Carl M. Allen, DMD, MSD
Evidence Many factor analyses indicate a two-factor model: ?hyperactivity-impulsivity? and ?inattention muscle relaxants sleep purchase tegretol 100 mg on-line. In an early study spasms near ovary buy tegretol 400mg, ?hyperactivity-impulsivity? was reported as a single factor muscle relaxant for sciatica cheap tegretol american express, where the factor ?hyperactivity? was defined as ?impulsive spasms in chest purchase tegretol pills in toronto, excitable hyperactivity? (Dreger et al. Looking specifically at children identified as having a behavioural problem, Conners (1969) found ?hyperactivity? and ?inattention? as separate and distinct factors. The factor structure of adolescent self-report behavioural data was investi gated by Conners and colleagues (1997): six factors were identified, including ?hyperactivity? and ?cognitive problems. The ?hyperactivity? factor included charac teristics such as being unable to sit still for very long, squirming and fidgeting and feeling restless inside when sitting still. The ?cognitive problems? factor consisted of 98 Diagnosis having trouble keeping focused attention, having problems organising tasks and forgetting things that were learnt. In a further study by Conners and colleagues (1998) similar findings were reported. Some studies have identified three factors, with ?hyperactivity? and ?impulsivity? as two distinct factors in addition to ?inattention?, in both population (Gomez et al. However, Gomez and colleagues (1999) showed that the model fit for the three-factor solution was only marginally better than the two-factor model. Werry and colleagues (1975), however, found that hyperactivity, impulsivity and inattention formed a single factor using both population control and ?hyperactive? samples. Using this approach, Hudziak and colleagues (1998) found that hyperactivity impulsivity and inattentive symptoms cluster together as a ?combined? type latent class, as well as separate hyperactive-impulsive and inattentive latent classes. The clustering of hyperactivity, impulsivity and inattention appear to be stable across a number of countries. They identified a factor of hyperactivity-inattention that was distinct from conduct disorder. Glutting and colleagues (2005) assessed university students aged 17 to 22 using parent-rated information in addition to self-rated data. Although most studies show separate factors for inattention and hyperactivity impulsivity, these are highly correlated in children (Gomez et al. Bauermeister and colleagues (1992) found that there was a single attention/impulsivity-hyperactivity factor in pre-school children, and separation into two factors in school-age children. In contrast, the study from Glutting (2005) using college students aged 17 to 22 found three factors, with the separation of hyperactive and impulsive symptoms. Similarly Kooij and colleagues (2005) using adult samples identified three separate factors. Summary There was strong evidence for clustering of inattentive and hyperactive-impulsive symptoms in both population and clinical samples. Evidence for one-, two and three factor models was found, with most studies supporting a two-factor model. Most studies found two correlated factors for hyperactivity-impulsivity and inattention, while others were able to distinguish between hyperactivity and impulsivity and a few found one combined factor for all three domains. There is some evidence that the number of factors identified depends on the age of the sample, with nearly all studies of school-age children reporting two factors. These findings have been observed in both population and clinical samples and in a number of different cultural settings. No systematic reviews were identified in the literature that addresses this question. These studies are highly consistent in being able to separate the items that describe oppositional-defiant and conduct problems from hyperactivity impulsivity and inattention. Although the behavioural items fall into separate dimen sions there are significant correlations between the various behavioural factors. Frouke and colleagues (2005) conducted a diagnostic study of 2,230 Dutch pre-adolescents from the general population. A further study from the Netherlands of disruptive behaviour in 636 7-year-old children (van Lier et al. For both the inattentive symptoms and combined inattentive/hyperactive-impulsive symptoms they found clustering either with or without symptoms of oppositional defiant disorder. Having said that, the two often occurred independently of each other and only partially shared aetiological factors. No systematic reviews were identified that were of direct relevance to this question. The previous search for primary studies revealed two factor-analytic studies relevant to this question. In addition, the symptom groups are separated on the basis of low, medium and high levels into distinct severity groups. It is not yet known whether the results would be different if full diagnostic criteria, including impairment, were to be applied. The current literature does not address the difference in interpretation of the latent class and quantitative approaches. The disorder can therefore only be defined on the basis of high levels of symptoms and their association with significant clinical impairments and risk for development of future impairments. They also have higher rates of both specific and generalised learning disabilities, poor reading skills (McGee et al. Hyperactive chil dren with or without conduct problems have higher rates of problems with peers and higher rates of social problems because of lack of constructive social activities (Taylor et al. Young adults with a diagnosis of ?hyperactivity? in child hood were more likely to have a diagnosis of antisocial disorder (32% versus 8%) and drug misuse (10% versus 1%) than were healthy controls at follow-up (Mannuzza et al. This included markedly elevated rates of antisocial, addictive, mood and anxiety disorders (Biederman et al. Impairments also result from the presence of coexisting problems including conduct problems, emotional problems and overlapping neurodevelopmental disorders. The search for systematic reviews and meta-analyses identified one review that was of relevance to this question. Relative to controls, levels of overactivity and inattention are developmentally stable (Taylor et al. Rietveld and colleagues (2004) reported 107 Diagnosis that parent ratings of attentional problems were moderately stable from age 3 to 7, and greater stability from age 7 to 10. Kuntsi and colleagues (2004) extended these data to age 8, and found similar moderate stability between the data for ages 2, 3 and 4 and the data for age 8. Larsson and colleagues (2004) completed a similar longitudi nal twin study of 8 to 13 year olds and found fairly high stability between the two ages. They further concluded that this stability was the result of shared genetic effects. Change in symptoms between childhood and adolescence was thought to be because of new genetic and environmental effects that become important during adolescence. The profile of symptoms may alter with a relative persistence of inattentive symptoms compared with hyperactive-impulsive symptoms. The evidence base for this conclusion is poor, however; it is based on the analysis of developmentally inappropriate measures of hyperactivity-impulsivity in adults. Having said that, it is envisaged that improved definitions that take into account developmental changes will develop as further evidence is accrued. The term executive function refers to a set of higher cognitive and emotional mental functions involved in the control and regulation of behaviour and performance. This includes concepts such as cognitive inhibition and initiation, self-regulation and motor output. The neural mechanisms by which the exec utive functions are implemented is a topic of ongoing debate in the field of cognitive neuroscience. It is not yet clear whether impairments in the performance of executive tasks is because of primary deficits in the brain processes underlying executive func tions, or whether the performance deficits are secondary to more general processes. The review from Hervey and colleagues (2004) did not point to impairments in one area of cognitive performance, but rather impairments across a range of cognitive functions. Although work has largely focused on the executive functions, there is an interest in non-executive processes (Rhodes et al. The pattern of findings suggested a more generalised impairment of attentional and cognitive processing rather than a primary deficit of behavioural inhi bition alone. The meta-analytic data showed reduced activation in regions in the left pre-frontal cortex, the anterior cingu late cortex, the right parietal lobe, the occipital cortex and in the thalamus and 109 Diagnosis claustrum. When only response inhibition studies were included in the analysis, a more restricted network was identified, which included the right caudate (part of the striatum). The extent of neural networks remains uncertain since the available data were limited by the narrow selection of tasks. A major limitation was the small number of suitable datasets and the unavoidable inclusion of studies that differed in the specific aspects of design and quality. Future downgrades could further adversely affect our cost of funds and related margins back spasms 24 weeks pregnant buy discount tegretol 100mg, liquidity spasms in chest order 100mg tegretol, competitive position and access to capital markets back spasms 6 weeks pregnant buy tegretol overnight, and a significant downgrade could have an adverse commercial impact on our industrial businesses spasms in chest buy tegretol 100mg on line. For example, if our short-term credit ratings were to fall below A-2/P-2, we would no longer have access to the tier-2 commercial paper market, and therefore our borrowing capacity in the commercial paper market would likely be further reduced. If any of our short-term credit ratings were to fall below A-1/P-2/F2, the timing or amount of liquidity generated by these programs could be adversely affected. In addition, in certain securitization transactions where we provide servicing for third-party investors, we are contractually permitted to commingle cash collected from customers on financing receivables sold or pledged to third-party investors with our own cash prior to making required payments to third-party investors, provided our short-term credit rating does not fall below A-2/P-2/F2. In the event our ratings were to fall below such levels, we would be required to segregate certain of these cash collections owed to third-party investors into restricted bank accounts and would lose the short-term liquidity benefit of commingling with respect to such collections. In addition, under various debt and derivative instruments, guarantees and covenants, we could be required to post additional capital or collateral in the event of a ratings downgrade, which would increase the impact of a ratings downgrade on our liquidity and capital position. For additional discussion about our current credit ratings and related considerations, refer to the Capital Resources and Liquidity Credit Ratings and Conditions section of this report. The business and operating results of our industrial businesses have been, and will continue to be, affected by worldwide economic conditions, including conditions in the air transportation, power generation, oil and gas, renewables, healthcare and other major industries we serve. Existing or potential customers may delay or cancel plans to purchase our products and services, including large infrastructure projects, and may not be able to fulfill their obligations to us in a timely fashion as a result of business deterioration, cash flow shortages, low oil prices or difficulty obtaining financing due to macroeconomic conditions, geopolitical disruptions, changes in law or other unexpected challenges affecting the strength of the global economy. The airline industry, for example, is highly cyclical, and the level of demand for air travel is correlated to the strength of the U. An extended disruption of regional or international travel, such as a disruption following a terrorist incident, or a recessionary economic environment that results in the loss of business and leisure traffic, could have a material adverse effect on our airline customers and the viability of their business. In particular, our ability to effect an operational turnaround in our Power business will be more challenging to the extent that markets for our products and services remain lower for longer than expected. Further, our vendors may experience similar conditions, which may impact their ability to fulfill their obligations to us. We may also face greater challenges collecting on receivables with customers that are sovereign governments or located in emerging markets. If there is significant deterioration in the global economy, our results of operations, financial position and cash flows could be materially adversely affected. For example, it is possible that future requirements for capital contributions to the insurance subsidiaries will be greater than currently estimated or could be accelerated by regulators. For example, if our annual testing of insurance reserves results in a premium deficiency, we are required to unlock and update the assumptions for our future policy benefit reserves, and any future adverse changes to these assumptions (to the extent not offset by any favorable changes to these assumptions) could result in an increase to future policy benefit reserves and, potentially, to the amount of capital we are required to contribute to the insurance subsidiaries. Certain of these options could have a material financial charge depending on the timing, negotiated terms and conditions of any ultimate arrangements. Our results of operations may be positively or negatively affected by the amount of income or expense we record for our defined benefit pension plans. These valuations reflect assumptions about financial market and other economic conditions, which may change based on changes in key economic indicators. The most significant year-end assumptions we use to estimate pension expense for 2019 are the discount rate and the expected long term rate of return on the plan assets. In addition, we are required to make an annual measurement of plan assets and liabilities, which may result in a significant reduction or increase to equity. Failure to achieve expected returns on plan assets driven by various factors, which could include a continued environment of low interest rates or sustained market volatility, could also result in an increase to the amount of cash we would be required to contribute to pension plans. In addition, there may be upward pressure on the cost of providing healthcare benefits to current employees and retirees. Although we have actively sought to control increases in these costs, there can be no assurance that we will succeed in limiting cost increases, and continued upward pressure could reduce our profitability. Government and regulatory risk includes the risk that the government or regulatory actions will impose additional cost on us or require us to make adverse changes to our business models or practices. Regulatory We are subject to a wide variety of laws, regulations and government policies that may change in significant ways. There can be no assurance that laws, regulations and policies will not be changed in ways that will require us to modify our business models and objectives or affect our returns on investments by restricting existing activities and products, subjecting them to escalating costs or prohibiting them outright. In particular, legislative, regulatory or other areas of significance for our businesses that U. In addition, efforts by public and private sectors to control the growth of healthcare costs may lead to lower reimbursements and increased utilization controls related to the use of our products by healthcare providers. Regulation or government scrutiny may impact the requirements for marketing our products and slow our ability to introduce new products, resulting in an adverse impact on our business. Inability to comply with these regulations could adversely affect our status in these projects and could have collateral consequences such as limiting our ability to participate in other projects involving multilateral development banks and adversely affect our results of operations, financial position and cash flows. Legal proceedings We are subject to legal proceedings, investigations and legal compliance risks, including trailing liabilities from businesses that we dispose of or that are inactive. We, our representatives, and the industries in which we operate are subject to continuing scrutiny by regulators, other governmental authorities and private sector entities or individuals in the U. While we believe that we have adopted appropriate risk management and compliance programs, the global and diverse nature of our operations and the current enforcement environment mean that legal and compliance risks will continue to exist with respect to our continuing and discontinued operations, and we may also be subject to material trailing legal liabilities from businesses that we dispose of or that are inactive. We also expect that additional legal proceedings and other contingencies, the outcome of which cannot be predicted with certainty, will arise from time to time. Moreover, we are increasingly selling products and services in growth markets where claims arising from a catastrophic product failure, alleged violations of law or other incidents involving our products and services may be adjudicated within legal systems that are less developed and less reliable than those of the U. See the Legal Proceedings section and Note 22 to the consolidated financial statements for further information about legal proceedings and other loss contingencies. The lawsuit is pending in the United States District Court for the District of Connecticut. The parties concluded their presentation of evidence and delivered closing arguments in June 2018. Based on a joint application by the parties, the District Court ordered a 30-day stay of proceedings on February 8, 2019, in light of ongoing settlement negotiations. In December 2015, we learned that, as part of continuing industry-wide investigation of subprime mortgages, the Civil Division of the U. The parties are negotiating the definitive settlement agreement, which will contain no admission of any allegation or liability and will conclude this investigation. While there was no fine in connection with that decision, claimants brought civil actions in 2013 seeking damages of approximately $950 million and $600 million, respectively, related to the alleged conduct underlying the decision that are pending before the Central District Court in Israel. In connection with alleged improper payments by Alstom relating to contracts won in 2006 and 2008 for work on a state-owned power plant in o tanj, Slovenia, the power plant owner in January 2017 filed an arbitration claim for damages of approximately $430 million before the International Chamber of Commerce Court of Arbitration in Vienna, Austria. In February 2017, a government investigation in Slovenia of the same underlying conduct proceeded to an investigative phase overseen by a judge of the Celje District Court. Four of these lawsuits are currently pending: the Gammel case, the Trueblood case and the Cuker case, which were filed in New York state court, and the Bennett case, which was filed in Massachusetts state court. The lawsuits allege violations of securities laws, breaches of fiduciary duties, unjust enrichment, waste of corporate assets, abuse of control and gross mismanagement. The Bennett case has been stayed pending resolution of the motion to dismiss in the Gammel case. It alleges violations of Sections 11, 12 and 15 of the Securities Act of 1933 and seeks damages on behalf of purchasers of senior notes issued in 2016 and rescission of transactions involving those notes. We are in the process of negotiating an agreement to stay this case pending resolution of the motion to dismiss the Hachem case. In February 2019, a putative class action (the Sheet Metal Workers Local 17 Trust Funds case) was filed in the U. These cases are at an early stage; we believe we have defenses to the claims and are responding accordingly. The full remedy will not be implemented until any appeals of the revised decision are resolved. Our business leaders monitor financial and operating systems, enabling us to identify potential opportunities and concerns at an early stage and positioning us to respond rapidly. The Board and its committees annually conduct a performance self-evaluation and recommend improvements. Our lead director chaired four meetings of our independent directors this year, helping us sharpen our full Board meetings to better cover significant topics. We strive to maintain a dynamic system of internal controls and procedures-including internal control over financial reporting designed to ensure reliable financial record-keeping, transparent financial reporting and disclosure, and protection of physical and intellectual property. Our internal audit function (Corporate Audit Staff) conducts financial, compliance and process improvement audits each year. We are keenly aware of the importance of full and open presentation of our financial position and operating results, and rely for this purpose on our disclosure controls and procedures, including our Disclosure Committee, which comprises senior executives with detailed knowledge of our businesses and the related needs of our investors. Buy tegretol online from canada. Vinoprin Reviews - Does Vinoprin Work Its Side Effects And Where To Buy Vinoprin.
Carbohydrate intake muscle relaxant juice order tegretol 200 mg without a prescription, both over the aquatic sport disciplines for athletes at every stage of day and in relation to training sessions spasms right side of stomach buy tegretol paypal, should be their development spasms in right side of abdomen purchase tegretol 400 mg with visa. A well-designed spasms under eye buy tegretol 100mg amex, periodised training manipulated according to the fuel costs of training and program remains the fundamental cornerstone of peak racing, and the varying importance of undertaking these performance outcomes, but this will mean little if sessions with high carbohydrate availability. Specialised sports nutrition experts should apply evidence-based science to the Informed management of body mass and composition is intake of key macro and micro-nutrients essential to the key to ensuring that athletes achieve peak performance, health, physique and performance of all athletes. When the training load Aquatic athletes are encouraged to consume a well changes during high volume phases, injury, taper, or in chosen diet with sufficient energy, macronutrients the off-season and after retirement, athletes should (particularly carbohydrate and protein), and adjust their energy intake according to the altered energy micronutrients, to maintain immune function and health. Recovery after training or competition Vitamin D status may be compromised in athletes who should address the nutritional aspects of restoration of are predominantly based indoors. Bone health requires homeostasis, adaptation to the exercise stimulus and adequate energy availability and micronutrient intake: preparation for optimal performance in the next bone-loading activities, which may be limited in an session. These challenges are specific to the session and aquatic sport training program, are also required. Supplements containing essential nutrients training sessions, up to a total of about 1. Pool swimmers should follow a well-planned training diet Athletes contemplating the use of supplements and with a focus on periodising energy and nutrient intakes sports foods should consider their legality, efficacy, cost, to optimise training and competition. Intakes should practicality, and safety, including the risk to health and match requirements for energy and nutrients and be performance. Contaminated supplements may cause a timed to maximise the adaption to each training session. A few evidence-based supplements Swimmers should recognise the individual nutrition may provide a performance benefit for some athletes needs of taper, complex competition schedules and the with no risk to health, but the scientific evidence specific off-season break. Ingesting carbohydrate via sports drinks, gels or sports foods Open water swimming: during intensive and/or prolonged training sessions Open water swimmers are exposed to variable should be beneficial for performance. Swimmers should begin Elite aquatic athletes are required to undertake arduous races with optimised glycogen stores and in a well training and competition schedules in challenging hydrated state. Events may last many hours, so swimmers conditions including varying water temperatures, air and are encouraged to begin feeding early and to consume water pollution, altitude and jetlag/travel fatigue. A planned nutrition approach incorporating strategies to facilitate Nutrition support in elite sport should be provided by recovery should be implemented following training qualified professionals and nutrition assessments should sessions and matches, particularly when short recovery be a key element of the periodic health examination. Players should commence Proactive nutrition screening can allow early detection intensified training sessions and competition well-fuelled and resolution of developing nutrition-related issues. Research into nutrition and aquatic sports is underdeveloped: much remains unknown, but some Diving: sound principles have been established. Education of the Divers require a combination of explosive power, athlete support team, including coaches, healthcare flexibility, strength, artistry and courage to achieve providers, parents, and athletes themselves is a crucial success. Divers must ensure adequate energy availability step to improving nutrition practices. Athletes should to satisfy the needs of daily training loads by dynamically also be aware of the need for long-term dietary planning matching nutrient intakes with the demands of the sport. It is important to Discipline Specific Recommendations make suitable foods and fluids available during prolonged practices and competitions to enable appropriate energy and nutrient intakes to be achieved. Nutrition for the Aquatic Sports 2014, 24, 347 348 Margo Mountjoy Physical and Energy Requirements of Competitive Swimming Events 2014, 24, 351 359 David B. Burke, Anu Koivisto Nutrition Considerations for Open-Water Swimming 2014, 24, 373 381 Gregory Shaw, Anu Koivisto, David Gerrard, Louise M. Cox, Inigo Mujika, Cees-Rein van den Hoogenband Nutritional Recommendations for Divers 2014, 24, 392 403 Dan Benardot, Wes Zimmermann, Gregory R. Cox, Saul Marks Nutritional Recommendations for Synchronized Swimming 2014, 24, 404 413 Sherry Robertson, Dan Benardot, Margo Mountjoy Nutrition and Training Adaptations in Aquatic Sports 2014, 24, 414 424 Inigo Mujika, Trent Stellingwerff, Kevin Tipton Nutrition for Recovery in Aquatic Sports 2014, 24, 425 436 Louise M. Burke, Inigo Mujika Dietary Supplements for Aquatic Sports 2014, 24, 437 449 Wim Derave, Kevin Tipton Disordered Eating and Eating Disorders in Aquatic Sports 2014, 24, 450 459 Anna Melin, Monica Klungland Torstveit, Louise M. Burke, Saul Marks, Jorunn Sundgot-Borgen Nutrition, Illness, and Injury in Aquatic Sports 2014, 24, 460 469 David B. Verhagen, Margo Mountjoy Nutrition Considerations in Special Environments for Aquatic Sports 2014, 24, 470 479 Trent Stellingwerff, David B. The study was conducted to evaluate soft tissue hydration and mass through pattern analysis of vector plots as height, normalized resistance, and reactance measurements by bioelectric impedance vector analysis in patients with head and neck cancer. All patients were previously untreated and without active nutritional interventions. Monitoring vector displacement trajectory toward the reference target vector position may represent useful feedback in support therapy planning of individual patients before surgery in patients with head and neck cancer in order to reduce post-operational complications. Resistance is the opposition to the flow of an electric current, In particular, phase angle measured at 50 kHz, because of its primarily related to the amount of water present in the tissues. Reactance causes the current to lag state observed in the diseased population, with diseased behind the voltage creating a phase shift, which is quantified conditions including cancer (10-18). To transform the result from radians to this study was conducted according to the guidelines set degrees, the result that was obtained was multiplied by 180?/. By using the bivariate Stydy population normal distribution of R/H and Xc/H, we calculated the bivariate 95% confidence limits for mean impedance vectors of cancer Between October 2009 and May 2010 56 subjects underwent patients and healthy subjects. For group underwent a baseline nutritional assessment, which included comparisons of metric data we used the Mann-Whitney-U-test. In our group of patients a pure disorder of soft tissue hydration can not be ruled out because the R component of the impedance vector was increased in comparison with the control group. Indeed, as documented in the literature, impedance vectors were longer and steeper in dehydration. The hypothesis of altered tissue structure due to alterations induced by cancer is also consistent with findings by Kadar and colleagues (29). The clinical usefulness of early detection of cancer metabolic activity independent of tumor mass would be determined by an increased precision of prognosis and the identification of subjects at risk for malnutrition and subsequent cancer cachexia, which can be useful in the tailoring of therapy. The results observed in our study provide valuable information on the nutritional status of the patient prior to surgery. This quick assessment of the nutritional status of the the assessment of body composition and nutritional status in patient can allow for early corrective intervention. Prospective outcome prediction and volume reported that altered tissue properties might reflect previous status assessment are difficult tasks. The invasive, bioelectric impedance vector analysis may offer objective observed impedance pattern indicated altered electrical measures to improve clinical decision-making and predict 104 outcomes. Bioelectric reference target vector position may represent useful feedback in impedance vector distribution in peritoneal dialysis support therapy planning of individual patients before surgery in patients with different hydration status. Altered tissue electric patient group would be valuable to monitor nutritional and properties in lung cancer patients as detected by bioelectric therapeutic interventions in this patient population. Modeling the Acknowledgements: the authors wish to thank Professor human body shape in bioimpedance vector measurements. Reference distribution of the bioelectrical impedance vector in healthy term Conflict of interests: None declared. Head and neck cancer: changing nutritional status and fluid deficits in advanced cancer. Validation of bioelectrical impedance analysis in patients Annu Rev Nutr 1997; 17: 527-558. The use of bioelectrical impedance analysis to standard reference intervals as bivariate Z scores. Bioelectrical impedance in clinical analysis: learning from electrocardiography and forgetting practice. A new method for analysis in clinical practice: a new perspective on its use monitoring body fluid variation by bioimpedance analysis: beyond body composition equations. Bioelectric impedance measurement for fluid the prognostic value of body protein in patients with lung status assessment. Nutrition 2003; 19: and early postnatal life, some aspects of regulation and 510-514. Gastelurrutia P, Nescolarde L, Rosell-Ferrer J, Domingo M, Ribas N, Bazes-Genis A. Contrib Nephrol 2010; Department, Medical University of Lublin, 11 Radziwillowska 165: 226-235. For details on the uncertainties that may cause our actual results to be materially different than those expressed in our forward-looking statements, see . They do not need any convincing that game of inches every day, not feet or miles, and I want us all to how we operate must change. Early fsh introduction is associated with less eczema muscle relaxant reversal discount tegretol generic, but not sensitization muscle spasms 7 little words purchase tegretol 400mg otc, in infants spasms liver best 100 mg tegretol. Age at the introduction of solid foods during the frst year and allergic sensitization at age 5 years muscle relaxant g 2011 generic 100mg tegretol free shipping. Early introduction of oats associated with decreased risk of persistent asthma and early introduction of fsh with decreased risk of allergic rhinitis. Exclusive breastfeeding and incident atopic dermatitis in childhood: a systematic review and meta-analysis of prospective cohort studies. Systematic review of the relationship between early introduction of solid foods to infants and the development of allergic disease. Fat-soluble vitamins in the maternal diet, infuence of cod liver oil supplementation and impact of the maternal diet on human milk composition. Effect of season and vitamin D supplementation on plasma concentrations of 25-hydroxyvitamin D in Norwegian infants. Timing of the introduction of complementary foods in infancy: a randomized controlled trial. Iron status with different infant feeding regimens: relevance to screening and prevention of iron defciency. Iron absorption in breast-fed infants: effects of age, iron status, iron supplements, and complementary foods. Nutrition and Iron Status of 1-Year Olds following a Revision in Infant Dietary Recommendations. Effect of delayed versus early umbilical cord clamping on neonatal outcomes and iron status at 4 months: a randomised controlled trial. Uusitalo L, Nyberg H, Pelkonen M, Sarlio-Lahteenkorva S, Hakulinen-Viitanen T, Virtanen S. Imevaisikaisten ruokinta Suomessa vuonna 2010 (Infant feeding in Finland in 2010) [In Finnish, short summary in Swedish]. Spedkost 6 maneder Norwegian national dietary survey among infants at 6 months (in Norwegian). Spedkost 12 maneder Norwegian national dietary survey among infants at 12 months (in Norwegian). Amning och foraldrars rokvanor Barn fodda 20010 [Breast feeding and smoking habits among parents of infants born in 20010] 2012. The Copenhagen cohort study on infant nutrition and growth: duration of breast feeding and infuencing factors. Infant feeding in Finland 2000 [In Finnish: Imevaisikaisten ruokinta Suomessa vuonna 2000]. Infant feeding practices and associated factors in the frst six months of life: the Norwegian infant nutrition survey. Complementary feeding: report of the global consultation, and summary of guiding principles for complementary feeding of the breastfed child. Such dietary patterns, especially if low in energy density and combined with physically active lifestyles, will reduce the risk of weight gain in the population. In contrast, dietary patterns characterized by high intakes of processed meat, red meat, and food products made from refned grains and sifted four as well as those high in sugar, salt, and saturated and trans-fatty acids are associated with adverse health effects and chronic disease. Non-communicable diseases are not simply caused by single nutrient imbalances, but are diseases with multifaceted aetiologies (2, 3). The search 103 for preventive measures against chronic disease, therefore, needs to take a broad approach. Over the past 15 to 20 years, a large number of obser vational studies and experimental trials have recognized the complexity of the diet and thus have focused on the impact of whole diets and of patterns of food consumption when examining diet-disease associations. The dietary habits in the Nordic countries have several common features, and food consumption trends tend to be similar. Some characteristics of these diets are an ample supply of milk and dairy products, moderate to high consumption of meat, and moderate consumption of vegetables and fruit. Food sources of nutrients and other bioactive substances Most foods contain a broad range of nutrients, with some exceptions such as refned sugar and household salt, and the distribution of nutrients difers across foods and food groups. Foods also contain a multitude of bioactive constituents other than nutrients that can afect the bioavailability, uptake, and metabolic response of nutrients. Diets are planned with the aim of promoting and maintaining optimal body function. A variety of common foods should be used in order to ensure that essential nutrients are pro vided as well as other food components for which human requirements have been less well defned. The descriptions of major food groups and their nutrient contributions given below are largely based on information provided in the Norwegian report of dietary guidelines for health (6). Beans and peas are good sources of protein, minerals (iron, zinc, magnesium, and potassium), B-vitamins (except B12), fbre, and starch. Although the energy density of many plant foods is low, others such as nuts and seeds, olives, root vegetables, legumes, and cereals are comparatively energy dense. The nutrient concentration per weight unit might be comparatively low when the water content of vegetables, fruits, or berries is high. Potatoes are comparatively rich in carbohydrates (starch), several minerals (such as potassium and magnesium), and vitamins such as vitamin C. Po tatoes have traditionally been important sources of vitamin C and protein, but today fruits and vegetables are the most important sources of vitamin C and animal products provide most of our protein. Whole grain is defned as intact grain (or cereal), and in processed whole grains the fractions of endosperm, bran, and germ are present in the same proportions as in the intact grain. Cereals are good sources of carbohy drates, such as the starch concentrated in the endosperm, and, therefore, are major sources of dietary energy. Whole grains also provide fbre, re sistant starch, minerals (iron, zinc, phosphorous, and magnesium), vita mins (vitamin E, thiamine, ribofavin, niacin, and vitamin B6), and phyto chemicals (see below). Cereals are processed and manufactured into a variety of products in cluding many diferent types of four, breads, and pasta and in mixed and complex products such as breakfast cereals, baked goods and bread. Be cause micronutrients and other bioactive compounds are mostly found in the germ and bran fractions, refned cereal products (made from sifed four) generally have lower nutrient content and also ofen contain higher amounts of added sugar, fat, and salt (see below). Most of these have important functions in the plant cells and can also infuence biological functions in the human body via a wide variety of mechanisms. Many are antioxidants with the potential to reduce oxidative stress, and others can infuence signalling systems, cell cycles, repair systems, and infammation reactions. The currently estimated number of bioactive phytochemicals is around 100,000 (6) and a single plant-based meal might provide around 25,000 diferent phytochemicals albeit with comparatively small amounts of each. The observed health efects associated with vegetable, fruit, berry, and whole grain consump tion can likely be explained by the combined action of many diferent phytochemicals and other nutrients. Vegetable oils, margarine, vegetable oil-based fat spreads, and butter are used in cooking and with bread and by the food industry to produce foods such as mayonnaise, dressings, baked goods, and soups. Vegetable oils are manufactured by pressing oil from seeds or plants such as rapeseeds, sunfower seeds, faxseeds, soya beans, olives, maize kernels, palm fruit, and coconuts. Vegetable oils, vegetable oil-based fat spreads, and butter contain fat, and thus dietary energy, and fat-soluble vitamins such as vitamins A, D, E, and K. Vegetable oils and vegetable oil-based fat spreads also contain essential fatty acids. Vitamins A and D are usually added (regulated by legislation) to vegetable oil-based fat spreads. Vegetable oils contain 100% fat, but margarines and spreads contain varying amounts of fat. The fatty acids composition can vary considerably depending on the fat source used in manufacturing. Lean fsh such as cod, had dock, saithe, plaice, and pike contain less than 2 g of fat per 100 g, medium fat fsh such as winter-mackerel, halibut, catfsh, and tuna contain 2?8 g of fat per 100 g, and fatty fsh such as herring, summer-mackerel, trout, salmon, and eel contain more than 8 g of fat per 100 g. Fatty fsh are a major source of dietary vitamin D, and some lean fresh-water fsh. However, the nutrient content might vary between wild fsh and farmed fsh depending on the feed. In general, fsh captured in the open sea have lower concentrations of pollutants than fsh from the Baltic Sea or Norwegian fords. As a consequence the national food agencies of the Nordic countries have issued specifc advice on fsh consumption for specifc population groups. Milk from ruminants is both a food in itself and a raw material for difer ent dairy products such as cheese, butter, fermented milk, yoghurt, and cream. Milk and milk products are good sources of protein, fat, vitamin A, ribofavin, vitamin B12, calcium, and iodine. Milk also contains short-chain fatty acids and the odd-chain fatty acids C15:0 and C17:0 (21). |
