1
|
Wikerholmen MB, Rosendahl-Riise H, Børresen KØ, Haugsgjerd TR, Gerdts E, Brantsæter AL. Low maternal iodine intake and subsequent risk of pharmacologically treated hypertension: A population-based prospective cohort study. Clin Nutr 2025; 45:148-155. [PMID: 39818179 DOI: 10.1016/j.clnu.2025.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2024] [Revised: 12/18/2024] [Accepted: 01/03/2025] [Indexed: 01/18/2025]
Abstract
BACKGROUND & AIMS Iodine deficiency is linked to multiple adverse health outcomes, but there is scarce knowledge regarding iodine intake and development of chronic hypertension. We aimed to investigate the prospective association between habitual dietary iodine intake and pharmacologically treated hypertension in mothers up to 10 years after delivery. METHODS The present study is based on data from an ongoing pregnancy cohort and includes 58,629 women without thyroid dysfunction and hypertension at baseline. The study outcome was new-onset hypertension defined according to antihypertensive medication use initiated 90 days after delivery registered in the national prescription database. We estimated hazard ratios (HR) with 95 % Confidence Intervals (95 % CI) using Cox regression models. RESULTS During a median follow-up duration of 7.1 years, a total of 1422 (2.4 %) women developed new-onset hypertension. There was a non-linear association between dietary iodine intake and new-onset hypertension. Women with iodine intakes lower than 100 μg/day had significantly higher risk than those with iodine intakes in the recommended range 150-199 μg/day (adjusted HR, 1.29; 95 % CI: 1.09, 1.53). This was evident in normotensive pregnancies (adjusted HR 1.25; 95 % CI: 1.01, 1.54) and in women with gestational hypertension (adjusted HR 1.35; 95 % CI: 1.00, 1.83). The association between low iodine intake and hypertension remained in all sensitivity analyses considering pre-pregnancy and pregnancy-related factors. CONCLUSIONS This study suggests that women with iodine intakes below 100 μg/day have a higher likelihood of new-onset hypertension and adds supporting evidence to the importance of correcting mild-to-moderate iodine deficiency in women of reproductive age.
Collapse
Affiliation(s)
- Mari Bergflødt Wikerholmen
- Department of Clinical Medicine, Faculty of Medicine, University of Bergen, P.O. Box 7804, NO-5020 Bergen, Norway.
| | - Hanne Rosendahl-Riise
- Department of Clinical Medicine, Faculty of Medicine, University of Bergen, P.O. Box 7804, NO-5020 Bergen, Norway; Mohn Nutrition Research Laboratory, Department of Clinical Medicine, University of Bergen, PO Box 7804, NO-5020 Bergen, Norway.
| | - Kristin Øksendal Børresen
- Mohn Nutrition Research Laboratory, Department of Clinical Medicine, University of Bergen, PO Box 7804, NO-5020 Bergen, Norway.
| | - Teresa Risan Haugsgjerd
- Department of Clinical Science, Center for Research on Cardiac Disease in Women, University of Bergen, P.O. Box 7804, NO-5020 Bergen, Norway.
| | - Eva Gerdts
- Department of Clinical Science, University of Bergen, P.O. Box 7804, NO-5020 Bergen, Norway; Department of Heart Disease, Haukeland University Hospital, Bergen, Norway.
| | - Anne Lise Brantsæter
- Department of Food Safety, Centre of Sustainable Diets, Norwegian Institute of Public Health, P.O. Box 222, NO-0213 Oslo, Norway.
| |
Collapse
|
2
|
Guo A, Brantsæter AL, Borge TC, M Hård Af Segerstad E, Imberg H, Mårild K, Størdal K. Maternal diet in pregnancy and the risk of inflammatory bowel disease in the offspring: a prospective cohort study. Am J Clin Nutr 2025; 121:32-39. [PMID: 39461723 PMCID: PMC11747187 DOI: 10.1016/j.ajcnut.2024.10.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2024] [Revised: 10/15/2024] [Accepted: 10/18/2024] [Indexed: 10/29/2024] Open
Abstract
BACKGROUND Diet has been hypothesized as a risk factor for the development of inflammatory bowel disease (IBD). OBJECTIVE The objective of this study was to explore associations between maternal diet diversity and quality in pregnancy and the offspring's risk of IBD. METHODS We used data from a nationwide cohort study on 85,129 Norwegian children followed from birth (1999-2009) with information on maternal diet in pregnancy from validated food frequency questionnaires. Hazard ratios (HRs) for IBD, Crohn disease (CD), and ulcerative colitis (UC) by maternal diet diversity, quality, and intake amounts of individual food groups were adjusted for maternal BMI, parental IBD, and sociodemographic factors. Sensitivity analyses were adjusted for the child's early-life diet quality and antibiotic treatment. Dietary exposures were classified into tertiles, comparing low (reference) with medium, and high levels. RESULTS During a mean follow-up time of 16.1 y (1,367,837 person-years of follow-up), 268 children developed IBD (CD, n = 119; UC, n = 76; IBD-unclassified, n = 73). High compared with low diet diversity in pregnancy was associated with a lower risk of UC in the offspring [adjusted HR (aHR) 0.46, 95% confidence interval: 0.25, 0.87], with consistent findings after further adjustment for the child's early-life diet quality and antibiotic treatment. High compared with low diet diversity in pregnancy yielded aHRs of 0.81 for CD (0.51-1.28) and 0.75 for any IBD (0.55-1.02) in the offspring. A high compared with low diet quality in pregnancy or intakes of specific food groups were not associated with the offspring's risk of IBD or its subtypes. CONCLUSIONS Our findings suggest that a higher maternal diet diversity in pregnancy may be associated with a lower risk of UC in the offspring.
Collapse
Affiliation(s)
- Annie Guo
- Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Anne Lise Brantsæter
- Department of Food Safety and Centre for Sustainable Diets, Norwegian Institute of Public Health, Oslo, Norway
| | - Tiril Cecilie Borge
- Cluster for Reviews and Health Technology Assessments, Norwegian Institute of Public Health, Oslo, Norway
| | - Elin M Hård Af Segerstad
- Pediatric Research Institute, Oslo University Hospital and Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Henrik Imberg
- Statistiska Konsultgruppen Sweden, Gothenburg, Sweden; Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Karl Mårild
- Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Pediatrics, Queen Silvia Children's Hospital, Gothenburg, Sweden
| | - Ketil Størdal
- Pediatric Research Institute, Oslo University Hospital and Faculty of Medicine, University of Oslo, Oslo, Norway; Department of Child and Adolescent Health, Oslo University Hospital, Oslo, Norway
| |
Collapse
|
3
|
Hooshmand S, Yousefian F, Rahimi H, Mohammadzadeh M, Dehghani R. Household Salt consumption and urinary iodine levels in Schoolchildren aged 8-10 in Darab City, Iran: 2022. Sci Rep 2024; 14:28349. [PMID: 39550423 PMCID: PMC11569123 DOI: 10.1038/s41598-024-78799-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2024] [Accepted: 11/04/2024] [Indexed: 11/18/2024] Open
Abstract
Iodized salt serves as an effective intervention strategy, combating iodine deficiency disorders (IDD) and promoting overall health. This study aimed to assess the household salt consumption status and its relationship with urinary iodine (UI) levels among school-aged children. This is a descriptive-cross-sectional study that was selected by cluster-random sampling from 5 girls' schools (182) and 5 boys' schools (169), with a total of 351 primary school students (8-10 years old) of Darab. To explore the relationship between independent variables and dependent variable, urinary iodine (UI) levels, linear regression model was applied. A significance level of 0.05 was adopted for all analyses. The median UI level was 138 µg/L (IQR = 111). Our findings revealed that 66% of used iodized salt. A significant majority of participants properly stored their salt in containers with lids. Nearly half of the students in Darab have insufficient iodine intake. Despite controlling for the effect of iodized foods consumption, no significant association (P-value = 0.693) was observed between the storage method and iodized foods. Our study showed that students do not receive enough iodine or have received more than the required amount of iodine. Therefore, efforts should be focused on increasing awareness of diseases caused by iodine deficiency.
Collapse
Affiliation(s)
- Sakineh Hooshmand
- Department of Environmental Health Engineering, Faculty of Health, Kashan University of Medical Sciences, Qotb-e Ravandi Blvd., First floor, P.O. Box: 8715973449, Kashan, Iran
| | - Fatemeh Yousefian
- Department of Environmental Health Engineering, Faculty of Health, Kashan University of Medical Sciences, Qotb-e Ravandi Blvd., First floor, P.O. Box: 8715973449, Kashan, Iran
| | - Habibollah Rahimi
- Department of Biostatistics & Epidemiology, School of Public Health, Kashan University of Medical Sciences, Kashan, IR, Iran
| | - Mahdiyeh Mohammadzadeh
- Department of Health in Emergencies and Disasters, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Rouhullah Dehghani
- Department of Environmental Health Engineering, Faculty of Health, Kashan University of Medical Sciences, Qotb-e Ravandi Blvd., First floor, P.O. Box: 8715973449, Kashan, Iran.
- Social Determinants of Health (SDH) Research Center, Department of Environmental Health, Kashan University of Medical Sciences, Kashan, Iran.
| |
Collapse
|
4
|
Andueza N, Muñoz‐Prieto D, Romo‐Hualde A, Cuervo M, Navas‐Carretero S. Changes in urinary metabolomic profile show the effectiveness of a nutritional intervention in children 6-12 years old: The ALINFA study. Food Sci Nutr 2024; 12:5663-5676. [PMID: 39139943 PMCID: PMC11317665 DOI: 10.1002/fsn3.4226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 04/26/2024] [Accepted: 04/30/2024] [Indexed: 08/15/2024] Open
Abstract
Diet plays an essential role in health and disease. Therefore, its determination is an important component of many investigations. The aim of the study was to evaluate the effect of a nutritional intervention on the urinary metabolome in children aged 6-12 years. Also, it was intended to identify biomarkers of diet quality and dietary intake. A 2-month, randomized, controlled, parallel trial was conducted in Spanish children. The analyses focused on the ALINFA group, which followed a full-fixed meal plan including healthy products, ready-to-eat meals, and healthy recipes. Diet quality was assessed by the KIDMED index and dietary intake by a food frequency questionnaire. Untargeted metabolomic analysis on urine samples was carried out, and multivariate analyses were performed for pattern recognition and characteristic metabolite identification. PLS-DA and Volcano plot analyses were performed to identify the discriminating metabolites of this group. 12 putative metabolites were found to be the most relevant to this intervention. Most of them were products derived from protein and amino acid metabolism (N-Ribosylhistidine, indolacrylic acid, and peptides) and lipid metabolism (3-oxo-2-pentylcyclopentane-1-hexanoic acid methyl, Suberoyl-L-carnitine, and 7-Dehydrodichapetalin E). All these metabolites decreased after the intervention, which was mainly associated with a decrease in the consumption of fatty meat and total fat, especially saturated fat. In turn, N-Ribosylhistidine and Suberoyl-L-carnitine were negatively associated with diet quality, as well as able to predict the change in KIDMED index. In conclusion, the changes observed in urinary metabolome demonstrate the effectiveness of the ALINFA nutritional intervention.
Collapse
Affiliation(s)
- Naroa Andueza
- Department of Nutrition, Food Sciences and Physiology, Faculty of Pharmacy and NutritionUniversity of NavarraPamplonaSpain
- Center for Nutrition ResearchUniversity of NavarraPamplonaSpain
| | - David Muñoz‐Prieto
- Department of Nutrition, Food Sciences and Physiology, Faculty of Pharmacy and NutritionUniversity of NavarraPamplonaSpain
- Center for Nutrition ResearchUniversity of NavarraPamplonaSpain
| | - Ana Romo‐Hualde
- Department of Nutrition, Food Sciences and Physiology, Faculty of Pharmacy and NutritionUniversity of NavarraPamplonaSpain
- Center for Nutrition ResearchUniversity of NavarraPamplonaSpain
| | - Marta Cuervo
- Department of Nutrition, Food Sciences and Physiology, Faculty of Pharmacy and NutritionUniversity of NavarraPamplonaSpain
- Center for Nutrition ResearchUniversity of NavarraPamplonaSpain
- Navarra Institute for Health Research (IdiSNA)PamplonaSpain
| | - Santiago Navas‐Carretero
- Department of Nutrition, Food Sciences and Physiology, Faculty of Pharmacy and NutritionUniversity of NavarraPamplonaSpain
- Center for Nutrition ResearchUniversity of NavarraPamplonaSpain
- Navarra Institute for Health Research (IdiSNA)PamplonaSpain
- Biomedical Research Networking Center for Physiopathology of Obesity and Nutrition (CIBERObn)Institute of Health Carlos IIIMadridSpain
| |
Collapse
|
5
|
Xue L, Chen X, Sun J, Fan M, Qian H, Li Y, Wang L. Maternal Dietary Carbohydrate and Pregnancy Outcomes: Quality over Quantity. Nutrients 2024; 16:2269. [PMID: 39064712 PMCID: PMC11280101 DOI: 10.3390/nu16142269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2024] [Revised: 06/30/2024] [Accepted: 07/12/2024] [Indexed: 07/28/2024] Open
Abstract
Dietary nutrition plays a crucial role in determining pregnancy outcomes, with poor diet being a major contributor to pregnancy metabolic syndrome and metabolic disorders in offspring. While carbohydrates are essential for fetal development, the excessive consumption of low-quality carbohydrates can increase the risk of pregnancy complications and have lasting negative effects on offspring development. Recent studies not only highlighted the link between carbohydrate intake during pregnancy, maternal health, and offspring well-being, but also suggested that the quality of carbohydrate foods consumed is more critical. This article reviews the impacts of low-carbohydrate and high-carbohydrate diets on pregnancy complications and offspring health, introduces the varied physiological effects of different types of carbohydrate consumption during pregnancy, and emphasizes the importance of both the quantity and quality of carbohydrates in nutritional interventions during pregnancy. These findings may offer valuable insights for guiding dietary interventions during pregnancy and shaping the future development of carbohydrate-rich foods.
Collapse
Affiliation(s)
- Lamei Xue
- State Key Laboratory of Food Science and Technology, School of Food Science and Technology, Jiangnan University, Wuxi 214122, China; (L.X.); (J.S.); (M.F.); (H.Q.)
| | - Xiaofang Chen
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China;
| | - Juan Sun
- State Key Laboratory of Food Science and Technology, School of Food Science and Technology, Jiangnan University, Wuxi 214122, China; (L.X.); (J.S.); (M.F.); (H.Q.)
| | - Mingcong Fan
- State Key Laboratory of Food Science and Technology, School of Food Science and Technology, Jiangnan University, Wuxi 214122, China; (L.X.); (J.S.); (M.F.); (H.Q.)
| | - Haifeng Qian
- State Key Laboratory of Food Science and Technology, School of Food Science and Technology, Jiangnan University, Wuxi 214122, China; (L.X.); (J.S.); (M.F.); (H.Q.)
| | - Yan Li
- State Key Laboratory of Food Science and Technology, School of Food Science and Technology, Jiangnan University, Wuxi 214122, China; (L.X.); (J.S.); (M.F.); (H.Q.)
| | - Li Wang
- State Key Laboratory of Food Science and Technology, School of Food Science and Technology, Jiangnan University, Wuxi 214122, China; (L.X.); (J.S.); (M.F.); (H.Q.)
| |
Collapse
|
6
|
Friel C, Leyland AH, Anderson JJ, Havdahl A, Brantsæter AL, Dundas R. Healthy Prenatal Dietary Pattern and Offspring Autism. JAMA Netw Open 2024; 7:e2422815. [PMID: 39023891 PMCID: PMC11258593 DOI: 10.1001/jamanetworkopen.2024.22815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 05/14/2024] [Indexed: 07/20/2024] Open
Abstract
Importance Prenatal diet may be causally related to autism; however, findings are inconsistent, with a limited body of research based on small sample sizes and retrospective study designs. Objective To investigate the associations of prenatal dietary patterns with autism diagnosis and autism-associated traits in 2 large prospective cohorts, the Norwegian Mother, Father, and Child Cohort Study (MoBa), and the Avon Longitudinal Study of Parents and Children (ALSPAC). Design, Setting, and Participants This cohort study used data from MoBa and ALSPAC birth cohort studies conducted across Norway and in the Southwest of England, respectively. Participants were people with singleton pregnancies with self-reported food frequency questionnaire responses. MoBa recruited between 2002 and 2008, and ALSPAC recruited between 1990 and 1992, and children were followed-up until age 8 years or older. Recruitment rates were 41% (95 200 of 277 702 eligible pregnancies) in MoBa and 72% (14 541 of 20 248 eligible pregnancies) in ALSPAC. Data analysis occurred February 1, 2022, to August 1, 2023. Exposure A healthy prenatal dietary pattern was derived using factor analysis and modeled as low, medium, and high adherence. Main Outcomes and Measures In MoBa, the offspring outcomes were autism diagnosis and elevated social communication questionnaire score at ages 3 years and 8 years, with further analysis of the social communication difficulties and restrictive and repetitive behaviors subdomains. In ALSPAC, offspring outcomes were elevated social communication difficulties checklist score at age 8 years. Odds ratios (ORs) were estimated using generalized nonlinear models. Results MoBa included 84 548 pregnancies (mean [SD] age, 30.2 [4.6] years; 43 277 [51.2%] male offspring) and ALSPAC had 11 760 pregnancies (mean [SD] age, 27.9 [4.7] years; 6034 [51.3%] male offspring). In the final adjusted models, high adherence to a healthy dietary pattern, compared with low adherence, was associated with reduced odds of autism diagnosis (OR, 0.78; 95% CI, 0.66-0.92) and social communication difficulties at age 3 years in MoBa (OR 0.76, 95% CI, 0.70-0.82) and age 8 years in ALSPAC (OR, 0.74; 95% CI, 0.55-0.98). There was no consistent evidence of association with the other outcomes. Conclusions and Relevance In this cohort study of mother-child dyads, adherence to a healthy prenatal dietary pattern was associated with a lower odds of autism diagnosis and social communication difficulties but not restrictive and repetitive behaviors.
Collapse
Affiliation(s)
- Catherine Friel
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, Scotland
| | - Alastair H. Leyland
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, Scotland
| | - Jana J. Anderson
- Public Health Research Group, School of Health & Wellbeing, University of Glasgow, Glasgow, Scotland
| | - Alexandra Havdahl
- Center for Genetic Epidemiology and Mental Health, Norwegian Institute of Public Health, Oslo, Norway
- Nic Waals Institute, Lovisenberg Diaconal Hospital, Oslo, Norway
- Department of Psychology, Promenta Research Center, University of Oslo, Oslo, Norway
| | | | - Ruth Dundas
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, Scotland
| |
Collapse
|
7
|
Brantsæter AL, Garthus-Niegel S, Brandlistuen RE, Caspersen IH, Meltzer HM, Abel MH. Mild-to-moderate iodine deficiency and symptoms of emotional distress and depression in pregnancy and six months postpartum - Results from a large pregnancy cohort. J Affect Disord 2022; 318:347-356. [PMID: 36096375 DOI: 10.1016/j.jad.2022.09.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 09/02/2022] [Accepted: 09/06/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND The relationship between iodine intake and depression is unknown. The aim of the present study was to investigate whether iodine intake was associated with symptoms of perinatal emotional distress and depression in a mild- to moderately iodine deficient population. METHODS The study population comprised 67,812 women with 77,927 pregnancies participating in the Norwegian Mother, Father and Child Cohort Study. Self-reported emotional distress and depressive symptoms were reported in pregnancy and at six months postpartum. Iodine intake was assessed by a food frequency questionnaire in mid-pregnancy. Urinary iodine concentration (UIC) was available for 2792 pregnancies. RESULTS The median iodine intake from food was 121 μg/day and the median UIC was 68 μg/L. The prevalence of high scores for emotional distress was 6.6 % in pregnancy and 5.8 % six months postpartum, and for high scores on postpartum depression it was 10.3 %. In non-users of iodine supplements (63 %), a low maternal iodine intake from food (lower than ~100-150 μg/day) was associated with increased risk of high scores of emotional distress and depression both in pregnancy and six months postpartum (p < 0.001). Iodine supplement use was associated with increased risk of high scores of emotional distress in pregnancy compared to no supplement use or use of supplements without iodine. LIMITATIONS Observational design, self-report information, and short scales to assess symptoms of emotional distress and depression. CONCLUSION A low habitual iodine intake was associated with increased prevalence of perinatal emotional distress and depression. The potential non-beneficial effect of iodine supplements may have biological explanations. More studies are needed.
Collapse
Affiliation(s)
- Anne Lise Brantsæter
- Division of Climate and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway.
| | - Susan Garthus-Niegel
- Department of Child Health and Development, Norwegian Institute of Public Health, Oslo, Norway; Institute for Systems Medicine (ISM) and Faculty of Medicine, Medical School Hamburg, Hamburg, Germany; Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | | | | | - Helle Margrete Meltzer
- Division of Climate and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Marianne Hope Abel
- Department of Physical Health and Ageing, Norwegian Institute of Public Health, Oslo, Norway
| |
Collapse
|
8
|
Børresen KØ, Rosendahl-Riise H, Brantsæter AL, Egeland GM. Intake of sucrose-sweetened beverages and risk of developing pharmacologically treated hypertension in women: cohort study. BMJ Nutr Prev Health 2022; 5:277-285. [PMID: 36619334 PMCID: PMC9813634 DOI: 10.1136/bmjnph-2022-000426] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 10/16/2022] [Indexed: 11/11/2022] Open
Abstract
Objective To investigate the association between intake of sucrose-sweetened beverages (SSBs) and risk of developing pharmacologically treated hypertension in a population of Norwegian mothers followed up to 10 years after delivery. Design Women without hypertension at baseline in the Norwegian Mother, Father and Child Cohort Study (n=60 027) who delivered between 2004 and 2009 were linked to the Norwegian Prescription Database to ascertain antihypertensive medication use after the first 90 days following delivery. Diet was assessed by a validated semiquantitative Food Frequency Questionnaire in mid pregnancy. Cox proportional hazard analyses evaluated HRs for the development of hypertension associated with SSB consumption as percent energy by quintiles in multivariable models. Supplemental analyses were stratified by gestational hypertension and by a low versus high sodium-to-potassium intake ratio (<0.78 compared with ≥0.78). Results A total of 1480 women developed hypertension within 10 years of follow-up. The highest relative to the lowest quintile of SSB intake was associated with an elevated risk for hypertension after adjusting for numerous covariates in adjusted models (HR: 1.20 (95% CI: 1.02 to 1.42)). Consistency in results was observed in sensitivity analyses. In stratified analyses, the high SSB intake quintile associated with elevated hypertension risk among women who were normotensive during pregnancy (HR: 1.25 (95% CI: 1.03 to 1.52)), who had normal body mass index (HR: 1.49 (95% CI: 1.13 to 1.93)) and among women with low sodium to potassium ratio (HR: 1.33 (95% CI: 1.04 to 1.70)). Conclusions This study provides strong evidence that SSB intake is associated with an increased risk of hypertension in women.
Collapse
Affiliation(s)
| | | | | | - Grace M Egeland
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway,Department of Health Registry Research and Development, Norwegian Institute of Public Health, Bergen, Norway
| |
Collapse
|
9
|
Petersen JM, Naimi AI, Kirkpatrick SI, Bodnar LM. Equal Weighting of the Healthy Eating Index-2010 Components May Not be Appropriate for Pregnancy. J Nutr 2022; 152:1886-1894. [PMID: 35641231 PMCID: PMC9361739 DOI: 10.1093/jn/nxac120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 05/18/2022] [Accepted: 05/24/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Adherence to the Dietary Guidelines for Americans is often assessed using the Healthy Eating Index (HEI). The HEI total score reflects overall diet quality, with all aspects equally important. Using the traditional weighting scheme for the HEI, all components are generally weighted equally in the total score. However, there is limited empirical basis for applying the traditional weighting for pregnancy specifically. OBJECTIVES We aimed to assess associations between the 12 HEI-2010 component scores and select pregnancy outcomes. METHODS The Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be was a prospective pregnancy cohort (US multicenter, 2010-2013). Participants enrolled in the study between 6 and 13 weeks of gestation. An FFQ assessed usual dietary intake 3 months prior to pregnancy (n = 7880). Scores for the HEI-2010 components were assigned using prespecified standards based on densities (standard units per 1000 kcal) of relevant food groups for most components, a ratio (PUFAs and MUFAs to SFAs) for fatty acids, and the contribution to total energy for empty calories. Using binomial regression, we estimated risk differences between each component score and cases of small-for-gestational age (SGA) birth, preterm birth, preeclampsia, and gestational diabetes, controlling for total energy and scores for the other HEI-2010 components. RESULTS Higher scores for greens and beans and total vegetables were associated with fewer cases of SGA birth, preterm birth, and preeclampsia. For instance, every 1-unit increase in the greens and beans score was associated with 1.2 fewer SGA infants (95% CI, 0.7-1.7), 0.7 fewer preterm births (95% CI, 0.3-1.1), and 0.7 fewer preeclampsia cases (95% CI, 0.2-1.1) per 100 deliveries. For gestational diabetes, the associations were null. CONCLUSIONS Vegetable-rich diets were associated with fewer cases of SGA birth, preterm birth, and preeclampsia, controlling for overall diet quality. Examination of the equal weighting of the HEI components (and underlying guidance) is needed for pregnancy.
Collapse
Affiliation(s)
| | - Ashley I Naimi
- Department of Epidemiology, Emory University, Rollins School of Public Health, Atlanta, GA, USA
| | | | - Lisa M Bodnar
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA
| |
Collapse
|
10
|
Moltedo A, Jiménez S, Álvarez-Sánchez C, Manyani T, Ramos MP, Custodio E. Raw versus cooked food matching: Nutrient intake using the 2015/16 Kenya Integrated Household Budget Survey. J Food Compost Anal 2021; 102:103879. [PMID: 34483479 PMCID: PMC8356072 DOI: 10.1016/j.jfca.2021.103879] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 03/03/2021] [Accepted: 03/03/2021] [Indexed: 11/20/2022]
Abstract
Dietary energy assessment does not require matching foods in cooked form. Macronutrient dietary assessment does not require matching foods in cooked form. Vitamin and mineral dietary assessment requires matching foods in cooked form.
In many countries, statistics from household consumption and expenditure surveys are increasingly being used to inform policies and programs. In household surveys, foods are typically reported as they are acquired (the majority are raw). However, the micronutrient content of some foods diminishes during processing and cooking. Using food consumption data from the 2015/16 Kenya Integrated Household Budget Survey, this study analyzes whether mean consumption estimates of dietary energy, macronutrients, and eight micronutrients are equivalent (applying a two-side paired equivalence test) when matching foods: (1) considering the nutrient content in raw foods (as reported in the survey), and (2) considering the nutrient content in foods as typically consumed, thus applying yield and retention factors as needed. Both food matching approaches rendered statistically equivalent mean consumption estimates, at national and county levels, for dietary energy, protein, fats, available carbohydrates, total fiber, calcium and zinc. Non-equivalent means were found for iron, vitamins A, B1, B2, B12, and C. The higher differences between the means were, in percentage change, for vitamin C (47 %), B1 (34 %) and B12 (26 %).
Collapse
Affiliation(s)
- Ana Moltedo
- Statistics Division, Food and Agriculture Organization of the United Nations, Viale delle Terme di Caracalla, 00153, Rome, Italy
| | - Sofía Jiménez
- Joint Research Centre, Sustainable Resources, Economics of Agriculture, European Commission, Joint Research Centre, C/Inca Garcilaso s/n, Sevilla, E-41092, Spain
| | - Cristina Álvarez-Sánchez
- Statistics Division, Food and Agriculture Organization of the United Nations, Viale delle Terme di Caracalla, 00153, Rome, Italy
| | - Talent Manyani
- Statistics Division, Food and Agriculture Organization of the United Nations, Viale delle Terme di Caracalla, 00153, Rome, Italy
| | - María Priscila Ramos
- Universidad de Buenos Aires. Facultad de Ciencias Económicas. Departamento de Economía, Buenos Aires, Argentina.,CONICET-Universidad de Buenos Aires, Instituto Interdisciplinario de Economía Política de Buenos Aires (IIEP-Baires), Avenida Córdoba 2122 - 2do Piso, C1120AAQ, Ciudad Autónoma de Buenos Aires, Argentina.,Centre d'Etudes Prospectives et d'Information Internationale (CEPII), 20 avenue de Ségur, 75334, Paris cedex 07, France
| | - Estefanía Custodio
- Joint Research Centre, Sustainable Resources, Economics of Agriculture, European Commission, Joint Research Centre, C/Inca Garcilaso s/n, Sevilla, E-41092, Spain
| |
Collapse
|
11
|
Hlucny K, Alexander BM, Gerow K, Larson-Meyer DE. Reflection of Dietary Iodine in the 24 h Urinary Iodine Concentration, Serum Iodine and Thyroglobulin as Biomarkers of Iodine Status: A Pilot Study. Nutrients 2021; 13:2520. [PMID: 34444680 PMCID: PMC8398459 DOI: 10.3390/nu13082520] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 07/18/2021] [Accepted: 07/18/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The iodine status of the US population is considered adequate, but subpopulations remain at risk for iodine deficiency and a biomarker of individual iodine status has yet to be determined. The purpose of this study was to determine whether a 3 day titration diet, providing known quantities of iodized salt, is reflected in 24 h urinary iodine concentration (UIC), serum iodine, and thyroglobulin (Tg). METHODS A total of 10 participants (31.3 ± 4.0 years, 76.1 ± 6.3 kg) completed three, 3 day iodine titration diets (minimal iodine, US RDA, (United States Recommended Daily Allowance), and 3× RDA). The 24 h UIC, serum iodine, and Tg were measured following each diet. The 24 h UIC and an iodine-specific food frequency questionnaire (FFQ) were completed at baseline. RESULTS UIC increased an average of 19.3 μg/L for every gram of iodized salt consumed and was different from minimal to RDA (p = 0.001) and RDA to 3× RDA diets (p = 0.04). Serum iodine was different from RDA to 3× RDA (p = 0.006) whereas Tg was not responsive to diet. Baseline UIC was associated with iodine intake from milk (r = 0.688, p = 0.028) and fish/seafood (r = 0.646, p = 0.043). CONCLUSION These results suggest that 24 h UIC and serum iodine may be reflective of individual iodine status and may serve as biomarkers of iodine status.
Collapse
Affiliation(s)
- Katelyn Hlucny
- Department of Family and Consumer Sciences, University of Wyoming, Laramie, WY 82071, USA;
| | - Brenda M. Alexander
- Department of Animal Science, University of Wyoming, Laramie, WY 82071, USA;
| | - Ken Gerow
- Department of Mathematics and Statistics, University of Wyoming, Laramie, WY 82071, USA;
| | - D. Enette Larson-Meyer
- Department of Human Nutrition, Foods and Exercise, Virginia Tech, Blacksburg, VA 24061, USA
| |
Collapse
|
12
|
Borge TC, Biele G, Papadopoulou E, Andersen LF, Jacka F, Eggesbø M, Caspersen IH, Aase H, Meltzer HM, Brantsæter AL. The associations between maternal and child diet quality and child ADHD - findings from a large Norwegian pregnancy cohort study. BMC Psychiatry 2021; 21:139. [PMID: 33685413 PMCID: PMC7941947 DOI: 10.1186/s12888-021-03130-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 02/21/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Attention Deficit Hyperactivity Disorder (ADHD) is a prevalent neurodevelopmental disorder. Effective long-term treatment options are limited, which warrants increased focus on potential modifiable risk factors. The aim of this study was to investigate associations between maternal diet quality during pregnancy and child diet quality and child ADHD symptoms and ADHD diagnosis. METHODS This study is based on the Norwegian Mother, Father and Child Cohort Study (MoBa). We assessed maternal diet quality with the Prenatal Diet Quality Index (PDQI) and Ultra-Processed Food Index (UPFI) around mid-gestation, and child diet quality using the Diet Quality Index (CDQI) at 3 years. ADHD symptoms were assessed at child age 8 years using the Parent Rating Scale for Disruptive Behaviour Disorders. ADHD diagnoses were retrieved from the Norwegian Patient Registry. RESULTS In total, 77,768 mother-child pairs were eligible for studying ADHD diagnoses and 37,787 for ADHD symptoms. Means (SD) for the PDQI, UPFI and CDQI were 83.1 (9.3), 31.8 (9.7) and 60.3 (10.6), respectively. Mean (SD) ADHD symptom score was 8.4 (7.1) and ADHD diagnosis prevalence was 2.9% (male to female ratio 2.6:1). For one SD increase in maternal diet index scores, we saw a change in mean (percent) ADHD symptom score of - 0.28 (- 3.3%) (CI: - 0.41, - 0.14 (- 4.8, - 1.6%)) for PDQI scores and 0.25 (+ 3.0%) (CI: 0.13, 0.38 (1.5, 4.5%)) for UPFI scores. A one SD increase in PDQI score was associated with a relative risk of ADHD diagnosis of 0.87 (CI: 0.79, 0.97). We found no reliable associations with either outcomes for the CDQI, and no reliable change in risk of ADHD diagnosis for the UPFI. CONCLUSIONS We provide evidence that overall maternal diet quality during pregnancy is associated with a small decrease in ADHD symptom score at 8 years and lower risk for ADHD diagnosis, with more robust findings for the latter outcome. Consumption of ultra-processed foods was only associated with increased ADHD symptom score of similar magnitude as for overall maternal diet quality, and we found no associations between child diet quality and either outcome. No causal inferences should be made based on these results, due to potential unmeasured confounding.
Collapse
Affiliation(s)
- Tiril Cecilie Borge
- Department of Child Health and Development, Norwegian Institute of Public Health, P.O. Box 222, Skøyen, 0213, Oslo, Norway.
| | - Guido Biele
- Department of Child Health and Development, Norwegian Institute of Public Health, P.O. Box 222, Skøyen, 0213, Oslo, Norway
| | - Eleni Papadopoulou
- Department of Environmental Health, Section of Environmental Exposure and Epidemiology, Norwegian Institute of Public Health, P.O. Box 222, Skøyen, 0213, Oslo, Norway
| | - Lene Frost Andersen
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, P.O. Box 1046, Blindern, 0317, Oslo, Norway
| | - Felice Jacka
- Food & Mood Centre, IMPACT, Deakin University, Geelong, VIC, Australia
- Centre for Adolescent Health, Murdoch Children's Research Institute, Parkville, VIC, Australia
- Black Dog Institute, Randwick, NSW, Australia
- James Cook University, Townsville, Qld, Australia
| | - Merete Eggesbø
- Department of Environmental Health, Section of Environmental Exposure and Epidemiology, Norwegian Institute of Public Health, P.O. Box 222, Skøyen, 0213, Oslo, Norway
| | - Ida Henriette Caspersen
- Department of Environmental Health, Section of Environmental Exposure and Epidemiology, Norwegian Institute of Public Health, P.O. Box 222, Skøyen, 0213, Oslo, Norway
| | - Heidi Aase
- Department of Child Health and Development, Norwegian Institute of Public Health, P.O. Box 222, Skøyen, 0213, Oslo, Norway
| | - Helle Margrete Meltzer
- Division of Infection Control and Environmental Health, Norwegian Institute of Public Health, P.O. Box 222, Skøyen, 0213, Oslo, Norway
| | - Anne Lise Brantsæter
- Department of Environmental Health, Section of Environmental Exposure and Epidemiology, Norwegian Institute of Public Health, P.O. Box 222, Skøyen, 0213, Oslo, Norway
| |
Collapse
|
13
|
Aslan Çin NN, Bezirganoğlu Altuntaş N, Özfer Özçelik A. Is iodized salt efficient to overcome iodine deficiency in pregnants? Turk J Obstet Gynecol 2020; 17:90-97. [PMID: 32850182 PMCID: PMC7406895 DOI: 10.4274/tjod.galenos.2020.20727] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Accepted: 04/24/2020] [Indexed: 12/01/2022] Open
Abstract
Objective: Iodine is a trace element that synthesizes thyroid hormones necessary for optimal human growth and development. The relationship between dietary iodine intake and spot urinary iodine excretion in pregnant women has not been previously evaluated in Trabzon city, which is an endemic area of iodine deficiency in the Black Sea region of Turkey. This study aimed to evaluate the relationship between dietary iodine intake and urine iodine excretion in pregnant women. Materials and Methods: This study enrolled 150 pregnant women aged between 19 and 45 years who applied to Clinic of Gynecology and Obstetrics in Trabzon. Spot urine specimens were taken, and dietary iodine intake data were collected using a food frequency questionnaire (FFQ) and 24-hours dietary recall (24-h DR) method. Results: The median urinary iodine concentration (UIC) in the general specimen was 100.6 μg/L. Of the pregnant women, 80.0% had insufficient and 20.0% had sufficient iodine levels, according to UIC. Although total iodine-rich food intake determined by FFQ was sufficient in 20.7% (n=31) of participants, 24-h DR iodine intake was sufficient only 10.7% (n=16). A significant association between urinary iodine excretion and iodine intake was observed in both 24-h DR and FFQ intake estimates (p<0.05). The iodine intake values obtained in both 24-h DR and FFQ and the iodized salt effect were correlated with UIC in all models (p<0.05). Even though 96.0% of pregnant women used iodized salt, its effect on UIC was 15.2%. Conclusion: Both methods indicate that the iodine intake of pregnant women might be insufficient in Trabzon area. Also, although iodized salt use is high in pregnant women in Trabzon, it is not enough to prevent iodine deficiency.
Collapse
Affiliation(s)
- Nazlı Nur Aslan Çin
- Ankara University Faculty of Health Sciences, Department of Nutrition and Dietetics, Ankara, Turkey
| | - Neslihan Bezirganoğlu Altuntaş
- University of Health Sciences Turkey, Trabzon Kanuni Training and Research Hospital, Clinic of Gynecology and Obstetrics, Trabzon, Turkey
| | - Ayşe Özfer Özçelik
- Ankara University Faculty of Health Sciences, Department of Nutrition and Dietetics, Ankara, Turkey
| |
Collapse
|
14
|
Øyen J, Aadland EK, Liaset B, Fjære E, Dahl L, Madsen L. Lean-seafood intake increases urinary iodine concentrations and plasma selenium levels: a randomized controlled trial with crossover design. Eur J Nutr 2020; 60:1679-1689. [PMID: 32856189 PMCID: PMC7987597 DOI: 10.1007/s00394-020-02366-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 08/10/2020] [Indexed: 12/31/2022]
Abstract
PURPOSE Iodine deficiency due to insufficient nutritional intake is a public health challenge in several European countries, including Norway. Lean-seafood has a high iodine and arsenic (As) content and is a good source of selenium (Se). Evidence of a direct effect of increased intake of lean-seafood on iodine status is limited. The main aims were to determine the iodine status at baseline and to investigate possible dietary effects on urinary iodine concentration (UIC) after intervention with lean-seafood versus non-seafood. Plasma Se, and plasma and urinary As concentrations were also measured. METHODS A randomized controlled crossover study comprising two 4 weeks experimental periods with two balanced diets varied in main proteins (60% of total dietary proteins) of lean-seafood and non-seafood, separated by a 5 week washout period. RESULTS Twenty participants (7 males, 13 females) were included and the mean ± SD age was 50.6 ± 15.3 years for all participants. Fasting UIC was median (25th, 75th percentile) 70 (38, 110) and 79 (49, 94) µg/L in the lean-seafood and non-seafood intervention at baseline, respectively. UIC increased after 4 weeks of the lean-seafood intervention to 135 (110, 278) µg/L, but not after the non-seafood intervention [58 (33, 91) µg/L] (P diet-effect < 0.001). Fasting plasma Se increased in the lean-seafood intervention and decreased in the non-seafood intervention (P diet-effect = 0.001). Fasting urinary and plasma As increased in the lean-seafood intervention and was unchanged in the non-seafood intervention (P diet-effect < 0.001). CONCLUSION The participant's UIC was below the recommended median (100 µg/L) at baseline, but increased sufficiently after a 4 week intervention with lean-seafood.
Collapse
Affiliation(s)
- Jannike Øyen
- Institute of Marine Research, P.O. Box 1870 Nordnes, 5817, Bergen, Norway.
| | - Eli Kristin Aadland
- Institute of Marine Research, P.O. Box 1870 Nordnes, 5817, Bergen, Norway.,Department of Sport, Food and Natural Sciences, Western Norway University of Applied Science, Bergen, Norway
| | - Bjørn Liaset
- Institute of Marine Research, P.O. Box 1870 Nordnes, 5817, Bergen, Norway
| | - Even Fjære
- Institute of Marine Research, P.O. Box 1870 Nordnes, 5817, Bergen, Norway
| | - Lisbeth Dahl
- Institute of Marine Research, P.O. Box 1870 Nordnes, 5817, Bergen, Norway
| | - Lise Madsen
- Institute of Marine Research, P.O. Box 1870 Nordnes, 5817, Bergen, Norway.,Department of Biology, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
15
|
Ollero MD, Martínez JP, Pineda J, Toni M, Espada M, Anda E. Change over time in the iodine nutritional status of pregnant women from the Pamplona healthcare region. ACTA ACUST UNITED AC 2020; 67:643-649. [PMID: 32327369 DOI: 10.1016/j.endinu.2019.12.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Revised: 11/30/2019] [Accepted: 12/11/2019] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Adequate iodine intake is essential during pregnancy. A previous study of pregnant women from the Pamplona healthcare region showed mild iodine deficiency (mean urinary iodine level, 125 mcg/L). This study was intended to ascertain the iodine intake of pregnant women in our region and to analyze the change over time in their iodine nutritional status. METHODS An observational study of 400 women in their first trimester of pregnancy. An iodine intake questionnaire was administered. To assess iodine status, urinary iodine concentration (UIC) was measured in a simple urine sample, and serum thyroglobulin levels were determined. In addition, thyroid volume was measured by cervical ultrasound examination. RESULTS Iodized salt was used by 70.5% of all participants (55.3% since the pre-gestational period) and 98.5% of them received iodine-containing supplements (mean dose, 202.6±30.1 mcg/day). Mean urinary iodine concentration was 242 mcg/L (138.5-415.5 mcg/L) and the mean serum thyroglobulin level was 12.3 mcg/L (8.3-9 mcg/L). Iodized salt intake was associated with higher UICs and lower thyroid volume. No differences were found in any of the tested parameters regarding the intake of dairy products, fish, or eggs. CONCLUSIONS Iodine intake by pregnant women in Pamplona has increased due to a greater use of iodized salt and to higher doses of iodine supplements. As a result of this, an adequate iodine status has been achieved in the last decade.
Collapse
Affiliation(s)
- M Dolores Ollero
- Servicio de Endocrinología y Nutrición, Complejo Hospitalario de Navarra, Pamplona (Navarra), España; Instituto de Investigación Sanitaria de Navarra (IdisNa), Pamplona (Navarra), España.
| | - Juan Pablo Martínez
- Sección de Endocrinología, Hospital García Orcoyen, Estella (Navarra), España
| | - Javier Pineda
- Servicio de Endocrinología y Nutrición, Complejo Hospitalario de Navarra, Pamplona (Navarra), España; Instituto de Investigación Sanitaria de Navarra (IdisNa), Pamplona (Navarra), España
| | - Marta Toni
- Instituto de Investigación Sanitaria de Navarra (IdisNa), Pamplona (Navarra), España; Sección de Endocrinología, Hospital García Orcoyen, Estella (Navarra), España
| | - Mercedes Espada
- Unidad de Química Clínica, Laboratorio de Salud Pública del Gobierno Vasco, Derio, España
| | - Emma Anda
- Servicio de Endocrinología y Nutrición, Complejo Hospitalario de Navarra, Pamplona (Navarra), España; Instituto de Investigación Sanitaria de Navarra (IdisNa), Pamplona (Navarra), España
| |
Collapse
|
16
|
Bengtson MB, Haugen M, Brantsæter AL, Aamodt G, Vatn MH. Intake of dairy protein during pregnancy in IBD and risk of SGA in a Norwegian population-based mother and child cohort. BMC Gastroenterol 2020; 20:28. [PMID: 32013916 PMCID: PMC6998088 DOI: 10.1186/s12876-020-1182-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 01/29/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patients with inflammatory bowel disease (IBD) tend to avoid dairy products to minimize abdominal pain and diarrhea. The aim of this study was to estimate the proportion of protein from dairy sources (PPDS) in mothers with and without IBD, and to explore the impact of PPDS on inadequate gestational weight gain (GWG) or small for gestational age (SGA) in IBD compared to non-IBD in the population-based Norwegian Mother, Father and Child Cohort Study (MoBa). METHODS MoBa includes about 95,000 pregnant women recruited throughout Norway from 1999 to 2008. IBD phenotype and complications during pregnancy and delivery were ascertained. This study included 148 mothers with Crohn disease (CD) and 194 with ulcerative colitis and 68,858 non-IBD mothers. In mid-pregnancy participants answered a comprehensive semi-quantitative food frequency questionnaire assessing diet since the start of pregnancy. PPDS was ranked in quartiles. The two lowest quartiles were merged and considered to represent the lowest of three PPDS groups. We used logistic regression analyses to model multivariate associations, adjusting for potential confounders. RESULTS The risk of belonging to the lowest PPDS group was twice as high in IBD mothers compared to non-IBD mothers (aOR = 2.02, 95% CI: 1.53, 2.67). Low compared to high PPDS strongly predicted inadequate GWG in CD (aOR = 4.22, 95% CI: 1.28, 13.92). Surprisingly, and in opposition to the non-IBD mothers, PPDS was positively associated with the risk of SGA in IBD mothers. IBD mother with low PPDS was associated with significantly lower risk of SGA than non-IBD mothers and IBD mothers with high PPDS (aOR = 0.19, 95% CI: 0.07, 0.50). The interaction term IBD/PPDS was the factor that linked SGA to IBD compared to non-IBD, and increased the association between IBD and SGA with a factor of three. CONCLUSION This study shows that intake of dairy products is lower in IBD mothers than in non-IBD mothers, and further, that low intake of dairy products in IBD mothers is associated with reduced risk of SGA compared to non-IBD and IBD mothers with high PPDS.
Collapse
Affiliation(s)
- May-Bente Bengtson
- EpiGen-Institute, Faculty Division Akershus University Hospital, University of Oslo, Oslo, Norway.
- Medical Department, Vestfold Hospital Trust, P.O. Box 2168, 3103, Tønsberg, Norway.
| | - Margaretha Haugen
- Division of Infection Control and Environmental Health, Department of Environmental Exposure and Epidemiology, Norwegian Institute of Public Health, P.O. Box 222-Skøyen, 0213, Oslo, Norway
| | - Anne Lise Brantsæter
- Division of Infection Control and Environmental Health, Department of Environmental Exposure and Epidemiology, Norwegian Institute of Public Health, P.O. Box 222-Skøyen, 0213, Oslo, Norway
| | - Geir Aamodt
- Department of Public Health Science, LANDSAM, Norwegian University of Life Sciences, P.O. Box 5003, 1432, Ås, Norway
| | - Morten H Vatn
- EpiGen-Institute, Faculty Division Akershus University Hospital, University of Oslo, Oslo, Norway
| |
Collapse
|
17
|
Dineva M, Rayman MP, Levie D, Guxens M, Peeters RP, Vioque J, González L, Espada M, Ibarluzea J, Sunyer J, Korevaar TIM, Bath SC. Similarities and differences of dietary and other determinants of iodine status in pregnant women from three European birth cohorts. Eur J Nutr 2020; 59:371-387. [PMID: 30734058 DOI: 10.1007/s00394-019-01913-w] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 01/23/2019] [Indexed: 12/31/2022]
Abstract
PURPOSE As a component of thyroid hormones, adequate iodine intake is essential during pregnancy for fetal neurodevelopment. Across Europe, iodine deficiency is common in pregnancy, but data are lacking on the predictors of iodine status at this life stage. We, therefore, aimed to explore determinants of iodine status during pregnancy in three European populations of differing iodine status. METHODS Data were from 6566 pregnant women from three prospective population-based birth cohorts from the United Kingdom (ALSPAC, n = 2852), Spain (INMA, n = 1460), and The Netherlands (Generation R, n = 2254). Urinary iodine-to-creatinine ratio (UI/Creat, µg/g) was measured in spot-urine samples in pregnancy (≤ 18-weeks gestation). Maternal dietary intake, categorised by food groups (g/day), was estimated from food-frequency questionnaires (FFQs). Multivariable regression models used dietary variables (energy-adjusted) and maternal characteristics as predictors of iodine status. RESULTS Median UI/Creat in pregnant women of ALSPAC, INMA, and Generation R was 121, 151, and 210 µg/g, respectively. Maternal age was positively associated with UI/Creat in all cohorts (P < 0.001), while UI/Creat varied by ethnicity only in Generation R (P < 0.05). Of the dietary predictors, intake of milk and dairy products (per 100 g/day) was positively associated with UI/Creat in all cohorts [ALSPAC (B = 3.73, P < 0.0001); INMA (B = 6.92, P = 0.002); Generation R (B = 2.34, P = 0.001)]. Cohort-specific dietary determinants positively associated with UI/Creat included fish and shellfish in ALSPAC and INMA, and eggs and cereal/cereal products in Generation R. CONCLUSIONS The cohort-specific dietary determinants probably reflect not only dietary habits but iodine-fortification policies; hence, public-health interventions to improve iodine intake in pregnancy need to be country-specific.
Collapse
Affiliation(s)
- Mariana Dineva
- Department of Nutritional Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, GU2 7XH, UK
| | - Margaret P Rayman
- Department of Nutritional Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, GU2 7XH, UK
| | - Deborah Levie
- The Generation R Study Group, Erasmus University Medical Centre, Rotterdam, The Netherlands
- Department of Internal Medicine, Academic Centre for Thyroid Diseases, Erasmus University Medical Centre, Rotterdam, The Netherlands
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Centre-Sophia Children's Hospital, Rotterdam, The Netherlands
- ISGlobal, Barcelona, Spain
- Pompeu Fabra University, Barcelona, Spain
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
| | - Mònica Guxens
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Centre-Sophia Children's Hospital, Rotterdam, The Netherlands
- ISGlobal, Barcelona, Spain
- Pompeu Fabra University, Barcelona, Spain
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
| | - Robin P Peeters
- Department of Internal Medicine, Academic Centre for Thyroid Diseases, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Jesus Vioque
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
- Nutritional Epidemiology Unit, Miguel Hernández University, ISABIAL-FISABIO, Alicante, Spain
| | - Llúcia González
- Epidemiology and Environmental Health Joint Research Unit, FISABIO-Universitat Jaume I-Universitat de València, Valencia, Spain
- Predepartamental Unit of Medicine, University Jaume I, Castelló, Spain
| | - Mercedes Espada
- Departamento de Salud del Gobierno Vasco, Public Health Laboratory of Bilbao, Basque Government, Derio, Spain
- BIODONOSTIA Health Research Institute, Donostia-San Sebastián, Spain
| | - Jesús Ibarluzea
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
- BIODONOSTIA Health Research Institute, Donostia-San Sebastián, Spain
- Departamento de Salud del Gobierno Vasco, Subdirección de Salud Pública de Guipúzcoa, Donostia-San Sebastián, Spain
- Facultad de Psicología, University of the Basque Country UPV/EHU, Donostia-San Sebastián, Spain
| | - Jordi Sunyer
- ISGlobal, Barcelona, Spain
- Pompeu Fabra University, Barcelona, Spain
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
- Hospital del Mar Research Institute (IMIM), Barcelona, Spain
| | - Tim I M Korevaar
- The Generation R Study Group, Erasmus University Medical Centre, Rotterdam, The Netherlands
- Department of Internal Medicine, Academic Centre for Thyroid Diseases, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Sarah C Bath
- Department of Nutritional Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, GU2 7XH, UK.
| |
Collapse
|
18
|
Borge TC, Brantsæter AL, Caspersen IH, Meltzer HM, Brandlistuen RE, Aase H, Biele G. Estimating the Strength of Associations Between Prenatal Diet Quality and Child Developmental Outcomes: Results From a Large Prospective Pregnancy Cohort Study. Am J Epidemiol 2019; 188:1902-1912. [PMID: 31375821 PMCID: PMC6825833 DOI: 10.1093/aje/kwz166] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 07/03/2019] [Accepted: 07/11/2019] [Indexed: 12/15/2022] Open
Abstract
Our aim in this study was to estimate the strength of associations between prenatal diet quality and child behavioral, language, and motor functions in the Norwegian Mother and Child Cohort Study (1999-2008). We created a prenatal diet quality index (PDQI) based on adherence to Norwegian dietary guidelines. Child outcomes were defined as sum scores on the Child Behavior Checklist, the Ages and Stages Questionnaire, and the Child Development Index at ages 18, 36, and 60 months. Using a longitudinal cohort study design and Bayesian hierarchical modeling, we estimated association strengths using inverse probability weighting to account for selection bias. In total, 27,529 mother-child pairs were eligible for inclusion. A 1-standard-deviation increase in PDQI score was associated with an absolute reduction in outcome sum scores of 0.02-0.21 and a 3%-7% relative decrease, with larger decreases seen for language and motor functions than for behavioral functions. PDQI scores were inversely associated with all child functions, but the estimated strength of each association was low. The results indicate that the observed variations in PDQI scores in an industrialized Western society may not profoundly influence the child functions studied.
Collapse
Affiliation(s)
- Tiril Cecilie Borge
- Correspondence to Tiril Cecilie Borge, Department of Child Health and Development, Norwegian Institute of Public Health, P.O. Box 222, Skøyen, 0213 Oslo, Norway (e-mail: )
| | | | | | | | | | | | | |
Collapse
|
19
|
Næss S, Aakre I, Kjellevold M, Dahl L, Nerhus I, Midtbø LK, Markhus MW. Validation and reproducibility of a new iodine specific food frequency questionnaire for assessing iodine intake in Norwegian pregnant women. Nutr J 2019; 18:62. [PMID: 31665021 PMCID: PMC6821006 DOI: 10.1186/s12937-019-0489-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 09/28/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Iodized salt is not mandatory in Norway, and the permitted level of iodine in table salt is low (5 μg/g). Thus, milk and dairy products, fish and eggs are the main dietary sources of iodine in Norway. Mild-to-moderate iodine deficiency in pregnant women has been described in several European countries, including Norway. There are few validated tools available to assess iodine intake in an efficient manner. The aim of the current study was to assess the validity and reproducibility of a new iodine-specific food frequency questionnaire (I-FFQ) in Norwegian pregnant women. METHODS An I-FFQ consisting of a total of 60 food items and the use of supplements was developed to assess iodine intake and was administrated to 137 pregnant women at gestational week 18-19. Reference methods were a structured 6-days iodine specific food diary, urinary iodine concentration (UIC) (pooled sample of spot UIC from six consecutive days), and thyroid function tests. Correlation analyses, Cohen's weighted kappa, Bland-Altman plots, and linear regression analyses were used to assess validity. Reproducibility of the I-FFQ was assessed in a subgroup (n = 47) at gestational week 35-36. RESULTS There was a strong correlation between estimated iodine intake from the I-FFQ and food diary (r = 0.62, P < 0.001) and an acceptable correlation between the I-FFQ and UIC (r = 0.21, P = 0.018). There was no significant association between the I-FFQ and thyroid function tests. The I-FFQ estimated higher iodine intake compared to the food diary with a mean absolute difference 33 μg/day. The limits of agreement from the Bland-Altman plots were large, however few participants fell outside the limits of agreement (5.2-6.5%). There was no difference between the estimated iodine intake from the I-FFQ assessed at gestational week 18-19, and gestational week 35-36 (P = 0.866), and there was a strong correlation between the two time points (r = 0.63, P < 0.001). CONCLUSION In summary, this study suggests that the I-FFQ can be used as a valid tool to estimate and rank iodine intake among Norwegian pregnant women. We further suggest that this I-FFQ may also be valid in other populations with similarly dietary patterns and where salt is not iodized. TRIAL REGISTRATION The study is registered in ClinicalTrials.gov (NCT02610959).
Collapse
Affiliation(s)
- Synnøve Næss
- Institute of Marine Research (IMR), 5817 Bergen, Norway
| | - Inger Aakre
- Institute of Marine Research (IMR), 5817 Bergen, Norway
| | | | - Lisbeth Dahl
- Institute of Marine Research (IMR), 5817 Bergen, Norway
| | - Ive Nerhus
- Institute of Marine Research (IMR), 5817 Bergen, Norway
| | | | | |
Collapse
|
20
|
Maternal probiotic milk intake during pregnancy and breastfeeding complications in the Norwegian Mother and Child Cohort Study. Eur J Nutr 2019; 59:2219-2228. [PMID: 31506766 PMCID: PMC7351866 DOI: 10.1007/s00394-019-02072-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 07/27/2019] [Indexed: 11/11/2022]
Abstract
Purpose During the time of breastfeeding, a third of all women contract (or: fall ill in) mastitis—the leading cause of precocious weaning. Recent studies indicate that probiotics intake may prevent mastitis by altering the breast’s bacterial flora. The aim of this study was to examine whether probiotic milk intake during pregnancy is associated with less breastfeeding complications and longer breastfeeding duration. Methods This study included 57,134 women, with live singleton term births, participating in the Norwegian Mother and Child Cohort Study. Probiotic milk intake during the first half of pregnancy was self-reported in a validated food frequency questionnaire at gestational week 22. At 6 month postpartum, women reported complications, including mastitis, and duration and exclusivity of breastfeeding. The association between probiotic milk intake and breastfeeding complications and duration was studied by adjusted logistic regression models. Results Probiotic milk intake was associated with increased risk for mastitis [adjusted odds ratio (aOR) 1.09, 95% confidence interval (CI) 1.02–1.16] and for any breastfeeding problems during the first month (aOR 1.19, 95% CI 1.10–1.21). However, cessation of predominant (aOR 0.95, 95% CI 0.91–0.96) or any (aOR 0.79, 95% CI 0.75–0.84) breastfeeding earlier than at 4 months was less frequent in probiotic milk consumers than in non-consumers. Conclusions Even though probiotic milk intake during the first half of pregnancy was statistically associated with increased risk for breastfeeding complications, including mastitis, the association is probably not causal. Probiotics intake was namely associated with longer breastfeeding duration and there was indication of socioeconomic confounding. Further studies, i.e., large randomized-controlled trials, are needed to understand the association between probiotic intake and breastfeeding complications. Electronic supplementary material The online version of this article (10.1007/s00394-019-02072-8) contains supplementary material, which is available to authorized users.
Collapse
|
21
|
Englund-Ögge L, Brantsæter AL, Juodakis J, Haugen M, Meltzer HM, Jacobsson B, Sengpiel V. Associations between maternal dietary patterns and infant birth weight, small and large for gestational age in the Norwegian Mother and Child Cohort Study. Eur J Clin Nutr 2019; 73:1270-1282. [PMID: 30459338 PMCID: PMC6760641 DOI: 10.1038/s41430-018-0356-y] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 06/16/2018] [Accepted: 10/01/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND/OBJECTIVES To assess whether quality of maternal diet affects birth weight and the risk of small for gestational age (SGA) and/or large for gestational age (LGA) babies. SUBJECTS/METHODS This study is based on the Norwegian Mother and Child Cohort Study (MoBa) and includes 65,904 pregnant women who answered a validated food frequency questionnaire at mid-pregnancy. Three maternal dietary patterns were extracted based on characteristics of food items in each pattern. From these we created four non-overlapping groups: "high prudent," "high Western," "high traditional," and "mixed". We obtained information about birth weight from the Norwegian Medical Birth Registry and calculated birth weight z-scores, SGA, and LGA according to an ultrasound-based, population-based, and a customized growth standards. Associations were studied by linear and multiple logistic regression. RESULTS Compared to the high Western group, the high prudent group was associated with lower birth weight (βultrasound z-scores -0.041 (95% confidence interval (CI): -0.068, -0.013)) and the high traditional group with higher birth weight (βultrasound 0.067 (95% CI: 0.040, 0.094)) for all three growth standards. The high prudent pattern was associated with increased SGA risk (SGAultrasound odds ratio (OR) 1.25 (95% CI: 1.02, 1.54)) and decreased LGA risk (LGApopulation OR 0.84 (95% CI: 0.75, 0.94)), while the high traditional group on the contrary was associated with decreased SGA (SGAcustomized OR 0.92 (95% CI: 0.84, 0.99)) and increased LGA risk (LGApopulation OR 1.12 (95% CI: 1.02, 1.24)). CONCLUSIONS Food quality was associated with birth weight in this well-nourished Norwegian population. Food quality may affect a woman's risk of giving birth to a SGA or LGA baby.
Collapse
Grants
- N01ES75558 NIEHS NIH HHS
- U01 NS047537 NINDS NIH HHS
- The Norwegian Research Council (FUGE 183220/S10, FRIMEDKLI-05 ES236011). NIH/NIEHS (contract no N01-ES-75558), NIH/NINDS (grant no.1 UO1 NS 047537- 01 and grant no.2 UO1 NS 047537-06A1)
- The Norwegian Research Council (FUGE 183220/S10, FRIMEDKLI-05 ES236011), the Jane and Dan Olsson Foundation, the Swedish Medical Society (SLS 2008-21198) and Swedish government grants to researchers in public health service (ALFGBG-2863, ALFGBG-11522). The Norwegian Mother and Child Cohort Study are supported by the Norwegian Ministry of Health and Care Services and the Ministry of Education and Research, NIH/NIEHS (contract no N01-ES-75558), NIH/NINDS (grant no.1 UO1 NS 047537- 01 and grant no.2 UO1 NS 047537-06A1).The Gothenburg Medical Society Grants.
- the Norwegian Research Council (FUGE 183220/S10, FRIMEDKLI-05 ES236011), the Jane and Dan Olsson Foundation, the Swedish Medical Society (SLS 2008-21198) and Swedish government grants to researchers in public health service (ALFGBG-2863, ALFGBG-11522). The Norwegian Mother and Child Cohort Study are supported by the Norwegian Ministry of Health and Care Services and the Ministry of Education and Research, NIH/NIEHS (contract no N01-ES-75558), NIH/NINDS (grant no.1 UO1 NS 047537- 01 and grant no.2 UO1 NS 047537-06A1).
Collapse
Affiliation(s)
- Linda Englund-Ögge
- Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, Gothenburg, Sweden.
- Department of Obstetrics and Gynecology, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.
| | - Anne Lise Brantsæter
- Division of Infection Control and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Julius Juodakis
- Department of Obstetrics and Gynecology, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Margareta Haugen
- Division of Infection Control and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Helle Margrete Meltzer
- Division of Infection Control and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Bo Jacobsson
- Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Obstetrics and Gynecology, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
- Domain of Health Data and Digitalisation, Norwegian Institute of Public Health, Oslo, Norway
| | - Verena Sengpiel
- Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Obstetrics and Gynecology, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| |
Collapse
|
22
|
Petrenya N, Skeie G, Melhus M, Brustad M. No ethnic disparities in nutritional adequacy between the Indigenous Sami and the non-Sami population living in rural Northern Norway—the SAMINOR 2 Clinical Survey. Nutr Res 2019; 64:9-23. [DOI: 10.1016/j.nutres.2018.12.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 12/11/2018] [Accepted: 12/20/2018] [Indexed: 12/29/2022]
|
23
|
Raghavan R, Dreibelbis C, Kingshipp BL, Wong YP, Abrams B, Gernand AD, Rasmussen KM, Siega-Riz AM, Stang J, Casavale KO, Spahn JM, Stoody EE. Dietary patterns before and during pregnancy and maternal outcomes: a systematic review. Am J Clin Nutr 2019; 109:705S-728S. [PMID: 30982868 DOI: 10.1093/ajcn/nqy216] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 07/11/2018] [Accepted: 08/06/2018] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Hypertensive disorders of pregnancy (HDP) and gestational diabetes mellitus (GDM) are common maternal complications during pregnancy, with short- and long-term sequelae for both mothers and children. OBJECTIVE Two systematic review questions were used to examine the relation between 1) dietary patterns before and during pregnancy, 2) HDP, and 3) GDM. METHODS A search was conducted from January 1980 to January 2017 in 9 databases including PubMed, Embase, and Cochrane. Two analysts independently screened articles using a priori inclusion and exclusion criteria; data were extracted from included articles, and risk of bias was assessed. After qualitative synthesis, a conclusion statement was drafted for each question and the evidence supporting the conclusion was graded. RESULTS Of the 9103 studies identified, 8 [representing 4 cohorts and 1 randomized controlled trial (RCT)] were included for HDP and 11 (representing 6 cohorts and 1 RCT) for GDM. Limited evidence in healthy Caucasian women with access to health care suggests dietary patterns before and during pregnancy that are higher in vegetables, fruits, whole grains, nuts, legumes, fish, and vegetable oils and lower in meat and refined grains are associated with reduced risk of HDP, including preeclampsia and gestational hypertension. Limited but consistent evidence suggests certain dietary patterns before pregnancy are associated with reduced risk of GDM. These protective dietary patterns are higher in vegetables, fruits, whole grains, nuts, legumes, and fish and lower in red and processed meats. Most of the research was conducted in healthy, Caucasian women with access to health care. Insufficient evidence exists on the associations between dietary patterns before and during pregnancy and risk of HDP in minority women and those of lower socioeconomic status, and dietary patterns during pregnancy and risk of GDM. CONCLUSIONS Although some conclusions were drawn from these systematic reviews, more research is needed to address gaps and limitations in the evidence.
Collapse
Affiliation(s)
| | | | | | | | - Barbara Abrams
- Division of Epidemiology, University of California Berkeley School of Public Health, Berkeley, CA
| | - Alison D Gernand
- Department of Nutritional Sciences, The Pennsylvania State University, University Park, PA
| | | | - Anna Maria Siega-Riz
- Department of Family, Community and Mental Health Systems, University of Virginia School of Nursing, Charlottesville, VA
| | - Jamie Stang
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN
| | - Kellie O Casavale
- Office of Disease Prevention and Health Promotion, US Department of Health and Human Services, Rockville, MD
| | | | - Eve E Stoody
- Food and Nutrition Service, USDA, Alexandria, VA
| |
Collapse
|
24
|
Santos JAR, Christoforou A, Trieu K, McKenzie BL, Downs S, Billot L, Webster J, Li M, Cochrane Public Health Group. Iodine fortification of foods and condiments, other than salt, for preventing iodine deficiency disorders. Cochrane Database Syst Rev 2019; 2:CD010734. [PMID: 30746700 PMCID: PMC6370918 DOI: 10.1002/14651858.cd010734.pub2] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Iodine deficiency disorders (IDD) affect close to 1.9 billion people worldwide, and are a major public health concern in many countries. Among children, iodine deficiency is the main cause of potentially preventable deficits of central nervous system development and impairment of cognitive function, as well as goitre and hypothyroidism in people of all ages. Salt iodisation is the preferred strategy for IDD prevention and control, however, in some instances where salt is not the major condiment, alternate vehicles for iodine fortification have been considered. OBJECTIVES To assess the effects of fortifying foods, beverages, condiments, or seasonings other than salt with iodine alone or in conjunction with other micronutrients, on iodine status and health-related outcomes in all populations. SEARCH METHODS Studies were identified through systematic searches of the following databases from their start date to January 2018: Cochrane Public Health Group Specialised Register; CENTRAL; MEDLINE; MEDLINE in Process; Embase; Web of Science; CINAHL; POPLINE; AGRICOLA; BIOSIS; Food Science and Technology Abstracts; OpenGrey; Bibliomap and TRoPHI; AGRIS; IBECS; Scielo; Global Index Medicus-AFRO and EMRO; LILACS; PAHO; WHOLIS; WPRO; IMSEAR; IndMED; and Native Health Research Database. We also searched reference list of relevant articles, conference proceedings, and databases of ongoing trials, and contacted experts and relevant organisations to identify any unpublished work. We applied no language or date restrictions. SELECTION CRITERIA Studies were eligible if they were randomised or quasi-randomised controlled trials (RCT) with randomisation at either the individual or cluster level (including cross-over trials), non-randomised RCTs, or prospective observational studies with a control group, such as cohort studies, controlled before-and-after studies, and interrupted time series. We included studies that examined the effects of fortification of food, beverage, condiment, or seasoning with iodine alone, or in combination with other micronutrients versus the same unfortified food, or no intervention. We considered the following measures: death (all-cause), goitre, physical development, mental development, cognitive function and motor skill development, cretinism, hypothyroidism, adverse effects (any reported by trialists), urinary iodine concentration, thyroid-stimulating hormone (TSH) concentration, and serum thyroglobulin concentration. We included all populations, including pregnant women, from any country. DATA COLLECTION AND ANALYSIS Two review authors independently assessed study eligibility, extracted data, and assessed risk of bias of included studies.We used random-effects meta-analyses to combine data and generate an overall estimate of treatment effect, when more than one study examined the same outcome measure. The overall effect estimate was calculated as the mean difference (MD) or standardised mean difference (SMD) between the intervention group and the comparison group for continuous outcomes, and as odds ratio (OR) for dichotomous outcomes. We assessed the level of heterogeneity through the I² statistic. We conducted post-hoc subgroup analyses to explore possible sources of heterogeneity, and sensitivity analyses to check the robustness of the findings from the primary analyses. We assessed the quality of the evidence for each outcome using the GRADE framework.Where it was not possible to pool the results in a meta-analysis, we provided a narrative summary of the outcomes. MAIN RESULTS Eleven studies met the criteria, providing 14 comparisons, and capturing data on 4317 participants. Seven studies were RCTs, three were cluster non-RCTs, and one was a randomised cross-over design. Seven studies were carried out among school children (N = 3636), three among women of reproductive age (N = 648), and one among infants (N = 33). The studies used diverse types of food as vehicle for iodine delivery: biscuits, milk, fish sauce, drinking water, yoghourt, fruit beverage, seasoning powder, and infant formula milk. Daily amounts of iodine provided ranged from 35 µg/day to 220 µg/day; trial duration ranged from 11 days to 48 weeks. Five studies examined the effect of iodine fortification alone, two against the same unfortified food, and three against no intervention. Six studies evaluated the effect of cofortification of iodine with other micronutrients versus the same food without iodine but with different levels of other micronutrients. We assessed one study to be at low risk of bias for all bias domains, three at low risk of bias for all domains apart from selective reporting, and seven at an overall rating of high risk of bias.No study assessed the primary outcomes of death, mental development, cognitive function, cretinism, or hypothyroidism, or secondary outcomes of TSH or serum thyroglobulin concentration. Two studies reported the effects on goitre, one on physical development measures, and one on adverse effects. All studies assessed urinary iodine concentration.The effects of iodine fortification compared to control on goitre prevalence (OR 1.60, 95% CI 0.60 to 4.31; 1 non-RCT, 83 participants; very low-quality evidence), and five physical development measures were uncertain (1 non-RCT, 83 participants; very low-quality evidence): weight (MD 0.23 kg, 95% CI -6.30 to 6.77); height (MD -0.66 cm, 95% CI -4.64 to 3.33); weight-for-age (MD 0.05, 95% CI -0.59 to 0.69); height-for-age (MD -0.30, 95% CI -0.75 to 0.15); and weight-for-height (MD -0.21, 95% CI -0.51 to 0.10). One study reported that there were no adverse events observed during the cross-over trial (low-quality evidence).Pooled results from RCTs showed that urinary iodine concentration significantly increased following iodine fortification (SMD 0.59, 95% CI 0.37 to 0.81; 6 RCTs, 2032 participants; moderate-quality evidence). This is equivalent to an increase of 38.32 µg/L (95% CI 24.03 to 52.61 µg/L). This effect was not observed in the meta-analysis of non-RCTs (SMD 0.25, 95% CI -0.16 to 0.66; 3 non-RCTs, 262 participants; very low-quality evidence). Sensitivity analyses did not change the effect observed in the primary analyses. AUTHORS' CONCLUSIONS The evidence on the effect of iodine fortification of foods, beverages, condiments, or seasonings other than salt on reducing goitre, improving physical development measures, and any adverse effects is uncertain. However, our findings suggest that the intervention likely increases urinary iodine concentration. Additional, adequately powered, high-quality studies on the effects of iodine fortification of foods on these, and other important outcomes, as well as its efficacy and safety, are required.
Collapse
Affiliation(s)
- Joseph Alvin R Santos
- The George Institute for Global Health, University of New South WalesOffice of the Chief ScientistSydneyAustralia
| | | | - Kathy Trieu
- The George Institute for Global Health, University of New South WalesOffice of the Chief ScientistSydneyAustralia
| | - Briar L McKenzie
- The George Institute for Global Health, University of New South WalesOffice of the Chief ScientistSydneyAustralia
| | - Shauna Downs
- Rutgers School of Public HealthDepartment of Health Systems and PolicyNew BrunswickNJUSA
| | - Laurent Billot
- The George Institute for Global Health, University of New South WalesOffice of the Chief ScientistSydneyAustralia
| | - Jacqui Webster
- The George Institute for Global Health, University of New South WalesOffice of the Chief ScientistSydneyAustralia
| | - Mu Li
- The University of SydneySydney School of Public HealthLevel 10, King George V Building RPA. 83‐117 Missenden RoadCamperdownNSWAustralia2050
| | | |
Collapse
|
25
|
Abel MH, Brandlistuen RE, Caspersen IH, Aase H, Torheim LE, Meltzer HM, Brantsaeter AL. Language delay and poorer school performance in children of mothers with inadequate iodine intake in pregnancy: results from follow-up at 8 years in the Norwegian Mother and Child Cohort Study. Eur J Nutr 2018; 58:3047-3058. [PMID: 30417257 PMCID: PMC6842354 DOI: 10.1007/s00394-018-1850-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 10/29/2018] [Indexed: 11/25/2022]
Abstract
Purpose Some studies indicate that mild-to-moderate iodine deficiency in pregnant women might negatively affect offspring neurocognitive development, including previous results from the Norwegian Mother and Child Cohort study (MoBa) exploring maternally reported child development at age 3 years. The aim of this follow-up study was to investigate whether maternal iodine intake in pregnancy is associated with language and learning at 8 years of age. Methods The study sample includes 39,471 mother–child pairs participating in MoBa with available information from a validated food frequency questionnaire covering the first half of pregnancy and a questionnaire on child neurocognitive development at 8 years. Multivariable regression was used to explore associations of iodine intake from food and supplements with maternally reported child outcomes. Results Maternal iodine intake from food less than ~ 150 µg/day was associated with poorer child language skills (p-overall = 0.013), reading skills (p-overall = 0.019), and writing skills (p-overall = 0.004) as well as poorer school test result in reading (p < 0.001), and increased likelihood of the child receiving special educational services (p-overall = 0.042) (in non-iodine supplement users). Although significant, differences were generally small. Maternal use of iodine supplements in pregnancy was not significantly associated with any of the outcomes. Conclusions Low habitual iodine intake in pregnant women, i.e., lower than the recommended intake for non-pregnant women, was associated with mothers reporting poorer child language, school performance, and increased likelihood of special educational services. We found no indications of benefits or harm of using iodine-containing supplements in pregnancy. Initiating use in pregnancy might be too late. Electronic supplementary material The online version of this article (10.1007/s00394-018-1850-7) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Marianne H Abel
- Division of Infection Control and Environmental Health, Department of Exposure and Environmental Epidemiology, Norwegian Institute of Public Health, Skøyen, P.O. Box 222, 0213, Oslo, Norway
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, St. Olavs plass, P.O. Box 4, 0130, Oslo, Norway
- Department of Nutrition, Tine, SA, P.O. Box 25, 0051, Oslo, Norway
| | - Ragnhild E Brandlistuen
- Division of Mental and Physical Health, Norwegian Institute of Public Health, Skøyen, P.O. Box 222, 0213, Oslo, Norway
| | - Ida H Caspersen
- Division of Infection Control and Environmental Health, Department of Exposure and Environmental Epidemiology, Norwegian Institute of Public Health, Skøyen, P.O. Box 222, 0213, Oslo, Norway
| | - Heidi Aase
- Division of Mental and Physical Health, Norwegian Institute of Public Health, Skøyen, P.O. Box 222, 0213, Oslo, Norway
| | - Liv E Torheim
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, St. Olavs plass, P.O. Box 4, 0130, Oslo, Norway
| | - Helle Margrete Meltzer
- Division of Infection Control and Environmental Health, Department of Exposure and Environmental Epidemiology, Norwegian Institute of Public Health, Skøyen, P.O. Box 222, 0213, Oslo, Norway
| | - Anne Lise Brantsaeter
- Division of Infection Control and Environmental Health, Department of Exposure and Environmental Epidemiology, Norwegian Institute of Public Health, Skøyen, P.O. Box 222, 0213, Oslo, Norway.
| |
Collapse
|
26
|
Abel MH, Korevaar TI, Erlund I, Villanger GD, Caspersen IH, Arohonka P, Alexander J, Meltzer HM, Brantsæter AL. Iodine Intake is Associated with Thyroid Function in Mild to Moderately Iodine Deficient Pregnant Women. Thyroid 2018; 28:1359-1371. [PMID: 30132420 PMCID: PMC6157349 DOI: 10.1089/thy.2018.0305] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Studies indicate that mild to moderate iodine deficiency in pregnancy may have a long-term negative impact on child neurodevelopment. These effects are likely mediated via changes in maternal thyroid function, since iodine is essential for the production of thyroid hormones. However, the impact of iodine availability on thyroid function during pregnancy and on thyroid function reference ranges are understudied. The aim of this study was to investigate the association between iodine intake and thyroid function during pregnancy. DESIGN In a population-based pregnancy cohort including 2910 pregnant women participating in The Norwegian Mother and Child Cohort Study, we explored cross sectional associations of maternal iodine intake measured (1) by a food frequency questionnaire and (2) as iodine concentration in a spot urine sample, with plasma thyroid hormones and antibodies. RESULTS Biological samples were collected in mean gestational week 18.5 (standard deviation 1.3) and diet was assessed in gestational week 22. Median iodine intake from food was 121 μg/day (interquartile range 90, 160), and 40% reported use of iodine-containing supplements in pregnancy. Median urinary iodine concentration (UIC) was 59 μg/L among those who did not use supplements and 98 μg/L in the women reporting current use at the time of sampling, indicating mild to moderate iodine deficiency in both groups. Iodine intake as measured by the food frequency questionnaire was not associated with the outcome measures, while UIC was inversely associated with FT3 (p = 0.002) and FT4 (p < 0.001). Introduction of an iodine-containing supplement after gestational week 12 was associated with indications of lower thyroid hormone production (lower FT4, p = 0.027, and nonsignificantly lower FT3, p = 0.17). The 2.5th and 97.5th percentiles of TSH, FT4, and FT3 were not significantly different by groups defined by calculated iodine intake or by UIC. CONCLUSION The results indicate that mild to moderate iodine deficiency affect thyroid function in pregnancy. However, the differences were small, suggesting that normal reference ranges can be determined based on data also from mildly iodine deficient populations, but this needs to be further studied. Introducing an iodine-containing supplement might temporarily inhibit thyroid hormone production and/or release.
Collapse
Affiliation(s)
- Marianne Hope Abel
- Division of Infection Control and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
- Department of Nursing and Health Promotion, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, Oslo, Norway
- Department of Nutrition, Tine SA, Oslo, Norway
| | - Tim I.M. Korevaar
- Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
- Academic Center for Thyroid Diseases, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Iris Erlund
- Genomics and Biomarkers Unit, National Institute for Health and Welfare, Helsinki, Finland
| | - Gro Dehli Villanger
- Division of Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Ida Henriette Caspersen
- Division of Infection Control and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Petra Arohonka
- Genomics and Biomarkers Unit, National Institute for Health and Welfare, Helsinki, Finland
| | - Jan Alexander
- Division of Infection Control and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Helle Margrete Meltzer
- Division of Infection Control and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Anne Lise Brantsæter
- Division of Infection Control and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
| |
Collapse
|
27
|
Egeland GM, Skurtveit S, Staff AC, Eide GE, Daltveit AK, Klungsøyr K, Trogstad L, Magnus PM, Brantsæter AL, Haugen M. Pregnancy-Related Risk Factors Are Associated With a Significant Burden of Treated Hypertension Within 10 Years of Delivery: Findings From a Population-Based Norwegian Cohort. J Am Heart Assoc 2018; 7:e008318. [PMID: 29755036 PMCID: PMC6015329 DOI: 10.1161/jaha.117.008318] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND The association between pregnancy complications and women's later cardiovascular disease has, primarily, been evaluated in studies lacking information on important covariates. This report evaluates the prospective associations between pregnancy-related risk factors (preeclampsia/eclampsia, gestational hypertension, pregestational and gestational diabetes mellitus, preterm delivery, and fetal growth restriction) and pharmacologically treated hypertension within 10 years after pregnancy, while adjusting for a wide range of covariates. METHODS AND RESULTS Prepregnancy normotensive women participating in the MoBa (Norwegian Mother and Child Cohort Study) from January 2004 through July 2009 were linked to the Norwegian Prescription Database to identify women with pharmacologically treated hypertension beyond the postpartum period of 3 months. The burden of hypertension associated with pregnancy-related risk factors was evaluated using an attributable fraction method. A total of 1480 women developed pharmacologically treated hypertension within the follow-up among 60 027 women (rate of hypertension, 3.6/1000 person-years). The proportion of hypertension associated with a history of preeclampsia/eclampsia, gestational hypertension, preterm delivery, and pregestational or gestational diabetes mellitus was 28.6% (95% confidence interval, 25.5%-31.6%) on the basis of multivariable analyses adjusting for numerous covariates. The proportion was similar for women with a healthy prepregnancy body mass index (18.5-24.9 kg/m2; attributable fraction (AF)% 25.9%; 95% confidence interval, 21.3%-30.3%), but considerably higher for nulliparous women at baseline within the first 5 years of follow-up. Small-for-gestational age, however, did not increase subsequent hypertension risk in multivariable analyses. CONCLUSIONS A structured postpartum follow-up of high-risk women identified through pregnancy-related risk factors would facilitate personalized preventive strategies to postpone or avoid onset of premature cardiovascular events.
Collapse
Affiliation(s)
- Grace M Egeland
- Divisions of Health Data and Digitalization and Mental and Physical Health, Norwegian Institute of Public Health, Bergen and Oslo, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Norway
| | - Svetlana Skurtveit
- Divisions of Health Data and Digitalization and Mental and Physical Health, Norwegian Institute of Public Health, Bergen and Oslo, Norway
| | - Anne Cathrine Staff
- Division of Obstetrics and Gynaecology, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, University of Oslo, Norway
| | - Geir Egil Eide
- Department of Global Public Health and Primary Care, University of Bergen, Norway
- Centre for Clinical Research, Haukeland University Hospital, Bergen, Norway
| | - Anne-Kjersti Daltveit
- Divisions of Health Data and Digitalization and Mental and Physical Health, Norwegian Institute of Public Health, Bergen and Oslo, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Norway
| | - Kari Klungsøyr
- Divisions of Health Data and Digitalization and Mental and Physical Health, Norwegian Institute of Public Health, Bergen and Oslo, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Norway
| | - Lill Trogstad
- Divisions of Health Data and Digitalization and Mental and Physical Health, Norwegian Institute of Public Health, Bergen and Oslo, Norway
| | - Per M Magnus
- Divisions of Health Data and Digitalization and Mental and Physical Health, Norwegian Institute of Public Health, Bergen and Oslo, Norway
| | - Anne Lise Brantsæter
- Divisions of Health Data and Digitalization and Mental and Physical Health, Norwegian Institute of Public Health, Bergen and Oslo, Norway
| | - Margaretha Haugen
- Divisions of Health Data and Digitalization and Mental and Physical Health, Norwegian Institute of Public Health, Bergen and Oslo, Norway
| |
Collapse
|
28
|
Madar AA, Meltzer HM, Heen E, Meyer HE. Iodine Status among Somali Immigrants in Norway. Nutrients 2018; 10:nu10030305. [PMID: 29510554 PMCID: PMC5872723 DOI: 10.3390/nu10030305] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Revised: 02/27/2018] [Accepted: 03/01/2018] [Indexed: 11/16/2022] Open
Abstract
We lack knowledge about iodine status in the Norwegian population in general, and particularly among immigrants. We aimed to estimate the iodine status and potentially associated factors in a Somali population in Norway. Somali men and women aged 20–73, who were living in one district in Oslo, were recruited between December 2015 and October 2016. Twenty-four-hour urine was collected from 169 participants (91 females and 78 males). Iodine was analysed using the Sandell–Kolthoff reaction on microplates and colorimetric measurement. Information about diet was collected using a short food frequency questionnaire. Iodine intake was calculated from the 24-h iodine excretion. The mean urine volume over 24-h was 1.93 liters (min–max: 0.55–4.0) and the urinary iodine concentration (UIC) varied from 13 to 263 µg/L with a median value of 62.5 µg/L indicating a population with mild iodine deficiency. The median daily iodine intake for the study population was estimated to be 124 μg/day. Mean serum thyroid-stimulating hormone, thyroxine (T4) and triiodothyronine (T3) was 2.1 (SD 1.1) mU/L, 15.0 (SD 2.1) pmol/L, and 5.1 (SD 0.6) pmol/L, respectively. No food groups were associated with iodine intake and neither was gender, age, education level nor length of residence in Norway. In conclusion, this study showed that iodine intake was low, and a considerable proportion of the Somali population studied had sub-optimal iodine status. Monitoring of iodine status should be prioritised and measures to ensure adequate iodine intake, particularly among vulnerable groups initiated.
Collapse
Affiliation(s)
- Ahmed A Madar
- Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, Post Box 1130 Blindern, 0318 Oslo, Norway.
| | | | - Espen Heen
- Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, Post Box 1130 Blindern, 0318 Oslo, Norway.
| | - Haakon E Meyer
- Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, Post Box 1130 Blindern, 0318 Oslo, Norway.
- Norwegian Institute of Public Health, 0318 Oslo, Norway.
| |
Collapse
|
29
|
Abel MH, Ystrom E, Caspersen IH, Meltzer HM, Aase H, Torheim LE, Askeland RB, Reichborn-Kjennerud T, Brantsæter AL. Maternal Iodine Intake and Offspring Attention-Deficit/Hyperactivity Disorder: Results from a Large Prospective Cohort Study. Nutrients 2017; 9:E1239. [PMID: 29137191 PMCID: PMC5707711 DOI: 10.3390/nu9111239] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 11/03/2017] [Accepted: 11/08/2017] [Indexed: 11/16/2022] Open
Abstract
Current knowledge about the relationship between mild to moderately inadequate maternal iodine intake and/or supplemental iodine on child neurodevelopment is sparse. Using information from 77,164 mother-child pairs in the Norwegian Mother and Child Cohort Study, this study explored associations between maternal iodine intake and child attention-deficit/hyperactivity disorder (ADHD) diagnosis, registered in the Norwegian Patient Registry and maternally-reported child ADHD symptoms at eight years of age. Pregnant women reported food and supplement intakes by questionnaire in gestational week 22. In total, 1725 children (2.2%) were diagnosed with ADHD. In non-users of supplemental iodine (53,360 mothers), we found no association between iodine intake from food and risk of child ADHD diagnosis (p = 0.89), while low iodine from food (<200 µg/day) was associated with higher child ADHD symptom scores (adjusted difference in score up to 0.08 standard deviation (SD), p < 0.001, n = 19,086). In the total sample, we found no evidence of beneficial effects of maternal use of iodine-containing supplements (n = 23,804) on child ADHD diagnosis or symptom score. Initiation of iodine supplement use in gestational weeks 0-12 was associated with an increased risk of child ADHD (both measures). In conclusion, insufficient maternal iodine intake was associated with increased child ADHD symptom scores at eight years of age, but not with ADHD diagnosis. No reduction of risk was associated with maternal iodine supplement use.
Collapse
Affiliation(s)
- Marianne Hope Abel
- Division of Infection Control and Environmental Health, Norwegian Institute of Public Health, 0456 Oslo, Norway.
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo and Akershus University College of Applied Sciences, 0167 Oslo, Norway.
- Department of Research and Development, TINE SA, 0902 Oslo, Norway.
| | - Eivind Ystrom
- Division of Mental and Physical Health, Norwegian Institute of Public Health, 0456 Oslo, Norway.
- Section of Health, Developmental and Personality Psychology, Department of Psychology, University of Oslo, 0315 Oslo, Norway.
- Pharmaco Epidemiology and Drug Safety Research Group, School of Pharmacy, University of Oslo, 0315 Oslo, Norway.
| | - Ida Henriette Caspersen
- Division of Infection Control and Environmental Health, Norwegian Institute of Public Health, 0456 Oslo, Norway.
| | - Helle Margrete Meltzer
- Division of Infection Control and Environmental Health, Norwegian Institute of Public Health, 0456 Oslo, Norway.
| | - Heidi Aase
- Division of Mental and Physical Health, Norwegian Institute of Public Health, 0456 Oslo, Norway.
| | - Liv Elin Torheim
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo and Akershus University College of Applied Sciences, 0167 Oslo, Norway.
| | - Ragna Bugge Askeland
- Division of Mental and Physical Health, Norwegian Institute of Public Health, 0456 Oslo, Norway.
| | - Ted Reichborn-Kjennerud
- Division of Mental and Physical Health, Norwegian Institute of Public Health, 0456 Oslo, Norway.
- Institute of Clinical Medicine, University of Oslo, 0315 Oslo, Norway.
| | - Anne Lise Brantsæter
- Division of Infection Control and Environmental Health, Norwegian Institute of Public Health, 0456 Oslo, Norway.
| |
Collapse
|
30
|
Egeland GM, Skurtveit S, Sakshaug S, Daltveit AK, Vikse BE, Haugen M. Low Calcium Intake in Midpregnancy Is Associated with Hypertension Development within 10 Years after Pregnancy: The Norwegian Mother and Child Cohort Study. J Nutr 2017; 147:1757-1763. [PMID: 28701386 PMCID: PMC5572493 DOI: 10.3945/jn.117.251520] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Revised: 05/18/2017] [Accepted: 06/19/2017] [Indexed: 12/29/2022] Open
Abstract
Background: Low dietary calcium intake may be a risk factor for hypertension, but studies conflict.Objective: We evaluated the ability to predict hypertension within 10 y after delivery based on calcium intake during midpregnancy.Methods: The Norwegian Mother and Child Cohort Study of women delivering in 2004-2009 was linked to the Norwegian Prescription Database (2004-2013) to ascertain antihypertensive medication usage >90 d after delivery. Women with hypertension before pregnancy were excluded, leaving 60,027 mothers for analyses. Age and energy-adjusted cubic splines evaluated dose-response curves, and Cox proportional hazard analyses evaluated HR and 95% CIs by calcium quartiles adjusting for 7 covariates. Analyses were stratified by gestational hypertension and by sodium-to-potassium intake ratio (<0.76 compared with ≥0.76).Results: Participants had a mean ± SD age of 30.5 ± 4.6 y, a body mass index (in kg/m2) of 24.0 ± 4.3 before pregnancy, and a mean follow-up duration of 7.1 ± 1.6 y. Cubic spline graphs identified a threshold effect of low calcium intake only within the range of dietary inadequacy related to increased risk. The lowest calcium quartile (≤738 mg/d; median: 588 mg/d), relative to the highest quartile (≥1254 mg/d), had an HR for hypertension of 1.34 (95% CI: 1.05, 1.70) among women who were normotensive during pregnancy, and an HR of 1.62 (95% CI: 1.14, 2.35) among women who had gestational hypertension, after adjusting for covariates. Women with gestational hypertension, who were in the lowest quartile of calcium intake, and who had a high sodium-to-potassium intake ratio had a risk of hypertension more than double that of their counterparts with a calcium intake in the highest quartile. Results were attenuated by adjusting for covariates (HR: 1.92; 95% CI: 1.09, 3.39).Conclusions: The results suggest that low dietary calcium intake may be a risk factor or risk marker for the development of hypertension, particularly for women with a history of gestational hypertension.
Collapse
Affiliation(s)
- Grace M Egeland
- Departments of Global Public Health and Primary Care and,Division of Health Data and Digitalisation, Norwegian Institute of Public Health, Bergen and Oslo, Norway
| | - Svetlana Skurtveit
- Division of Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway; and
| | - Solveig Sakshaug
- Division of Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway; and
| | - Anne Kjersti Daltveit
- Departments of Global Public Health and Primary Care and,Division of Health Data and Digitalisation, Norwegian Institute of Public Health, Bergen and Oslo, Norway
| | - Bjørn E Vikse
- Clinical Medicine, University of Bergen, Bergen, Norway;,Department of Medicine, Haugesund Hospital, Haugesund, Norway
| | - Margaretha Haugen
- Division of Health Data and Digitalisation, Norwegian Institute of Public Health, Bergen and Oslo, Norway
| |
Collapse
|
31
|
Riestra Fernández M, Menéndez Torre E, Díaz Cadórniga F, Fernández Fernández JC, Delgado Álvarez E. Iodine nutritional status in Asturian schoolchildren. ACTA ACUST UNITED AC 2017; 64:491-497. [PMID: 29050705 DOI: 10.1016/j.endinu.2017.06.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Revised: 06/13/2017] [Accepted: 06/19/2017] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Iodine deficiency is a public health problem, and iodine nutritional status should therefore be regularly measured. OBJECTIVE To ascertain iodine nutritional status in Asturias and its relation to use of iodized salt and to other sociodemographic and nutritional parameters. MATERIAL AND METHODS A descriptive, observational study was conducted in a random sample of schoolchildren aged 5 to 14 years, in whom urinary iodine levels were measured by high-performance liquid chromatography. Families completed a survey on use of iodized salt, consumption of dairy products and fish, and sociodemographic data. RESULTS The study sample consisted of 705 schoolchildren (51.1% females) with a mean age of 9.9 years (SD 2.6). In a total of 620 valid measurements, mean urinary iodine level was 204.1 μg/L (SD 120.6), while the median value was 180.7 μg/L (P25-P75: 124-252.3 μg/L, interquartile range 128.3 μg/L). Urinary iodine levels were <100 μg/L in 16.6% of children, and very low (<20 μg/L) in 0.2%. Iodized salt was used in 69.3% of all households, and in all school canteens. Consumption of dairy products was significantly associated to urinary iodine levels (P<.0005). CONCLUSION Iodine nutrition of Asturian schoolchildren is adequate, although the target of use of iodized salt in 90% of households is still far away. Adequate iodine nutrition may be due to other sources, such as dairy products. Public health campaigns are required to promote iodized salt consumption. Regular assessment of iodine nutritional status is also needed.
Collapse
Affiliation(s)
| | - Edelmiro Menéndez Torre
- Servicio Endocrinología y Nutrición, Hospital Universitario Central de Asturias, Oviedo, España
| | | | | | - Elías Delgado Álvarez
- Servicio Endocrinología y Nutrición, Hospital Universitario Central de Asturias, Oviedo, España
| |
Collapse
|
32
|
Głąbska D, Malowaniec E, Guzek D. Validity and Reproducibility of the Iodine Dietary Intake Questionnaire Assessment Conducted for Young Polish Women. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14070700. [PMID: 28661461 PMCID: PMC5551138 DOI: 10.3390/ijerph14070700] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/20/2017] [Revised: 06/21/2017] [Accepted: 06/23/2017] [Indexed: 11/16/2022]
Abstract
The aim of this study was to analyse a designed brief iodine dietary intake questionnaire based on a food frequency assessment (IOdine Dietary INtake Evaluation-Food Frequency Questionnaire—IODINE-FFQ), including the assessment of validity and reproducibility in a group of 90 Polish women aged 20–35 years. Participants collected 3-day dietary records and filled in the IODINE-FFQ twice (FFQ1—directly after the dietary record and FFQ2—6 weeks later). The analysis included an assessment of validity (comparison with the results of the 3-day dietary record) and of reproducibility (comparison of the results obtained twice—FFQ1 and FFQ2). In the analysis of validity, a Bland-Altman index of 5.5% and 4.4% was recorded, respectively for FFQ1 and FFQ2. In the analysis of reproducibility it was 6.7%, but the share of individuals correctly classified into tertiles was over 70% (weighted κ of 0.675). It was stated, that assessment of IODINE-FFQ revealed a satisfactory level of validity and reproducibility in the analysis of Bland-Alman plot. The IODINE-FFQ may be indicated as a tool for the assessment of iodine intake in the young women in Poland, however further studies should be considered in order to obtain the practical tool for public health specialists. Due to the lack of validated iodine-specific food frequency questionnaires for countries of Eastern Europe, the IODINE-FFQ may be adjusted for courtiers other than Poland including iodine-fortified products.
Collapse
Affiliation(s)
- Dominika Głąbska
- Department of Dietetics, Faculty of Human Nutrition and Consumer Sciences, Warsaw University of Life Sciences (WULS-SGGW), 02-787 Warsaw, Poland.
| | - Ewa Malowaniec
- Department of Dietetics, Faculty of Human Nutrition and Consumer Sciences, Warsaw University of Life Sciences (WULS-SGGW), 02-787 Warsaw, Poland.
| | - Dominika Guzek
- Department of Organization and Consumption Economics, Faculty of Human Nutrition and Consumer Sciences, Warsaw University of Life Sciences (WULS-SGGW), 02-787 Warsaw, Poland.
| |
Collapse
|
33
|
Henjum S, Lilleengen AM, Aakre I, Dudareva A, Gjengedal ELF, Meltzer HM, Brantsæter AL. Suboptimal Iodine Concentration in Breastmilk and Inadequate Iodine Intake among Lactating Women in Norway. Nutrients 2017; 9:E643. [PMID: 28640217 PMCID: PMC5537763 DOI: 10.3390/nu9070643] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 06/15/2017] [Accepted: 06/17/2017] [Indexed: 11/24/2022] Open
Abstract
Breastfed infants depend on sufficient maternal iodine intake for optimal growth and neurological development. Despite this, few studies have assessed iodine concentrations in human milk and there is currently no published data on iodine status among lactating women in Norway. The aim of this study was to assess iodine concentrations in breast milk (BMIC) in lactating women and estimate iodine intake. Five Mother and Child Health Centres in Oslo were randomly selected during 2016, and 175 lactating women between 2nd and 28th weeks postpartum participated. Each of the women provided four breastmilk samples which were pooled and analysed for iodine concentrations. Participants also provided information on iodine intake from food and supplements covering the last 24 h and the habitual iodine intake (food frequency questionnaire). The median (p25, p75 percentiles) BMIC was 68 (45, 98) µg/L and 76% had BMIC <100 µg/L. Only 19% had taken an iodine-containing supplement during the last 24 h. The median 24 h iodine intake from food (p25, p75) was 121 (82, 162) µg/day and the total intake (food and supplements) was 134 (95, 222) µg/day. The majority of lactating women had suboptimal BMIC and inadequate intake of iodine from food and supplements.
Collapse
Affiliation(s)
- Sigrun Henjum
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo and Akershus University, College of Applied Sciences, Oslo 0310, Norway.
| | - Anne Marie Lilleengen
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo and Akershus University, College of Applied Sciences, Oslo 0310, Norway.
| | - Inger Aakre
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo and Akershus University, College of Applied Sciences, Oslo 0310, Norway.
| | - Anna Dudareva
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo and Akershus University, College of Applied Sciences, Oslo 0310, Norway.
| | - Elin Lovise Folven Gjengedal
- Faculty of Environmental Sciences and Natural Resource Management, Norwegian University of Life Sciences, Aas 1433, Norway.
| | - Helle Margrete Meltzer
- Division of Infection Control and Environmental Health, Norwegian Institute of Public Health, Oslo 0403, Norway.
| | - Anne Lise Brantsæter
- Division of Infection Control and Environmental Health, Norwegian Institute of Public Health, Oslo 0403, Norway.
| |
Collapse
|
34
|
Nazeri P, Mirmiran P, Tahmasebinejad Z, Hedayati M, Delshad H, Azizi F. The Effects of Iodine Fortified Milk on the Iodine Status of Lactating Mothers and Infants in an Area with a Successful Salt Iodization Program: A Randomized Controlled Trial. Nutrients 2017; 9:nu9020180. [PMID: 28241419 PMCID: PMC5331611 DOI: 10.3390/nu9020180] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 02/06/2017] [Accepted: 02/17/2017] [Indexed: 11/20/2022] Open
Abstract
Iodine deficiency during the first two years of life may cause irreversible brain damage and mental retardation. The aim of the present study was to investigate, for the first time, the effect of iodine fortified milk on the iodine status of lactating mothers and their infants. In this multicenter randomized controlled trial, 84 lactating mother-infant pairs from health care centers were randomly selected. After meeting the inclusion criteria, lactating mothers were randomly assigned to two groups: the iodine fortified milk group and the control group (n = 42 each). Maternal and infant urine and breast milk samples were collected at 3–5 (baseline), 7, 10, 14 days, and 1 month postpartum, for a measurement of the iodine concentration. A total of 84 lactating mothers, with a mean age of 28.2 ± 4.5 years, and 84 infants, with a mean age of 4.2 ± 0.7 days, were included in the study. Compared to mothers of the control group, mothers receiving iodine fortified milk had higher urinary (p < 0.001) and breast milk (p < 0.001) iodine concentrations. Urinary iodine levels in infants revealed no significant differences between the two groups. The findings of this study indicate that supplementation with daily iodine fortified milk provides iodine nutrition adequacy among lactating mothers. However, it had no effect on the iodine status of infants, who were previously iodine sufficient.
Collapse
Affiliation(s)
- Pantea Nazeri
- Nutrition and Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, 19395-4763 Tehran, Iran.
| | - Parvin Mirmiran
- Nutrition and Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, 19395-4763 Tehran, Iran.
- Department of Nutrition and Clinical Dietetics, Faculty of Nutrition Sciences and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, 19395-4741 Tehran, Iran.
| | - Zhale Tahmasebinejad
- Nutrition and Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, 19395-4763 Tehran, Iran.
| | - Mehdi Hedayati
- Cellular and Molecular Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, 19395-4763 Tehran, Iran.
| | - Hossein Delshad
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, 19395-4763 Tehran, Iran.
| | - Fereidoun Azizi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, 19395-4763 Tehran, Iran.
| |
Collapse
|
35
|
Chen W, Li X, Wu Y, Bian J, Shen J, Jiang W, Tan L, Wang X, Wang W, Pearce EN, Zimmermann MB, Carriquiry AL, Zhang W. Associations between iodine intake, thyroid volume, and goiter rate in school-aged Chinese children from areas with high iodine drinking water concentrations. Am J Clin Nutr 2017; 105:228-233. [PMID: 27927635 DOI: 10.3945/ajcn.116.139725] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Accepted: 11/02/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Excessive iodine intake may have adverse effects on the thyroid, particularly in children, but the safe upper iodine intake concentration in children is unclear. OBJECTIVE We assessed the adverse effects of high iodine intake from iodine-rich drinking water on thyroid size in children by examining associations between thyroid volume (Tvol), total goiter rate (TGR), and iodine intake. DESIGN In a multistage cross-sectional survey, we collected two 24-h urine samples on 2 nonconsecutive days and determined 24-h urinary iodine excretion, then calculated habitual daily iodine intake. Ultrasonographic Tvol was measured, and TGR was calculated based on international and Chinese reference ranges for Tvol in children. RESULTS This study included 2089 children from Shandong province, where the median (IQR) drinking water iodine concentration was 183 μg/L (69-406 μg/L). The median (IQR) 24-h urinary iodine concentrations for the 2 collections were 381 μg/L (203-649 μg/L) and 398 μg/L (202-687 μg/L), respectively. The median (IQR) habitual daily iodine intake of children was 298 μg/d (186-437 μg/d). Tvols were slightly higher in boys than in girls (P = 0.035). The overall TGR was 9.7% and did not differ by sex. The TGR was ∼5% for children aged 7-10 and 11-14 y at iodine intakes of 200-249 and 250-299 μg/d, respectively. With the use of logistic regression and 2-step linear regression, a nonlinear association was observed between Tvol, TGR, and iodine intake, with a threshold intake of 150 μg/d. CONCLUSIONS Tvol begins to increase in children when iodine intake is ≥150 μg/d, and the TGR exceeds 5% when daily iodine intake is ≥250 μg/d for children aged 7-10 y and ≥300 μg/d for children aged 11-14 y. Our findings suggest that 150-249 and 150-299 μg/d seem to be safe upper iodine intake ranges for children aged 7-10 and 11-14 y, respectively. This trial was registered at clinicaltrials.gov as NCT02915536.
Collapse
Affiliation(s)
- Wen Chen
- Department of Nutrition and Food Hygiene, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Xiang Li
- Department of Nutrition and Food Hygiene, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Yalan Wu
- Department of Nutrition and Food Hygiene, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Jianchao Bian
- Shandong Institute for Endemic Disease Control and Research, Jinan, China
| | - Jun Shen
- Department of Nutrition and Food Hygiene, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Wen Jiang
- Shandong Institute for Endemic Disease Control and Research, Jinan, China
| | - Long Tan
- Department of Nutrition and Food Hygiene, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Xiaoming Wang
- Shandong Institute for Endemic Disease Control and Research, Jinan, China
| | - Wei Wang
- Department of Nutrition and Food Hygiene, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Elizabeth N Pearce
- Section of Endocrinology, Diabetes, and Nutrition, Boston University School of Medicine, Boston, MA
| | - Michael B Zimmermann
- Human Nutrition Laboratory, Swiss Federal Institute of Technology (ETH), Zürich, Switzerland; and
| | | | - Wanqi Zhang
- Department of Nutrition and Food Hygiene, School of Public Health, Tianjin Medical University, Tianjin, China;
| |
Collapse
|
36
|
Condo D, Huyhn D, Anderson AJ, Skeaff S, Ryan P, Makrides M, Mühlhaüsler BS, Zhou SJ. Iodine status of pregnant women in South Australia after mandatory iodine fortification of bread and the recommendation for iodine supplementation. MATERNAL AND CHILD NUTRITION 2016; 13. [PMID: 27982512 DOI: 10.1111/mcn.12410] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Revised: 11/02/2016] [Accepted: 11/11/2016] [Indexed: 12/25/2022]
Abstract
Mandatory iodine fortification of bread was introduced in 2009 in Australia in response to the reemergence of iodine deficiency. The aim of this study was to assess iodine intake, urinary iodine concentration (UIC) and their correlation in pregnant women (n = 783) recruited from South Australia 2 years following mandatory iodine fortification. Total iodine intake (food and supplements) and UIC were assessed at study entry (<20 weeks') and at 28 weeks' gestation. Mean (±SD) total iodine intake at study entry and 28 weeks' gestation was 307 ± 128 μg/day and 300 ± 127 μg/day, respectively. Overall, 85.9% of women met the estimated average intake (≥160 μg/day) for iodine in pregnancy, but only 44.5% met the estimated average intake from food alone. The main food sources of iodine were dairy foods and iodine-fortified bread. Median (interquartile range) UIC at study entry and 28 weeks' gestation was 189 μg/L and 172 μg/L, respectively. At study entry, median UIC was higher in women taking supplements containing iodine ≥150 μg/day compared with those containing iodine <150 μg/day (221 μg/L vs. 163 μg/L, p = .003) and those not taking supplements containing iodine (221 μg/L vs. 159 μg/L, p < .001). At 28 weeks' gestation, the median UIC for the groups was 187, 152 and 141 μg/L, respectively (each of the two comparisons yielded p < .001). Total iodine intake (food and supplements) from all women was positively, though weakly, correlated with UIC (r = .23, p < .001). In conclusion, pregnant women in South Australia are iodine sufficient postmandatory iodine fortification of bread. However, without iodine supplementation, it may be difficult to achieve a UIC >150 μg/L.
Collapse
Affiliation(s)
- Dominique Condo
- Women's and Children's Health Research Institute, North Adelaide, South Australia, Australia.,Deakin University, School of Exercise and Nutrition Sciences, Geelong, Australia.,Deakin University, Institute for Physical Activity and Nutrition (I-PAN), Geelong, Australia
| | - Dao Huyhn
- FOOD plus Research Centre, School of Agriculture, Food & Wine, University of Adelaide, Waite Campus, Urrbrae, South Australia, Australia
| | - Amanda J Anderson
- Women's and Children's Health Research Institute, North Adelaide, South Australia, Australia.,Healthy Mothers, Babies and Children, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Sheila Skeaff
- Department of Human Nutrition, University of Otago, Dunedin, New Zealand
| | - Philip Ryan
- School of Population Health, University of Adelaide, Adelaide, South Australia, Australia
| | - Maria Makrides
- Women's and Children's Health Research Institute, North Adelaide, South Australia, Australia.,Healthy Mothers, Babies and Children, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia.,School of Paediatrics & Reproductive Health, University of Adelaide, Adelaide, South Australia, Australia
| | - Beverly S Mühlhaüsler
- Women's and Children's Health Research Institute, North Adelaide, South Australia, Australia.,FOOD plus Research Centre, School of Agriculture, Food & Wine, University of Adelaide, Waite Campus, Urrbrae, South Australia, Australia
| | - Shao J Zhou
- Women's and Children's Health Research Institute, North Adelaide, South Australia, Australia.,FOOD plus Research Centre, School of Agriculture, Food & Wine, University of Adelaide, Waite Campus, Urrbrae, South Australia, Australia
| |
Collapse
|
37
|
Katagiri R, Asakura K, Uechi K, Masayasu S, Sasaki S. Iodine Excretion in 24-hour Urine Collection and Its Dietary Determinants in Healthy Japanese Adults. J Epidemiol 2016; 26:613-621. [PMID: 27374137 PMCID: PMC5121429 DOI: 10.2188/jea.je20150245] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2015] [Accepted: 01/05/2016] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Since seaweed is a common component of the Japanese diet, iodine intake in Japanese is expected to be high. However, urinary iodine excretion, measured using 24-hour urine samples, and its dietary determinants are not known. METHODS Apparently healthy adults aged 20 to 69 years living in 20 areas throughout Japan were recruited in February and March, 2013. Urinary iodine excretion was evaluated using 24-hour urine collected from 713 subjects (362 men and 351 women), and the difference among age groups was assessed. The association between dietary intake of food groups and urinary iodine excretion was assessed among 358 subjects who completed a semi-weighed 4-day diet record (DR) and urine collection. The correlations between iodine intake and iodine excretion were also evaluated, and correlation coefficients were calculated for iodine intake in the DR of the overlapping day or the DR 1 day before and after urine collection. RESULTS Median iodine excretion in 24-hour urine was 365 µg, and excretion was significantly higher in older subjects. Iodine intake estimated by the DRs was significantly correlated with urinary iodine excretion when DRs and urine collection were obtained on the same day (r = 0.37). After adjustment for confounding factors, iodine excretion was significantly associated with intakes of kelp and soup stock from kelp and fish. CONCLUSIONS Although multiple measurements for urinary iodine are required to confirm our results, this study showed the current iodine status of healthy Japanese adults. The results suggest that kelp and fish are the main contributors to Japanese iodine status measured by 24-hour urine.
Collapse
Affiliation(s)
- Ryoko Katagiri
- Department of Social and Preventive Epidemiology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Keiko Asakura
- Department of Social and Preventive Epidemiology, School of Public Health, University of Tokyo, Tokyo, Japan
- Interfaculty Initiative in Information Studies, University of Tokyo, Tokyo, Japan
| | - Ken Uechi
- Department of Social and Preventive Epidemiology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | | | - Satoshi Sasaki
- Department of Social and Preventive Epidemiology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
- Department of Social and Preventive Epidemiology, School of Public Health, University of Tokyo, Tokyo, Japan
| |
Collapse
|
38
|
Petrovic D, Estoppey Younes S, Pruijm M, Ponte B, Ackermann D, Ehret G, Ansermot N, Mohaupt M, Paccaud F, Vogt B, Pechère-Bertschi A, Martin PY, Burnier M, Eap CB, Bochud M, Guessous I. Relation of 24-hour urinary caffeine and caffeine metabolite excretions with self-reported consumption of coffee and other caffeinated beverages in the general population. Nutr Metab (Lond) 2016; 13:81. [PMID: 27891166 PMCID: PMC5112879 DOI: 10.1186/s12986-016-0144-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Accepted: 11/10/2016] [Indexed: 02/07/2023] Open
Abstract
Background Caffeine intake is generally estimated by self-reported consumption, but it remains unclear how well self-report associates with metabolite urinary excretion. We investigated the associations of self-reported consumption of caffeinated drinks with urinary excretion of caffeine and its major metabolites in an adult population. Methods We used data from the population-based Swiss Kidney Project on Genes in Hypertension (SKIPOGH) study. Consumption of caffeinated coffee, decaffeinated coffee and other caffeinated beverages was assessed by self-administered questionnaire. Quantification of caffeine, paraxanthine, theobromine and theophylline was performed by ultra-high performance liquid chromatography tandem mass spectrometry in 24-h urine. Association of reported consumption of caffeinated drinks with urinary caffeine derived metabolites was determined by quantile regression. We then explored the association between urinary metabolite excretion and dichotomized weekly consumption frequency of caffeinated coffee, with Receiver Operator Characteristic (ROC) analysis. Results In the present analysis, we included 598 individuals (52% women, mean age =46 ± 17 years). Self-reported caffeinated coffee intake was positively associated with 24-h urinary excretions of paraxanthine, theophylline and caffeine (p < 0.001), whereas reported intakes of decaffeinated coffee and other caffeinated beverages showed no association. In ROC analysis, optimal discrimination between individuals consuming less than one caffeinated coffee/week, vs. at least one coffee, was obtained for 24-h urinary paraxanthine (Area Under Curve (AUC) = 0.868, 95% Confidence Interval (CI) [0.830;0.906]), with slightly lower performance for theophylline and caffeine, whereas theobromine did not allow any discrimination. Conclusion Our results suggest that reported consumption of caffeinated coffee is positively associated with 24-h urinary excretion of caffeine, paraxanthine, and theophylline, and may be used as a marker of caffeine intake for epidemiological studies. Electronic supplementary material The online version of this article (doi:10.1186/s12986-016-0144-4) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Dusan Petrovic
- Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Route de la corniche 10, Lausanne, 1010 Switzerland
| | - Sandrine Estoppey Younes
- Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Route de la corniche 10, Lausanne, 1010 Switzerland
| | - Menno Pruijm
- Department of Nephrology and Hypertension, Lausanne University Hospital, Rue du Bugnon 17, Lausanne, 1011 Switzerland
| | - Belén Ponte
- Department of Nephrology and Hypertension, University Hospital of Geneva (HUG), Rue Gabrielle Perret-Gentil 4, Geneva, 1205 Switzerland
| | - Daniel Ackermann
- University Clinic for Nephrology, Hypertension and Clinical Pharmacology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 15, Bern, 3010 Switzerland
| | - Georg Ehret
- Department of Cardiology, University Hospital of Geneva (HUG), Rue Gabrielle Perret-Gentil 4, Geneva, 1205 Switzerland
| | - Nicolas Ansermot
- Unit of Pharmacogenetics and Clinical Psychopharmacology, Centre for Psychiatric Neuroscience, Department of Psychiatry, Lausanne University Hospital, Prilly, 1008 Switzerland
| | - Markus Mohaupt
- Department of Nephrology and Hypertension, University Hospital of Geneva (HUG), Rue Gabrielle Perret-Gentil 4, Geneva, 1205 Switzerland
| | - Fred Paccaud
- Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Route de la corniche 10, Lausanne, 1010 Switzerland
| | - Bruno Vogt
- University Clinic for Nephrology, Hypertension and Clinical Pharmacology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 15, Bern, 3010 Switzerland
| | - Antoinette Pechère-Bertschi
- Department of Nephrology and Hypertension, University Hospital of Geneva (HUG), Rue Gabrielle Perret-Gentil 4, Geneva, 1205 Switzerland
| | - Pierre-Yves Martin
- Department of Nephrology and Hypertension, University Hospital of Geneva (HUG), Rue Gabrielle Perret-Gentil 4, Geneva, 1205 Switzerland
| | - Michel Burnier
- Department of Nephrology and Hypertension, Lausanne University Hospital, Rue du Bugnon 17, Lausanne, 1011 Switzerland
| | - Chin B Eap
- Unit of Pharmacogenetics and Clinical Psychopharmacology, Centre for Psychiatric Neuroscience, Department of Psychiatry, Lausanne University Hospital, Prilly, 1008 Switzerland ; School of Pharmaceutical Sciences, University of Geneva, University of Lausanne, Geneva, Switzerland
| | - Murielle Bochud
- Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Route de la corniche 10, Lausanne, 1010 Switzerland
| | - Idris Guessous
- Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Route de la corniche 10, Lausanne, 1010 Switzerland ; Unit of Population Epidemiology, Division of Primary Care Medicine, Department of Community Medicine and Primary Care and Emergency Medicine, University Hospital of Geneva (HUG), Rue Gabrielle Perret-Gentil 4, Geneva, 1205 Switzerland ; Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, USA ; Lausanne University Outpatient Clinic, Rue du Bugnon 44, Lausanne, 1011 Switzerland ; Unit of Population Epidemiology, University Hospital of Geneva (HUG), Rue Gabrielle Perret-Gentil 4, Geneva, 1205 Switzerland
| |
Collapse
|
39
|
Nyström HF, Brantsæter AL, Erlund I, Gunnarsdottir I, Hulthén L, Laurberg P, Mattisson I, Rasmussen LB, Virtanen S, Meltzer HM. Iodine status in the Nordic countries - past and present. Food Nutr Res 2016; 60:31969. [PMID: 27283870 PMCID: PMC4901513 DOI: 10.3402/fnr.v60.31969] [Citation(s) in RCA: 87] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Revised: 05/08/2016] [Accepted: 05/09/2016] [Indexed: 11/19/2022] Open
Abstract
Background Adequate iodine nutrition is dependent on ground water content, seafood, and, as many countries use iodized cow fodder, dairy products. In most countries, salt fortification programs are needed to assure adequate iodine intake. Objectives The objectives are threefold: 1) to describe the past and present iodine situation in the Nordic countries, 2) to identify important gaps of knowledge, and 3) to highlight differences among the Nordic countries’ iodine biomonitoring and fortification policies. Design Historical data are compared with the current situation. The Nordic countries’ strategies to achieve recommended intake and urine iodine levels and their respective success rates are evaluated. Results In the past, the iodine situation ranged from excellent in Iceland to widespread goiter and cretinism in large areas of Sweden. The situation was less severe in Norway and Finland. According to a 1960 World Health Organization (WHO) report, there were then no observations of iodine deficiency in Denmark. In Sweden and Finland, the fortification of table salt was introduced 50–75 years ago, and in Norway and Finland, the fortification of cow fodder starting in the 1950s helped improve the population's iodine status due to the high intake of milk. In Denmark, iodine has been added to household salt and salt in bread for the past 15 years. The Nordic countries differ with regard to regulations and degree of governmental involvement. There are indications that pregnant and lactating women, the two most vulnerable groups, are mildly deficient in iodine in several of the Nordic countries. Conclusion The Nordic countries employ different strategies to attain adequate iodine nutrition. The situation is not optimal and is in need of re-evaluation. Iodine researchers, Nordic national food administrations, and Nordic governmental institutions would benefit from collaboration to attain a broader approach and guarantee good iodine health for all.
Collapse
Affiliation(s)
- Helena Filipsson Nyström
- Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Endocrinology, Sahlgrenska University Hospital, Gothenburg, Sweden;
| | | | - Iris Erlund
- National Institute for Health and Welfare, Helsinki, Finland
| | - Ingibjörg Gunnarsdottir
- Unit for Nutrition Research, University of Iceland and Landspitali National University Hospital, Reykjavik, Iceland
| | - Lena Hulthén
- Department of Clinical Nutrition, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Peter Laurberg
- Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | | | - Lone Banke Rasmussen
- Department of Endocrinology, Bispebjerg University Hospital, Copenhagen, Denmark
| | - Suvi Virtanen
- National Institute for Health and Welfare, Helsinki, Finland.,School of Health Sciences, University of Tampere, Finland
| | | |
Collapse
|
40
|
Zamroziewicz MK, Barbey AK. Nutritional Cognitive Neuroscience: Innovations for Healthy Brain Aging. Front Neurosci 2016; 10:240. [PMID: 27375409 PMCID: PMC4893495 DOI: 10.3389/fnins.2016.00240] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Accepted: 05/17/2016] [Indexed: 11/29/2022] Open
Abstract
Nutritional cognitive neuroscience is an emerging interdisciplinary field of research that seeks to understand nutrition's impact on cognition and brain health across the life span. Research in this burgeoning field demonstrates that many aspects of nutrition—from entire diets to specific nutrients—affect brain structure and function, and therefore have profound implications for understanding the nature of healthy brain aging. The aim of this Focused Review is to examine recent advances in nutritional cognitive neuroscience, with an emphasis on methods that enable discovery of nutrient biomarkers that predict healthy brain aging. We propose an integrative framework that calls for the synthesis of research in nutritional epidemiology and cognitive neuroscience, incorporating: (i) methods for the precise characterization of nutritional health based on the analysis of nutrient biomarker patterns (NBPs), along with (ii) modern indices of brain health derived from high-resolution magnetic resonance imaging (MRI). By integrating cutting-edge techniques from nutritional epidemiology and cognitive neuroscience, nutritional cognitive neuroscience will continue to advance our understanding of the beneficial effects of nutrition on the aging brain and establish effective nutritional interventions to promote healthy brain aging.
Collapse
Affiliation(s)
- Marta K Zamroziewicz
- Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-ChampaignUrbana, IL, USA; Neuroscience Program, University of Illinois at Urbana-ChampaignChampaign, IL, USA
| | - Aron K Barbey
- Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-ChampaignUrbana, IL, USA; Neuroscience Program, University of Illinois at Urbana-ChampaignChampaign, IL, USA; Carle R. Woese Institute for Genomic Biology, University of Illinois at Urbana-ChampaignChampaign, IL, USA; Department of Bioengineering, University of Illinois at Urbana-ChampaignChampaign, IL, USA; Department of Internal Medicine, University of Illinois at Urbana-ChampaignChampaign, IL, USA; Department of Psychology, University of Illinois at Urbana-ChampaignChampaign, IL, USA; Department of Speech and Hearing Science, University of Illinois at Urbana-ChampaignChampaign, IL, USA
| |
Collapse
|
41
|
Chen W, Wu Y, Lin L, Tan L, Shen J, Pearce EN, Guo X, Wang W, Bian J, Jiang W, Zhang W. 24-Hour Urine Samples Are More Reproducible Than Spot Urine Samples for Evaluation of Iodine Status in School-Age Children. J Nutr 2016; 146:142-6. [PMID: 26609173 DOI: 10.3945/jn.115.215806] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Accepted: 10/28/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Variation in different urinary measurements for evaluation of iodine status is of concern to clinicians and researchers. OBJECTIVE This study evaluated variations between urine iodine concentration (UIC), spot and 24-h urine sample creatinine concentrations, and 24-h urine iodine excretion (24-h UIE) in repeated samples from school-age children. METHODS Urine samples (24 h and morning spot) were collected on 2 occasions from 981 children in Ningjin and Lingxian counties, China. Samples from Ningjin were collected in October and November 2013, and samples from Lingxian were collected in April and May 2014. Morning spot urine iodine concentration (MUIC), morning spot urine creatinine, 24-h UIC, and 24-h urine creatinine were measured in all samples. The 24-h UIE was calculated by multiplying the 24-h UIC by the 24-h urine volume. RESULTS In Ningjin County, the 24-h UIC and 24-h UIE did not differ between repeated collections [192 and 172 μg/L, respectively, for 24-h UIC (P = 0.08); 123 and 120 μg/L, respectively, for 24-h UIE (P = 0.56)], whereas the MUIC was lower in November 2013 than in October 2013 (170 and 190 μg/L, respectively; P = 0.034). In Lingxian County, no significant differences were observed in 24-h UIC between the repeated collections (230 and 218 μg/L, respectively; P = 0.79), whereas the 24-h UIE and MUIC were higher in the samples collected in May 2014 than in April 2014 [161 and 155 μg/L, respectively, for 24-h UIE (P = 0.002); 244 and 203 μg/L, respectively, for MUIC (P < 0.001)]. When data from both counties were combined, no difference was observed between repeated 24-h UIC (214 compared with 196 μg/L; P = 0.17) and 24-h UIE (143 compared with 143 μg/d; P = 0.06), but MUICs were lower in the first collection than in the second collection (199 and 207 μg/L, respectively; P = 0.002). The κ values were >0.4 for 24-h UIC and mean UIE, whereas relatively low κ values were observed for MUIC and mean UIE. CONCLUSION The 24-h UIC was more accurate and reproducible than the MUIC in evaluating iodine status in a large-scale population study of school-age children.
Collapse
Affiliation(s)
- Wen Chen
- The Department of Nutrition and Food Hygiene, School of Public Health
| | - Yalan Wu
- The Department of Nutrition and Food Hygiene, School of Public Health
| | - Laixiang Lin
- Tianjin Institution of Endocrinology, Tianjin Medical University, Tianjin, China
| | - Long Tan
- The Department of Nutrition and Food Hygiene, School of Public Health
| | - Jun Shen
- The Department of Nutrition and Food Hygiene, School of Public Health
| | - Elizabeth N Pearce
- Section of Endocrinology, Diabetes, and Nutrition, Boston University School of Medicine, Boston, MA; and
| | - Xiaohui Guo
- The Department of Nutrition and Food Hygiene, School of Public Health
| | - Wei Wang
- The Department of Nutrition and Food Hygiene, School of Public Health
| | - Jianchao Bian
- The Shandong Institute for Endemic Disease Control and Research, Shangdong Province, China
| | - Wen Jiang
- The Shandong Institute for Endemic Disease Control and Research, Shangdong Province, China
| | - Wanqi Zhang
- The Department of Nutrition and Food Hygiene, School of Public Health,
| |
Collapse
|
42
|
Farbu J, Haugen M, Meltzer HM, Brantsæter AL. Impact of singlehood during pregnancy on dietary intake and birth outcomes- a study in the Norwegian Mother and Child Cohort Study. BMC Pregnancy Childbirth 2014; 14:396. [PMID: 25475509 PMCID: PMC4268900 DOI: 10.1186/s12884-014-0396-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Accepted: 11/18/2014] [Indexed: 12/04/2022] Open
Abstract
Background Little attention has been given to the impact of singlehood during pregnancy. The aim of this study was to examine the impact of marital status on diet during pregnancy and pregnancy outcome. Methods The study population comprised 62,773 women participating in the Norwegian Mother and Child Cohort Study. Marital status was categorised into singles living alone, singles living with parents and married/cohabiting (reference group). Participants answered a general health questionnaire in gestational week 15–17 and a food frequency questionnaire in gestational week 22. We used nonparametric tests to compare dietary intakes by marital status, and multiple logistic regression to estimate odds ratios (OR) and 95% confidence intervals (CI) for infants being small for gestational age (SGA), large for gestational age (LGA), and preterm delivery (defined as delivery before gestational week 37). Results Single women living with parents had lower intakes of fruits and vegetables, higher intake of total energy, higher proportion of energy from added sugar, and lower intake of fibre than the reference group. Singles living alone also had a higher intake of added sugar. In both of the single groups, daily smoking was more prevalent than in women living with a partner. In analyses adjusted for maternal age, pre-pregnancy BMI, energy intake, energy contributed by protein, education, income, parity and nausea, single women living alone had increased risk of SGA with OR = 1.27 (95% CI: 1.05, 1.55). When smoking was included among the confounding variables, the association was no longer significant. Likewise, singles living alone had increased risk of preterm delivery, with OR = 1.32 (95% CI: 1.01, 1.72) in a partly adjusted model, but the association did not remain significant in a model fully adjusted for confounding variables. Conclusions Single mothers had lower dietary quality and included more smokers than women who lived with a partner. Single mothers living alone had higher prevalence of SGA and preterm delivery, but the associations with adverse pregnancy outcomes were confounded by other variables. This study shows that single mothers should be given special attention during antenatal care and counselling.
Collapse
|
43
|
Torjusen H, Brantsæter AL, Haugen M, Alexander J, Bakketeig LS, Lieblein G, Stigum H, Næs T, Swartz J, Holmboe-Ottesen G, Roos G, Meltzer HM. Reduced risk of pre-eclampsia with organic vegetable consumption: results from the prospective Norwegian Mother and Child Cohort Study. BMJ Open 2014; 4:e006143. [PMID: 25208850 PMCID: PMC4160835 DOI: 10.1136/bmjopen-2014-006143] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE Little is known about the potential health effects of eating organic food either in the general population or during pregnancy. The aim of this study was to examine associations between organic food consumption during pregnancy and the risk of pre-eclampsia among nulliparous Norwegian women. DESIGN Prospective cohort study. SETTING Norway, years 2002-2008. PARTICIPANTS 28 192 pregnant women (nulliparous, answered food frequency questionnaire and general health questionnaire in mid-pregnancy and no missing information on height, body weight or gestational weight gain). MAIN OUTCOME MEASURE Relative risk was estimated as ORs by performing binary logistic regression with pre-eclampsia as the outcome and organic food consumption as the exposure. RESULTS The prevalence of pre-eclampsia in the study sample was 5.3% (n=1491). Women who reported to have eaten organic vegetables 'often' or 'mostly' (n=2493, 8.8%) had lower risk of pre-eclampsia than those who reported 'never/rarely' or 'sometimes' (crude OR=0.76, 95% CI 0.61 to 0.96; adjusted OR=0.79, 95% CI 0.62 to 0.99). The lower risk associated with high organic vegetable consumption was evident also when adjusting for overall dietary quality, assessed as scores on a healthy food pattern derived by principal component analysis. No associations with pre-eclampsia were found for high intake of organic fruit, cereals, eggs or milk, or a combined index reflecting organic consumption. CONCLUSIONS These results show that choosing organically grown vegetables during pregnancy was associated with reduced risk of pre-eclampsia. Possible explanations for an association between pre-eclampsia and use of organic vegetables could be that organic vegetables may change the exposure to pesticides, secondary plant metabolites and/or influence the composition of the gut microbiota.
Collapse
Affiliation(s)
- Hanne Torjusen
- National Institute for Consumer Research (SIFO), Oslo, Norway
- Division of Environmental Medicine, Norwegian Institute of Public Health, Oslo, Norway
| | - Anne Lise Brantsæter
- Division of Environmental Medicine, Norwegian Institute of Public Health, Oslo, Norway
| | - Margaretha Haugen
- Division of Environmental Medicine, Norwegian Institute of Public Health, Oslo, Norway
| | - Jan Alexander
- Office of the Director-General, Norwegian Institute of Public Health, Oslo, Norway
| | - Leiv S Bakketeig
- Division of Epidemiology, The Norwegian Institute of Public Health, Oslo, Norway
| | - Geir Lieblein
- Department of Plant Sciences, Norwegian University of Life Sciences, Ås, Norway
| | - Hein Stigum
- Division of Epidemiology, The Norwegian Institute of Public Health, Oslo, Norway
| | - Tormod Næs
- Nofima, Ås, Norway
- Department of Food Science, University of Copenhagen, Copenhagen, Denmark
| | - Jackie Swartz
- Uppsala University Hospital, Uppsala, Sweden
- Vidarkliniken, Järna, Sweden
| | - Gerd Holmboe-Ottesen
- Department of General Practice and Community Medicine, Faculty of Medicine, University of Oslo, Norway
| | - Gun Roos
- Division of Environmental Medicine, Norwegian Institute of Public Health, Oslo, Norway
| | | |
Collapse
|
44
|
Rohner F, Zimmermann M, Jooste P, Pandav C, Caldwell K, Raghavan R, Raiten DJ. Biomarkers of nutrition for development--iodine review. J Nutr 2014; 144:1322S-1342S. [PMID: 24966410 PMCID: PMC4093988 DOI: 10.3945/jn.113.181974] [Citation(s) in RCA: 170] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Revised: 09/04/2013] [Accepted: 05/21/2014] [Indexed: 10/25/2022] Open
Abstract
The objective of the Biomarkers of Nutrition for Development (BOND) project is to provide state-of-the-art information and service with regard to selection, use, and interpretation of biomarkers of nutrient exposure, status, function, and effect. Specifically, the BOND project seeks to develop consensus on accurate assessment methodologies that are applicable to researchers (laboratory/clinical/surveillance), clinicians, programmers, and policy makers (data consumers). The BOND project is also intended to develop targeted research agendas to support the discovery and development of biomarkers through improved understanding of nutrient biology within relevant biologic systems. In phase I of the BOND project, 6 nutrients (iodine, vitamin A, iron, zinc, folate, and vitamin B-12) were selected for their high public health importance because they typify the challenges faced by users in the selection, use, and interpretation of biomarkers. For each nutrient, an expert panel was constituted and charged with the development of a comprehensive review covering the respective nutrient's biology, existing biomarkers, and specific issues of use with particular reference to the needs of the individual user groups. In addition to the publication of these reviews, materials from each will be extracted to support the BOND interactive Web site (http://www.nichd.nih.gov/global_nutrition/programs/bond/pages/index.aspx). This review represents the first in the series of reviews and covers all relevant aspects of iodine biology and biomarkers. The article is organized to provide the reader with a full appreciation of iodine's background history as a public health issue, its biology, and an overview of available biomarkers and specific considerations for the use and interpretation of iodine biomarkers across a range of clinical and population-based uses. The review also includes a detailed research agenda to address priority gaps in our understanding of iodine biology and assessment.
Collapse
Affiliation(s)
- Fabian Rohner
- Groundwork LLC, Crans-près-Céligny, Switzerland Global Alliance for Improved Nutrition (GAIN), Geneva, Switzerland
| | - Michael Zimmermann
- Institute of Food, Nutrition and Health, Swiss Federal Institute of Technology (ETH), Zurich, Switzerland The International Council for the Control of Iodine Deficiency Disorders (ICCIDD) Global Network, Zurich, Switzerland
| | - Pieter Jooste
- Centre of Excellence for Nutrition, Faculty of Health Sciences, North-West University, Potchefstroom, South Africa Southern Africa Office, The ICCIDD Global Network, Capetown, South Africa
| | - Chandrakant Pandav
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India South Asia Office, The ICCIDD Global Network, New Delhi, India
| | | | - Ramkripa Raghavan
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, Bethesda, MD
| | - Daniel J Raiten
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, Bethesda, MD
| |
Collapse
|
45
|
Scalbert A, Brennan L, Manach C, Andres-Lacueva C, Dragsted LO, Draper J, Rappaport SM, van der Hooft JJJ, Wishart DS. The food metabolome: a window over dietary exposure. Am J Clin Nutr 2014; 99:1286-308. [PMID: 24760973 DOI: 10.3945/ajcn.113.076133] [Citation(s) in RCA: 355] [Impact Index Per Article: 32.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
The food metabolome is defined as the part of the human metabolome directly derived from the digestion and biotransformation of foods and their constituents. With >25,000 compounds known in various foods, the food metabolome is extremely complex, with a composition varying widely according to the diet. By its very nature it represents a considerable and still largely unexploited source of novel dietary biomarkers that could be used to measure dietary exposures with a high level of detail and precision. Most dietary biomarkers currently have been identified on the basis of our knowledge of food compositions by using hypothesis-driven approaches. However, the rapid development of metabolomics resulting from the development of highly sensitive modern analytic instruments, the availability of metabolite databases, and progress in (bio)informatics has made agnostic approaches more attractive as shown by the recent identification of novel biomarkers of intakes for fruit, vegetables, beverages, meats, or complex diets. Moreover, examples also show how the scrutiny of the food metabolome can lead to the discovery of bioactive molecules and dietary factors associated with diseases. However, researchers still face hurdles, which slow progress and need to be resolved to bring this emerging field of research to maturity. These limits were discussed during the First International Workshop on the Food Metabolome held in Glasgow. Key recommendations made during the workshop included more coordination of efforts; development of new databases, software tools, and chemical libraries for the food metabolome; and shared repositories of metabolomic data. Once achieved, major progress can be expected toward a better understanding of the complex interactions between diet and human health.
Collapse
Affiliation(s)
- Augustin Scalbert
- From the International Agency for Research on Cancer, Lyon, France (AS); University College Dublin, Dublin, Ireland (LB); the Institut National de la Recherche Agronomique, Clermont-Ferrand, France (CM); Clermont University, Clermont-Ferrand, France (CM); the University of Barcelona, Barcelona, Spain (CA-L); the University of Copenhagen, Frederiksberg, Denmark (LOD); Aberystwyth University, Aberystwyth, United Kingdom (JD); the University of California, Berkeley, CA (SMR); the University of Glasgow, Glasgow, United Kingdom (JJJvdH); and the University of Alberta, Edmonton, Canada (DSW)
| | - Lorraine Brennan
- From the International Agency for Research on Cancer, Lyon, France (AS); University College Dublin, Dublin, Ireland (LB); the Institut National de la Recherche Agronomique, Clermont-Ferrand, France (CM); Clermont University, Clermont-Ferrand, France (CM); the University of Barcelona, Barcelona, Spain (CA-L); the University of Copenhagen, Frederiksberg, Denmark (LOD); Aberystwyth University, Aberystwyth, United Kingdom (JD); the University of California, Berkeley, CA (SMR); the University of Glasgow, Glasgow, United Kingdom (JJJvdH); and the University of Alberta, Edmonton, Canada (DSW)
| | - Claudine Manach
- From the International Agency for Research on Cancer, Lyon, France (AS); University College Dublin, Dublin, Ireland (LB); the Institut National de la Recherche Agronomique, Clermont-Ferrand, France (CM); Clermont University, Clermont-Ferrand, France (CM); the University of Barcelona, Barcelona, Spain (CA-L); the University of Copenhagen, Frederiksberg, Denmark (LOD); Aberystwyth University, Aberystwyth, United Kingdom (JD); the University of California, Berkeley, CA (SMR); the University of Glasgow, Glasgow, United Kingdom (JJJvdH); and the University of Alberta, Edmonton, Canada (DSW)
| | - Cristina Andres-Lacueva
- From the International Agency for Research on Cancer, Lyon, France (AS); University College Dublin, Dublin, Ireland (LB); the Institut National de la Recherche Agronomique, Clermont-Ferrand, France (CM); Clermont University, Clermont-Ferrand, France (CM); the University of Barcelona, Barcelona, Spain (CA-L); the University of Copenhagen, Frederiksberg, Denmark (LOD); Aberystwyth University, Aberystwyth, United Kingdom (JD); the University of California, Berkeley, CA (SMR); the University of Glasgow, Glasgow, United Kingdom (JJJvdH); and the University of Alberta, Edmonton, Canada (DSW)
| | - Lars O Dragsted
- From the International Agency for Research on Cancer, Lyon, France (AS); University College Dublin, Dublin, Ireland (LB); the Institut National de la Recherche Agronomique, Clermont-Ferrand, France (CM); Clermont University, Clermont-Ferrand, France (CM); the University of Barcelona, Barcelona, Spain (CA-L); the University of Copenhagen, Frederiksberg, Denmark (LOD); Aberystwyth University, Aberystwyth, United Kingdom (JD); the University of California, Berkeley, CA (SMR); the University of Glasgow, Glasgow, United Kingdom (JJJvdH); and the University of Alberta, Edmonton, Canada (DSW)
| | - John Draper
- From the International Agency for Research on Cancer, Lyon, France (AS); University College Dublin, Dublin, Ireland (LB); the Institut National de la Recherche Agronomique, Clermont-Ferrand, France (CM); Clermont University, Clermont-Ferrand, France (CM); the University of Barcelona, Barcelona, Spain (CA-L); the University of Copenhagen, Frederiksberg, Denmark (LOD); Aberystwyth University, Aberystwyth, United Kingdom (JD); the University of California, Berkeley, CA (SMR); the University of Glasgow, Glasgow, United Kingdom (JJJvdH); and the University of Alberta, Edmonton, Canada (DSW)
| | - Stephen M Rappaport
- From the International Agency for Research on Cancer, Lyon, France (AS); University College Dublin, Dublin, Ireland (LB); the Institut National de la Recherche Agronomique, Clermont-Ferrand, France (CM); Clermont University, Clermont-Ferrand, France (CM); the University of Barcelona, Barcelona, Spain (CA-L); the University of Copenhagen, Frederiksberg, Denmark (LOD); Aberystwyth University, Aberystwyth, United Kingdom (JD); the University of California, Berkeley, CA (SMR); the University of Glasgow, Glasgow, United Kingdom (JJJvdH); and the University of Alberta, Edmonton, Canada (DSW)
| | - Justin J J van der Hooft
- From the International Agency for Research on Cancer, Lyon, France (AS); University College Dublin, Dublin, Ireland (LB); the Institut National de la Recherche Agronomique, Clermont-Ferrand, France (CM); Clermont University, Clermont-Ferrand, France (CM); the University of Barcelona, Barcelona, Spain (CA-L); the University of Copenhagen, Frederiksberg, Denmark (LOD); Aberystwyth University, Aberystwyth, United Kingdom (JD); the University of California, Berkeley, CA (SMR); the University of Glasgow, Glasgow, United Kingdom (JJJvdH); and the University of Alberta, Edmonton, Canada (DSW)
| | - David S Wishart
- From the International Agency for Research on Cancer, Lyon, France (AS); University College Dublin, Dublin, Ireland (LB); the Institut National de la Recherche Agronomique, Clermont-Ferrand, France (CM); Clermont University, Clermont-Ferrand, France (CM); the University of Barcelona, Barcelona, Spain (CA-L); the University of Copenhagen, Frederiksberg, Denmark (LOD); Aberystwyth University, Aberystwyth, United Kingdom (JD); the University of California, Berkeley, CA (SMR); the University of Glasgow, Glasgow, United Kingdom (JJJvdH); and the University of Alberta, Edmonton, Canada (DSW)
| |
Collapse
|
46
|
Combet E, Lean MEJ. Validation of a short food frequency questionnaire specific for iodine in U.K. females of childbearing age. J Hum Nutr Diet 2014; 27:599-605. [PMID: 24620754 DOI: 10.1111/jhn.12219] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Widespread subclinical iodine insufficiency has recently been reported in Europe, based on urinary iodine using World Health Organization/Food and Agriculture Organization criteria, in particular among young women. Although urinary iodine concentration (UIC) is a useful measurement of the iodine status in a population, it does not provide an insight into the habitual iodine intake of this population. This is compounded by the fact that very few iodine-specific food frequency questionnaires (FFQ) have been validated so far. The present study aimed to develop and validate a new, simple, rapid survey tool to assess dietary iodine exposure in females of childbearing age. METHODS Iodine was measured in a duplicate 24-h urine collection. Iodine intake was measured with duplicate 4-day semi-quantitative food diaries and the FFQ. Correlation, cross-classification and Bland-Altman analyses were used to estimate agreement, bias and the reliability of the method. The triangular (triad) method was used to calculate validity coefficients. RESULTS Forty-three women, aged 19-49 years, took part in the validation of the 17-items FFQ. Median (interquartile range) UIC was 74 (47-92) μg L(-1) , which is indicative of mild iodine insufficiency. The FFQ showed good agreement with food diaries with respect to classifying iodine intake (82% of subjects were classified in the same or adjacent quartile). The FFQ was moderately correlated with the food diaries (rs = 0.45, P = 0.002) and urinary excretion in μg L(-1) (rs = 0.34, P = 0.025) but not in μg day(-1) (P = 0.316). The validity coefficients were 0.69, 0.66 and 0.52 for the food diaries, FFQ and urinary iodine excretion, respectively. CONCLUSIONS The FFQ provides a rapid and reliable estimate of dietary iodine exposure to identify those population subgroups at risk of iodine deficiency.
Collapse
Affiliation(s)
- E Combet
- Human Nutrition, School of Medicine, College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow Royal Infirmary, Glasgow, UK
| | | |
Collapse
|
47
|
Englund-Ögge L, Brantsæter AL, Sengpiel V, Haugen M, Birgisdottir BE, Myhre R, Meltzer HM, Jacobsson B. Maternal dietary patterns and preterm delivery: results from large prospective cohort study. BMJ 2014; 348:g1446. [PMID: 24609054 PMCID: PMC3942565 DOI: 10.1136/bmj.g1446] [Citation(s) in RCA: 161] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/30/2014] [Indexed: 01/24/2023]
Abstract
OBJECTIVE To examine whether an association exists between maternal dietary patterns and risk of preterm delivery. DESIGN Prospective cohort study. SETTING Norway, between 2002 and 2008. PARTICIPANTS 66 000 pregnant women (singletons, answered food frequency questionnaire, no missing information about parity or previously preterm delivery, pregnancy duration between 22+0 and 41+6 gestational weeks, no diabetes, first enrolment pregnancy). MAIN OUTCOME MEASURE Hazard ratio for preterm delivery according to level of adherence to three distinct dietary patterns interpreted as "prudent" (for example, vegetables, fruits, oils, water as beverage, whole grain cereals, fibre rich bread), "Western" (salty and sweet snacks, white bread, desserts, processed meat products), and "traditional" (potatoes, fish). RESULTS After adjustment for covariates, high scores on the "prudent" pattern were associated with significantly reduced risk of preterm delivery hazard ratio for the highest versus the lowest third (0.88, 95% confidence interval 0.80 to 0.97). The prudent pattern was also associated with a significantly lower risk of late and spontaneous preterm delivery. No independent association with preterm delivery was found for the "Western" pattern. The "traditional" pattern was associated with reduced risk of preterm delivery for the highest versus the lowest third (hazard ratio 0.91, 0.83 to 0.99). CONCLUSION This study showed that women adhering to a "prudent" or a "traditional" dietary pattern during pregnancy were at lower risk of preterm delivery compared with other women. Although these findings cannot establish causality, they support dietary advice to pregnant women to eat a balanced diet including vegetables, fruit, whole grains, and fish and to drink water. Our results indicate that increasing the intake of foods associated with a prudent dietary pattern is more important than totally excluding processed food, fast food, junk food, and snacks.
Collapse
Affiliation(s)
- Linda Englund-Ögge
- Department of Obstetrics and Gynecology, Institute of Clinical Sciences, Sahlgrenska Academy, Sahlgrenska University Hospital, SE-41685 Gothenburg, Sweden
| | | | | | | | | | | | | | | |
Collapse
|
48
|
von Ruesten A, Brantsæter AL, Haugen M, Meltzer HM, Mehlig K, Winkvist A, Lissner L. Adherence of pregnant women to Nordic dietary guidelines in relation to postpartum weight retention: results from the Norwegian Mother and Child Cohort Study. BMC Public Health 2014; 14:75. [PMID: 24456804 PMCID: PMC3908932 DOI: 10.1186/1471-2458-14-75] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Accepted: 01/21/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Pregnancy is a major life event for women and often connected with changes in diet and lifestyle and natural gestational weight gain. However, excessive weight gain during pregnancy may lead to postpartum weight retention and add to the burden of increasing obesity prevalence. Therefore, it is of interest to examine whether adherence to nutrient recommendations or food-based guidelines is associated with postpartum weight retention 6 months after birth. METHODS This analysis is based on data from the Norwegian Mother and Child Cohort Study (MoBa) conducted by the Norwegian Institute of Public Health. Diet during the first 4-5 months of pregnancy was assessed by a food-frequency questionnaire and maternal weight before pregnancy as well as in the postpartum period was assessed by questionnaires. Two Healthy Eating Index (HEI) scores were applied to measure compliance with either the official Norwegian food-based guidelines (HEI-NFG) or the Nordic Nutrition Recommendations (HEI-NNR) during pregnancy. The considered outcome, i.e. weight retention 6 months after birth, was modelled in two ways: continuously (in kg) and categorically (risk of substantial postpartum weight retention, i.e. ≥ 5% gain to pre-pregnancy weight). Associations between the HEI-NFG and HEI-NNR score with postpartum weight retention on the continuous scale were estimated by linear regression models. Relationships of both HEI scores with the categorical outcome variable were evaluated using logistic regression. RESULTS In the continuous model without adjustment for gestational weight gain (GWG), the HEI-NFG score but not the HEI-NNR score was inversely related to postpartum weight retention. However, after additional adjustment for GWG as potential intermediate the HEI-NFG score was marginally inversely and the HEI-NNR score was inversely associated with postpartum weight retention. In the categorical model, both HEI scores were inversely related with risk of substantial postpartum weight retention, independent of adjustment for GWG. CONCLUSIONS Higher adherence to either the official Norwegian food guidelines or possibly also to Nordic Nutrition Recommendations during pregnancy appears to be associated with lower postpartum weight retention.
Collapse
Affiliation(s)
| | - Anne Lise Brantsæter
- Division of Environmental Medicine, Norwegian Institute of Public Health, Oslo, Norway.
| | | | | | | | | | | |
Collapse
|
49
|
Iodine deficiency in pregnant women living in the South East of the UK: the influence of diet and nutritional supplements on iodine status. Br J Nutr 2014; 111:1622-31. [PMID: 24398008 DOI: 10.1017/s0007114513004030] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Iodine is a key component of the thyroid hormones which are crucial for brain development. Adequate intake of iodine in pregnancy is important as in utero deficiency may have lifelong consequences for the offspring. Data on the iodine status of UK pregnant women are sparse, and there are no such data for pregnant women in the South East of the UK. A total of 100 pregnant women were recruited to a cross-sectional study carried out at the Royal Surrey County Hospital, Guildford, at their first-trimester visit for an ultrasound scan. The participants provided a spot-urine sample (for the measurement of urinary iodine concentration (UIC) and creatinine concentration) and 24 h iodine excretion was estimated from the urinary iodine:creatinine ratio. Women completed a general questionnaire and a FFQ. The median UIC (85·3 μg/l) indicated that the group was iodine deficient by World Health Organisation criteria. The median values of the iodine:creatinine ratio (122·9 μg/g) and of the estimated 24 h iodine excretion (151·2 μg/d) were also suggestive of iodine deficiency. UIC was significantly higher in women taking an iodine-containing prenatal supplement (n 42) than in those not taking such a supplement (P< 0·001). In the adjusted analyses, milk intake, maternal age and iodine-containing prenatal supplement use were positively associated with the estimated 24 h urinary iodine excretion. Our finding of iodine deficiency in these women gives cause for concern. We suggest that women of childbearing age and pregnant women should be given advice on how to improve their iodine status through dietary means. A national survey of iodine status in UK pregnant women is required.
Collapse
|
50
|
Urinary bisphenol A concentrations in pregnant women. Int J Hyg Environ Health 2013; 216:641-4. [DOI: 10.1016/j.ijheh.2012.10.002] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2012] [Revised: 10/05/2012] [Accepted: 10/15/2012] [Indexed: 11/17/2022]
|