as perspetivas didáticas patentes nos manuais escolares de Matemática do 2º ano de escolaridade, mais utilizados nas escolas de Beja, relativamente ao bloco temático Números e Operações. Para esta análise, foram considerados vários parâmetros de acordo com os critérios de apreciação, seleção e adoção dos manuais escolares definidos pelo Ministério de Educação – Organização e Método, Informação e Comunicação e Caraterísticas Materiais (MEC, 2014) – e ainda os pré-requisitos, as atividades propostas, o número de exercícios, o grau de dificuldade dos exercícios, os extras e ainda a visualização estética. Neste estudo, foram abordados, numa primeira parte os seguintes pontos: o enquadramento legal do manual escolar e problemas gerais; a evolução histórica dos manuais escolares; a definição e função dos manuais escolares; a utilização e importância dos manuais escolares; os manuais escolares e as práticas pedagógicas e os manuais escolares tendo em conta as metas de aprendizagem e o Programa de Matemática do 1º ciclo do Ensino Básico no 2º ano de escolaridade. Numa segunda parte, serão estudados, os conceitos de Números e Operações e todos os conteúdos que neles estão integrados no Programa de Matemática do 2º ano. A metodologia utilizada foi baseada fundamentalmente numa análise em grelha dos diferentes parâmetros, acima mencionados, avaliados numa escala apreciativa/ordinal - Insuficiente, Suficiente, Bom e Muito Bom, à semelhança da escala utilizada/aconselhada pelo Ministério da Educação e Ciência

Facilitators and barriers to the use of economic evaluations in nutrition and public health

Aims: Interventions targeting diets have the potential to reduce a consistent fraction of the chronic disease burden. Economic evaluations of such interventions can be an important tool in guiding public health practitioners and decision makers at various levels, yet there are still not many economic evaluations in this area. This qualitative study explored facilitators and barriers in conducting and using economic analyses to inform decision makers in the field of public health nutrition. Methods: Data were collected through written, open-ended questionnaires administered to twenty-three participants (13 from academia and 10 from government) using purposive sampling and analysed through a conventional content analysis. Results: The analysis revealed two broad categories of barriers, which included: i) “Methodological challenges”, and; ii) “Barriers related to application of economic evaluations.” Two main categories of facilitators were also identified: i) “Facilitators to improving the methodology of economic evaluations”, with subcategories further detailing frameworks and methods to be applied, and; ii) “Facilitators to broaden the use of economic evaluations”, with most subcategories addressing science-into-policy translations. These barriers and facilitators to the use of economic evaluations in public health are perceived differently by researchers and policymakers, the former more focused on implementation aspects, the latter more concerned by methodological gaps. Conclusion: Public health nutrition policies seldom take into account data from formal economic evaluations. Economic evaluation methodologies can be improved to ensure their broader application to decision making. &nbsp

Facilitators and barriers to the use of economic evaluations in nutrition and public health

Aims: Interventions targeting diets have the potential to reduce a consistent fraction of the chronic disease burden. Economic evaluations of such interventions can be an important tool in guiding public health practitioners and decision makers at various levels, yet there are still not many economic evaluations in this area. This qualitative study explored facilitators and barriers in conducting and using economic analyses to inform decision makers in the field of public health nutrition. Methods: Data were collected through written, open-ended questionnaires administered to twenty-three participants (13 from academia and 10 from government) using purposive sampling and analysed through a conventional content analysis. Results: The analysis revealed two broad categories of barriers, which included: i) “Methodological challenges”, and; ii) “Barriers related to application of economic evaluations.” Two main categories of facilitators were also identified: i) “Facilitators to improving the methodology of economic evaluations”, with subcategories further detailing frameworks and methods to be applied, and; ii) “Facilitators to broaden the use of economic evaluations”, with most subcategories addressing science-into-policy translations. These barriers and facilitators to the use of economic evaluations in public health are perceived differently by researchers and policymakers, the former more focused on implementation aspects, the latter more concerned by methodological gaps. Conclusion: Public health nutrition policies seldom take into account data from formal economic evaluations. Economic evaluation methodologies can be improved to ensure their broader application to decision making.   Conflicts of interest: None declared.   Acknowledgements: The work of AL is partially supported by a Jean Monnet Erasmus+ grant (574376-EPP-1-2016-1-IT-EPPJMO-MODULE)

Public health economic evaluation of different European Union–level policy options aimed at reducing population dietary trans fat intake.

Background: The adverse relation between dietary trans fatty acid (TFA) intake and coronary artery disease risk is well established. Many countries in the European Union (EU) and worldwide have implemented different policies to reduce the TFA intake of their populations. Objective: The aim of this study was to assess the added value of EU-level action by estimating the cost-effectiveness of 3 possible EU-level policy measures to reduce population dietary TFA intake. This was calculated against a reference situation of not implementing any EU-level policy (i.e., by assuming only national or selfregulatory measures).post-print582 K

Invaginação intestinal secundária a linfoma de Burkitt em cão jovem.

Introdução Foi presente à consulta uma cadela de 11 meses de idade de raça indeterminada referenciada por outro Centro de Atendimento Médico Veterinário por motivo de abdómen agudo. Na história pregressa verificou-se que existia a suspeita de ingestão de corpo estranho (CE) no dia anterior à consulta, vómito incoercível com 24 horas de duração, dor abdominal e anorexia parcial. Ao exame clínico, registaram-se diversas alterações entre as quais a presença de mucosa oral congestionada, desidratação de 5% e ligeira hipotermia (37,8°C) estando os restantes parâmetros dentro dos limites normais. Na palpação manual da cavidade abdominal detectou-se a presença de uma massa tubular no abdómen médio. Tendo em conta os achados do exame clínico, o paciente foi admitido para exames complementares de diagnóstico por suspeita de obstrução intestinal. Objectivos Os objectivos desta comunicação são a descrição de uma neoplasia intestinal rara num cão jovem como causa de invaginação intestinal. Metodologia Após a obtenção da história pregressa e exame físico realizaram-se diversos exames complementares de diagnóstico que incluiu perfil bioquímico sérico, hemograma, radiologia abdominal simples com projecções latero-lateral e ventro-dorsal. Adicionalmente foi também realizada ecografia abdominal. Resultados O hemograma evidenciou uma leucocitose com neutrofilia e trombocitopenia. No perfil bioquímico sérico realizado os parâmetros estavam dentro dos intervalos de referência para a espécie. Os achados radiológicos evidenciaram a presença de um CE não linear radiopaco na região do abdómen médio e uma massa com radiopacidade de tecido mole com efeito de massa igualmente no abdómen médio. A ecografia abdominal confirmou a presença de obstrução intestinal pela presença de um CE associada a uma invaginação intestinal. Após estabilização pré-cirúrgica, o paciente foi sujeito a laparatomia exploratória, procedimento no qual se confirmou a presença de um CE não linear (um aglomerado de fios de nylon de um esfregão) no jejuno e caudalmente a este uma invaginação jejuno-jejunal. Procedeu-se a desinvaginação e observou-se num segmento da porção jejunal invaginada um espessamento da parede intestinal com estenose do lúmen e com congestão e hemorragia da serosa. Em consequência deste achado realizou-se uma enterectomia do segmento estenosado com uma margem de segurança de 4 cm, seguida de anastomose intestinal topo a topo com padrão de sutura simples interrompida. O CE foi removido pela incisão da enterectomia devido á sua proximidade. Explorou-se a cavidade abdominal e todo o tubo digestivo não se registando alterações macroscópicas adicionais. O segmento intestinal removido foi enviado para análise histopatológica. O diagnóstico histopatológico determinou uma infiltração de células neoplásicas linfóides em toda a espessura da parede intestinal concluindo-se pela presença de um linfoma de Burkitt. A recuperação pós-operatória decorreu sem complicações maiores tendo sido concedido alta ao paciente 4 dias após a cirurgia. Conclusões Os CE, as enterites víricas e parasitárias são causas frequentes de invaginação intestinal em pacientes jovens, no entanto as neoplasias intestinais são a principal causa de invaginação em animais geriátricos1,3. A ocorrência de neoplasia intestinal e especificamente o linfoma de Burkitt nunca foi descrita anteriormente como causa de invaginação intestinal em cão jovem. Referências bibliográficas 1. Schwandt, C.S., (2008). Low-grade or benign intestinal tumours contribute to intussusception: a reporton one feline and two canine cases. Journal of Small Animal Practice, 49, 651 – 654. 2. Radovanović, Z., Slavković, A., Marjanović, Z., Živanović, D., Djordjević, I. (2017). Burkitt lymphoma as a cause of intussusceptions – The significance of positron emission tomography scan in the follow-up. Vojnosanit Pregl. 74(3): 294– 297. 3. Levien, A.S., Baines S.J., (2011). Histological examination of the intestine from dogs and cats with intussusception. Journal of Small Animal Practice, 52 (11):599-606

Trans fatty acids in Europe: where do we stand?

Trans fatty acids (TFA) are a particular type of unsaturated fatty acid. They are naturally present in food products made from ruminant animals such as dairy and meat from cattle, sheep or goat (naturally occurring ruminant TFA or rTFA) but can also be produced industrially (TFA of industrial origin or iTFA). Consumption of TFA is associated with increased risk of coronary heart disease (CHD). The European Food Safety Authority (EFSA) states that ‘TFA intakes should be as low as is possible within the context of a nutritionally adequate diet'. Denmark was the first country to adopt legislation limiting the content of TFA in foods in 2003. Since 2003, Switzerland (2008), Austria (2009), Iceland (2011), Hungary (2013) and Norway (2014) have legislation in place and now also limit the content of TFA in foodstuffs. EU legislation does not regulate the content of TFA in foodstuffs nor does it require its labelling.The European Parliament and the Council have however requested as part of the recent Regulation (EC) No1169/11 on the provision of food information to consumers that the European Commission (EC) reports on ‘the presence of trans fats in foods and in the overall diet of the Union population’. It is expected that the results can inform further decisions on introducing, at European level, ‘appropriate means that could enable consumers to make healthier food and overall dietary choices or that could promote the provision of healthier food options to consumers, including, among others, the provision of information on trans fats to consumers or restrictions on their use’. This report is a first step in addressing this request. The analysis of the most recent publicly available data confirms reported reduction of TFA in foods but also shows that there are still a number of foods with high levels of TFA (above 2g TFA per 100g of fat) in some European food markets. Results from dietary surveys also indicate that although the overall population TFA intake is below the World Health Organization (WHO)-recommended maximum of 1 E% there are subpopulations exceeding the recommended threshold. As long as products with high TFA content remain in the food market, it is possible that individuals may consume more than the recommended maximum. As it stands, there appears to be room for improvement of the European situation as regards the presence of iTFA in foodstuffs.JRC.I.2-Public Health Policy Suppor

Mapping of National School Food Policies across the EU28 plus Norway and Switzerland

Background: With childhood obesity prevalence on the rise in many European countries, schools may serve as a protected environment for children to learn healthy diet and lifestyle habits. Policy makers, educators and researchers would benefit from a comprehensive overview of European school food policies. Methods: We screened public databases, EU level reports, national ministerial websites and the scientific literature to collate official school food policies across Europe. Member States representatives checked that all appropriate documents (total of 34 policies) had been identified and referenced, and they reviewed and confirmed the extracted data. Results: Mandatory standards are defined in 18 of the policies (53%), the remainder offering voluntary guidelines. Top 3 policy aims are to improve child nutrition (97%), teach healthy dietary/lifestyle habits (94%) and reduce/prevent obesity (88%). Variations mainly relate to the types of meals targeted (e.g. lunch, breakfast, snack, dinner); whether standards/recommendations are nutrient- and/or food-based; and if vending machines and the wider food environment (kiosks near schools, packed lunches from home, etc.) are considered. Conclusion: We provide an up-to-date overview of European school food policies. The next step will be to assess the need and feasibility for developing best practice guidelines for school food policies in Europe, bearing in mind cultural and structural differences between countries.JRC.I.2-Public Health Policy Suppor