Fruits have never been a diabetes patient’s friend and we do have major controversies surrounding the consumption of various fruits in people with increased blood glucose levels. Being a natural source of sugar, various fruits such as mangoes, sapodillas, custard apple and jackfruits have a reputation of being crossed out of a diabetic patient’s diet as they have the characteristic to increase sugar levels to a great extent. But the notion that no fruit should be consumed by such people is a misjudgment and the restriction on the type and quantity of fruit depends on the daily diet routine and blood sugar levels of the concerned person. Type 2 diabetes exists as one of the most prevalent public health concerns worldwide becoming a global epidemic. Diabetes rates are expected to cross 550 million by 2030 owing to vagaries in diet intake and haphazard lifestyles. Variation in insulin secretions, insulin action or both together characterize type 2 diabetes whose side effect can result in advanced cardiovascular disease. Diabetes also increases oxidative stress and inflammation of which inflammation is greatly affected by dietary components.
Diabetes is often controlled with medications and lifestyle changes. But hypoglycemic drugs present with undesired side effects that often leave patients frustrated and irritated. Till date, the quest for a new anti-diabetic agent has continued. We do have positive results on natural antioxidants such as polyphenols that impart beneficial effects on endothelial function but there are also studies showing their effective results on glucose and lipid disorders apart from having anti-inflammatory effects. Different foods contain polyphenols and are said to have an anti-inflammatory effect that include fruits as well. One such fruit is pomegranate-Punica granatum.
Pomegranate as an Anti-diabetic Agent
Haven’t we all heard it from our elders that the pomegranate is an excellent source of iron that’s used to stave away anemia from attacking a person? Not many individuals choose pomegranate as their favorite fruit as it has a lingering tinge of bitterness even when its available in juice form after adding ample sugar! The fruit is packed with high levels of antioxidants and polyphenols which makes it an excellent research element for anti-inflammatory, anti-atherogenic, antioxidant and anti-hyperglycemic effects. Pomegranate juice (PJ) is rich in polyphenolic acids such as ferulic acid, chlorogenic acid, caffeic acid and gallic acid and non-phenolic acids and the pomegranate seed oil (PSO) contains 80% conjugated linolenic acid or punicic acid. Pomegranate extract (PE) contains much of anthocyanin, punicalin, pedunculagin, punicalagin, gallagic acid and ellagic acid. There are various studies showing PJ as a good source of anti-inflammatory, anticancer, antihypertensive, anti-atherogenic and anti-diabetic agent, the fruit supplements have been shown to improve cognitive and functional recovery in ischemic stroke patients. There is also research evidence that pomegranate juice or extract improves glucose metabolism, lowers insulin requirements and ameliorates insulin sensitivity. The primary way in which PJ brings bout beneficial effects on the body is by reducing oxidative stress, the imbalance between reactive oxygen species (ROS) and antioxidants and lipid peroxidation. There are observational studies that link pomegranate consumption with decreased risk of diabetes and improved glycemic control but their exact effect on insulin and glucose metabolism in humans is inconsistent.
A research team performed a meta-analysis and systemic review of randomized controlled trials (RCTs) to understand the effects of pomegranate consumption on glucose levels and insulin sensitivity. The team selected studies based on various inclusion criteria which included that participants should be above 18 years of age with/without the presence of co-morbidities such as hypertension, diabetes and peripheral arterial diseases. Several keywords were used to extract relevant studies which was done by two investigators who independently performed the searches. From every selected trial several information including the participants’ information such as mean age, sex, body mass index (BMI) and health status were extracted. The initial search yielded 139 studies but after several exclusion criteria the team was left with 16 RCTs. Every trial consisted of 14-74 participants amounting to a total of 627 subjects whose mean age was between 30 and 70 years. Participants were required to have ingested a pomegranate intervention for ≥1 week and studies where pomegranate was combined with other interventions (such as intake of medications for diabetes) were also included when the control group received the same treatment. Of the 16 trials included, 11 trials used pomegranate juice as a supplement, 2 used pomegranate seed oil and 3 studies used pomegranate extract as an intervention and the duration for each lasted anywhere between 1 and 12 weeks. 12 studies consisted of individuals who were at a risk of cardiovascular disease owing to the presence of type 2 diabetes mellites, overweight, obesity, hypertension and metabolic syndrome. Of the remaining 4, 3 trials consisted of healthy subjects and one trial consisted of patients with chronic obstructive pulmonary disease.
The trials primarily focused on differences in the levels of fasting blood glucose (FBG) and fasting blood insulin (FBI) while secondary outcomes included glycated hemoglobin (HbA1c) and homeostatic model assessment of insulin resistance (HOMO-IR). Results showed that:
A study published in the Nutrition Research journal found that regular consumption of PJ helps in controlling blood sugar levels in type 2 diabetes patients but with the only exception that the same was not observed in healthy people. Evidences ae mixed and we are still unable to figure out the exact effect of the fruit on diabetes. Until then, it is always safe to restrict consumption of pomegranate in any form as every fruit contains a certain amount of sugar and it’s only the quantity that varies from fruit to fruit. Practicing healthy lifestyle changes and leading an active life can go a long way towards helping people control blood sugar levels.
Lack of Efficacy of Pomegranate Supplementation for Glucose Management, Insulin Levels & Sensitivity: https://nutritionj.biomedcentral.com/articles/10.1186/s12937-017-0290-1
Antioxidant-rich Pomegranate Juice May Aid Blood Sugar Management for Diabetics: https://www.nutraingredients-usa.com/Article/2014/08/25/Antioxidant-rich-pomegranate-juice-may-aid-blood-sugar-management-for-diabetics-Human-data
Every mother-to-be is given an estimated due date for her fetus but rarely more than 5% of infants are born on this date. As the name suggests, the specified date is only an ‘estimated’ date and not the exact date on which the child is due anyway. Every parent wishes for a full-term (happens after 37th week of pregnancy) delivery but deviations do happen frequently and some children are born before the start of the 37th week of pregnancy. The baby can be born as early as the 25th week of pregnancy and we call such babies as ‘extremely preterm’ infants. Any preterm baby is subjected to complications and the intensity of the complication depends on how early a baby is born.
Of the various complications, unmet nutritional requirements exist as one of the concerns for every person attending to a preterm infant. This is a challenge as establishing adequate intake is extremely painful to achieve in the initial few weeks after delivery. The recommended dietary intakes are based on needs for maintenance and growth alongside the assumption that post-natal growth approximates that in utero at the same post conceptional age. Even if these recommended nutrition levels are established in such infants there are frequent clinical interventions during the first 3-4 weeks after delivery that cause much hindrance to fulfill these requirements. Again, recommendations for weight gain include that it approximates that of the normal fetus at the same post conception age (10-15 g/kg/day). But this is practically not easy to achieve as preterm infants lose weight before regaining birth weight and there is the chance of a lag in expected weight at the same postconceptional age in these infants. If any infant wishes to break this and gain normal weight the weight gain must be in excess of what would happen in utero and this is next to impossible during the first few days/weeks of hospital stay.
Many of the preterm infants have reduced organ development and the foremost goal of enteral feed is to support postnatal intestinal adaptation. We have research data supporting the fact that such children adapt better to human milk compared to low birthweight infant formula. If the infant doesn’t adapt well to human milk term infant formula might be fed until he/she adapts well and from thereon, preterm infant formula might be given. While it is of great importance that infants adopt well to enteral feeding once the tolerance is sustained it is then crucial to ensure that intake meets growth needs.
Supplementing Nutritional Requirements
Though breast milk is the recommended form of enteral nutrition for all infants including preterm babies sadly we do also understand this this alone is not sufficient to meet recommended nutritional needs for growth in preterm infants. Preterm infants feeding on human milk gain less weight than those feeding on fortified human milk. Also, those preterm infants feeding on human milk alone show poorer growth compared to those infants feeding on preterm infant formula because of lower concentration of proteins, minerals and energy density in human milk comparatively. It is better to provide these newborns with fortified human milk, preterm infant formula or a combination of both. It is easier said than done and fortification of human milk poses a significant challenge and there have been several steps taken to minimize this challenge. Among these steps, adjustable fortification (ADJ) seems to display favorable results-this includes using a protein supplement on an individualized basis alongside a multi-component fortifier. This basically involves providing the newborn with protein based on his/her metabolic response but this remains a challenge as the availability of a high-quality, well-tolerated protein supplement is almost non-existent. Doctors don’t recommend cow’s milk until a child’s first birthday owing to various reasons that include a risk of allergies and chances of intestinal inflammation in preterm neonates but most of the multi-nutrient fortifiers are derived from bovine milk that has a protein composition that’s different from human milk. Such disadvantages led researchers to check out on exclusive HM diets (human milk-based fortifier and donor HM when mother’s milk is unavailable) and one such research led them to donkey milk. These researchers were surprised to find that when children allergic to cow milk were fed with donkey milk (DM) it was well-tolerated by these kids as the protein and lipid structure of DM was similar to human milk composition. According to the research group, feeding preterm children with human milk fortified by protein and multi-component supplements derived from DM is more suitable than any other fortification for their short- and long-term well-being.
The study selected infants that were born before 32 weeks of pregnancy, <1500 g at birth, fed with exclusive breast milk (mother’s own or donor milk) and did not suffer from certain medical conditions laid down. Once selected, the kids were divided into two groups-the control group and the fortilat group. The kids in the control group were fed with multi-component fortifier and protein concentrate named BMC and BPC respectively derived from bovine milk for a minimum period of 21 days. The fortilat group were provided with multi-component fortifier and protein concentrate namely DMC and DPC derived from donkey milk for a period of 21 days.
The study included 115 infants who were born before 32 weeks of gestation weighing less than 1500 grams with breastfeeding initiation rates present in 90% of kids. The researchers found that the DM had an n-3 PUFA (poly unsaturated fatty acids) structure that was similar to the one found in humans and was also rich in lysosome, a protein that has antibacterial property, that can hamper pathogen growth and milk spoilage. Supplementing infants with DM decreases body lipid concentration and affects glucose and lipid metabolism in ways similar to human milk than cow’s milk. The researchers hypothesized from the study that feeding newborns with human milk fortified by protein and multi-component supplements derived from DM will improve feeding tolerance and clinical, metabolic, neurological and auxological outcomes. But we do need further evidence to confirm the usage of DM as a fortifier for human milk. This would indeed open the door for a sea of opportunities as it minimizes the risk of neurocognitive impairment and poor health outcomes such as retinopathy and bronchopulmonary dysplasia. It is mandatory that human milk is supplemented with nutrients such as protein, calcium and phosphate to meet the nutrient requirements of babies.
Nutritional Adequacy of a Novel Human Milk Fortifier from Donkey Milk in Feeding Preterm Infants: https://nutritionj.biomedcentral.com/articles/10.1186/s12937-017-0308-8
Feeding Issues in Preterm Infants: https://fn.bmj.com/content/fetalneonatal/83/3/F215.full.pdf
Fortification in Human Milk for Preterm Infants: https://www.frontiersin.org/articles/10.3389/fped.2019.00076/full
Fed up of having a crying child around the house while you are busy finishing your pending office files or household chores? The best thing is to stop the crying with a big chocolate bar or a doughnut. Bribing kids with processed foods seems to be the only way out to get things done according to a large section of the parent population. Take a moment to think of the various situations in which you have voluntarily given a candy or a soft drink to your kid and you are sure to be surprised of the frequency! Yes. It’s time to realize the wrongdoings and set things right. The next time you want your child to perform well in dramatics play, study for an exam, do homework or sleep early take a pledge to never bribe them with their favorite snacks but lookout for other non-food rewards that would work out equally well! Failing to change to such means can lead to grave results as the current health scenario in kids and adolescents is barely up to the mark. There is a rise in obesity/overweight rates in kids and oral health is going for a toll with the spread of soft drinks consumption and processed foods. The consumption of soft drinks has increased by 500 times in the last 50 years and the major consumers are children, teens and young adults. Boys are found to be greater consumers of these beverages compared to girls.
Sour Effects of Sweet Food Intake
The intake of sugar sweetened beverages and snacks has a high risk of causing obesity, diabetes and also marks the path for an unhealthy lifestyle. Above all, sugar, the main ingredient in soft drinks and many snacks is the cause behind dental decay and tooth caries. According to public health experts without sugar there is not much scope for developing decay. The fact that 95% of 12-year-old kids in Philippines have tooth decay and cavities, 7 in 10 kids in India have tooth decay, one-third of Tanzanian teens and almost 1 in every 3 Brazilian kids suffer from dental problems does indeed emphasize the volume of the problem at hand. Earlier, it was only developed countries that ate a major portion of processed foods and low-income countries mainly relied upon plant- and meat-based diets, less sugar and processed foods but changes in the economy brought about a change to people’s diet as well. In the opinion of Marion Nestle who has written the book Soda Politics major soda companies such as Coca Cola and India are willing to spend billions of rupees in marketing in countries such as Africa and India alone.
If you look at the major cause behind tooth decay dental erosion (DE) occupies number one position. DE does not involve bacteria but is a gradual deterioration in tooth structure and dentine by chemical processes that affect primary teeth rapidly than permanent teeth due to the presence of a fragile enamel layer in primary teeth. Side effects of DE include hypersensitivity of the tooth, altered occlusion, eating difficulties and dental abscess. Its common in older children but UK’s National diet and nutrition survey reports 10% of 1.5-year-old kids and 53% of 5-year-old kids suffering from dental erosion presently. In Riyadh (Saudi Arabia), DE is present in 34% of 5-6-year-old children and 26% of 12-14-year-old kids and a study in a preschool in Jeddah showed that DE was 31% present in primary incisors. The main causes of such erosions include increased consumption of acidic fruits, fruit juices and carbonated drinks. Higher the consumption of beverages greater is the prevalence of dental erosion and the timing of consumption too is equally important. Health experts always suggest parents to refrain from using the feeding bottle at night for kids as there are greater chances of dental erosion when the bottle lingers in the kid’s mouth for a prolonged period. An acidic diet has all the possibilities of causing a destruction to tooth structure at night. It is sad to know that there is a high degree of ignorance among public when it comes to dental erosion compared to other dental disorders and there is a greater need to assess the status of DE in kids as DE in primary teeth is important for predicting the chances of DE in permanent teeth as well.
Understanding the Relationship between Dental Erosion & Dietary Intake
A study in Riyadh focused on understanding the prevalence of dental erosion in 3-5-year-old preschool children and to know whether there was any relationship between dental erosion and dietary intake in kids. The research team came up with a questionnaire that included information on the child’s age, gender, food habits (cakes, sandwiches, donuts, candy, ice cream) and interest in beverage consumption (fresh fruit juice, citric fruit juice, mixed fruit juice, flavored milk, plain milk). Clinical examinations were carried out at the kid’s schools using mouth mirrors, gauze, tweezers, masks, gloves, gowns, eyeglasses and lights. Each tooth surface was examined for loss of enamel surface characteristics and other DE presence. Every kid was put into one of the two groups based on the tooth surface scores. A child with score ‘0’ was placed in the no erosion group, a child with a score of 1 was placed in the low erosion group, score 2 was placed under ‘moderate erosion’ group and scores 3 and above were placed in the severe erosion group. In genera kids with no erosion on any tooth surface were placed in the ‘group without erosion’ and those with erosion on one or more teeth were put into the ‘group with erosion’.
The study included 388 kids of which 184 (47%) were boys and 204 (53%) were girls aged between three and five years selected from 10 different preschools. Shockingly among the 388 kids tested 235 (61%) of them had erosion on at least one tooth surface. The study showed that:
Factors Affecting Dental Caries
The form of food, frequency of consumption and combination of other foods play a significant role in causing tooth caries in kids. Most of the commercial soft drinks are highly acidic with a pH between 2.5 and 3.3. When kids consume sugar-laden drinks the pH falls below 5.0 due to acid production by bacterial metabolism. Most of the bacterial components of dental plaque linked to healthy sites can bear such a fall in pH. But such falls in pH is more commonly present in those subjects who consumed sugar-laden drinks and snacks in between meals. Such a condition encourages the growth of certain acid-tolerant bacterial species which puts the person at a higher risk of dental caries.
Hair Samples as Biomarkers of Dental Caries
The study was conducted in Alaska on 51 children aged between 6 and 17 years. Each of the parent-kid team was asked multiple questions pertaining to child and family demographics and child oral health behavior (sugar-sweetened beverage intake, toothbrushing, fluoride access, etc). All of the children involved in the study were taken samples of their hair and every kid received a tooth surface-level dental exam based on World Health Organization criteria.
The study population consisted of 50% females whose mean age was 10.8 years. Parental survey revealed that 49% of kids reported consuming sugar-sweetened beverages 2-3 times/day and 15.7% consuming it ≥4 times/day at home. Almost 14% kids consumed soda 2-3 times/day, 43.1% consumed soda 1-4 times/week and 33.3% never consumed soda. More than 45% kids consumed 100% juice and 65% kids drank plain water. Almost 71% children consumed sweets, 78% had salty snacks at least once a week, less than 30% had a serving of vegetable once a day and 15.7% never ate vegetable at home. Lesser than 14% had a serving of fruit once a day and 17.6% never ate fruit. Only more than a quarter of kids brushed their teeth more than once a day while 37.3% kids brushed it once a day.
30.8% children suffered from dental caries where the percentage decreased from 6-12 years and increased from 13-17 years. A 40 g/day increase in added sugar was associated with a 6.4% absolute increase in the proportion of carious tooth surface and a 24.2% relative increase in proportion of carious tooth surface. On an average, children consumed around 193 g of added sugar per day. It was observed that the children in the study consumed 16 times the maximum allowed daily sugar intake recommended for kids. Sugar-sweetened fruit drinks are the main source of added sugar among these kids where a major proportion of the beverage is consumed at home.
Parents can play a major role in helping kids reduce their consumption of such sugar-sweetened beverages. They should realize the importance of fresh fruit consumption and provide it as an alternative for these beverages. Kids should be exposed to fluorides in the form of toothpastes or water, a well-balanced diet regimen that includes minimal sugar-based foods and a healthy lifestyle must be followed to minimize the risk of dental caries in kids.
The Influence of Frequently Consumed Beverages & Snacks on Dental Erosion among Preschool Kids in Saudi Arabia: https://nutritionj.biomedcentral.com/articles/10.1186/s12937-017-0307-9
Association between Added Sugar Intake and Dental Caries in Children Using a Novel Hair Biomarker: https://link.springer.com/article/10.1186/s12903-015-0101-z
Sugar Rules the World & Ruins Teeth: https://www.npr.org/sections/goatsandsoda/2019/07/19/743500431/study-sugar-rules-the-world-and-ruins-teeth
Sugar-sweetened Beverages: General & Oral Health Hazards in Kids & Adolescents: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5030497/
Three square meals a day is indispensable for life. Earlier, our ancestors ate full-fledged meals in the morning and night with something light to fill the tummy during evenings. With the advent of the modern age there have been tremendous changes in our lifestyle and mankind has reached a stage where we eat five to six times daily splitting the meals into smaller portions and snacks remains an integral part of this meal schedule. Some love to eat heavily during breakfast and lunch while some love to munch upon something every once a while to keep themselves out of hunger pangs. If you look at these different methods, even experts agree that splitting food into smaller portions and keeping yourself satisfied through the day is the best way to avoid overeating and hunger pangs. Despite such calculated meal intakes and multitudinous availability of food there is no shortage of obesity, overweight and health problems that attack mankind from every direction possible. Where are we making a mistake and what could be done to avoid these erroneous circumstances?
Nothing Nutritious in Between
Snacking has become a regularity in each of our daily schedules: mid-morning snacks, evening snacks and even late-night snacking are a routine affair in many people’s homes. Such between-meal snacks contribute a majority of the solid fats, added sugars and sodium in our diets which are great contributors of ‘empty’ calories that provide abundant energy but minimal nutrients. Snacks can be healthy or otherwise depending on what and when we consume. Snacking is healthy when we don’t pile upon calorie consumption over the day and the same snacking is also one of the critical causes of obesity and weight gain expressed as a public health concern when taken inappropriately. Our meals must contain all five food groups contributing towards nutrient requirements ideally. But when such nutrients remain unfulfilled snacks come to our rescue when we choose to eat smart. Such healthy snacking increases the nutrition graph by improving diet quality, reducing sodium and empty calorie intake and covering up for nutrition losses, if any. Such healthy snacking also moves fat intake from solid fats such as saturated and trans fats to mono- and polyunsaturated fats (MUFAs and PUFAs). People residing anywhere in the world consume more of sodium and empty calories while decreasing consumption of whole grains, plants, seafood, whole fruits and vegetables.
Eat your Nuts with Guts
Salads, pulses and fruits are regular snacking recommendations and nuts such as almonds, cashews and walnuts are highly recommended these days as a regular part of dietary guidelines. Nuts are nothing new to mankind and their consumption dates back to as early as Stone Age. Since then they have been a prized possession around the world right from Persia and Europe to China and Scandinavia. Tree nuts are great sources of unsaturated fats, fiber, minerals and vitamins whose regular consumption is associated with numerous advantages such as reduction in blood cholesterol levels and CVD risk. Presently, nuts find themselves in many delicacies prepared, as snacks, spreads and recipe ingredients. They are enjoyed in various forms by people present worldwide. They are one of the most tempting snacks that’s high in fat content proving itself to be energy dense. But, these nuts mainly contain unsaturated fats-polyunsaturated fats in walnuts and pine nuts and monounsaturated fats in pistachios, almonds and hazelnuts. Cashews, Brazil nuts and macadamia nuts contain more saturated fats whose increased consumption can lead to increase in cholesterol levels but another nut called the chestnut is lower in all types of fats and high in starch carbs than other nuts.
A National Health & Nutrition Examination Surveys (NHANES) shows that tree nut consumption was linked to better nutrient adequacy, higher diet quality and improved health risk markers. Being a rich source of energy there have been concerns regarding their role in weight gain as individuals perceive this snack to be fattening and ineffective against heart protection. But we do have authentic cohort studies that support the benefits of nut consumption including reduction in all-cause mortality, death due to heart problems, cancer and even reduction in weight gain. Such benefits of these nutrient-rich tree nuts prompted a group of researchers in America to replace between-meal snacks with tree nuts or almonds. This group went about researching on the feasibility of nuts as a snack by creating a tree nut composite that had details about the relative frequency of consumption of different nuts such as walnuts, pecans and almonds in a given population. The research team’s main aim was to find out whether replacing other snacking options with nuts could have effect on dietary constituents such as sodium, potassium, solid fats, sugars, fatty acids and magnesium.
Dietary data drawn from NHANES was available for 17,444 kids, adolescents and adults ≥1y. Excluding kids who consumed breast milk the study team was left with 6,881 kids and adolescents and 10,563 adults (≥20y). Two recalls were taken with the first one taken face-to-face and the second one done over phone. While 85% participants completed both the recalls the remaining 15% could take up only either of the two. Information on the favorable food groups including nuts, seeds, added sugars, solid fats and oils of all the participants were also noted down. The team came up with two different models. Model 1 replaced all between-meal snacks with tree nuts on a calorie-per-calorie basis. Model 2 exempted all between-meal snacks such as fruits, non-starchy vegetables and grains containing more than 50% whole grains. Both the models were applicable only to solid snacks with no changes made to between-meal beverages such as fruit juices, soft drinks, cola and alcohol. The diet of those individuals who have already been consuming tree nuts as snacks was not altered in any way.
A composite tree nut was made based on current consumption patterns. For this, a list of all tree nuts consumed by the participants was made and then weighted frequency of consumption was marked and a weight was given to each tree nut based on its frequency of consumption. Almonds were the commonly consumed tree nut which was assigned a weight of 0.268. Other nuts assigned values included walnuts (.208), pecans (0.088), dry roast almonds (0.086), cashews (0.076), pistachio nuts (0.069) and dry roast almonds without salt (0.071). The nutrition value of the composite tree nut was used in the models depending on the amount of snack energy that’s eligible for substitution. The researchers found potassium, fiber and magnesium to be nutrients of interest. The 2010 Healthy Eating Index (HEI-2010), an energy-adjusted measure of diet quality based on 12 components including 9 healthy components such as total fruits, whole fruit, total vegetables, greens and beans, whole grains, dairy, total protein, protein from plant and seafood sources and fatty acid and 3 other unhealthy components such as refined grains, energy from solid fat and added sugars and sodium was also used in the study.
Among the 17,444 participants 76.9% participants had a snack on the first day of recall. Overall mean energy from snacks was 303 kcal/d and the median was 204 kcal/d. Among those who consumed snacks, mean energy from snacks was 394 kcal/d and median was 293 kcal/d. Mean energy from solid snacks eligible for substitution was 252 kcal/d and median was 148 kcal/d. In Model 1 the amount of solid snacks that was eligible for substitution depended on age: 250 (ages 1–3y), 341(4–8y), 374 (9–13y), 350 (14–19y), 316 (20–30y), 309 (31–50y), 285 (51–70y), and 206 (71 + y). Median energy from snacks (293 kcal/d) corresponds to 51 g of almonds or 45g of walnuts. Cookies, brownies, frozen dairy dessert, cakes, pies and candy containing chocolates were the primary source of snack calories from solid food. Popcorns, bananas, apples and other fruits contributed to 1% of snack calories from solid foods. Results showed that:
Replacing American Snacks with Tree Nuts Increases Consumption of Key Nutrients Among US Children and Adults: https://nutritionj.biomedcentral.com/articles/10.1186/s12937-017-0238-5
I’m Confused-are Nuts a Healthy Snack? https://www.bhf.org.uk/informationsupport/heart-matters-magazine/nutrition/ask-the-expert/nuts-as-a-healthy-snack
Tree Nuts & Peanuts as Components of a Healthy Diet: https://academic.oup.com/jn/article/138/9/1736S/4750848
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