Diet fortification for mild and moderate picky eating in typically developed children:Opinion review of Middle East consensus

BACKGROUND Picky eating is a commonly observed behavior among children globally,negatively impacting their physical and mental growth.Although common characteristics distinguish peaky eaters,including food selectivity,food neophobia,and food avoidance,there is no clear definition to assess this behavior.Due to the unavailability of data regarding picky eating,it wasn’t easy to estimate its prevalence.AIM To develop a regional protocol to help healthcare professionals identify and manage mild and moderate picky eating cases.METHODS A virtual roundtable discussion was held in April 2021 to gather the opinions of seven pediatricians and two pediatric dietitians from eight Middle Eastern countries who had great experience in the management of picky eating.The discussion covered different topics,including clearly defining mild and moderate picky eating,identifying the role of diet fortification in these cases,and the possibility of developing a systematic approach to diet fortification.RESULTS The panel identified picky eating as consuming an inadequate amount and variety of foods by rejecting familiar and unfamiliar food.Most of the time,moderate picky eating cases had micronutrient deficiencies with over-or undernutrition;the mild cases only showed inadequate food consumption and/or poor diet quality.Paying attention to the organic red flags like growth faltering and development delay and behavioral red flags,including food fixation and anticipatory gagging,will help healthcare professionals evaluate the picky eaters and the caregivers to care for their children.Although dietary supplementation and commercial food fortification play an important role in picky eating,they were no benefit in the Middle East.CONCLUSION The panel agreed that food fortification through a food-first approach and oral nutritional supplements would be the best for Middle Eastern children.These recommendations would facilitate identifying and managing picky-eating children in the Middle East.

Scientific and technical aspects of yogurt fortification:A review

Food fortification is one of the most important processes for improvement of the nutrients quality and quantity in food.It can be a very cost effective public health intervention.Due to the high consumption rate of dairy products such as yogurt,fortification of these products will effectively reduce or prevent diseases associated with nutritional deficiencies.The aim of this investigation is to study the technical aspects involved in production of different types of fortified yogurts and their role in disease prevention and correction of deficiencies.In this paper,firstly,fortification is defined and the main reasons behind carrying out this process are presented and then yogurt production process and a variety of minerals,vitamins,and functional ingredients which are used in the process are briefly discussed.©2015 Beijing Academy of Food Sciences.Production and hosting by Elsevier B.V.All rights reserved.

Planning and Implementing Food Fortification Programs to Combat Micronutrient Malnutrition: Iron

Iron deficiency anemia is the most prevalent nutritional deficiency in the world and food fortification is a cost-effective approach to combat it. This paper reviews the food fortification process with micronutrients, with special emphasis on iron and the most critical steps and common difficulties found when implementing a program. The first step is to measure the magnitude of the problem and the groups affected by iron deficiency and anemia, to determine if there is a need for fortification. Then the adequate iron compound and vehicle should be selected, to obtain a bioavailable form of iron in a frequently consumed food item without changing the taste, appearance or cooking characteristics of the final food item or complete meals containing it, to assure the acceptance by consumers. Before implementation, bioavailability studies are in order for the fortified food item and for complete meals especially typical or traditional meals, followed by field studies and pilot tests. Once implemented, the program should be monitored and evaluated continuously, and the impact on health assessed periodically to give the program the flexibility for continuation made changes or finalization when necessary. Other key elements for successful implementation of food fortification programs include the presence of a viable food industry;available channels for food marketing and distribution;a health care system to identify and monitor micronutrient malnutrition in the population;institutions for education, treatment and evaluation of the impact of the program;and continuous and effective input into the planning, implementation, monitoring and evaluation of the intervention to ensure sustainability of the intervention.

The Introduction of European Fortification in the Late Ming Period

In the late Ming period,Xu Guangqi and other Catholic literati were actively involved with military affairs because of the invasion of the Manchu forces and the threat of uprisings.The story of how they imported European cannons and gunners from Macao is now quite famous.However,the introduction of European fortifications,mainly the trace Italienne,in the same period is still relatively unknown.Xu Guangqi and his student Sun Yuanhua exerted considerable efforts in advocating European-style bastions.Xu not only received help from Jesuits,but also support from some Fujianese who were familiar with Intramuros,the Spanish walled city of Manila.In addition to Xu and Sun,Han Lin and Han Yun(also Xu’s students)prepared a Chinese treatise on European fortification architecture based on Italian sources and tried to put the knowledge into practice.Another relevant figure is Ma Weicheng,who allegedly directed the building of 32 angled bastions in three cities around 1640.Although a few recorded writings and practices of constructing European-style fortification appeared in the first half of the seventeenth century,soon afterwards the art of trace Italienne met its end prematurely in China.To a great extent,the swift collapse of the Ming dynasty eliminated the possibility of spreading the new defense technology.Throughout the eighteenth century,the Qing dynasty enjoyed long-term peace,and the warfare at the frontiers brought few threats to the city walls.There was thus little urgency to develop innovative defensive works and European fortification sunk into oblivion until the mid-nineteenth century.

Research on the seismic fortification level of offshore platform in Bohai Sea and adjacent areas

API code is introduced at first, and then a comparison of seismic character and seismic hazard between Bohai and Southern California is carried out. The analysis indicates both the seismic frequency and intensity and the seismic hazard of Bohai are much weaker than that of Southern California. API code states the strength level and deformation level of permanent structures in Southern California takes 200 a and several hundred to a few thousand years respectively. But in the reference codes in China, the seismic levels take 500 a and 10000 a for strength design and deformation design, and it seems too conservative. In China, the deformation level of class A structure takes 2%-3% probabilities of exceedance in reference period 100 a, and that of class B and C often takes 2%-3% in 50 a. Now that offshore platforms may cause server subsequent risk, it is safe to take 1% in 30 a as its deformation design level. On the basis of the above analyses and social economic level and the consistency with present codes, the strength design level and deformation design level of Chinese offshore platforms is suggested to take 200 a and 3000 a respectively.

Protein Fortification of Corn <i>Tortillas</i>: Effects on Physicochemical Characteristics, Nutritional Value and Acceptance

The aim of this study was to evaluate the texture of corn dough as well as the nutritional quality and acceptance of corn cakes (tortillas) made either with a readymade commercial corn flour (CCF) or with a traditional way (nixtamal) both fortified with lys + tryp (L + T) or with a protein concentrate from Phaseolus lunatus added with L + T (PC + L + T). All treatments were analyzed to investigate the physical properties of the dough and tortillas as well as their physicochemical and nutritional quality. Results showed that cohesion was affected (p tortillas made with nixtamal showed no difference. Adhesion was not affected by treatments. Weight loss increased only in the fortified tortillas made with CCF (p tortillas increased with the fortification being the highest value 0.96 N. Color was not affected in tortillas made with CCF (p tortillas made with CCF and fortified with PC + L + T. Acceptance was greater for tortillas fortified with L+T alone. Protein fortification of tortillas made with either CCF or nixtamal is feasible using either L + T together or in combination with a PC from Phaseolus lunatus improving their nutritional value without negative effects on their physicochemical characteristics or acceptance.

Large, moderate, small earthquakes and seismic fortification criterion

This paper discusses the relation between two-step seismic design and the standard of probability of exceedance, and the relation of three-levels seismic ground motion parameters given by probability method and comprehensive probability method. The relative size relations of the ground motions with 2%, 10%, 63% probability of exceedance in 50 years, namely large earthquake, moderate earthquake, and small earthquake, are discussed through a practical example of seismic hazard analysis. The methods to determine seismic fortification criterion are discussed.

A knowledge-to-action approach to food fortification: Guiding principles for the design of fortification programs as a means of effectively addressing micronutrient malnutrition

The gap that exists between research and the dissemination and implementation of research findings has been well established. Food fortification, one of the most cost-effective means of addressing micronutrient malnutrition, is no exception. With decades of implementation experience, there is need to strengthen mechanisms that effectively broadcast proven strategies to promote the successful implementation of fortification programs in changing, challenging, and dynamic environments. This requires clear channels of communication, well-defined in-country leadership, and a streamlined and focused approach that can be adapted to country-specific contexts. Based on experience designing and implementing fortification programs throughout Africa and a broad understanding of past successes and failures, a model is proposed that articulates often over-looked program elements critical to design and implementation.

Iodine and Selenium Intake in a Sample of Women of Childbearing Age in Palmerston North, New Zealand after Mandatory Fortification of Bread with Iodised Salt

Iodine deficiency is a worldwide public health problem, which has long been observed in many parts of the world, including New Zealand (NZ). The aim of this study was to assess iodine and selenium intake among women of childbearing age in Palmerston North, New Zealand post mandatory fortification of bread with iodised salt. Fifty women of childbearing age completed a researcher-led questionnaire, including a semi-quantitative food frequency questionnaire. Iodine and selenium were analysed in 24-hour urine samples. The median urinary iodine concentration (UIC) was 65 μg/l with 30% below 50 μg/l;representing mild iodine deficiency according to the World Health Organization. The estimated median daily iodine intake (130 μg/day) was higher than the Estimated Average Requirement (100 μg/day) and higher than seen in women prior to fortification. The median excretion of selenium (32 μg/day) was slightly above level suggested as adequate (30 μg/day) and estimated median intake (57 μg/day) was higher than Estimated Average Requirement (50 μg/day). Selenium and iodine excretion were significantly correlated (Spearman’s rank order;r(50) = 0.547, p 0.001). The major contributors to iodine intake were milk (36%), bread (25%) and fish/seafood (15%). Participants had a mean intake of 2.5 slices of bread/day, which contributed approximately 14 to 20 μg of iodine. The majority of participants (74%) had iodised salt at home, but less than half (48%) used iodised salt exclusively. In conclusion, despite the mandatory fortification of bread with iodised salt in NZ, UIC of the study population indicates iodine deficiency although their estimated dietary intakes appear adequate. It is essential that government initiatives to improve iodine status are evaluated for their efficacy.

Optimization of Bioactive Fortification in Apple Snacks through Vacuum Impregnation Using Response Surface Methodology

Fortification of apple slices with t-resveratrol glucoside was obtained by vacuum impregnation (VI) of apple slices with a solution containing grape juice using response surface methodology (RSM). Three independent variables of the VI process: vacuum pressure, application time and relaxation time, were coded at five levels in a central composite design. The VI-treated and dried apple slices were analyzed for t-resveratrol glucoside concentration and textural attributes (gradient and linear distance). Multiple response optimization revealed the following optimum VI condi-tions for the bioactive enrichment and improved textural quality of dried apple slices: vacuum pressure of 6 in. of Hg, application time of 10 min, and relaxation time of 22.5 min.

Potential use of waste cinnamon leaves in stirred yogurt fortification

Cinnamon leaf essential oil has wide applications due to its prominent antimicrobial and antioxidant activities.However,abundant cinnamon leaves are discarded as by-product after essential oil extraction.This study aims to investigate the potential use of aqueous extract(CLE)produced from waste cinnamon leaves as a bioactive additive in stirred yogurt.The effects of CLE fortification and encapsulation on the chemical,antioxidant and anti-inflammation activity of yogurt were determined.Besides,the stability of bioactivity of CLE in yogurt toward digestion was also investigated.Results suggest that CLE produced via 1 h extraction contains the highest total phenolic content(TPC),total flavonoid content(TFC),DPPH scavenging activity(DPPH),ferric reducing antioxidant power(FRAP)and albumin denaturation inhibition(ADI)activity.Fortification of yogurt with CLE(both unencapsulated and encapsulated form)significantly increased TPC,TFC,DPPH and FRAP of yogurt.Moreover,addition of encapsulated-CLE significantly reduced the syneresis of yogurt without affecting its viscosity.However,ADI activity was not detected in CLE-fortified yogurt,even though CLE was proven to contain high ADI activity.Nonetheless,the highest ADI activity(89.71±1.62%)was detected in yogurt containing unencapsulated CLE after digestion.Contrarily,digestion caused substantial reduction of DPPH and FRAP in yogurt.Among the sample,yogurt containing encapsulated-CLE exhibited the highest DPPH(25.31±1.67%)and FRAP(63.0±0.5μg Fe2+ml-1)after intestinal digestion.Encapsulation using agar was proven to effectively protect antioxidants from lost during digestion.This study provides new insight into the potential use of waste cinnamon leaves as functional additive in stirred yogurt.

Storming Fortifications

Feel for boulders while crossing the river. ---Deng Xiaoping After a 20-year track record of extraordinary successes, however, China’sleaders now confront the toughest issues since reforms began in 1978. The domes-tic economic growth rate is declining, and the surrounding region is confronting

Lectotype optimization of mid-highrise residential building based on site conditions and seismic fortification intensity

A multi-objective lectotype optimization model based on site conditions and seismic fortification intensity is presented for mid-highrise residential buildings taking into account multiple items such as the original investment, disaster losses and maintenance cost, the integral stiffness, the total ductility, the construction period, and so on. A Three-Scale Fuzzy Analytical Hierarchy process is proposed by introducing the Three-Scale Analytical Hierarchy process and the trapezoid fuzzy number. The result of a calculation example shows that the T-FAHP is practical.

The Planned Conservation of the Urban Fortifications of Tuscany: Satellite Interferometry as an Innovative Monitoring Technology for Asset Management

The “Monitoring City Walls” research project by the University of Pisa approaches planned conservation as a process that pursues an in-depth understanding of historic city walls and their surroundings to define a system of effective risk prevention. This multidisciplinary research adopts monitoring strategies and technologies at the large scale and in relationship to natural and urban conditions. The underlying logic frames the conservation of these historic fortifications within the more general mitigation of risks generated by context. The research aims to develop an innovative approach to monitoring ancient defensive structures in historical towns. The integrated use of advanced technologies allows for the control and, most importantly, advance identification of possible risks. These new technologies, in particular satellite interferometry, make it possible to improve and increase the operational capacity of monitoring processes by facilitating the acquisition and investigation of data relative to the system defined by ancient city walls and their surroundings. These technologies also represent a cost-effective tool for managing the important transition from the observation and study of individual monuments to the monitoring of large monumental complexes or even entire historical centers.

Study on the Seismic Fortification Criteria of Offshore Platforms in the Bohai Sea

This paper analyzes the seismicity and seismic risk distribution in the Bohai Sea. Based on the seismic design parameters of 46 platforms in the Bohai Sea, a statistic analysis is made on the ratios of the peak accelerations for different probability levels. In accordance with the two-stage design method, a scheme of two design seismic levels is proposed, and two fortification goals are established respectively for strength level earthquakes and ductility level earthquakes. Through analogy and comparison to the Chinese seismic code for buildings, it is proposed that the probability level for the strength and ductility level earthquakes takes return periods of 200a and 1000～2500a respectively, and we further expounded on its rationality. Finally, the fortification parameters in the sub-regions of Bohai Sea area are given in the light of seismic risk zonation and ground motion division. This article is a summary of experiences from many years of offshore platform seismic fortification work, and an exploratory study on the seismic fortification standards of offshore platforms in China, which may provide some references for the establishment of the standard.

Study on the Relationship of Seismic Design Ground Motion at Different Fortification Levels in the Xinjiang Region

The seismic risk analysis results of 79 cities in Xinjiang are presented, and the bedrock peak ground accelerations under three seismic levels and their ratios are discussed. Then, the relationship between earthquake environments and the seismic risk analysis results of different exceeding probabilities are researched. The results show that minor and major earthquake motion parameters calculated from moderate earthquakes do not have a consistent probability and the ratio of bedrock peak accelerations under different exceedance probabilities are dosdy correlated with earthquake environments.

A Comparison of Domestic and Foreign Seismic Fortification Standards for Electrical Equipment

It is of great significance to make comparative analyses of seismic fortification criteria at home and abroad for improving the anti-seismic capability of electrical equipment and revising the relevant national standards.A brief overview of American,Japanese,IEC standards and Chinese seismic design codes for electrical equipment is presented.Differences between these seismic fortification standards of electrical equipment are compared and analyzed in respect of the goal and level of seismic fortification and the seismic design spectrum.The advantages and disadvantages of Chinese standards are pointed out.Through learning from foreign experience on the determination of seismic fortification standards,recommendations are made for the improvement and revision of Chinese seismic fortification standards for electrical equipment.

Enhanced recovery of high-purity Fe powder from iron-rich electrolytic manganese residue by slurry electrolysis

Iron-rich electrolytic manganese residue(IREMR)is an industrial waste produced during the processing of electrolytic metal manganese,and it contains certain amounts of Fe and Mn resources and other heavy metals.In this study,the slurry electrolysis technique was used to recover high-purity Fe powder from IREMR.The effects of IREMR and H2SO4 mass ratio,current density,reaction temper-ature,and electrolytic time on the leaching and current efficiencies of Fe were studied.According to the results,high-purity Fe powder can be recovered from the cathode plate,and the slurry electrolyte can be recycled.The leaching efficiency,current efficiency,and purity of Fe reached 92.58%,80.65%,and 98.72wt%,respectively,at a 1:2.5 mass ratio of H2SO4 and IREMR,reaction temperature of 60℃,electric current density of 30 mA/cm^(2),and reaction time of 8 h.In addition,vibrating sample magnetometer(VSM)analysis showed that the coercivity of electrolytic iron powder was 54.5 A/m,which reached the advanced magnetic grade of electrical pure-iron powder(DT4A coercivity standard).The slurry electrolytic method provides fundamental support for the industrial application of Fe resource recovery in IRMER.

Effect of Na Fe EDTA-Fortified Soy Sauce on Anemia Prevalence in China: A Systematic Review and Meta-analysis of Randomized Controlled Trials

Objective To assess the effect of sodium iron ethylenediaminetetraacetate （NaFeEDTA）-fortified soy sauce on anemia prevalence in the Chinese population. Methods A systematic review was performed to identify potential studies by searching the electronic databases of PubMed, Cochrane Library, WHO Library, HighWire, CNKI, and other sources. The selection criteria included randomized controlled trials that compared the efficacy of NaFeEDTA-fortified soy sauce with that of non-fortified soy sauce. Anemia rates and hemoglobin levels were the outcomes of interest. Inclusion decisions, quality assessment, and data extraction were performed by two reviewers independently. A total of 16 studies met the inclusion criteria for anemia rate analysis, of which 12 studies met the inclusion criteria for hemoglobin analysis. All included studies assessed the effect of NaFeEDTA-fortified soy sauce on anemia rates and hemoglobin concentrations. Results After the intervention, the hemoglobin concentration increased and anemia rates decreased significantly as compared with the non-fortified soy sauce groups. For anemia rates, data from 16 studies could be pooled, and the pooled estimate odds ratio was 0.25 （95% CI 0.19-0.35）. For hemoglobin concentrations, data from 12 studies could be pooled, and the pooled weighted mean difference was 8.81 g/L （95% CI 5.96-11.67）. Conclusion NaFeEDTA-fortified soy sauce has a positive effect on anemia control and prevention in the at-risk population.

Effects of Nutrient Fortified Complementary Food Supplements on Anemia of Infants and Young Children in Poor Rural of Gansu

Objective To assess the effectiveness of complementary food supplements with protein and multi-micronutrients on hemoglobin and anemia in infants and young children. Methods In 5 poor counties of Gansu, 984 children aged 6-12 months were enrolled and divided into two groups. In addition to the usual home-made complementary food, all the children were fed one sachet of either Formula Ⅰ or Formula Ⅱ supplements each day. Protein and micronutrients were provided in Formula Ⅰ, while the same energy intake was secured in Formula Ⅱ as in Formula Ⅰ. A massive dose of vitamin A was supplemented to all the children every 6 months. Hemoglobin test was done at the same time. Results Prevalence of anemia was about 35% in both Formula Ⅰ and Formula Ⅱ group at baseline, and there were no differences in hemoglobin concentration between the two groups, During the 6-month and 12-month supplementation, hemoglobin of children in Formula Ⅰ group was higher than that in Formula Ⅱ group （P〈0.05）, and hemoglobin increase in Formula Ⅰ group was significantly higher than that in Formula Ⅱ group （P〈0.001）. After 6- and 12-mouth supplementation, the prevalence of anemia in Formula Ⅰ group dropped to 19.1% and 8.2% respectively, and it was 28.0% and 12.4% in Formula 2 group. The prevalence of anemia in Formula Ⅰ group was significantly lower than that in Formula Ⅱ group （P〈0.05）. After adjusting age and hemoglobin level at baseline, the hemoglobin increase at age of 24 months in formula 1 group was higher （10.7 g/L vs 7.9 g/L, P〈0.0001）. Conclusion Micronutrient fortified complementary food supplements, with large-dose vitamin A, is effective for children aged 6-12 months in terms of iron deficiency prevention.