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Eussen SRBM, Wielders S, de Rooij WE, Van Ampting MTJ, Van Esch BCAM, de Vries JHM, Bredenoord AJ, Vlieg‐Boerstra B. Dietary composition of adult eosinophilic esophagitis patients is related to disease severity. Immun Inflamm Dis 2024; 12:e1206. [PMID: 38456617 PMCID: PMC10921897 DOI: 10.1002/iid3.1206] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 02/07/2024] [Accepted: 02/15/2024] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND In addition to the elimination diet, dietary composition may influence disease severity in patients with eosinophilic esophagitis (EoE) through modulation of the immune response. AIM To explore the immunomodulatory role of nutrition before and during elimination diet in adult EoE patients. METHODS Nutritional intake was assessed in 39 Dutch adult EoE patients participating in the Supplemental Elemental Trial (Dutch trial registry NL6014, NTR6778) using 3-day food diaries. In this randomized controlled trial, diagnosed patients received either a four-food elimination diet alone (FFED) or FFED with addition of an amino acid-based formula for 6 weeks. Multiple linear regression analyses were performed to assess associations between the intake of nutrients and food groups per 1000 kCal and peak eosinophil count/high power field (PEC), both at baseline and after 6 weeks. RESULTS At baseline, we found a statistically significant negative (thus favorable) relationship between the intake of protein, total fat, phosphorus, zinc, vitamin B12, folate, and milk products and PEC (p < .05), while calcium (p = .058) and full-fat cheese/curd (p = .056) were borderline (favorably) significant. In contrast, total carbohydrates, prepacked fruit juice, and white bread were significantly positively (unfavorable) related to PEC (p < .05), while ultra-processed meals (p = .059) were borderline (unfavorably) significant. After dietary intervention, coffee/tea were significantly negatively (favorably) related to PEC, hummus/legumes were significantly positively (unfavorably) related with PEC, while peanuts were borderline significantly positively related (p = .058). CONCLUSION Dietary composition may be related to inflammation in adult EoE patients. High-quality and anti-inflammatory diets may be a promising adjuvant therapy in the dietary management of EoE.
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Affiliation(s)
| | - Sanne Wielders
- Division of Human NutritionWageningen UniversityWageningenThe Netherlands
| | - Willemijn E. de Rooij
- Department of Gastroenterology & HepatologyAmsterdam University Medical CenterAmsterdamThe Netherlands
| | | | - Betty C. A. M. Van Esch
- Danone Nutricia ResearchUtrechtThe Netherlands
- Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of ScienceUtrecht UniversityUtrechtThe Netherlands
| | | | - Albert J. Bredenoord
- Department of Gastroenterology & HepatologyAmsterdam University Medical CenterAmsterdamThe Netherlands
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2
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Chatchatee P, Nowak-Wegrzyn A, Lange L, Benjaponpitak S, Chong KW, Sangsupawanich P, Eussen SRBM, van Ampting MTJ, Oude Nijhuis MM, Langford JE, Trendelenburg V, Pesek R, Davis CM, Muraro A, Erlewyn-Lajeunesse M, Fox AT, Michaelis LJ, Beyer K. Tolerance development in cow's milk-allergic children receiving amino acid-based formula with synbiotics: 36-Months follow-up of a randomized controlled trial (PRESTO Study). J Pediatr Gastroenterol Nutr 2024; 78:699-703. [PMID: 38504410 DOI: 10.1002/jpn3.12104] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 11/15/2023] [Accepted: 11/27/2023] [Indexed: 03/21/2024]
Abstract
The objective of the present study is to assess the rates of acquired tolerance to cow's milk (CM) after 36 months in subjects who consumed amino acid-based formula with synbiotics (AAF-S) or amino acid-based formula without synbiotics (AAF) during a 1-year intervention period in early life as part of the PRESTO study (Netherlands Trial Register number NTR3725). Differences in CM tolerance development between groups were analysed using a logistic regression model. Results show that the proportion of subjects (mean [±SD] age, 3.8 ± 0.27 years) who developed CM tolerance after 36 months was similar in the group receiving AAF-S (47/60 [78%]) and in the group receiving AAF (49/66 [74%]) (p = 0.253), that is, figures comparable to natural outgrowth of CM allergy. Our data suggest that the consumption of AAF and absence of exposure to CM peptides do not slow down CM tolerance acquisition.
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Affiliation(s)
- Pantipa Chatchatee
- Center of Excellence for Allergy and Clinical Immunology, Division of Allergy and Immunology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Anna Nowak-Wegrzyn
- Allergy and Immunology, Department of Pediatrics, New York University Langone Health, New York, USA
| | | | - Suwat Benjaponpitak
- Pediatric Allergy and Immunology Division, Department of Pediatrics, Mahidol University, Bangkok, Thailand
| | - Kok W Chong
- Department of Paediatrics, KK Women's & Children's Hospital, Singapore
| | - Pasuree Sangsupawanich
- Department of Pediatrics, Faculty of Medicine, Prince of Songkla Hospital, Hat Yai, Thailand
| | | | | | | | | | - Valerie Trendelenburg
- Department of Pediatric Respiratory Medicine, Immunology, and Critical Care Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany
| | | | - Carla M Davis
- Baylor College of Medicine, Texas Children's Hospital, Houston, USA
| | - Antonella Muraro
- Food Allergy Centre, Padua General University Hospital, Padua, Italy
| | | | - Adam T Fox
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Louise J Michaelis
- Great North Children's Hospital, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Kirsten Beyer
- Department of Pediatric Respiratory Medicine, Immunology, and Critical Care Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany
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Moya-Alvarez V, Eussen SRBM, Mank M, Koyembi JCJ, Nyasenu YT, Ngaya G, Mad-Bondo D, Kongoma JB, Stahl B, Sansonetti PJ, Bourdet-Sicard R. Human milk nutritional composition across lactational stages in Central Africa. Front Nutr 2022; 9:1033005. [PMID: 36466422 PMCID: PMC9709887 DOI: 10.3389/fnut.2022.1033005] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 10/27/2022] [Indexed: 03/11/2024] Open
Abstract
The African region encompasses the highest undernutrition burden with the highest neonatal and infant mortality rates globally. Under these circumstances, breastfeeding is one of the most effective ways to ensure child health and development. However, evidence on human milk (HM) composition from African women is scarce. This is of special concern, as we have no reference data from HM composition in the context of food insecurity in Africa. Furthermore, data on the evolution of HM across lactational stages in this setting lack as well. In the MITICA study, we conducted a cohort study among 48 Central-African women and their 50 infants to analyze the emergence of gut dysbiosis in infants and describe the mother-infant transmission of microbiota between birth and 6 months of age. In this context, we assessed nutritional components in HM of 48 lactating women in Central Africa through five sampling times from week 1 after birth until week 25. Unexpectedly, HM-type III (Secretor + and Lewis genes -) was predominant in HM from Central African women, and some nutrients differed significantly among HM-types. While lactose concentration increased across lactation periods, fatty acid concentration did not vary significantly. The overall median level of 16 detected individual human milk oligosaccharides (HMOs; core structures as well as fucosylated and sialylated ones) decreased from 7.3 g/l at week 1 to 3.5 g/l at week 25. The median levels of total amino acids in HM dropped from 12.8 mg/ml at week 1 to 7.4 mg/ml at week 25. In contrast, specific free amino acids increased between months 1 and 3 of lactation, e.g., free glutamic acid, glutamine, aspartic acid, and serine. In conclusion, HM-type distribution and certain nutrients differed from Western mother HM.
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Affiliation(s)
- Violeta Moya-Alvarez
- Unité de Pathogénie Microbienne Moléculaire, INSERM U1202, Department of Cell Biology and Infection, Institut Pasteur, Paris, France
- Epidemiology of Emergent Diseases Unit, Global Health Department, Institut Pasteur, Paris, France
| | - Simone R. B. M. Eussen
- Human Milk Research and Analytical Science, Danone Nutricia Research, Utrecht, Netherlands
| | - Marko Mank
- Human Milk Research and Analytical Science, Danone Nutricia Research, Utrecht, Netherlands
| | | | - Yawo Tufa Nyasenu
- Laboratoire d'Analyses Médicales, Institut Pasteur de Bangui, Bangui, Central African Republic
- Laboratoire de Biologie Moléculaire et d'Immunologie, Université de Lomé, Lomé, Togo
| | - Gilles Ngaya
- Laboratoire de Biologie Moléculaire et d'Immunologie, Université de Lomé, Lomé, Togo
| | - Daniel Mad-Bondo
- Direction du Service de Santé de la Gendarmerie, Sis Camp Henri Izamo, Bangui, Central African Republic
| | - Jean-Bertrand Kongoma
- Direction du Service de Santé de la Gendarmerie, Sis Camp Henri Izamo, Bangui, Central African Republic
| | - Bernd Stahl
- Human Milk Research and Analytical Science, Danone Nutricia Research, Utrecht, Netherlands
- Department of Chemical Biology and Drug Discovery, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, Netherlands
| | - Philippe J. Sansonetti
- Unité de Pathogénie Microbienne Moléculaire, INSERM U1202, Department of Cell Biology and Infection, Institut Pasteur, Paris, France
- Chaire de Microbiologie et Maladies Infectieuses, Collège de France, Paris, France
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Bottin JH, Eussen SRBM, Igbinijesu AJ, Mank M, Koyembi JCJ, Nyasenu YT, Ngaya G, Mad-Bondo D, Kongoma JB, Stahl B, Sansonetti PJ, Bourdet-Sicard R, Moya-Alvarez V. Food Insecurity and Maternal Diet Influence Human Milk Composition between the Infant's Birth and 6 Months after Birth in Central-Africa. Nutrients 2022; 14:4015. [PMID: 36235668 PMCID: PMC9573613 DOI: 10.3390/nu14194015] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 09/19/2022] [Accepted: 09/21/2022] [Indexed: 11/16/2022] Open
Abstract
Although the World Health Organization (WHO) and UNICEF recommend that infants should be exclusively breastfed for the first 6 months of life, evidence is scarce on how the mother’s undernourishment status at delivery and maternal dietary factors influence human milk (HM) composition during the first 6 months of life in regions with high food insecurity. The maternal undernourishment status at delivery, maternal diet, and HM nutrients were assessed among 46 women and their 48 vaginally born infants in Bangui at 1, 4, 11, 18, and 25 weeks after birth through 24-h recalls and food consumption questionnaires from December 2017 to June 2019 in the context of the "Mother-to-Infant TransmIssion of microbiota in Central-Africa" (MITICA) study. High food insecurity indexes during the follow-up were significantly associated with them having lower levels of many of the human milk oligosaccharides (HMOs) that were measured and with lower levels of retinol (aß-coef = −0.2, p value = 0.04), fatty acids (aß-coef = −7.2, p value = 0.03), and amino acids (aß-coef = −2121.0, p value < 0.001). On the contrary, women from food-insecure households displayed significantly higher levels of lactose in their HM (aß-coef = 3.3, p value = 0.02). In parallel, the consumption of meat, poultry, and fish was associated with higher HM levels of many of the HMOs that were measured, total amino acids (aß-coef = 5484.4, p value < 0.001), and with lower HM levels of lactose (aß-coef = −15.6, p value = 0.01). Food insecurity and maternal diet had a meaningful effect on HM composition with a possible impact being an infant undernourishment risk. Our results plead for consistent actions on food security as an effective manner to influence the nutritional content of HM and thereby, potentially improve infant survival and healthy growth.
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Affiliation(s)
| | | | | | - Marko Mank
- Danone Nutricia Research, 3584 CT Utrecht, The Netherlands or
| | | | - Yawo Tufa Nyasenu
- Laboratoire d’Analyses Médicales, Institut Pasteur de Bangui, Bangui BP923, Central African Republic
- Laboratoire de Biologie Moléculaire et d’Immunologie, Université de Lomé, Lomé P.O. Box 1396, Togo
| | - Gilles Ngaya
- Laboratoire d’Analyses Médicales, Institut Pasteur de Bangui, Bangui BP923, Central African Republic
| | - Daniel Mad-Bondo
- Direction du Service de Santé de la Gendarmerie, Sis Camp Henri IZAMO, Bangui BP790, Central African Republic
| | - Jean-Bertrand Kongoma
- Direction du Service de Santé de la Gendarmerie, Sis Camp Henri IZAMO, Bangui BP790, Central African Republic
| | - Bernd Stahl
- Danone Nutricia Research, 3584 CT Utrecht, The Netherlands or
- Department of Chemical Biology & Drug Discovery, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, 3584 CG Utrecht, The Netherlands
| | - Philippe J. Sansonetti
- Chaire de Microbiologie et Maladies Infectieuses, Collège de France, 75005 Paris, France
- Unité de Pathogénie Microbienne Moléculaire, INSERM U1202, Department of Cell Biology and Infection, Institut Pasteur, 75015 Paris, France
| | | | - Violeta Moya-Alvarez
- Unité de Pathogénie Microbienne Moléculaire, INSERM U1202, Department of Cell Biology and Infection, Institut Pasteur, 75015 Paris, France
- Epidemiology of Emergent Diseases Unit, Global Health Department, Institut Pasteur, 75015 Paris, France
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de Rooij WE, Vlieg – Boerstra B, Warners MJ, Van Ampting MT, van Esch BCAM, Eussen SRBM, Bredenoord AJ. Effect of amino acid-based formula added to four-food elimination in adult eosinophilic esophagitis patients: A randomized clinical trial. Neurogastroenterol Motil 2022; 34:e14291. [PMID: 34792264 PMCID: PMC9286809 DOI: 10.1111/nmo.14291] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 08/22/2021] [Accepted: 10/14/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND Elimination of key foods restricts dietary options in eosinophilic esophagitis (EoE) patients. Addition of amino acid-based formula (AAF) to an elimination diet might facilitate adherence and, therefore, enhance efficacy of dietary management. AIM To evaluate whether addition of AAF to a four-food elimination diet (FFED) is more effective than FFED alone in decreasing eosinophilia, endoscopic signs, and clinical outcomes. METHODS This randomized controlled trial enrolled 41 adult patients with active EoE (≥15 eosinophils (eos) per high power field (hpf)) at baseline biopsy. Subjects were randomized (1:1 ratio) to groups given a FFED or FFED with addition of AAF providing 30% of their daily energy needs (FFED + AAF). Histological disease activity, endoscopic signs, symptoms, and disease-related quality of life (EoEQoL) were measured at baseline and after 6 weeks of intervention. RESULTS Patients (60% male, age 34.5 (interquartile range (IQR) 29-42.8 years)) were randomized to FFED (n = 20) or FFED + AAF (n = 21); 40 participants completed the diet. Complete histological remission (<15 eos/hpf) was achieved in 48% of FFED + AAF subjects (n = 21) vs. 25% of FFED subjects (n = 20), respectively (p = 0.204). Peak eosinophil counts (PEC) decreased significantly in both groups between baseline and week 6, but the change in PEC between groups was not different (p = 0.130). A significant but similar endoscopic and symptomatic reduction was observed in both groups (all; p<0.05). Total EoEQoL scores significantly improved in the FFED + AAF group between baseline and week 6 (p = 0.007), and not in the FFED group. CONCLUSION The addition of AAF to a FFED did not lead to a larger decrease in PEC between baseline and 6 weeks, but may result in a significant improvement of QoL in adult EoE patients NL6014 (NTR6778).
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Affiliation(s)
- Willemijn E. de Rooij
- Department of Gastroenterology & HepatologyAmsterdam University Medical CenterAmsterdamThe Netherlands
| | - Berber Vlieg – Boerstra
- Department of PaediatricsOLVGAmsterdamThe Netherlands,Department of Nutrition & DieteticsHanze University of Applied SciencesGroningenThe Netherlands
| | - Marijn J. Warners
- Department of Gastroenterology & HepatologyAmsterdam University Medical CenterAmsterdamThe Netherlands,Department of Gastroenterology and HepatologyUniversity Medical Center Utrecht and St. Antonius Hospital NieuwegeinAmsterdamThe Netherlands
| | | | - Betty C. A. M. van Esch
- Danone Nutricia ResearchUtrechtThe Netherlands,Division of PharmacologyUtrecht Institute for Pharmaceutical SciencesFaculty of ScienceUtrecht UniversityUtrechtThe Netherlands
| | | | - Albert J. Bredenoord
- Department of Gastroenterology & HepatologyAmsterdam University Medical CenterAmsterdamThe Netherlands
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6
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Di Maso M, Bravi F, Ferraroni M, Agostoni C, Eussen SRBM, Decsi T, Quitadamo PA, Tonetto P, Peila C, Profeti C, Salvatori G, Kazmierska I, Decarli A, Vacca E, Bertino E, Stahl B, Moro GE. Adherence to Mediterranean Diet of Breastfeeding Mothers and Fatty Acids Composition of Their Human Milk: Results From the Italian MEDIDIET Study. Front Nutr 2022; 9:891376. [PMID: 35719165 PMCID: PMC9201754 DOI: 10.3389/fnut.2022.891376] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 04/26/2022] [Indexed: 11/13/2022] Open
Abstract
Background and AimsThe content of fatty acids (FA) in human milk may be influenced by maternal nutrition. We evaluated the role of a Mediterranean diet in influencing the content of FA in human milk among 282 breastfeeding mothers participating in the MEDIDIET study.Materials and MethodsMediterranean Diet Score (MDS), a composite index, was used to evaluate adherence to the Mediterranean diet. It includes 9 components (i.e., vegetables, fruit, cereals, legumes, monounsaturated to saturated FA ratio – MUFA/SFA, fish, dairy products, meat, and alcohol) and therefore potentially ranges from 0 (no adherence) to 9 (complete adherence) points. None of the mothers obtained the highest score due to the low alcohol consumption in the study population. Mothers were categorized in approximate tertiles of adherence: 0–3 (34.4%), 4 (26.2%), and 5–8 points (39.4%). The mean content of FA across categories of MDS was compared using ANOVA and test for trend.ResultsA high adherence of breastfeeding mothers to the Mediterranean diet was associated with lower content of SFA in human milk (42.58 ± 4.36 for MDS = 0–3, 42.58 ± 4.89 for MDS = 4, and 40.92 ± 5.22% of fats for MDS = 5–8 points; p ANOVA and p for trend = 0.02). Conversely, a high adherence was associated with higher content of MUFA in human milk (43.27 ± 4.27 for MDS = 0–3, 43.27 ± 4.47 for MDS = 4, and 45.24 ± 5.22% of fats for MDS = 5–8 points; p ANOVA and p for trend < 0.01), ω-3 FA (1.07 ± 0.25 for MDS = 0–3, 1.22 ± 0.49 for MDS = 4, and 1.31 ± 0.51% of fats for MDS = 5–8 points; p ANOVA and p for trend < 0.01), and the major types of ω-3 FA (i.e., α-linolenic acid – ALA, eicosapentaenoic acid – EPA, docosahexaenoic acid – DHA, docosapentaenoic acid – DPA). These associations were mainly driven by the adherence to the vegetables, MUFA/SFA, fish, and dairy products components of the Mediterranean diet.ConclusionA high adherence to the Mediterranean diet was associated with human milk showing a lower content of SFA and higher content of MUFA and ω-3 FA, including DHA. The Mediterranean diet may contribute in human milk production with higher content of specific FA which is directly involved in infant’s neural and visual development, as reported by previous studies.
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Affiliation(s)
- Matteo Di Maso
- Department of Clinical Sciences and Community Health, Branch of Medical Statistics, Biometry and Epidemiology “G.A. Maccacaro”, Università degli Studi di Milano, Milan, Italy
| | - Francesca Bravi
- Department of Clinical Sciences and Community Health, Branch of Medical Statistics, Biometry and Epidemiology “G.A. Maccacaro”, Università degli Studi di Milano, Milan, Italy
| | - Monica Ferraroni
- Department of Clinical Sciences and Community Health, Branch of Medical Statistics, Biometry and Epidemiology “G.A. Maccacaro”, Università degli Studi di Milano, Milan, Italy
- Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milan, Italy
- *Correspondence: Monica Ferraroni,
| | - Carlo Agostoni
- Pediatric Intermediate Care Unit, Fondazione IRCCS Ospedale Cà Granda-Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Science and Community Health, Università degli Studi di Milano, Milan, Italy
| | | | - Tamás Decsi
- Department of Paediatrics, University of Pécs, Pécs, Hungary
| | - Pasqua A. Quitadamo
- Neonatology and Neonatal Intensive Care Unit, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Paola Tonetto
- Neonatal Intensive Care Unit, City of Health and Science, University of Turin, Turin, Italy
| | - Chiara Peila
- Neonatal Intensive Care Unit, City of Health and Science, University of Turin, Turin, Italy
| | - Claudio Profeti
- Azienda Ospedaliera Universitaria Meyer di Firenze, Florence, Italy
| | - Guglielmo Salvatori
- Neonatal Intensive Care Unit, IRCCS Ospedale Pediatrico Bambino Gesù, Rome, Italy
| | - Iwona Kazmierska
- Neonatal Intensive Care Unit, Ospedale Buccheri La Ferla Fatebenefratelli, Palermo, Italy
| | - Adriano Decarli
- Department of Clinical Sciences and Community Health, Branch of Medical Statistics, Biometry and Epidemiology “G.A. Maccacaro”, Università degli Studi di Milano, Milan, Italy
| | | | - Enrico Bertino
- Department of Public Health and Pediatrics, Neonatal Intensive Care Unit, Università degli Studi di Torino, Turin, Italy
| | - Bernd Stahl
- Danone Nutricia Research, Utrecht, Netherlands
- Department of Chemical Biology and Drug Discovery, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht, Netherlands
| | - Guido E. Moro
- Italian Association of Human Milk Banks (AIBLUD), Milan, Italy
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Montez de Sousa ÍR, Wang Z, Hu R, Stahl B, Jin Y, Eussen SRBM, Li J. Dietary Intake of Chinese Lactating Women Is Associated with the Fatty Acid Profile of Their Milk. Ann Nutr Metab 2021; 78:33-45. [PMID: 34856550 DOI: 10.1159/000520515] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 10/26/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The present study aimed to explore the relationship between the dietary intake and the human milk (HM) fatty acid (FA) profile of Chinese lactating women. METHODS HM samples and food records were obtained from 122 Chinese women over 5 visits between 0 and 51 days postpartum. Adjusted multiple regression was performed to explore associations between maternal dietary intakes of energy, macronutrients, FAs and foods, and the HM FA profile. Analyses were performed separately for colostrum and mature milk. RESULTS Dietary intakes of total polyunsaturated FAs (PUFAs), eicosapentaenoic acid (EPA), and docosahexaenoic acid were positively associated with the HM contents of PUFAs, omega-6 (n-6) PUFAs, and linoleic acid (LA), and the intakes of n-3 PUFAs and α-linolenic acid (ALA) were negatively associated with saturated FA levels in HM. Associations were stronger for mature milk. Intakes of milk/dairy, meat/poultry, and eggs were negatively associated with n-6 PUFAs, LA, and EPA in mature milk, whereas the opposite was seen for fish/shrimp. Positive associations were also found between fish/shrimp and total and n-3 PUFAs in mature milk. CONCLUSION The HM FA profile of Chinese women is associated with their diet, and in particular with their FA intake. Tailored nutritional advice based on HM FA composition may optimize HM FA profile and thereby contribute to healthy infant development.
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Affiliation(s)
- Íris R Montez de Sousa
- Division of Human Nutrition and Health, Wageningen University, Wageningen, The Netherlands
| | - Zhixu Wang
- Department of Maternal, Child and Adolescent Health, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Rui Hu
- Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Bernd Stahl
- Danone Nutricia Research, Utrecht, The Netherlands.,Department of Chemical Biology & Drug Discovery, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht, The Netherlands
| | - Yi Jin
- Danone Nutricia Research, Shanghai, China
| | | | - Jing Li
- Department of Neonatology, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, China
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8
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Di Maso M, Eussen SRBM, Bravi F, Moro GE, Agostoni C, Tonetto P, Quitadamo PA, Salvatori G, Profeti C, Kazmierska I, Vacca E, Decarli A, Stahl B, Bertino E, Ferraroni M. Dietary Intake of Breastfeeding Mothers in Developed Countries: A Systematic Review and Results of the MEDIDIET Study. J Nutr 2021; 151:3459-3482. [PMID: 34386823 DOI: 10.1093/jn/nxab258] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 05/21/2021] [Revised: 07/08/2021] [Accepted: 07/12/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Lactation is a demanding period for women, and a good nutrition is crucial for optimal health of mothers and infants. OBJECTIVES To provide new data and summarize the overall evidence on maternal nutrient intakes during lactation in developed countries, we present a systematic review (SR) of the literature and concurrently original results of the Italian MEDIDIET study. We compared nutrient intakes with dietary reference values (DRVs) proposed by the European Food Safety Authority. METHODS Studies were identified searching PubMed/Embase databases up to February 2020. Observational studies reporting at least energy and macronutrient intakes of healthy breastfeeding mothers who followed non-restricted and non-specific diets were included. Studies on populations with severe nutritional deficiencies were excluded. The MEDIDIET study enrolled 300 healthy breastfeeding mothers at 6 ± 1 wk postpartum. Usual diet was concomitantly evaluated through a validated and reproducible FFQ. Nutrient intakes were estimated using a food composition database. RESULTS Twenty-eight articles regarding 32 distinct study populations were included. Maternal nutrient intakes were generally in agreement across studies included in the SR and conforming to DRVs. Within micronutrients, vitamin D intake was below the recommendation. In the MEDIDIET study, mean intakes of energy (1950 ± 445 kcal/d), carbohydrates (270 ± 20.1 g/d), proteins (87.8 ± 20.1 g/d), and fats (65.6 ± 18.9 g/d) were similar to those observed in the SR. Moreover, observed intakes seemed to reflect the typical Mediterranean diet, with low intakes of carbohydrates, SFAs, and PUFAs and high intakes of MUFAs and vitamins. Conversely, protein intake was mainly derived from animal sources. CONCLUSIONS This SR showed that nutrient intakes of breastfeeding mothers in developed countries are generally in line with DRVs despite different dietary patterns worldwide. Some nutritional deficiencies emerged, highlighting the need for additional nutritional advice. Mothers participating in the MEDIDIET study showed a nutritional profile in agreement with the Mediterranean diet.
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Affiliation(s)
- Matteo Di Maso
- Department of Clinical Sciences and Community Health, Branch of Medical Statistics, Biometry and Epidemiology "G.A. Maccacaro," Università degli Studi di Milano, Milan, Italy
| | | | - Francesca Bravi
- Department of Clinical Sciences and Community Health, Branch of Medical Statistics, Biometry and Epidemiology "G.A. Maccacaro," Università degli Studi di Milano, Milan, Italy
| | - Guido E Moro
- Italian Association of Human Milk Banks (AIBLUD), Milan, Italy
| | - Carlo Agostoni
- Pediatric Intermediate Care Unit, Fondazione IRCCS Ospedale Cà Granda-Ospedale Maggiore Policlinico, Milan, Italy.,Department of Clinical Science and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Paola Tonetto
- Neonatal Intensive Care Unit, City of Health and Science, University of Turin, Turin, Italy
| | - Pasqua A Quitadamo
- Neonatology-Neonatal Intensive Care Unit, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Guglielmo Salvatori
- Neonatal Intensive Care Unit, IRCCS Ospedale Pediatrico Bambino Gesù, Rome, Italy
| | - Claudio Profeti
- Azienda Ospedaliera Universitaria Meyer di Firenze, Florence, Italy
| | - Iwona Kazmierska
- Neonatal Intensive Care Unit, Ospedale Buccheri La Ferla Fatebenefratelli, Palermo, Italy
| | | | - Adriano Decarli
- Department of Clinical Sciences and Community Health, Branch of Medical Statistics, Biometry and Epidemiology "G.A. Maccacaro," Università degli Studi di Milano, Milan, Italy
| | - Bernd Stahl
- Danone Nutricia Research, Utrecht, The Netherlands.,Department of Chemical Biology & Drug Discovery, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht, The Netherlands
| | - Enrico Bertino
- Department of Public Health and Pediatrics, Neonatal Intensive Care Unit, Università degli Studi di Torino, Turin, Italy
| | - Monica Ferraroni
- Department of Clinical Sciences and Community Health, Branch of Medical Statistics, Biometry and Epidemiology "G.A. Maccacaro," Università degli Studi di Milano, Milan, Italy
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9
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Hu R, Eussen SRBM, Sijtsma FPC, Papi B, Stahl B, Jin Y, Mank M, Li J, Wang Z. Maternal dietary patterns are associated with human milk composition in Chinese lactating women. Nutrition 2021; 91-92:111392. [PMID: 34303959 DOI: 10.1016/j.nut.2021.111392] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 09/04/2020] [Revised: 06/04/2021] [Accepted: 06/10/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Dietary patterns are a useful tool to study the impact of overall maternal diet on human milk (HM) composition beyond single foods or nutrients. The present study aimed to identify dietary patterns among Chinese lactating women and assess their associations with HM macronutrient composition. METHODS Dietary intake data and HM samples were collected from 122 Chinese mothers at three to five study visits during the first 52 d postpartum. Dietary patterns were derived using principal component analysis. Cross-sectional associations of dietary patterns and HM macronutrients were assessed using multivariable linear regression models adjusted for total energy intake. All analyses were done separately for colostrum (postpartum days 0-7) and mature milk (postpartum days 8-52). RESULTS Four dietary patterns were identified: high-in-animal-foods, high-in-eggs, high-in-plant-foods, and high-in-fruits. Compared with the lowest tertile (T1), participants in the highest tertile (T3) of the high-in-animal-foods and high-in-plant-foods patterns had lower protein (respectively, T3 - T1 = -1.09 g/100 mL, Ptrend = 0.002; T3 - T1 = -0.54 g/100 mL, Ptrend = 0.001) and higher fat (respectively, T3 - T1 = 0.86 g/100 mL, Ptrend = 0.040; T3 - T1 = 0.40 g/100 mL, Ptrend = 0.004) concentrations in colostrum. In contrast, in mature milk the high-in-animal-foods pattern was positively associated with carbohydrates (T3 - T1 = 0.53 g/100 mL, Ptrend = 0.008) and the high-in-plant-foods pattern was negatively associated with fat (T3 - T1 = -0.64 g/100 mL, Ptrend = 0.002). The high-in-eggs pattern was weakly positively associated with protein concentration in mature milk (T3 - T1 = 0.10 g/100 mL, Ptrend = 0.023). CONCLUSIONS Maternal dietary patterns with high proportions of animal and plant-based foods were associated with higher fat and lower protein concentrations in colostrum. Different associations were found in mature milk. Dietary-pattern analysis provides an opportunity to characterize total diet and may be more predictive of HM composition than single foods or nutrients.
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Affiliation(s)
- Rui Hu
- Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | | | | | - Bianca Papi
- Medtronic Brain and Spine Therapies, Rotterdam, The Netherlands
| | - Bernd Stahl
- Medtronic Brain and Spine Therapies, Rotterdam, The Netherlands; Department of Chemical Biology & Drug Discovery, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht, The Netherlands
| | - Yi Jin
- Danone Nutricia Research, Shanghai, China
| | - Marko Mank
- Medtronic Brain and Spine Therapies, Rotterdam, The Netherlands
| | - Jing Li
- Department of Neonatology, Shanghai First Maternity and Infant Hospital, Shanghai, China
| | - Zhixu Wang
- Department of Maternal, Child and Adolescent Health, School of Public Health, Nanjing Medical University, Nanjing, China
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10
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Bergwitz C, Eussen SRBM, Janssens PLHR, Visser M, Carpenter TO, van Helvoort A. Different elemental infant formulas show equivalent phosphorus and calcium bioavailability in healthy volunteers. Nutr Res 2020; 85:71-83. [PMID: 33450668 DOI: 10.1016/j.nutres.2020.11.004] [Citation(s) in RCA: 2] [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: 07/09/2020] [Revised: 11/09/2020] [Accepted: 11/12/2020] [Indexed: 12/18/2022]
Abstract
Retrospective chart reviews have reported hypophosphatemia associated with elemental formula use in infants and children with systemic disease involving multiple diagnoses. The present study aims to evaluate the bioavailability of phosphorus from 2 commercial elemental formulas and to test our hypothesis of bioequivalence of the 2 products in healthy volunteers receiving gastric acid-suppressive medication. A single-center, double-blind, randomized, cross-over study was conducted in healthy volunteers with esomeprazole-induced hypochlorhydria. After a standardized low phosphorus meal followed by overnight fasting, subjects consumed 1 gram of phosphorus in a single oral dose of 1217 kcal of Product A (Neocate) or Product B (Elecare). The alternate product was given following a 1-week washout period. Blood and urine were collected at baseline and different time-points for up to 6 hours after product consumption. Area-under-the-curve (AUC) and peak values (Cpeak) for serum phosphate and calcium and urinary creatinine-corrected phosphate and calcium were assessed for bioequivalence of Products A and B. Results show that the geometric mean ratio (GMR) and 90% CI for serum phosphate were 1.041 (0.998-1.086) and 1.020 (0.963-1.080) for AUC0-360 and Cpeak, respectively, meeting the predetermined criteria for bioequivalence. Urinary creatinine-corrected phosphate followed a similar pattern after intake of Product A and B, but did not reach bioequivalence criteria (GMR: AUC70-370 = 1.105 (0.918-1.330); Cpeak = 1.182 (1.040-1.343)). Serum calcium concentrations (GMR: AUC0-360 = 1.002 (0.996-1.009); Cpeak = 0.991 (0.983-0.999)) and urinary creatinine-corrected calcium excretion (GMR: AUC70-370 = 1.117 (1.023-1.219); Cpeak = 1.157 (1.073-1.247)) demonstrated bioequivalence of the products. In conclusion, both elemental infant formulas showed equivalent serum phosphorus and calcium bioavailability in healthy volunteers even if combined with treatment with acid-suppressive medication.
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Affiliation(s)
- Clemens Bergwitz
- Yale University School of Medicine, Section of Endocrinology and Metabolism, New Haven, CT, USA
| | | | | | | | - Thomas O Carpenter
- Yale University School of Medicine, Department of Pediatrics, New Haven, CT, USA
| | - Ardy van Helvoort
- Danone Nutricia Research, Utrecht, The Netherlands; Maastricht University, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht, The Netherlands
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11
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Kroon MLA, Warners MJ, Ampting MTJ, Harthoorn LF, Bredenoord AJ, Doorn M, Kok M, Rhijn BD, Eussen SRBM, Vlieg‐Boerstra BJ. The relationship of habitual diet with esophageal inflammation and integrity in eosinophilic esophagitis. Allergy 2019; 74:1005-1009. [PMID: 30515844 DOI: 10.1111/all.13695] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Marlou L. A. Kroon
- Department of Health Sciences University Medical Center Groningen, University of Groningen Groningen The Netherlands
| | - Marijn J. Warners
- Department of Gastroenterology & Hepatology Academic Medical Center Amsterdam The Netherlands
| | | | - Lucien F. Harthoorn
- Nutricia Research Nutricia Advanced Medical Nutrition Utrecht The Netherlands
| | - Arjan J. Bredenoord
- Department of Gastroenterology & Hepatology Academic Medical Center Amsterdam The Netherlands
| | - Mylene Doorn
- Division of Human Nutrition Wageningen University Wageningen The Netherlands
| | - Melanie Kok
- Department of Gastroenterology & Hepatology Academic Medical Center Amsterdam The Netherlands
| | - Bram D. Rhijn
- Department of Dermatology & Allergology University Medical Center Utrecht The Netherlands
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12
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Alles MS, Eussen SRBM, van der Beek EM. Nutritional challenges and opportunities during the weaning period and in young childhood. Ann Nutr Metab 2014; 64:284-93. [PMID: 25300272 DOI: 10.1159/000365036] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The early years of life are a period of very rapid growth and development. In this critical phase, food preferences are formed which carry over into childhood and beyond and foundations are laid for a healthy adult life. Excess energy, imbalances in macronutrient quality, and nutritional deficiencies may form inappropriate nutritional signals, leading to metabolic disturbances and affecting the obesity risk. For instance, the intake of protein and sugar-sweetened beverages in young children has been associated with an increased risk of overweight and obesity. In reality, scientific reports have shown that the dietary intakes of vegetables, α-linolenic acid, docosahexaenoic acid, iron, vitamin D, and iodine are low and the intakes of protein, saturated fatty acids, and added sugar are high in young children living in Europe. A focus on improving feeding habits and approaches to support more balanced nutritional intakes early in life may have significant public health benefits.
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Affiliation(s)
- Martine S Alles
- Nutricia Research, Danone Nutricia Early Life Nutrition, Utrecht, The Netherlands
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13
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Eussen SRBM, Geleijnse JM, Giltay EJ, Rompelberg CJM, Klungel OH, Kromhout D. Effects of n-3 fatty acids on major cardiovascular events in statin users and non-users with a history of myocardial infarction. Eur Heart J 2012; 33:1582-8. [PMID: 22301766 DOI: 10.1093/eurheartj/ehr499] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [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] [Indexed: 11/13/2022] Open
Abstract
AIMS Recent secondary prevention trials have failed to demonstrate a beneficial effect of n-3 fatty acids on cardiovascular outcomes, which may be due to the growing use of statins since the mid-1990s. The aim of the present study was to assess whether statins modify the effects of n-3 fatty acids on major adverse cardiovascular events in patients with a history of myocardial infarction (MI). METHODS AND RESULTS Patients who participated in the Alpha Omega Trial were divided into consistent statin users (n = 3740) and consistent statin non-users (n = 413). In these two groups of patients, the effects of an additional daily amount of 400 mg eicosapentaenoic acid (EPA) plus docosahexaenoic acid (DHA), 2 g α-linolenic acid (ALA), or both on major cardiovascular events were evaluated. Multivariable Cox's proportional hazard models were used to calculate adjusted hazard rate ratios (HR(adj)). Among the statin users 495 (13%) and among the statin non-users 62 (15%) developed a major cardiovascular event. In statin users, an additional amount of n-3 fatty acids did not reduce cardiovascular events [HR(adj) 1.02; 95% confidence interval (CI): 0.80, 1.31; P = 0.88]. In statin non-users, however, only 9% of those who received EPA-DHA plus ALA experienced an event compared with 18% in the placebo group (HR(adj) 0.46; 95% CI: 0.21, 1.01; P= 0.051). CONCLUSION In patients with a history of MI who are not treated with statins, low-dose supplementation with n-3 fatty acids may reduce major cardiovascular events. This study suggests that statin treatment modifies the effects of n-3 fatty acids on the incidence of major cardiovascular events.
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Affiliation(s)
- Simone R B M Eussen
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
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14
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van den Elsen LWJ, Noakes PS, van der Maarel MA, Kremmyda LS, Vlachava M, Diaper ND, Miles EA, Eussen SRBM, Garssen J, Willemsen LEM, Wilson SJ, Godfrey KM, Calder PC. Salmon consumption by pregnant women reduces ex vivo umbilical cord endothelial cell activation. Am J Clin Nutr 2011; 94:1418-25. [PMID: 22011457 DOI: 10.3945/ajcn.111.016592] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND In vitro exposure of endothelial cells (ECs) to n-3 (omega-3) long-chain PUFAs (LCPUFAs) reduces cell adhesion molecule (CAM) expression. However, to our knowledge, no previous human studies have examined the influence of an altered diet on CAM expression. OBJECTIVE We assessed whether salmon (rich in n-3 LCPUFAs) consumption twice a week during pregnancy affected offspring umbilical vein EC CAM expression. DESIGN Women were randomly assigned to maintain their habitual diets or to consume 2 portions of salmon per week during pregnancy months 4-9. ECs were isolated from umbilical cord veins collected at birth and cultured. The cell surface expression of intercellular adhesion molecule 1 (ICAM-1) and vascular cell adhesion molecule 1 (VCAM-1) was assessed by flow cytometry after the culture of ECs in the presence and absence of bacterial LPS for 24 h. Cytokine and growth factor concentrations in culture supernatant fluid were measured by using a multiplex assay. RESULTS LPS increased the expression of VCAM-1 and the production of several cytokines and growth factors. The level of ICAM-1 expression per cell [ie, the median fluorescence intensity (MFI)] was increased by LPS stimulation in the control group (16.9 ± 2.4 compared with 135.3 ± 20.2; P < 0.001) and to a lesser extent in the salmon group (14.1 ± 3.8 compared with 65.8 ± 22.4; P = 0.037). The ICAM-1 MFI in the salmon group after LPS stimulation was lower than in the control group (P = 0.006). CONCLUSION Increased dietary salmon intake in pregnancy dampens offspring EC activation, which implicates a role for n-3 LCPUFAs in the suppression of inflammatory processes in humans. This trial was registered at clinicaltrials.gov as NCT00801502.
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Affiliation(s)
- Lieke W J van den Elsen
- Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Netherlands
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15
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Eussen SRBM, Bouvy ML, Rompelberg CJM, van der Elst ME, Garssen J, Oosterveld MH, de Boer A, de Gier JJ, van Kranen HJ, Klungel OH. Influence of the use of functional foods enriched with phytosterols/-stanols on adherence to statin therapy. Pharmacoepidemiol Drug Saf 2011; 20:830-7. [DOI: 10.1002/pds.2168] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2011] [Revised: 03/04/2011] [Accepted: 04/14/2011] [Indexed: 11/10/2022]
Affiliation(s)
- Simone R. B. M. Eussen
- Utrecht Institute for Pharmaceutical Sciences; Utrecht The Netherlands
- National Institute for Public Health and the Environment (RIVM); Bilthoven The Netherlands
| | - Marcel L. Bouvy
- Utrecht Institute for Pharmaceutical Sciences; Utrecht The Netherlands
| | - Cathy J. M. Rompelberg
- National Institute for Public Health and the Environment (RIVM); Bilthoven The Netherlands
| | | | - Johan Garssen
- Utrecht Institute for Pharmaceutical Sciences; Utrecht The Netherlands
| | | | - Anthonius de Boer
- Utrecht Institute for Pharmaceutical Sciences; Utrecht The Netherlands
| | - Johan J. de Gier
- Department of Pharmacotherapy and Pharmaceutical Care; University of Groningen; Groningen The Netherlands
| | - Henk J. van Kranen
- National Institute for Public Health and the Environment (RIVM); Bilthoven The Netherlands
| | - Olaf H. Klungel
- Utrecht Institute for Pharmaceutical Sciences; Utrecht The Netherlands
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16
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Eussen SRBM, van der Elst ME, Klungel OH, Rompelberg CJM, Garssen J, Oosterveld MH, de Boer A, de Gier JJ, Bouvy ML. A pharmaceutical care program to improve adherence to statin therapy: a randomized controlled trial. Ann Pharmacother 2010; 44:1905-13. [PMID: 21119098 DOI: 10.1345/aph.1p281] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Despite the well-known beneficial effects of statins, many patients do not adhere to chronic medication regimens. OBJECTIVE To implement and assess the effectiveness of a community pharmacy-based pharmaceutical care program developed to improve patients' adherence to statin therapy. METHODS An open-label, prospective, randomized controlled trial was conducted at 26 community pharmacies in the Netherlands. New users of statins who were aged 18 years or older were randomly assigned to receive either usual care or a pharmacist intervention. The intervention consisted of 5 individual counseling sessions by a pharmacist during a 1-year period. During these sessions, patients received structured education about the importance of medication adherence, lipid levels were measured, and the association between adherence and lipid levels was discussed. Adherence to statin therapy was assessed as discontinuation rates 6 and 12 months after statin initiation, and as the medication possession ratio (MPR), and compared between the pharmaceutical care and usual care groups. RESULTS A total of 899 subjects (439 in the pharmaceutical care group and 460 in the usual care group) were evaluable for effectiveness analysis. The pharmaceutical care program resulted in a significantly lower rate of discontinuation within 6 months after initiating therapy versus usual care (HR 0.66, 95% CI 0.46 to 0.96). No significant difference between groups was found in discontinuation at 12 months (HR 0.84, 95% CI 0.65 to 1.10). Median MPR was very high (>99%) in both groups and did not differ between groups. CONCLUSIONS These results demonstrate the feasibility and effectiveness of a community pharmacy-based pharmaceutical care program to improve medication adherence in new users of statins. Frequent counseling sessions (every 3 months) are necessary to maintain the positive effects on discontinuation. Although improvements are modest, the program can be applied easily to a larger population and have a large impact, as the interventions are relatively inexpensive and easy to implement in clinical practice.
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Affiliation(s)
- Simone R B M Eussen
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht, Netherlands.
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17
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Eussen SRBM, de Jong N, Rompelberg CJM, Garssen J, Verschuren WMM, Klungel OH. Effects of the use of phytosterol/-stanol-enriched margarines on adherence to statin therapy. Pharmacoepidemiol Drug Saf 2010; 19:1225-32. [DOI: 10.1002/pds.2042] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2010] [Revised: 06/24/2010] [Accepted: 08/04/2010] [Indexed: 12/26/2022]
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