L-amino acids do not imprint taste preferences in children with PKU

Food acceptance and neophobia in children with phenylketonuria: a prospective controlled study

Evans et al., JHND Early View


In phenylketonuria (PKU), little is known about the effect of bitter-tasting phenylalanine-free l-amino acid exposure on taste preference development. The present prospective study aimed to determine the flavour preferences of children with PKU versus healthy control children.


Thirty-five children with PKU and 35 age/gender-matched controls, aged 4–13 years, tasted 10 blinded puree foods in random order. They were rated using a seven-point pictorial hedonic scale (super yummy to super yucky) and ranked in preferential order. Caregivers completed a neophobia and food frequency questionnaire on behalf of their children.


Both PKU and control groups rated sweet foods higher than savoury, bitter and sour foods. However, control children ranked fruits as a group higher than PKU children (mean 3.7 versus 4.6; P = 0.03), whereas PKU children ranked vegetables as a group higher than controls (mean 5.6 versus 6.3; P = 0.05). Children with PKU had more neophobia and were untrusting/fearful of new foods.


Although there was some evidence to suggest that children with PKU aged ≥4 years prefer savoury foods (vegetables) more than control children, they did not prefer bitter-tasting foods, and so early and persistent administration of bitter-tasting l-amino acids was not associated with apparent taste imprinting. Neophobia appears to play significant part in food refusal in PKU, perhaps more so than taste preferences.

New journal guidelines on transparency and accuracy of reporting for research studies

The Journal has recently made some alterations to author guidelines which will impact on all manuscripts that are submitted from January 2016. These changes relate to a number of issues (use of supplementary material, word limits for articles) but most significantly include new guidance on the transparent and accurate reporting of research studies.

Transparent and accurate reporting of research studies

The Journal of Human Nutrition and Dietetics is committed to ensuring full and accurate reporting of research methods to ensure quality and integrity of the research we publish. The journal has a requirement for research manuscripts to conform to specific guidelines. Articles that do not fulfill this requirement will not be considered for publication. From January 2016 all new submissions must include a section entitled ‘Transparency Declaration’. This section should state:

“The lead author affirms that this manuscript is an honest, accurate, and transparent account of the study being reported, that no important aspects of the study have been omitted and that any discrepancies from the study as planned (and registered with…) have been explained. The reporting of this work is compliant with CONSORT1/STROBE2/PRISMA3 guidelines.”

1Randomised controlled trials
We strongly welcome the submission of randomized controlled trials. Articles which are reporting the findings of randomised controlled trials involving human subjects must comply with the Consolidated Standards of Reporting Trials (CONSORT) guidelines. The guidelines can be accessed at http://www.consort-statement.org and authors should include a completed CONSORT checklist and flow diagram with their manuscript submission (the flowchart should be included as a figure within the paper, but the checklist will not be published) and include a statement about compliance with the guidelines within the Transparency Declaration section of the work. Manuscripts must include the term “randomised controlled trial” in their title.

2Observational Studies
Articles which report the findings of observational epidemiological studies (cross-sectional, case-control, cohort studies) must comply with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. The guidelines can be accessed at http://www.strobe-statement.org and authors should include a completed STROBE checklist with their manuscript submission (this will not be published as part of the paper) and include a statement about compliance with the guidelines within the Transparency Declaration section of the work. Manuscripts should include the study design (e.g. a case-control study) within their title.

3Systematic reviews and meta-analyses
The journal publishes systematic review articles and meta-analyses and endorses the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement, a guideline to help authors report a systematic review and meta-analysis. Systematic review or meta-analysis should follow the PRISMA guidelines (http://prisma-statement.org). Every systematic review/meta-analysis should be submitted along with a copy of the PRISMA checklist, that clearly indicates where in the manuscript each of the PRISMA recommendations are addressed. The PRISMA checklist can be downloaded from http://www.prisma-statement.org/statement.htm. When submitting a systematic review/meta-analysis, the PRISMA checklist can be uploaded included in the covering letter to the editor. Please note, the checklist is a guide for the authors and peer-reviewers, but will not be published. Manuscripts should include the term “systematic review” or “meta-analysis” in their title.

Registration of investigations
JHND strongly encourages authors to register all clinical trials and observational studies in a public trials registry relevant to national organisations. Such registries include ICMJE-approved public trials registries (http://www.clinicaltrials.gov,  http://www.anzctr.org.au/,  http://www.isrctn.orghttp://www.umin.ac.jp,  http://www.trialregister.nl). When submitting a manuscript please report the study ID number and the website where the clinical trial is registered in the manuscript, section Transparency Declaration.

The use of simulated patients in dietetic training

An observational study investigating the impact of simulated patients in teaching communication skills in preclinical dietetic students

Gibson and Davidson JHND Early View


Simulated patients (SPs) are often used in dietetics for the teaching and assessment of communication skills. The present study aimed to determine the impact of a SP encounter on communication skills in undergraduate preclinical dietetic students in the context of the resources required for delivering this educational strategy.


This observational study collected assessment data from four cohorts of third-year dietetic students to examine the effect of participation in SP-embedded Objective Structured Clinical Exams. Students completed two SP interviews, 2 weeks apart, and communication skills were measured on both occasions. A subgroup of students received a video of their SP encounter. Differences between the two SP interview scores were compared to assess the impact of the SP encounter on communication skills. The required staff and resources were described.


Data were collected involving 215 students. Out of 30 marks, there was a modest mean (SD) improvement in communication skills from the first to the second SP interview of 2.5 (4.2) (P < 0.01). There was an association between student ability and improvement in communication skills, with failing students demonstrating the greatest improvement between SP encounters. There were no observed benefits for the subset of students who received videos.


Providing repeat SP interview opportunities results in only modest improvement in communication skills for most students. The use of SPs needs to be considered in context of the substantial costs and resources involved and tailored to student ability.

Reassurance about food cravings in pregnancy

Reassurance about food cravings in pregnancy

Hill et al 2015

The effect of maternal nutrition during pregnancy has far reaching influence on the life-long health of the baby and possibly subsequent generations. As a result, studies investigating the eating habits and nutrient intake of pregnant women can yield important information that is relevant at population level.

Food cravings in pregnancy are widely reported as experienced by a substantial proportion of women with the prevalence varying with stage of pregnancy and reporting methods. From a popular viewpoint, there seems to be interest in food cravings that varies from exaggeration – “… the best and worst parts of pregnancy …”, through amusement – “… and so my husband went to the all-night garage to buy more chocolate at 03.30 …”, to competitive web-sharing of unusual eating – “… honestly, pickled onions and toffee ice cream…”. However from a health perspective, an examination of the impact of food cravings on gestational nutrition is important and worthy of investigation.

A recent study, published in JHND by Alison Hill and colleagues from the University of Ulster, provides insight into the prevalence and types of foods craved during pregnancy and relates these to anthropometric, clinical and dietary intake variables in >1600 women during pregnancy. The study utilised records collected from the Belfast arm of the multi-centred Hyperglycaemia and Adverse Pregnancy Outcome (HAPO) study. These included a validated food frequency questionnaire and interrogation of energy intake data using the Goldberg cut-offs – in other words, good quality checks were in place. The results identified the most commonly craved foods were sweets items, like chocolate, experienced by 35% of women whilst spicy food, including curry, was amongst the least popular at 3%. Foods that are considered important in pregnancy, for example fruit, vegetables, dairy and protein foods (including meat), were craved by 13%, 4%, 8% and 8% of women respectively. The mean energy intake of women with food cravings was slightly but significantly higher than those without cravings, even after excluding participants who under-reported (10131 ± 2875 vs 9745 ± 2558 kJ, p=0.008). However, there were no other significant differences between the two groups in terms of other nutrient intakes, maternal health outcomes (e.g. weight gain or HbA1c) or neonatal outcomes (e.g. birth weight, length and head circumference).

Whilst these findings differ from other published studies, the authors conclude that these results from this large group of women provide no evidence that food cravings in pregnancy are associated with altered overall dietary intake and that the small increase in energy intake was not associated with adverse pregnancy outcomes. Hopefully this provides reassurance to women who may experience food cravings whilst not encouraging over-indulgence and also highlights the importance of eating well during pregnancy.

Angela Madden
Editorial Board Member
University of Hertfordshire, UK

To recommend reviewers, or to not recommend reviewers

To recommend reviewers, or to not recommend reviewers that is the question… It is routine now for submission of a research manuscript to a journal to be quite a long drawn out and often frustrating affair. In the old days life was relatively simple and authors would prepare triplicate hard copies of their manuscript (typed double spaced) and pop it in the post with a covering letter. All journals now operate online submission portals and authors will run the gamut of required fields on esoteric subjects such as funding, conflicts of interest, open access options or keywords. And then, after everything is entered, there is the request for suggested reviewers.

As an author my heart usually sinks at this point, especially if the journal does not give the option to skip the question and leave it to the editors to find reviewers without guidance. As an editor of a journal where reviewer suggestions are not mandatory, my heart sings when there are at least a couple of names suggested by the authors. From that perspective I would urge prospective authors to make some recommendations for review, but there is a definite need for caution.

The integrity of the peer-review process is strongly underpinned by a review process which is independent of bias. Only through the use of expert peer-reviewers who are basing their judgements solely on the quality of the science can journals maintain high standards and reinforce their reputations.  The helpful process of authors suggesting reviewers is a potential threat to the independence of peer review and editors must find a happy and appropriate balance between saving time in the search for reviewers and ensuring that standards are maintained.

As an author you need to think very carefully about whom you suggest as potential peer reviewers. Also think about how many you might suggest. At JHND it is common to see 2-3 author suggestions for reviewers (we will accept up to 4) and we will sometimes see names of people who the authors don’t want to review the work. Once the suggestions are made, how do editors work with the suggestions?

Although I am grateful for reviewer suggestions I will be very careful about how they are used. Within our editorial system we can queue up reviewers to be approached. This involves ranking the reviewers in order (usually 1-4) and then inviting the top two on the list, with automatic invitations going out to the reserves if the top two decline. I am generally wary about allocating suggested reviewers in those top two positions. Although journals may instruct authors to avoid suggesting who they collaborate with or maybe have published with, most authors cannot resist putting their close contacts down as potential reviewers (I do it myself as an author). With this in mind, most editors will take the approach that I take and try to generate a list of reviewers that is a half-half mixture of author recommended and editor-identified reviewers. This gives some control over possible reviewer bias that might be associated with the author suggestions. I know that some editors avoid the author suggested list altogether, but I am guessing they have more time than I have to search for reviewers in subject areas which lie outside my core knowledge.

I have already alluded to the fact that some authors suggest reviewers who they do not want to review their work. I do this myself on occasion, particularly when applying for grant funding. Is this a reasonable thing to allow authors to do? With my author hat on I might argue that Professor X has a bias against me, or a conflict of interest as our work is closely related and our competition will impact upon the integrity of peer review. With my editor hat on, however, I would challenge this view unless there is obvious evidence to support the assertion. If an author has suggested 4 reviewers and listed 4 non-preferred reviewers, is it not the case that the author is trying to do my job for me and is in fact taking control of the peer review process? My current practice is to put non-preferred reviewers into the lost of reviewers (generating a mix of author recommended, author non-preferred and editor-selected reviewers), unless the covering letter from the authors has given cogent explanation of why non-preferred reviewers should be avoided. In fact I view non-preferred reviewers as the people most likely to be in a position to give a thorough critique of the submitted work. There is nobody like a close competitor to apply the required level of skepticism and thoroughly review the evidence presented.

As a final comment and piece of advice I would say that the selection of appropriate reviewers for a paper is best aided by authors providing a clear and well-worded title and abstract and appropriate keywords to allow the editor to search databases effectively. If those keyword fields in the submission system are completed accurately then there is a strong chance that strong reviewers will be chosen without having to dive into the complex psychology of author-editor relationships.

Vitamin D supplementation has metabolic benefits for women at risk of pre-eclampsia

The effects of vitamin D plus calcium supplementation on metabolic profiles, biomarkers of inflammation, oxidative stress and pregnancy outcomes in pregnant women at risk for pre-eclampsia

Samimi et al., JHND Early View


The present study was designed to examine the effects of vitamin D plus calcium administration on metabolic profiles and pregnancy outcomes among women at risk for pre-eclampsia.


In a prospective, double-blind, placebo-controlled trial, 60 women at risk for pre-eclampsia were randomised to take either 50 000 IU vitamin D3 every 2 weeks plus 1000 mg day−1 calcium supplements (as calcium carbonate) (n = 30) or to receive placebos at the same times (n = 30) from 20 to 32 weeks of gestation. Fasting blood samples were taken at baseline and 12 weeks after intervention to determine related variables. Newborn anthropometric measurements were determined.


Taking combined cholecalciferol and calcium supplements, compared to placebo, led to significant reductions in fasting plasma glucose (FPG) [mean (SD)] [−5.7 (5.5) versus −0.6 (12.6) mg dL−1P = 0.04], serum insulin concentrations [−2.8 (6.0) versus +7.7 (9.8) μIU mL−1P< 0.001], homeostasis model of assessment-insulin resistance [−0.8 (1.3) versus +1.6 (2.2), P < 0.001], homeostatic model assessment-beta cell function [−8.2 (25.8) versus +32.6 (41.3, P < 0.001] and a significant rise in quantitative insulin sensitivity check index score [+0.02 (0.02) versus −0.02 (0.02, P < 0.001]. Additionally, pregnant women who received cholecalciferol plus calcium supplements had increased serum high-density lipoprotein (HDL)-cholesterol [+4.6 (8.3) versus −2.9 (7.7) mg dL−1P = 0.001] and plasma total glutathione (GSH) concentrations [+23.4 (124.0) versus −94.8 (130.2) μm, P = 0.001] compared to placebo. However, after adjustment for the baseline levels, maternal age and baseline body mass index, the effects on FPG levels (P = 0.13) and systolic blood pressure (P = 0.13) disappeared.


Vitamin D plus calcium administration for 12 weeks had beneficial effects on glycaemic status, HDL-cholesterol, GSH and blood pressure among women at risk for pre-eclampsia.

Global sugar consumption


A review of sugar consumption from nationally representative dietary surveys across the world

Newens and Walton, JHND Early View


Government and health organisations worldwide have recently reviewed the evidence on the role of dietary sugars in relation to health outcomes. Hence, it is timely to review current intakes of dietary sugars with respect to this guidance and as a benchmark for future surveillance.


This review collates data from nationally representative dietary surveys across the world and reports estimates of intakes of total and added sugars, and sucrose in different population subgroups. Total sugars includes all mono- and disaccharides; namely, glucose, fructose, lactose, sucrose and maltose. Added and free sugars differ in the quantity of natural sugars included in their definitions. Free sugars include sugars naturally present in honey, syrups, fruit juices and fruit juice concentrates, whereas added sugars typically only refer to those added during processing.


Most countries reported intakes of total sugars, with fewer reporting intakes of added sugars and sucrose. No country reported intakes of free sugars. The available data suggest that total sugars as a percentage of energy were highest in the infant (<4 years), with mean values ranging from 20.0% to 38.4%, and decreased over the lifespan to 13.5–24.6% in adults. Intakes of added sugars were higher in school-aged children and adolescents (up to 19% of total energy) compared to younger children or adults.


Further research into the dietary patterns contributing to added sugars intake in children and adolescents is warranted. It would also be beneficial to policy guidance if future dietary surveys employed a uniform way of expressing sugars that is feasible to measure and has public health significance.