Platelet Activating Factor (PAF) is a pro-inflammatory mediator of atherogenesis. Food enriched with PAF inhibitors may have potential cardioprotective properties. In this attempt our group along with a well-known Greek dairy company incorporated bioactive ingredients (BAL) from olive-oil by-products, rich in PAF receptor specific inhibitors, into another typical food of the Mediterranean diet, namely yogurt. The aim of the present study was to evaluate the cardioprotective properties of the enriched yogurt in apparently healthy volunteers.

Ninety two apparently healthy volunteers (35–65 years) were randomly allocated into three groups by block-randomization based on age, sex and BMI. The volunteers in Group A did not consume any yogurt. The volunteers of Group B consumed a non-enriched yogurt daily. The Group C volunteers ate daily an enriched yogurt. The intervention lasted 8 weeks. Volunteers’ adherence to the study protocol was assessed by two 24 h recalls every two weeks conducted by trained personnel. Blood and urine samples were collected at baseline, at 4th week and at 8th week of the intervention and biochemical and inflammatory markers were determined. In addition, platelet aggregation in volunteers’ platelet rich plasma against PAF, ADP and TRAP were measured and the results expressed as the concentration of the agonist that cause 50% of the maximum aggregation (EC50, efficient concentration fifty values).

Among classical anthropometric and biochemical markers, only a decrease of blood pressure (systolic and diastolic) levels was observed (p0–8weeks < 0.05) in group B but with no clinical significance. Reduced levels of IL-10 was observed in group C compared to B both in the meantime (p4weeks = 0.01) and at the end of the intervention (p8weeks = 0.04). Furthermore, platelet sensitivity against PAF was only decreased (higher EC50 PAF,) in group C (p0–4weeks = 0.005 and p0–8weeks = 0.05). A trial effect was observed in the meantime among the three groups (p = 0.03).

The consumption of the enriched yogurt led to attenuation of subclinical inflammation and platelet sensitivity to thrombotic stimuli in apparently healthy volunteers, indicating a potential cardioprotective role of PAF inhibitors.

The work is funded by SYNERGASIA 2011 PROGRAMME. This Programme is co-funded by the European Regional Development Fund and National Resources, Project Code 11SYN-2-652.

A link has recently been underlined between one-carbon metabolism and body weight and body composition, suggesting that folate may account for body mass determination and lipid metabolism. The aim of this study was thus to analyze whether folate intake is associated with body weight, body mass index (BMI), body fat percentage, and liver status.

409 subjects aged 20–40 were enrolled in Poznań, Poland from 2016 to 2018. Food intake was assessed using three-day food records. Folate intake was calculated based on food composition tables using the Diet 5.0 program (National Food and Nutrition Institute, Poland). Weight to 0.1 kg and height to 0.01 m were measured using an electronic scale and a stadiometer, respectively. BMI was calculated as body weight in kilograms divided by height in meters squared. Fat mass and lean body mass were determined using whole-body air-displacement plethysmography (BodPod, Cosmed, Italy). Genotyping of rs1801133 (MTHFR) was performed with TaqMan probes. The following biomarkers of liver steatosis were calculated: NAFLD liver fat score (NAFLD-LFS), fatty liver index (FLI), and hepatic steatosis index (HSI). To analyze the associations between folate intake and the measured parameters, we used multiple regression with adjustments for age, sex, and energy intake.

The mean body weight was 78.57 ± 18.14 kg, BMI 25.96 ± 5.28 kg/m2, and fat percentage 29.20% ± 10.78%. The median folate intake was 299.3 μg/day. Dietary folate intake was negatively associated with body weight, BMI, and body fat percentage (p < 0.05 for all associations). Folate intake was also associated with fatty liver indices—namely HSI (p < 0.05) and FLI (p < 0.05). There was no association between folate intake and NAFLD-LFS. MTHFR rs1801133 polymorphism was not associated with any of the measured parameters.

Our findings suggest that folate intake may affect body weight and composition, as well as liver status. Higher folate intake could have a protective effect against obesity, but further studies are necessary to investigate the mechanism.

The authors declare that they have no conflict of interests.

This work was supported by the Polish National Science Centre

(grants 2014/15/B/NZ9/02134 and 2016/21/N/NZ9/01195).

Chronic stress is associated with impacting eating behavior, namely food choice and energy intake, with a shift towards more palatable and energy dense foods. Additionally, eating behavior is influenced by other psychological factors like mood and emotions. The categorization of people into eating types such as restrained, emotional, and external eaters has gained attraction. Reported changes in eating behavior due to psychological stress are only occasionally accompanied by measures of physiological hunger through ghrelin. The primary objective of this study was to investigate how chronic stress and acute cortisol reactivity affect active ghrelin secretion and how these outcomes account for different eating types. 16 healthy, young males (age: 23 ± 3 years, BMI: 22.5 ± 1.3kg/m2) with low (n = 8) and average-to-high (n = 8) chronic stress level were subjected to the Trier Social Stress Test (TSST) and a control version on two separate days. Active ghrelin, cortisol, glucose, and heart rate were measured throughout the test. Subjects rated their hunger by means of visual analog scale and current mood was assessed with the Positive and Negative Affect Scale (PANAS). In addition, participants filled out the Dutch Eating Behavior Questionnaire (DEBQ) to account for their subjective eating behavior. Overall ghrelin values where higher on the test day compared to the control day. Ghrelin values were also higher during the time leading up to the stress or control test (TSST) than during the conclusion of said tests. On both days, mean values for active ghrelin where higher in individuals with low chronic stress exposure compare to those with average-to-high chronic stress exposure. While values from test to control day decreased for lower stressed participants, they slightly increased for higher stressed participants. Cortisol responders displayed higher ghrelin values on test day than cortisol non-responders, but this association inverted for the control day. Results indicate that chronic stress influences acute stress response and further alters active ghrelin production, which in turn can influence eating behavior. Replication in a greater group of participants of differing weight and sex could yield a greater understanding of stress induced eating. Factors such as relaxation techniques and coping mechanisms could further improve our knowledge and evaluate treatment possibilities.

High diversity is considered a property of gut microbiota that is beneficial for human health. A higher dietary fiber intake has been shown to increase gut microbiota diversity. Similarly, there is preliminary evidence that an excess adiposity relates to low diversity. Our objective was to investigate the relationship between dietary fiber intake and gut microbiota diversity whilst considering the overweight and obesity status. Overweight (n = 52, prepregnancy BMI ≥ 25 kg/m2) and obese (n = 47, BMI ≥ 30 kg/m2) women were studied in early pregnancy (a mean of 13 weeks of gestation). The mean daily fiber intake (g) was calculated from 3-day food diaries by computerized software. To evaluate the gut microbiota α-diversity we determined the divergence-based measure, phylogenetic diversity (PD), and the qualitative and quantitative species-based measures, Chao 1 and Shannon index, from 16S RNA gene sequencing using QIIME pipeline. Dietary fiber intake (mean ± SD: 19.7 ± 6.2 g) correlated directly with PD (rho = 0.33, P = 0.002) and Chao 1 index (rho = 0.31, P = 0.004), but not with Shannon index (rho = 0.20, P = 0.06) in all women. Instead, no correlation between BMI and microbiota diversity indexes were seen, except for obese women in whom the BMI correlated inversely with PD (rho = -0.31, P = 0.04). Interestingly, distinct associations between fiber intake and microbiota diversity were detected in overweight and obese women. Fiber intake correlated directly with PD (rho = 0.34, P = 0.02 vs. rho = 0.32, P = 0.04), the measure depicting the phylogenetic branch length, in both overweight and obese women, the correlation with Chao 1 (rho = 0.35, P = 0.02), which depicts the presence or absence of each taxon i.e. richness, was seen only in obese women. Nevertheless, no correlation was seen between fiber intake and Shannon index (rho = -0.004, P = 0.98 vs. rho = -0.18, P = 0.25), the measure depicting the presence and absence as well as the abundance of each taxon i.e. richness and evenness, either in overweight or obese pregnant women. We found direct correlations between dietary fiber intake and gut microbiota α-diversity but obesity status intervened in this relation. In contrast to overweight women, in obese women, the higher dietary intake was reflected in a higher gut microbiota diversity measured at the level of taxon richness, suggesting that particularly obese pregnant women may benefit from a higher dietary fiber intake.

Bariatric surgery, including Gastric Bypass (GBP) Surgery, is the most efficient modality to manage severe obesity. Resting Energy Expenditure (REE) is an area of interest in the context of weight loss (WL) as it has been postulated to be an independent predictor of WL success following GBP. As such, the aim of this study is to investigate the impact of REE on WL following GBP. 31 GBP patients (77.4% females BMI 45.5 ± 7.0kg/m2 ; 47.3 ± 11.6y) and 32 weight-stable controls (46.9% females; BMI 27.0 ± 4.6kg/m2 ; 41.1 ± 13.5y) were assessed at one-month pre-surgery and at 3 and 12-months post-surgery. Fat mass (FM) and fat-free mass (FFM) were measured using dual energy X-ray absorptiometry (Lunar iDXA, GE Healthcare). REE was measured under standardised conditions using indirect calorimetry (ECAL, Metabolic Health Solutions). Statistical analyses were performed with SPSS v24.0, Armonk, NY. Multiple regression analysis showed that FM (P = 0.001), FFM (P < 0.0001) and gender (P = 0.012) significantly predicted the interindividual variability in REE. Total body weight (TBW) was removed from the model due to collinearity. Adjusted-REE values were then generated using the above predictor variables. Low-REE and high-REE groups were created using within-group adjusted-REE split. At both follow-ups (3- and 12-months post-surgery), patients had a greater reduction in TBW, FM, FFM, measured-REE and adjusted-REE values compared with controls (P < 0.0001). There was also no significant difference between measured and adjusted-REE values at all time-points (P > 0.05). Patients with high REEs at baseline lost more TBW than those in the low-REE group at 3-months post-surgery (-24.9 ± 6.5 kg vs. -16.6 ± 7.0 kg; P = 0.005) and 12-months post-surgery (-41.3 ± 12.5 kg vs. -25.8 ± 10.4.0 kg; P = 0.003). There was no significant difference in mean TBW changes for controls in the low-and high-REE groups at both follow-ups. Patients with high REEs at 3-months post-surgery did not lose more TBW than those in the low-REE group at 12-months post-surgery (-30.1 ± 12.8 kg vs. -38.6 ± 14.4 kg; P = 0.155). Similarly, there was no difference in mean TBW reduction between controls in the low- and high-REE groups (P = 0.115). Thus while patients with a high adjusted-REE value at baseline (> 9746.6kJ/day) lost more weight at 3- and 12-months post-GBP, it is plausible that from the third to the 12th month post-surgery, other key drivers of weight loss, particularly the reduction in energy intake are more important in predicting WL. Further research with a larger sample size is required to increase the chances of detecting a true effect.

The oxidative stress has been considered one of the main aspects related to psoriatic arthritis (PsA), diabetes, hypertension, obesity, dyslipidemia and metabolic syndrome. Based in the premise that there is a close relationship between the metabolic and inflammatory domain in PsA patients, our aim was to evaluate the role of a 12-week nutritional intervention, including hypocaloric diet and antioxidant supplementation, on inflammatory markers and disease activity in patients with PsA.

A total of 97 patients diagnosed with PsA (CASPAR, 2006) were included in this randomized, double-blinded placebo-controlled trial. Patients were distributed in three different groups: control (C) that received placebo (3 g of soybean oil); diet plus supplementation (DS) with hypocaloric diet plus omega 3 supplementation (3g); diet (D) with hypocaloric diet plus placebo supplementation (3 g of soybean oil). It was evaluated skin (PASI and BSA) and joint activity (DAS28-CRP, DAS28-ESR, BASDAI) and biochemical parameters, such as inflammatory markers (CRP, ESR, adiponectin, TBARs) and glucose and fat metabolism serum levels (HbA1c, fasting glucose and insulin, total cholesterol and fractions, triglycerides, AGER, oxidized- LDL, electronegative LDL (-) and anti-LDL (-) autoantibody) at baseline (T0) and after 12-week intervention (T3). Descriptive statistics are expressed as mean, standard deviation and frequency. Results were then compared using Kruskal-Wallis, ANOVA, Wilocoxon, Man-Whitney and T-Student test and multiple regressions. Level of significance was set as p < 0.05.

At baseline there was an increase of inflammatory markers (CRP, ESR, TBARs, AGER, LDL modifications), decrease of anti-inflammatory (adiponectin) and high prevalence of hypercholesterolemia (41.2%) and peripheral insulin resistance (60%). Our data showed a significant correlation between electronegative LDL and PASI and a correlation between AGER and DAS28-ESR, indicating that a decrease of inflammatory parameters could be related to skin and joint improvement. However, after 12-week nutritional intervention there has no improvement of proinflammatory markers in the group. There was only a significant increase of adiponectin serum levels in all 3 groups, suggesting a benefit effect on chronic inflammation. According our results, omega 3 supplementation was not more effective to improve inflammation, oxidative stress and disease activity.

Starch is one of the major sources of carbohydrates (CHO) contributing to about 50–70% of the daily energy intake in human diet. Processed foods contribute to an important part of daily energy intake, especially in occidental countries. During food processing, starch undergoes dramatic changes when heated in the presence of water or high pressure. The objective of this work was to evaluate the impact of controlling food processes on starch digestibility profile in cereal-based foods and the interest of preserving starch in its native, slowly digestible, form on in vivo metabolic fate.

Four different food processes were evaluated: extrusion, dry bread, soft cake and rotary-moulded biscuit. The resulting differences in gelatinization of each product translated to different SDS levels. Imaging techniques (X-ray diffraction, microtomography and electronic microscopy) were used to investigate the changes in SDS structure obtained through the different food processes. For in vivo evaluation, 12 healthy subjects were recruited and consumed a portion of 50 g of available CHOs of each product, in a crossover design. Glycemic and insulin responses were evaluated over 120 minutes in postprandial period.

We showed that rotary molding technology preserved starch in its intact form and provided the highest SDS content (28g/100g) when the three other technologies (dried bread, soft cake and extrusion) led to SDS content below 3g/100 g. In addition, the lowest SDS contents are explained by a higher level of starch structure disruption which translated in a shift from crystalline structure into amorphous one. These data were linked to in vivo results. The global analysis for GI indicated that a significant difference existed among the foods’ mean GI values (p < 0.0001). Rotary product showed the lowest GI values. The soft, the dried bread had medium GI and extruded product had the highest GI with 77. The global analysis for II indicated that a significant difference existed among the foods’ mean II values (p < 0.0001), with the same order as for GI values. In addition, a portion of rotary-molded biscuit decreased significantly the glycemic peak by 1 mM compared to the 3 other products.

Decrease of postprandial glycemia is a meaningful target in the prevention of metabolic diseases. This can be achieved through the modification of dietary factors such as starch digestibility.

The redox state of plasma albumin would reflect albumin synthesis rate, and could be useful to demonstrate the presence of potential protein undernutrition. Aiming to delineate the characteristics of plasma albumin redox state as a nutritional biomarker, adult male Wistar rats were maintained on AIN-93M (14% casein, control diet) or an AIN-93M-based low protein diet (5% casein) ad libitum for 4 weeks, and the two groups were compared by examining plasma albumin redox state, plasma/serum levels of conventional biomarkers for protein nutritional status, and plasma proteome. While no significant difference was seen in body weight at the end of the experimental period, plantaris muscle mass trended lower in the low protein diet group, implicating the manifestation of moderate protein undernutrition. The redox of plasma albumin was shifted to more oxidized state in the low protein diet group, and the shift persisted during the entire experimental period. In contrast, the levels of conventional biomarkers, plasma albumin and prealbumin, were initially decreased in the low protein diet group, and the differences were then dissolved later in the experimental period. Similarly, the levels of other biomarkers, plasma transferrin and serum retinol-binding protein-4, did not differ significantly at the end of the experimental period. Plasma proteomic analysis revealed that the abundances of proteins that constitute high-density lipoprotein (HDL), apolipoprotein A-II and paraoxonase-1, were decreased in the low protein diet group, which were then validated by confirming decreases in plasma HDL level, plasma HDL-cholesterol level, and serum paraoxonase-1 activity in the low protein diet group. According to epidemiological reports, dietary protein intake is positively associated with plasma HDL-cholesterol level, and the risk factors of cardiovascular diseases, including lower HDL-cholesterol level, are closely related to frailty. Thus, it can be conceived that moderate dietary protein insufficiency would increase cardiovascular risks, such as reduction in HDL level and function (paraoxonase-1 activity), which could prime the onset of amyotropic diseases later in life, such as sarcopenia and frailty. Collectively, moderate dietary protein insufficiency would lead to decreased skeletal muscle mass, and also attenuate circulating HDL level and function, which could even aggravate the attenuation of skeletal muscle accretion; the redox state of plasma albumin would be instrumental over conventional biomarkers as an indicator of potentially protein undernourished status.

Eating at night has been linked to impaired glucose metabolism and dyslipidaemia that is likely a consequence of an underlying disrupted circadian rhythm in metabolic processes. An understanding of the mechanisms causing metabolic disruption after eating at night is important for prevention and management of disease risk factors. The aim of this study was to explore the transcriptomic differences in nutrient metabolism after eating a meal at night compared with the same meal in the morning. In a cross over design, 10 healthy adults fasted for > 10 hours and then completed two acute meal challenges at 8am and 8pm on non-consecutive days separated by a wash out. Fasting and postprandial blood samples were collected to assess glucose and insulin responses. For a subset of five participants RNA sequencing was completed on the Illumina NextSeq500. Total RNA was extracted from peripheral blood mononuclear cells at fasting (baseline) and 2 h after the test meal, the quality of all samples was above RIN 8 (AATI Fragment Analyzer). Differential expression analysis was completed using the DESeq2 package. False discovery rate correction was applied at the pathway analysis level, conducted in PathVisio. Postprandial blood glucose was significantly higher at 8pm vs. 8am (208.8(154.1)mmol/L.3hr vs 36.4(99.6)mmol/L.3hr, p = 0.005) no concurrent changes in insulin responses were observed (p = 0.100). Under fasting conditions, 704 genes were differentially expressed between morning and night, with 60% of these genes being down regulated at night. The meal challenges were associated with changes in gene expression compared with fasting in the morning 552 genes were differentially expressed and 532 genes were differentially expressed in the evening, however only 7% were commonly differentially regulated at both times of day. Pathway analysis of the differentially expressed genes identified that more immune system and signal transduction pathways were enriched after eating at night compared with morning, where as a greater number of pathways involved in lipid metabolism were enriched in the morning. The time of day a meal is consumed has an effect on which genes are differentially regulated in the acute postprandial period, and the biological pathways they are involved in. Investigating the differences in the transcriptomic response to food at night provides a greater understanding of the mechanisms underlying the phenotypic dissimilarities observed in circulating metabolic biomarkers according to the time of day.

Non-alcoholic fatty liver disease (NAFLD) is a significant public health concern closely linked to obesity, affecting an estimated 25% of adults in Europe. Understudied in Ireland, the aim of this research was to examine the effects of a 12-week multi-component dietary intervention on weight loss and markers of liver injury in Irish NAFLD patients in tertiary care. Biopsy confirmed NAFLD patients (n = 27) were recruited from St James’ Hospital in Dublin, Ireland. Consenting participants underwent a 12-week moderate-intensity intervention incorporating weekly group nutritional education, behavioural change and group support, as well as individualised advice and weigh-ins from a trained nutritionist. Control group participants were given routine clinical care. All participants were clinically reviewed before, immediately after, and 3 months post intervention. Individuals (n = 12) with histological evidence of steatohepatitis underwent a repeat liver biopsy on completion of the intervention. Detailed dietary assessment was performed using both a 4-day diet diary (4DDD) and a novel, recently validated, short food frequency questionnaire (SFFQ) designed specifically to assess habitual intakes of food items related to NAFLD. Nutrient intakes were analysed using myFood24TM dietary analysis software, and the Mediterranean diet quality score (MDQS) was used to assess the overall change in dietary patterns. Of the 15 participants who completed the intervention, 80% (n = 12) achieved a weight loss exceeding 5%, with 47% (n = 7) achieving > 7%. There were significant improvements from baseline to week 12 in the intervention group for the majority of clinical parameters including HbA1c (p = 0.0054), liver enzymes (ALT, p = 0.0108; GGT, p = 0.0001) and transient elastography (kPA, p = 0.0308; CAP, p = 0.0081). However, these results failed to maintain significance when analysed compared to controls. The overall dietary pattern was significantly improved after 12 weeks as assessed by the MDQS (p = 0.03), with no apparent compromise in micronutrient intake despite the energy reduction. Reductions in energy, saturated fat, carbohydrate and sugar intakes at 12 weeks, were maintained at three months follow up. Analysis of pre- and post-intervention liver biopsies in the intervention group demonstrated a clinically significant improvement in NAS score (p = 0.0273), attributable to reductions in hepatic steatosis (p = 0.0078). A significant correlation was observed between improvement in liver histology and change in sugar intake (r = 0.7534, p = 0.0093). Although results were somewhat limited by small sample size, nutritional education achieved beneficial dietary changes that persisted after the intervention ceased. Notably, achieving reductions in sugar intakes may be particularly beneficial in reducing the severity of hepatic steatosis in Irish adults with NAFLD.

A major challenge in dietary assessment is the manual pre-processing of dietary data. Digital food registration via online platforms that are coupled to large food databases can automate this process. The accuracy of such platforms depends on the quality of the associated food database. In this study we validated the database of MyFitnessPal (MFP) versus the Belgian food composition database Nubel.

Fifty participants collected a 4-day dietary record using MFP at 2 time points, T1 and T2. Nutrient intake values extracted from MFP at T1 were used as training set to define a cut-off for each parameter (energy intake (EI), carbohydrates (CH), fat (F), protein (P), fibre (Fi), sugar (S), cholesterol (Ch) and sodium (So)) by optimising correlation with Nubel calculated values. Application of these criteria to the values extracted at T2 (n = 2826) resulted in rejection rate of 2.8%. The remaining values were correlated (Pearson or Spearman) with the Nubel calculated values. Fixed and proportional biases were traced using Bland-Altman analysis and impact on sample size was estimated from a power simulation.

MFP demonstrated strong correlation with the Nubel database for EI (r = 0.95), CH (r = 0.90), F (r = 0.90), P (r = 0.88), Fi (r = 0.80) and S (r = 0.77), but weak correlations for Ch (ρ = 0.51) and So (ρ = 0.53); all p < 0.001. Bland-Altman analysis showed no fixed bias between both methods, whereas a proportional bias was found for cholesterol. A practical implication is a loss of statistical power by 5–10% for EI and macronutrients compared to the Nubel database and the need to increase sample size accordingly.

We conclude that dietary analysis with MFP is accurate and efficient for total energy intake, macronutrients, fibre and sugar, but not for cholesterol and sodium

Periconceptional folic acid (FA) has an established role in the prevention of neural tube defects (NTDs), leading to global recommendations for FA supplementation before and in early pregnancy. However, it is unclear whether there are any benefits for offspring brain health arising from continued maternal FA supplementation beyond the first trimester. The aim of this study was to investigate the role of maternal folate nutrition during pregnancy in relation to cognitive performance and brain function in the offspring at 11 years. The children of mothers who had participated in a randomised trial of Folic Acid Supplementation in the Second and Third Trimesters (FASSTT) were investigated, providing a unique opportunity to examine offspring brain health in relation to maternal folate (the FASSTT Offspring trial; n = 68). Cognitive performance was assessed using the Wechsler Intelligence Scale for Children, Fourth UK Edition (WISC-IV). The WISC-IV measures Full Scale IQ and specific domains of cognitive performance: Verbal Comprehension, Perceptual Reasoning, Working Memory and Processing Speed. Brain function was measured using magnetoencephalography (MEG) in a subset of the child participants (n = 33). The results showed no significant difference in Full Scale IQ between the children of mothers who had received folic acid versus placebo during pregnancy (P = 0.993). Processing Speed subtest scores were however significantly higher in the folic acid group compared with placebo (Symbol Search: P = 0.046 and Cancellation: P = 0.011). The application of MEG analysis showed that at rest, there were differences in brain functioning with significantly lower overall power at Broad band [1–48Hz] (P = 0.041) and a trend (not significant) towards lower power in all other frequency bands (Theta, Mu, Beta, Low Gamma and High Gamma) in children from the FA group compared with placebo. Results for the responses to the language task (congruent and incongruent sentences) in children from the FA group showed significantly lower power within the Theta band [4–8Hz] and significantly higher power within high frequency bands i.e. Beta [13–30 Hz] and High Gamma [49–70 Hz]. This suggested more efficient language processing abilities in these children compared to children of mothers in the placebo group. The findings provide scientific evidence that continuing FA supplementation beyond the periconceptional period that is protective against NTDs, may be beneficial for brain health in the offspring. Furthermore, this study demonstrates that MEG is a useful tool for objective assessment of functional brain activity in healthy children in response to nutrition intervention.