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Saros L, Hart K, Koivuniemi E, Egan B, Raats M, Laitinen K. Micronutrient supplement recommendations in pregnancy vary across a geographically diverse range of countries: a narrative review. Nutr Res 2024; 123:18-37. [PMID: 38228076 DOI: 10.1016/j.nutres.2023.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 12/21/2023] [Accepted: 12/22/2023] [Indexed: 01/18/2024]
Abstract
Specific food supplements are essential during preconception and pregnancy to ensure adequate intake of vitamins and minerals to support fetal growth and development and metabolic changes in the maternal body. Our objective was to identify food supplement recommendations, particularly those of folic acid, iron, Vitamin D, and iodine, during preconception and/or pregnancy across a geographically diverse range of countries. Further, we investigated whether country location and income-level related to the recommendations. We performed an electronic search and identified country-specific preconception and pregnancy food supplement recommendations, policy documents, and official guidelines of national organizations informing recommendations. To ensure the data were as accurate as possible, country-specific experts were contacted. Data were collected in 2017 and reevaluated in 2022. Country income level was determined by the World Bank classification. Each inspected country (n = 43) recommended folic acid supplementation, typically 400 µg/day, before and during pregnancy. About half of the countries recommended an iron supplement (dose range, 16-195 mg/day) and one quarter Vitamin D (typically 10 µg/d in higher latitudes) and iodine (150-200 µg/day). Country location and income level had some influence on the recommendations. Vitamin D was more often recommended in higher latitude, high-income countries. Almost all upper-middle and lower-middle income countries recommended iron supplementation, whereas less than one third of high-income countries had a corresponding recommendation. Findings suggest that food supplement recommendations for pregnant women vary across countries, likely influenced by geographic location as well as income level. These data may be used in the harmonization of food supplement recommendations.
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Affiliation(s)
- Lotta Saros
- Institute of Biomedicine, Research Centre for Integrative Physiology and Pharmacology, University of Turku, 20520 Turku, Finland.
| | - Kathryn Hart
- Faculty of Health & Medical Sciences, University of Surrey, Guildford, GU2 7XH, UK
| | - Ella Koivuniemi
- Institute of Biomedicine, Research Centre for Integrative Physiology and Pharmacology, University of Turku, 20520 Turku, Finland
| | - Bernadette Egan
- Faculty of Health & Medical Sciences, University of Surrey, Guildford, GU2 7XH, UK
| | - Monique Raats
- Faculty of Health & Medical Sciences, University of Surrey, Guildford, GU2 7XH, UK
| | - Kirsi Laitinen
- Institute of Biomedicine, Research Centre for Integrative Physiology and Pharmacology, University of Turku, 20520 Turku, Finland; Nutrition and Food Research Center, University of Turku, 20014 Turku, Finland
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Alanne S, Koivuniemi E, Löyttyniemi E, Laitinen K. Elementary School-Aged Children's and Parents' Report of Health-Related Quality of Life and Relationships with Lifestyle Measures: A Cross-Sectional Study. Nutrients 2023; 15:nu15051264. [PMID: 36904263 PMCID: PMC10005714 DOI: 10.3390/nu15051264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 02/27/2023] [Accepted: 03/01/2023] [Indexed: 03/06/2023] Open
Abstract
Supporting a child's health-promoting lifestyle is an investment in their future health and health-related quality of life (HRQoL). Particularly children with overweight and obesity may be at an increased risk of a poor HRQoL. Currently, a comprehensive evaluation of lifestyle factors and age in relation to HRQoL in healthy children and, further, separate child and parental proxy-reports of HRQoL are lacking. The aims of this cross-sectional study in Finland are to compare healthy elementary school-aged children's and parents' reports of the child's HRQoL, and to view them in relation to lifestyle markers. The HRQoL was measured with Pediatric Quality of Life InventoryTM 4.0, and the following lifestyle markers: leisure-time physical activity as MET, diet quality via a validated index (ES-CIDQ), sleeping time and screen time by questionnaires. Furthermore, age and BMI were recorded. Data were obtained from 270 primary school-aged children (6-13 years). Female gender, the child's older age (8-13 years), high physical activity level and less screen time were strong predictors of a higher HRQoL in both the child's and parental proxy-reports. Means to promote healthy lifestyles should be particularly targeted to young children, especially boys, and new ways to promote physical activity and other forms of free-time activities should be sought.
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Affiliation(s)
- Soili Alanne
- Department of Clinical Nutrition, Wellbeing Services of County of South Ostrobothnia, 60220 Seinäjoki, Finland
- Institute of Biomedicine, Research Centre for Integrative Physiology and Pharmacology, University of Turku, 20014 Turku, Finland
- Correspondence: ; Tel.: +358-50-4744092
| | - Ella Koivuniemi
- Institute of Biomedicine, Research Centre for Integrative Physiology and Pharmacology, University of Turku, 20014 Turku, Finland
- Functional Foods Forum (FFF), University of Turku, 20014 Turku, Finland
| | | | - Kirsi Laitinen
- Institute of Biomedicine, Research Centre for Integrative Physiology and Pharmacology, University of Turku, 20014 Turku, Finland
- Functional Foods Forum (FFF), University of Turku, 20014 Turku, Finland
- Department of Obstetrics and Gynecology, Turku University Hospital, 20521 Turku, Finland
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Saros L, Vahlberg T, Koivuniemi E, Houttu N, Niinikoski H, Tertti K, Laitinen K. Fish Oil And/Or Probiotics Intervention in Overweight/Obese Pregnant Women and Overweight Risk in 24-Month-Old Children. J Pediatr Gastroenterol Nutr 2023; 76:218-226. [PMID: 36705702 PMCID: PMC9848211 DOI: 10.1097/mpg.0000000000003659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 11/18/2022] [Indexed: 01/28/2023]
Abstract
OBJECTIVES To evaluate whether a fish oil and/or probiotics intervention in pregnant women with overweight or obesity would influence the tendency of their 24-month-old children to become overweight and alter their body fat percentage. METHODS Women (n = 439) were double-blindly randomized into 4 intervention groups: fish oil+placebo, probiotics+placebo, probiotics+fish oil, and placebo+placebo (fish oil: 1.9 g docosahexaenoic acid and 0.22 g eicosapentaenoic acid, probiotics: Lacticaseibacillus rhamnosus HN001 and Bifidobacterium animalis ssp. lactis 420, 1010 colony-forming units each). The intervention lasted from early pregnancy until 6 months postpartum. Children's (n = 330) growth data (height, weight, head circumference), a secondary outcome of the trial, were evaluated at birth, 3, 6, 12, and 24 months of age and compared to Finnish growth charts. Body fat percentage was measured with air displacement plethysmography (24 months). Logistic regression and general linear models were used to analyze the data. RESULTS Probiotics+placebo [weight-for-height% adj. Odds ratio (OR) = 0.36, 95% confidence interval (CI) = 0.14-0.95] and probiotics+fish oil [weight-for-age standard deviation score (SD-score) adj. OR = 0.22, 95% CI = 0.07-0.71] associated with lower overweight odds in 24-month-old children compared to placebo+placebo. Results remained essentially the same, when probiotics' main effect (combined probiotics+placebo and probiotics+fish oil) was estimated; that is, lower overweight odds (weight-for-height% adj. OR = 0.48, 95% CI = 0.25-0.95 and weight-for-age SD-score adj. OR = 0.42, 95% CI = 0.20-0.88) compared to non-probiotics. No fish oil main effect (combined fish oil+placebo and probiotics+fish oil) was seen. The intervention did not influence body fat percentage. CONCLUSIONS The administration of probiotics solely and in combination with fish oil during pregnancy to women with overweight or obesity lowered the overweight odds of their 24-month-old children.
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Affiliation(s)
- Lotta Saros
- From the Institute of Biomedicine, Integrative Physiology and Pharmacology, University of Turku, Turku, Finland
| | - Tero Vahlberg
- the Institute of Clinical Medicine and Biostatistics, University of Turku, Turku, Finland
| | - Ella Koivuniemi
- From the Institute of Biomedicine, Integrative Physiology and Pharmacology, University of Turku, Turku, Finland
| | - Noora Houttu
- From the Institute of Biomedicine, Integrative Physiology and Pharmacology, University of Turku, Turku, Finland
| | - Harri Niinikoski
- From the Institute of Biomedicine, Integrative Physiology and Pharmacology, University of Turku, Turku, Finland
- the Department of Pediatrics and Adolescent Medicine, Turku University Hospital, Turku, Finland
| | - Kristiina Tertti
- the Department of Obstetrics and Gynecology, Turku University Hospital and University of Turku, Turku, Finland
| | - Kirsi Laitinen
- From the Institute of Biomedicine, Integrative Physiology and Pharmacology, University of Turku, Turku, Finland
- Functional Foods Forum, University of Turku, Turku, Finland
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Koivuniemi E, Hart K, Mazanowska N, Ruggeri S, Egan B, Censi L, Roccaldo R, Mattila L, Buonocore P, Löyttyniemi E, Raats MM, Wielgos M, Laitinen K. Food Supplement Use Differs from the Recommendations in Pregnant Women: A Multinational Survey. Nutrients 2022; 14:2909. [PMID: 35889867 PMCID: PMC9322729 DOI: 10.3390/nu14142909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 07/01/2022] [Accepted: 07/12/2022] [Indexed: 11/16/2022] Open
Abstract
The aim was to investigate, among pregnant women, (1) the use of food supplements and (2) the awareness of food supplement recommendations and beliefs about food supplement use in four European countries: Finland, Italy, Poland, and the United Kingdom. The participants (n = 1804) completed an online questionnaire with predefined statements. Daily intakes of vitamins and minerals were calculated using uploaded pictures or weblinks of the supplement packages. Country differences were assessed. Most participants (91%) used at least one food supplement during pregnancy. A prenatal multivitamin was the most commonly used supplement type (84% of the users), and 75% of the participants thought consumption of multivitamin is recommended. Of the participants, 81% knew that folic acid is recommended during pregnancy while 58% knew the recommendation for vitamin D. In 19% of the supplement users, the daily safe upper intake limit of at least one nutrient was exceeded. Nevertheless, most participants agreed that they knew which supplements (91%) and doses of supplements (87%) needed to be used during pregnancy. To conclude, the majority of the participants used food supplements, but lower proportions knew and adhered to the recommended intakes. Between-country differences were observed in the use and knowledge of and beliefs regarding supplements. The results suggest a need for assessment and monitoring of supplement use in antenatal care to ensure appropriate use.
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Affiliation(s)
- Ella Koivuniemi
- Research Centre for Integrative Physiology and Pharmacology, Institute of Biomedicine, University of Turku, 20014 Turku, Finland; (L.M.); (K.L.)
| | - Kathryn Hart
- Department of Nutritional Sciences, School of Biosciences and Medicine, Faculty of Health and Medical Sciences, University of Surrey, Guildford GU2 7XH, UK;
| | - Natalia Mazanowska
- First Department of Obstetrics and Gynecology, Medical University of Warsaw, 02-091 Warsaw, Poland; (N.M.); (M.W.)
| | - Stefania Ruggeri
- Council for Agricultural Research and Economics (CREA), Research Centre for Food and Nutrition, 00178 Rome, Italy; (S.R.); (L.C.); (R.R.); (P.B.)
| | - Bernadette Egan
- Food, Consumer Behaviour and Health (FCBH) Research Centre, University of Surrey, Guildford GU2 7XH, UK; (B.E.); (M.M.R.)
| | - Laura Censi
- Council for Agricultural Research and Economics (CREA), Research Centre for Food and Nutrition, 00178 Rome, Italy; (S.R.); (L.C.); (R.R.); (P.B.)
| | - Romana Roccaldo
- Council for Agricultural Research and Economics (CREA), Research Centre for Food and Nutrition, 00178 Rome, Italy; (S.R.); (L.C.); (R.R.); (P.B.)
| | - Lilja Mattila
- Research Centre for Integrative Physiology and Pharmacology, Institute of Biomedicine, University of Turku, 20014 Turku, Finland; (L.M.); (K.L.)
| | - Pasquale Buonocore
- Council for Agricultural Research and Economics (CREA), Research Centre for Food and Nutrition, 00178 Rome, Italy; (S.R.); (L.C.); (R.R.); (P.B.)
| | - Eliisa Löyttyniemi
- Biostatistics, Department of Clinical Medicine, University of Turku, 20014 Turku, Finland;
| | - Monique M. Raats
- Food, Consumer Behaviour and Health (FCBH) Research Centre, University of Surrey, Guildford GU2 7XH, UK; (B.E.); (M.M.R.)
| | - Miroslaw Wielgos
- First Department of Obstetrics and Gynecology, Medical University of Warsaw, 02-091 Warsaw, Poland; (N.M.); (M.W.)
| | - Kirsi Laitinen
- Research Centre for Integrative Physiology and Pharmacology, Institute of Biomedicine, University of Turku, 20014 Turku, Finland; (L.M.); (K.L.)
- Functional Foods Forum, University of Turku, 20014 Turku, Finland
- Department of Obstetrics and Gynecology, Turku University Hospital, 20521 Turku, Finland
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Koivuniemi E, Laitinen K. Overweight and Obesity Associates With Diet Quality in Mothers of Newborn Babies. Curr Dev Nutr 2022. [PMCID: PMC9193993 DOI: 10.1093/cdn/nzac061.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Objectives The aim of this study was to investigate whether diet quality differs in women with normal weight (nw) and overweight or obesity (ow/ob) one month after delivery. Methods Data was collected with online questionnaires from early pregnancy until one month postpartum from a representative sample of women across Finland. Postpartum data (mean of 6.8 ± 1.9 weeks after delivery) was used in this study. Diet quality was measured with validated index of diet quality (IDQ, total score 0–15, scores ≥ 10 indicate good diet quality). In addition, IDQ components were evaluated by comparing to Finnish dietary recommendations. Ow/ob status was determined based on pre-pregnancy body mass index (BMI, ≥25 kg/m2) calculated from self-reported weight and height. Results Of the women, 96% (331/346) were breastfeeding and 32% had ow/ob. Good diet quality was observed in 49% of the women. The IDQ scores were lower in ow/ob women compared to nw women (8.9 ± 2.3 and 9.6 ± 2.1 respectively, p = 0.006). Considering the IDQ components, the proportion of ow/ob women consuming vegetables, fruit and berries ≥ 5 servings/day was lower than that of nw women (28% and 40% respectively, p = 0.041). Moreover, ow/ob women were less likely to consume fruit and berries (41% and 62% respectively, P < 0.001) and whole grain products daily compared to nw women (63% and 76% respectively, p = 0.015). No differences in the consumption of vegetables daily, fish ≥ 2 servings/week and vegetable-oil based spread on bread as well as having a regular meal pattern (skipping ≤ 2 main meals/week) were seen between nw and ow/ob women. Conclusions Only half of the women had good diet quality in this population of mainly breastfeeding women. The diet quality score of ow/ob women was lower and they consumed health-promoting foods less likely compared to nw women. Health-promoting diet of breastfeeding women is of vast importance considering impacts on breast milk composition as well as prevention of chronic lifestyle-related conditions including type 2 diabetes. Funding Sources This material is based upon work supported by Business Finland. Personal support for EK from the Diabetes Research Foundation, the Finnish Cultural Foundation (Varsinais-Suomi Regional Fund), the Jalmari and Rauha Ahokas Foundation and the Juho Vainio Foundation.
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Affiliation(s)
- Ella Koivuniemi
- Institute of Biomedicine, Research Centre for Integrative Physiology and Pharmacology, University of Turku
| | - Kirsi Laitinen
- Institute of Biomedicine, Research Centre for Integrative Physiology and Pharmacology, University of Turku & Turku University Hospital
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Houttu N, Mokkala K, Saleem WT, Virtanen S, Juhila J, Koivuniemi E, Pellonperä O, Tertti K, Luokola P, Sorsa T, Salonen A, Lahti L, Laitinen K. Potential pathobionts in vaginal microbiota are affected by fish oil and/or probiotics intervention in overweight and obese pregnant women. Biomed Pharmacother 2022; 149:112841. [PMID: 35344737 DOI: 10.1016/j.biopha.2022.112841] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 03/07/2022] [Accepted: 03/16/2022] [Indexed: 11/28/2022] Open
Abstract
New means to stabilize the microbial balance during pregnancy could benefit maternal health. Our objectives were to investigate in overweight/obese pregnant women 1) the impact of long-chain polyunsaturated fatty acids (fish oil) and/or probiotics on the vaginal microbiota, 2) its relation to gestational diabetes mellitus (GDM) and 3) its interaction with vaginal active matrix metalloproteinase-8 (aMMP-8) and serum high sensitivity C-reactive protein (hsCRP) and phosphorylated insulin-like growth factor-binding protein-1 (phIGFBP-1), IGFBP-1 and aMMP-8. The women were allocated to fish oil + placebo, probiotics + placebo, fish oil + probiotics and placebo + placebo-groups, from early pregnancy onwards (fish oil: 1.9 g docosahexaenoic acid and 0.22 g eicosapentaenoic acid; probiotics: Lacticaseibacillus rhamnosus HN001 (formerly Lactobacillus rhamnosus HN001) and Bifidobacterium animalis ssp. lactis 420, 1010 colony-forming units each). Vaginal and serum samples (early pregnancy, n = 112; late pregnancy, n = 116), were analyzed for vaginal microbiota using 16S rRNA gene amplicon sequencing and vaginal aMMP-8 and serum hsCRP, aMMP-8, phIGFBP-1 and IGFBP-1 by immunoassays. GDM was diagnosed from a 2-h 75 g OGTT. ClinicalTrials.gov, NCT01922791. The intervention exerted effects on many low-abundant bacteria. Compared to the placebo-group, there was a lower abundance of potential pathobionts, namely Ureaplasma urealyticum in the fish oil-group, Ureaplasma, U. urealyticum and Prevotella disiens in the probiotics-group, Dialister invisus and Prevotella timonensis in the fish oil + probiotics-group. Moreover, probiotics decreased the abundance of a few potential pathobionts during pregnancy. Many bacteria were related to GDM. The vaginal aMMP-8 level correlated significantly with α-diversity and inversely with two Lactobacillus species. Dietary interventions, especially probiotics, may have beneficial effects on the vaginal microbiota during pregnancy.
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Affiliation(s)
- Noora Houttu
- Institute of Biomedicine, Research Centre for Integrative Physiology and Pharmacology, University of Turku, Turku, Finland.
| | - Kati Mokkala
- Institute of Biomedicine, Research Centre for Integrative Physiology and Pharmacology, University of Turku, Turku, Finland
| | - Wisam Tariq Saleem
- Department of Computing, Faculty of Technology, University of Turku, Turku, Finland
| | - Seppo Virtanen
- Human Microbiome Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland; Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | | | - Ella Koivuniemi
- Institute of Biomedicine, Research Centre for Integrative Physiology and Pharmacology, University of Turku, Turku, Finland
| | - Outi Pellonperä
- Department of Obstetrics and Gynecology, University of Turku and Turku University Hospital, Turku, Finland
| | - Kristiina Tertti
- Department of Obstetrics and Gynecology, University of Turku and Turku University Hospital, Turku, Finland
| | | | - Timo Sorsa
- Department of Oral and Maxillofacial Disease, University of Helsinki and Helsinki University Hospital, Helsinki, Finland; Department of Oral Diseases, Karolinska Institutet, Huddinge, Sweden
| | - Anne Salonen
- Human Microbiome Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Leo Lahti
- Department of Computing, Faculty of Technology, University of Turku, Turku, Finland
| | - Kirsi Laitinen
- Institute of Biomedicine, Research Centre for Integrative Physiology and Pharmacology, University of Turku, Turku, Finland
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Muhli E, Koivuniemi E, Laitinen K. Living with Overweight, Rather than a History of Gestational Diabetes, Influences Dietary Quality and Physical Activity during Pregnancy. Nutrients 2022; 14:nu14030651. [PMID: 35277010 PMCID: PMC8837922 DOI: 10.3390/nu14030651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 02/01/2022] [Accepted: 02/01/2022] [Indexed: 12/10/2022] Open
Abstract
(1) Background: Clinical practice guidelines recommend dietary and physical activity counselling for pregnant women with gestational diabetes (GDM). The aim of this study was to evaluate the extent to which a history of GDM and living with overweight before pregnancy modify dietary quality and physical activity during pregnancy. (2) Methods: The study is a cross-sectional study of 1034 pregnant women from different parts of Finland. The data were collected through electronic questionnaires. Dietary quality and physical activity were measured with stand-alone indices and compared according to the history of GDM and overweight status based on body mass index (BMI) category. (3) Results: Overall, 53% of the women had a poor dietary quality (Index of Diet Quality (IDQ) score < 10) and 45% a light physical activity level. The IDQ score or physical activity levels did not differ between women with and without a history of GDM. Instead, in women with overweight/obesity both the IDQ score and physical activity levels were lower compared to their normal-weight counterparts (p < 0.001). (4) Conclusions: Pregnant women, particularly if living with overweight, commonly have a poor dietary quality and a light level of physical activity. A history of GDM is not reflected in the lifestyle habits, despite the assumption that they have received lifestyle counselling during a previous pregnancy. Pregnant women would benefit from new means to promote healthy lifestyle changes.
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Affiliation(s)
- Ella Muhli
- Research Centre for Integrative Physiology and Pharmacology, Institute of Biomedicine, University of Turku, 20014 Turku, Finland; (E.M.); (E.K.)
| | - Ella Koivuniemi
- Research Centre for Integrative Physiology and Pharmacology, Institute of Biomedicine, University of Turku, 20014 Turku, Finland; (E.M.); (E.K.)
| | - Kirsi Laitinen
- Research Centre for Integrative Physiology and Pharmacology, Institute of Biomedicine, University of Turku, 20014 Turku, Finland; (E.M.); (E.K.)
- Department of Obstetrics and Gynecology, Turku University Hospital, 20521 Turku, Finland
- Correspondence:
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Hulkkonen P, Kataja EL, Vahlberg T, Koivuniemi E, Houttu N, Pellonperä O, Mokkala K, Karlsson H, Laitinen K. The efficacy of probiotics and/or n-3 long-chain polyunsaturated fatty acids intervention on maternal prenatal and postnatal depressive and anxiety symptoms among overweight and obese women. J Affect Disord 2021; 289:21-30. [PMID: 33930612 DOI: 10.1016/j.jad.2021.04.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 04/01/2021] [Accepted: 04/06/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Maternal depression and anxiety may endanger well-being of both mother and child. We investigated the efficacy of probiotics and/or fish oil (FO) in modifying pre- and postnatal depressive and anxiety symptoms. Symptom trajectories were identified and the influence of lifestyle factors on symptoms was evaluated. METHODS Overweight women (n = 439) were randomized to intervention groups (probiotics+FO, probiotics+placebo, FO+placebo, placebo+placebo) from early pregnancy until six months postpartum, and assessed for depressive and anxiety symptoms with Edinburgh Postnatal Depression Scale (EPDS) and Anxiety subscale of Symptoms Checklist (SCL-90) at early and late pregnancy and three, six and 12 months postpartum. Latent growth mixture modeling was used to model the symptom courses. Dietary quality and physical activity were assessed with validated indices. RESULTS Symptom scores were generally low. Statistically significant intervention effect was seen during pregnancy (p = 0.017): EPDS scores increased (by 1.11 points) in the FO+probiotics group and decreased (by 0.85 points) in the FO+placebo group. At 12 months postpartum, FO+placebo group had lower EPDS scores compared to probiotics+placebo group (p = 0.039). No differences in SCL scores were seen in response to the intervention. Irrespective of the intervention, three depressive and two anxiety symptoms trajectories were identified. Dietary quality correlated negatively with depressive symptoms in early pregnancy and six months postpartum and with anxiety symptoms in early pregnancy. Perinatal events including mother-reported colic were related to symptoms. LIMITATIONS Secondary outcomes of the primary trial. CONCLUSIONS Intervention had a modest impact on depressive symptoms. Diet and obstetric events were associated with depressive and anxiety symptoms.
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Affiliation(s)
- P Hulkkonen
- Institute of Biomedicine, Research Centre for Integrative Physiology and Pharmacology, University of Turku, Turku, Finland; Department of Psychology and Logopedics, University of Turku, Finland
| | - E-L Kataja
- Department of Psychology and Logopedics, University of Turku, Finland; The FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Institute of Clinical Medicine, University of Turku, Finland
| | - T Vahlberg
- Department of Clinical Medicine, Biostatistics, University of Turku, Turku, Finland
| | - E Koivuniemi
- Institute of Biomedicine, Research Centre for Integrative Physiology and Pharmacology, University of Turku, Turku, Finland
| | - N Houttu
- Institute of Biomedicine, Research Centre for Integrative Physiology and Pharmacology, University of Turku, Turku, Finland
| | - O Pellonperä
- Department of Obstetrics and Gynecology, University of Turku and Turku University Hospital, Turku, Finland
| | - K Mokkala
- Institute of Biomedicine, Research Centre for Integrative Physiology and Pharmacology, University of Turku, Turku, Finland
| | - H Karlsson
- The FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Institute of Clinical Medicine, University of Turku, Finland; Turku University Hospital and University of Turku, Department of Psychiatry, Finland; Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland
| | - K Laitinen
- Institute of Biomedicine, Research Centre for Integrative Physiology and Pharmacology, University of Turku, Turku, Finland.
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Mokkala K, Paulin N, Houttu N, Koivuniemi E, Pellonperä O, Khan S, Pietilä S, Tertti K, Elo LL, Laitinen K. Metagenomics analysis of gut microbiota in response to diet intervention and gestational diabetes in overweight and obese women: a randomised, double-blind, placebo-controlled clinical trial. Gut 2021; 70:309-318. [PMID: 32839200 DOI: 10.1136/gutjnl-2020-321643] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 07/13/2020] [Accepted: 07/14/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Gut microbiota and diet are known to contribute to human metabolism. We investigated whether the metagenomic gut microbiota composition and function changes over pregnancy are related to gestational diabetes mellitus (GDM) and can be modified by dietary supplements, fish oil and/or probiotics. DESIGN The gut microbiota of 270 overweight/obese women participating in a mother-infant clinical study were analysed with metagenomics approach in early (mean gestational weeks 13.9) and late (gestational weeks 35.2) pregnancy. GDM was diagnosed with a 2 hour 75 g oral glucose tolerance test. RESULTS Unlike women with GDM, women without GDM manifested changes in relative abundance of bacterial species over the pregnancy, particularly those receiving the fish oil + probiotics combination. The specific bacterial species or function did not predict the onset of GDM nor did it differ according to GDM status, except for the higher abundance of Ruminococcus obeum in late pregnancy in the combination group in women with GDM compared with women without GDM. In the combination group, weak decreases over the pregnancy were observed in basic bacterial housekeeping functions. CONCLUSIONS The specific gut microbiota species do not contribute to GDM in overweight/obese women. Nevertheless, the GDM status may disturb maternal gut microbiota flexibility and thus limit the capacity of women with GDM to respond to diet, as evidenced by alterations in gut microbiota observed only in women without GDM. These findings may be important when considering the metabolic complications during pregnancy, but further studies with larger populations are called for to verify the findings.
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Affiliation(s)
- Kati Mokkala
- Institute of Biomedicine, Research Centre for Integrative Physiology and Pharmacology, University of Turku, Turku, Finland
| | - Niklas Paulin
- Turku Bioscience Centre, University of Turku and Åbo Akademi University, Turku, Finland
| | - Noora Houttu
- Institute of Biomedicine, Research Centre for Integrative Physiology and Pharmacology, University of Turku, Turku, Finland
| | - Ella Koivuniemi
- Institute of Biomedicine, Research Centre for Integrative Physiology and Pharmacology, University of Turku, Turku, Finland
| | - Outi Pellonperä
- Department of Obstetrics and Gynecology, Turku University Hospital, University of Turku, Turku, Finland
| | - Sofia Khan
- Turku Bioscience Centre, University of Turku and Åbo Akademi University, Turku, Finland
| | - Sami Pietilä
- Turku Bioscience Centre, University of Turku and Åbo Akademi University, Turku, Finland
| | - Kristiina Tertti
- Department of Obstetrics and Gynecology, Turku University Hospital, University of Turku, Turku, Finland
| | - Laura L Elo
- Turku Bioscience Centre, University of Turku and Åbo Akademi University, Turku, Finland.,Institute of Biomedicine, University of Turku, Turku, Finland
| | - Kirsi Laitinen
- Institute of Biomedicine, Research Centre for Integrative Physiology and Pharmacology, University of Turku, Turku, Finland
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Houttu N, Mokkala K, Koivuniemi E, Pellonperä O, Juhila J, Sorsa T, Laitinen K. The Impacts of Fish Oil and/or Probiotic Intervention on Low-Grade Inflammation, IGFBP-1 and MMP-8 in Pregnancy: A Randomized, Placebo-Controlled, Double-Blind Clinical Trial. Biomolecules 2020; 11:biom11010005. [PMID: 33375174 PMCID: PMC7822218 DOI: 10.3390/biom11010005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 12/12/2020] [Accepted: 12/17/2020] [Indexed: 12/15/2022] Open
Abstract
Background: We investigated the impact of fish oil and/or probiotics on serum and vaginal inflammatory and metabolic proteins and their relation to the onset of gestational diabetes mellitus (GDM). Methods: Overweight/obese pregnant women received fish oil + placebo, probiotics + placebo, fish oil + probiotics or placebo + placebo from early pregnancy until six months postpartum (fish oil: 1.9 g docosahexaenoic acid and 0.22 g eicosapentaenoic acid; probiotics: Lactobacillus rhamnosus HN001 and Bifidobacterium animalis ssp. lactis 420, 1010 colony-forming units each). Serum high sensitivity C-reactive protein (hsCRP) and serum/vaginal (s/v) phosphorylated insulin-like growth factor binding-protein-1 (phIGFBP-1), IGFBP-1 and matrix metalloproteinase 8 (MMP-8) were analyzed. GDM was diagnosed according to 2 h 75 g OGTT. Results: The intervention had no impact on the change in proteins during pregnancy. Nevertheless, s-MMP-8 decreased and s-IGFBP-1 increased more in obese than in overweight women in the fish oil + probiotics group, while a decrease in s-MMP-8 was seen in obese women and an increase was seen in overweight women in the probiotics + placebo group. The late pregnancy s-phIGFBP-1 was higher in women who developed GDM in fish oil + probiotics-group compared to fish oil + placebo-group. The concentrations of s-phIGFBP-1 (635.9 ± 315.3 ng/mL vs. 753.2 ± 335.1 ng/mL, p = 0.005) and s-IGFBP-1 (3.78 ± 0.72 ng/mL vs. 3.96 ± 0.69 ng/mL, p = 0.042) were lower in early pregnancy in women who developed GDM than in women remaining healthy. Conclusions: The intervention per se had no impact on the proteins, but obesity and GDM may modify the effect. IGFBPs may affect the development of GDM.
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Affiliation(s)
- Noora Houttu
- Institute of Biomedicine, Research Centre for Integrative Physiology and Pharmacology, University of Turku, 20520 Turku, Finland; (K.M.); (E.K.); (K.L.)
- Correspondence:
| | - Kati Mokkala
- Institute of Biomedicine, Research Centre for Integrative Physiology and Pharmacology, University of Turku, 20520 Turku, Finland; (K.M.); (E.K.); (K.L.)
| | - Ella Koivuniemi
- Institute of Biomedicine, Research Centre for Integrative Physiology and Pharmacology, University of Turku, 20520 Turku, Finland; (K.M.); (E.K.); (K.L.)
| | - Outi Pellonperä
- Department of Obstetrics and Gynecology, University of Turku and Turku University Hospital, 20520 Turku, Finland;
| | | | - Timo Sorsa
- Department of Oral and Maxillofacial Disease, University of Helsinki and Helsinki University Hospital, 00014 Helsinki, Finland;
- Department of Oral Diseases, Karolinska Institutet, 141 04 Huddinge, Sweden
| | - Kirsi Laitinen
- Institute of Biomedicine, Research Centre for Integrative Physiology and Pharmacology, University of Turku, 20520 Turku, Finland; (K.M.); (E.K.); (K.L.)
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11
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Mokkala K, Vahlberg T, Houttu N, Koivuniemi E, Laitinen K. Distinct Metabolomic Profile Because of Gestational Diabetes and its Treatment Mode in Women with Overweight and Obesity. Obesity (Silver Spring) 2020; 28:1637-1644. [PMID: 32705820 DOI: 10.1002/oby.22882] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 03/18/2020] [Accepted: 04/24/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Whether the presence of gestational diabetes (GDM) and its treatment mode influence the serum metabolic profile in women with overweight or obesity was studied. METHODS The serum metabolic profiles of 352 women with overweight or obesity participating in a mother-infant clinical study were analyzed with a targeted NMR approach (at 35.1 median gestational weeks). GDM was diagnosed with a 2-hour 75-g oral glucose tolerance test. RESULTS The metabolomic profile of the women with GDM (n = 100) deviated from that of women without GDM (n = 252). Differences were seen in 70 lipid variables, particularly higher concentrations of very low-density lipoprotein particles and serum triglycerides were related to GDM. Furthermore, levels of branched-chain amino acids and glycoprotein acetylation, a marker of low-grade inflammation, were higher in women with GDM. Compared with women with GDM treated with diet only, the women treated with medication (n = 19) had higher concentrations of severalizes of VLDL particles and their components, leucine, and isoleucine, as well as glycoprotein acetylation. CONCLUSIONS A clearly distinct metabolic profile was detected in GDM, which deviated even more if the patient was receiving medical treatment. This suggests a need for more intense follow-up and therapy for women with GDM during pregnancy and postpartum to reduce their long-term adverse health risks.
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Affiliation(s)
- Kati Mokkala
- Institute of Biomedicine, Research Centre for Integrative Physiology and Pharmacology, University of Turku, Turku, Finland
| | - Tero Vahlberg
- Department of Clinical Medicine, Biostatistics, University of Turku, Turku, Finland
| | - Noora Houttu
- Institute of Biomedicine, Research Centre for Integrative Physiology and Pharmacology, University of Turku, Turku, Finland
| | - Ella Koivuniemi
- Institute of Biomedicine, Research Centre for Integrative Physiology and Pharmacology, University of Turku, Turku, Finland
| | - Kirsi Laitinen
- Institute of Biomedicine, Research Centre for Integrative Physiology and Pharmacology, University of Turku, Turku, Finland
- Turku University Hospital, Turku, Finland
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Mokkala K, Houttu N, Koivuniemi E, Sørensen N, Nielsen HB, Laitinen K. GlycA, a novel marker for low grade inflammation, reflects gut microbiome diversity and is more accurate than high sensitive CRP in reflecting metabolomic profile. Metabolomics 2020; 16:76. [PMID: 32564244 PMCID: PMC7306047 DOI: 10.1007/s11306-020-01695-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 06/05/2020] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Gut microbiota is, along with adipose tissue, recognized as a source for many metabolic and inflammatory disturbances that may contribute to the individual's state of health. OBJECTIVES We investigated in cross-sectional setting the feasibility of utilizing GlycA, a novel low grade inflammatory marker, and traditional low grade inflammatory marker, high sensitivity CRP (hsCRP), in reflecting serum metabolomics status and gut microbiome diversity. METHODS Fasting serum samples of overweight/obese pregnant women (n = 335, gestational weeks: mean 13.8) were analysed for hsCRP by immunoassay, GlycA and metabolomics status by NMR metabolomics and faecal samples for gut microbiome diversity by metagenomics. The benefits of GlycA as a metabolic marker were investigated against hsCRP. RESULTS The GlycA concentration correlated with more of the metabolomics markers (144 out of 157), than hsCRP (55 out of 157) (FDR < 0.05). The results remained essentially the same when potential confounding factors known to associate with GlycA and hsCRP levels were taken into account (P < 0.05). This was attributable to the detected correlations between GlycA and the constituents and concentrations of several sized VLDL-particles and branched chain amino acids, which were statistically non-significant with regard to hsCRP. GlycA, but not hsCRP, correlated inversely with gut microbiome diversity. CONCLUSION GlycA is a superior marker than hsCRP in assessing the metabolomic profile and gut microbiome diversity. It is proposed that GlycA may act as a novel marker that reflects both the gut microbiome and adipose tissue originated metabolic aberrations; this proposal will need to be verified with regard to clinical outcomes. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov, NCT01922791, August 14, 2013.
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Affiliation(s)
- Kati Mokkala
- Institute of Biomedicine, Research Centre for Integrative Physiology and Pharmacology, University of Turku, 20014, Turku, Finland.
| | - Noora Houttu
- Institute of Biomedicine, Research Centre for Integrative Physiology and Pharmacology, University of Turku, 20014, Turku, Finland
| | - Ella Koivuniemi
- Institute of Biomedicine, Research Centre for Integrative Physiology and Pharmacology, University of Turku, 20014, Turku, Finland
| | | | | | - Kirsi Laitinen
- Institute of Biomedicine, Research Centre for Integrative Physiology and Pharmacology, University of Turku, 20014, Turku, Finland
- Department of Obstetrics and Gynecology, Turku University Hospital, 20521, Turku, Finland
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Mokkala K, Vahlberg T, Pellonperä O, Houttu N, Koivuniemi E, Laitinen K. Distinct Metabolic Profile in Early Pregnancy of Overweight and Obese Women Developing Gestational Diabetes. J Nutr 2020; 150:31-37. [PMID: 31529056 DOI: 10.1093/jn/nxz220] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 07/11/2019] [Accepted: 08/20/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Reliable biomarkers for gestational diabetes mellitus (GDM) would be beneficial in the early prevention of adverse metabolic outcomes during pregnancy and beyond. OBJECTIVES The objective of this study was to investigate whether the early pregnancy serum metabolic profile differs in women developing GDM from those remaining healthy. Furthermore, we evaluated the potential of these metabolites to act as predictive markers for GDM. METHODS This was a prospective study investigating overweight and obese [prepregnancy BMI (in kg/m2) ≥25 and >30, respectively] pregnant women (prepregnancy median BMI: 28.5; IQR: 26.4-31.5; n = 357). Fasting serum samples were analyzed with a targeted NMR approach in early pregnancy (median: 14.3 weeks of gestation). GDM was diagnosed on the basis of a 2-h, 75-g oral-glucose-tolerance test at a median of 25.7 weeks of gestation. RESULTS In early pregnancy, 78 lipid metabolites differed in women who later developed GDM (n = 82) compared with those who remained healthy (n = 275) (ANCOVA, adjusted for confounding factors and corrected for multiple comparisons; false discovery rate <0.05). Higher concentrations of several-sized VLDL particles and medium- and small-sized HDL particles, and lower concentrations of very large-sized HDL particles, were detected in women developing GDM. Furthermore, concentrations of amino acids including 2 branched-chain amino acids, isoleucine and leucine, and GlycA, a marker for low-grade inflammation, were higher in women who developed GDM. Receiver operating characteristic analysis revealed that the most predictive marker for GDM was a higher concentration of small-sized HDL particles (AUC: 0.71; 95% CI: 0.67, 0.77; P < 0.001). CONCLUSIONS We identified a distinct early pregnancy metabolomic profile especially attributable to small HDL particles in women developing GDM. The aberrant metabolic profile could represent a novel way to allow early identification of this most common medical condition affecting pregnant women. This trial was registered at clinicaltrials.gov as NCT01922791.
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Affiliation(s)
- Kati Mokkala
- Institute of Biomedicine, University of Turku, Turku, Finland
| | - Tero Vahlberg
- Department of Clinical Medicine, Biostatistics, University of Turku, Turku, Finland
| | - Outi Pellonperä
- Department of Obstetrics and Gynecology, University of Turku and Turku University Hospital, Turku, Finland
| | - Noora Houttu
- Institute of Biomedicine, University of Turku, Turku, Finland
| | - Ella Koivuniemi
- Institute of Biomedicine, University of Turku, Turku, Finland
| | - Kirsi Laitinen
- Institute of Biomedicine, University of Turku, Turku, Finland
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Pellonperä O, Mokkala K, Houttu N, Vahlberg T, Koivuniemi E, Tertti K, Rönnemaa T, Laitinen K. Efficacy of Fish Oil and/or Probiotic Intervention on the Incidence of Gestational Diabetes Mellitus in an At-Risk Group of Overweight and Obese Women: A Randomized, Placebo-Controlled, Double-Blind Clinical Trial. Diabetes Care 2019; 42:1009-1017. [PMID: 30967436 DOI: 10.2337/dc18-2591] [Citation(s) in RCA: 87] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 02/27/2019] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To assess whether the risk of gestational diabetes mellitus (GDM) may be lowered and glucose metabolism improved by daily administration of fish oil and/or probiotic supplements in overweight and obese pregnant women. RESEARCH DESIGN AND METHODS We randomized in a double-blind manner 439 women (mean 13.9 ± 2.1 gestational weeks [gw]) into four intervention groups: fish oil + placebo, probiotics + placebo, fish oil + probiotics, and placebo + placebo. Fish oil (1.9 g docosahexaenoic acid and 0.22 g eicosapentaenoic acid) and probiotic supplements (Lactobacillus rhamnosus HN001 and Bifidobacterium animalis ssp. lactis 420, 1010 colony-forming units each) were provided for daily consumption from randomization beyond delivery. Primary outcomes were the incidence of GDM diagnosed with oral glucose tolerance test targeted at 24-28 gw and the change in fasting glucose between randomization and late pregnancy (mean 35.2 ± 0.9 gw). Insulin concentration, insulin resistance HOMA2-IR index, and pregnancy outcomes were determined, as were adverse effects related to the intervention. Analyses were by intent to treat. RESULTS No differences were found among the intervention groups in the maternal and neonatal pregnancy outcomes or side effects related to the intervention (P > 0.05). The proportion of women with GDM (94 of 377; fish oil + placebo, 23 of 96, 24.0%; probiotics + placebo, 25 of 99, 25.3%; fish oil + probiotics, 26 of 91, 28.6%; and placebo + placebo, 20 of 91, 22.0%) and the change in glucose, insulin, or HOMA2-IR (n = 364) did not differ among the intervention groups (P > 0.11 for all comparisons). CONCLUSIONS An intervention with fish oil and/or probiotics during pregnancy seemed to be both safe and well tolerated but conferred no benefits in lowering the risk of GDM or improving glucose metabolism in overweight and obese women.
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Affiliation(s)
- Outi Pellonperä
- Department of Obstetrics and Gynecology, University of Turku and Turku University Hospital, Turku, Finland
| | - Kati Mokkala
- Integrative Physiology and Pharmacology, Institute of Biomedicine, University of Turku, Turku, Finland
| | - Noora Houttu
- Integrative Physiology and Pharmacology, Institute of Biomedicine, University of Turku, Turku, Finland
| | - Tero Vahlberg
- Biostatistics, Institute of Clinical Medicine, University of Turku, Turku, Finland
| | - Ella Koivuniemi
- Integrative Physiology and Pharmacology, Institute of Biomedicine, University of Turku, Turku, Finland
| | - Kristiina Tertti
- Department of Obstetrics and Gynecology, University of Turku and Turku University Hospital, Turku, Finland
| | - Tapani Rönnemaa
- Department of Medicine, University of Turku and Turku University Hospital, Turku, Finland
| | - Kirsi Laitinen
- Integrative Physiology and Pharmacology, Institute of Biomedicine, University of Turku, Turku, Finland
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Pellonperä O, Koivuniemi E, Vahlberg T, Mokkala K, Tertti K, Rönnemaa T, Laitinen K. Body composition measurement by air displacement plethysmography in pregnancy: Comparison of predicted versus measured thoracic gas volume. Nutrition 2018; 60:227-229. [PMID: 30677546 DOI: 10.1016/j.nut.2018.09.035] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 08/09/2018] [Accepted: 09/01/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Body composition measurements with air displacement plethysmography (ADP) define body volume, which must be corrected for thoracic gas volume (TGV). We hypothesized that physiologic changes owing to pregnancy could affect the accuracy of predicted TGV and introduce errors into body composition measurements. METHODS We investigated the effect of measuring versus predicting TGV on the accuracy of body composition calculations measured with ADP in overweight and obese pregnant women. The fat and fat-free masses of 110 women were determined with ADP with predicted and measured TGV. RESULTS Measured TGV decreased from early to late pregnancy (P = 0.0002). Compared with measured TGV, predicted TGV was 6.3% higher during early gestation and 12.6% higher during late gestation (both P ≤ 0.001). The use of predicted instead of measured TGV in body composition calculations resulted in an overestimation of fat mass by 0.8% during the early stage, and 2.6% during the late stage of pregnancy (both P ≤ 0.001). CONCLUSIONS Measuring TGV increases the accuracy of body composition measurement by ADP in overweight and obese women, particularly during the late stage of pregnancy.
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Affiliation(s)
- Outi Pellonperä
- University of Turku and Turku University Hospital, Department of Obstetrics and Gynecology, Turku, Finland.
| | - Ella Koivuniemi
- University of Turku, Institute of Biomedicine, Turku, Finland
| | - Tero Vahlberg
- University of Turku and Turku University Hospital, Department of Biostatistics, Turku, Finland
| | - Kati Mokkala
- University of Turku, Institute of Biomedicine, Turku, Finland
| | - Kristiina Tertti
- University of Turku and Turku University Hospital, Department of Obstetrics and Gynecology, Turku, Finland
| | - Tapani Rönnemaa
- University of Turku and Turku University Hospital, Department of Medicine, Turku, Finland
| | - Kirsi Laitinen
- University of Turku, Institute of Biomedicine, Turku, Finland
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Pellonperä O, Koivuniemi E, Vahlberg T, Mokkala K, Tertti K, Rönnemaa T, Laitinen K. Dietary quality influences body composition in overweight and obese pregnant women. Clin Nutr 2018; 38:1613-1619. [PMID: 30224302 DOI: 10.1016/j.clnu.2018.08.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 06/26/2018] [Accepted: 08/25/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND & AIMS Excessive adiposity and gestational weight gain (GWG) have been linked with maternal and offspring morbidity. We investigated the relation of maternal diet, physical activity and GWG on body composition in overweight and obese pregnant women. METHODS Fat mass (FM) and fat free mass (FFM) of 110 overweight and obese pregnant women were measured by air displacement plethysmography in early and late pregnancy (mean 13.5 and 35.3 gestational weeks). At the same time points, the quality of overall diet was assessed by validated index of diet quality (IDQ) questionnaire (score < 10/15 denotes poor dietary quality and score ≥ 10/15 denotes good dietary quality), nutrient intakes by 3-day food diaries, and physical activity by questionnaire. Weight gain between early and late pregnancy was compared to the gestational weight gain guidelines issued by Institute of Medicine. RESULTS Of the women, 77% gained more weight than recommended; this was related to greater dietary fat consumption (80 ± 21 g/day vs. 67 ± 11 g/day, p = 0.010) and greater increase in FM (2.7 ± 3.0 kg vs. -1.0 ± 2.4 kg, p < 0.001) compared to women with ideal GWG. Dietary protein intake (g) correlated positively with FFM at both time points (early pregnancy: r = 0.31, p < 0.002, late pregnancy: r = 0.39, p < 0.001). Women with higher dietary quality index score had more FFM, compared to women with lower dietary quality (early pregnancy FFM: 48.8 ± 5.8 kg vs. 45.8 ± 4.7 kg, p = 0.004, late pregnancy FFM: 56.1 ± 6.4 kg vs. 53.4 ± 5.6 kg, p = 0.025). No correlations were detected between total energy intake or physical activity and FM or FFM at early or late pregnancy. CONCLUSIONS Body composition changes from early to late pregnancy were related to the amount of weight gained and overall dietary quality during pregnancy. Higher dietary quality and protein intake were associated with greater FFM, while dietary fat intake was related to excess weight gain. Identification of these dietary determinants of body composition and weight offers new targets for dietary counseling of pregnant women and thus potential for ensuing health benefits through reduced adiposity.
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Affiliation(s)
- Outi Pellonperä
- University of Turku and Turku University Hospital, Department of Obstetrics and Gynecology, Finland.
| | | | - Tero Vahlberg
- University of Turku and Turku University Hospital, Department of Clinical Medicine, Biostatistics, Finland
| | - Kati Mokkala
- University of Turku, Institute of Biomedicine, Finland
| | - Kristiina Tertti
- University of Turku and Turku University Hospital, Department of Obstetrics and Gynecology, Finland
| | - Tapani Rönnemaa
- University of Turku and Turku University Hospital, Department of Medicine, Finland
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Mokkala K, Pussinen P, Houttu N, Koivuniemi E, Vahlberg T, Laitinen K. The impact of probiotics and n-3 long-chain polyunsaturated fatty acids on intestinal permeability in pregnancy: a randomised clinical trial. Benef Microbes 2018; 9:199-208. [PMID: 29345158 DOI: 10.3920/bm2017.0072] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
A disruption in intestinal barrier integrity may predispose individuals to metabolic aberrations, particularly during the vulnerable period of pregnancy. We investigated whether intestinal permeability, as measured by serum zonulin concentration, changes over the duration of pregnancy and whether this change is reflected in lipopolysaccharide (LPS) activity. Second, we tested in a randomised double-blind placebo controlled clinical trial the impact of consuming dietary probiotics and/or long chain polyunsaturated fatty acid (LC-PUFA) supplements in lowering serum zonulin concentration and LPS activity. The probiotic supplement was a combination of two bacteria, Bifidobacterium animalis ssp. lactis 420 and Lactobacillus rhamnosus HN001. This study included 200 overweight pregnant women participating in an on-going study; participants were randomised to consume either (1) probiotics, (2) LC-PUFA, (3) probiotics and LC-PUFA, or (4) placebo for each supplement. Blood samples were obtained at early, the baseline, and late pregnancy (mean 14 and 35 weeks of gestation, respectively). Serum zonulin concentration increased from early (mean (standard deviation): 62.7 (12.9) ng/ml) to late pregnancy by 5.3 (95%CI 3.7-6.9) ng/ml, and LPS activity increased from (0.16 (0.04) EU/ml) by 0.04 (95%CI 0.03-0.05) EU/ml. No differences among the intervention groups were detected in the change from early to late pregnancy in serum zonulin concentration (P=0.8) or LPS activity (P=0.2). The change in serum zonulin concentration during the pregnancy was associated with the weeks of follow up (r=0.25, P<0.001). Serum LPS activity was correlated with higher maternal weight gain (r=0.19, P=0.008). As a conclusion, intestinal permeability increased with the progression of pregnancy in overweight and obese women and was reflected in LPS activity. No efficacy of supplementation with probiotics and/or LC-PUFA was demonstrated in pregnancy-induced changes in serum zonulin concentration or LPS activity.
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Affiliation(s)
- K Mokkala
- 1 Institute of Biomedicine, University of Turku, 20014 Turku, Finland
| | - P Pussinen
- 2 Oral and Maxillofacial Diseases, University of Helsinki and University Hospital of Helsinki, 00014 Helsinki, Finland
| | - N Houttu
- 1 Institute of Biomedicine, University of Turku, 20014 Turku, Finland
| | - E Koivuniemi
- 1 Institute of Biomedicine, University of Turku, 20014 Turku, Finland.,3 Turku University Hospital, Department of Obstetrics and Gynaecology, 20014 Turku, Finland
| | - T Vahlberg
- 4 Department of Clinical Medicine, Biostatistics, University of Turku and Turku University Hospital, 20014 Turku, Finland
| | - K Laitinen
- 1 Institute of Biomedicine, University of Turku, 20014 Turku, Finland
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Jaroma M, Danner P, Koivuniemi E. Sensory integrative therapy and speech therapy for improving the perceptual motor skills and speech articulation of a dyspractic boy. Folia Phoniatr (Basel) 1984; 36:261-6. [PMID: 6519607 DOI: 10.1159/000265753] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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