Relationship between health practices with attitudes towards pregnancy and motherhood and pregnancy symptoms in Iranian pregnant women: a cross-sectional study

OBJECTIVES

Pregnancy is a vulnerable period for women's health, and health practices play an essential role in this period. This study aimed to determine the relationship between health practices with attitudes toward pregnancy and motherhood and pregnancy symptoms.

DESIGN

It was a cross-sectional study using cluster sampling conducted on 351 pregnant women in 2021-2022. Data were collected using questionnaires of socio-demographic characteristics, health practices in pregnancy (Health Practices Questionnaire-II), attitude towards motherhood and pregnancy (Prenatal Attitudes Towards motherhood and Pregnancy) and pregnancy symptoms (Pregnancy Symptoms Inventory). The general linear model (GLM), with the adjustment of socio-demographic characteristics, was used to determine the relationship of the health practices with attitudes towards motherhood and pregnancy and pregnancy symptoms.

SETTING

Health centres in Tabriz city, Iran.

PARTICIPANTS

Women were eligible if living in the Tabriz city, Iran, were pregnant and had a personal health record at the health centre.

RESULTS

The mean (SD) of the total health practices score was 117.9 (20.5) out of 34-170. The mean (SD) of the attitudes towards motherhood and pregnancy was 33.4 (4.5) out of 11-44. The mean (SD) of the pregnancy symptoms was 28.0 (12.1) out of 0-123. According to the Pearson correlation test, there was a significant direct correlation between health practices with attitudes towards motherhood and pregnancy (r=0.39; p<0.001) and a significant inverse correlation with pregnancy symptoms (r=-0.29; p<0.001). Based on the GLM with an increase in the score of health practices, the mean score of the attitude towards motherhood and pregnancy increased (B=0.07; 95% CI: 0.05 to 0.1), and the mean score of pregnancy symptoms decreased (B=-0.1; 95% CI: -0.2 to -0.05).

CONCLUSION

Considering the relationship between health practices with the attitude towards motherhood and pregnancy symptoms, healthcare providers better use educational and counselling strategies to promote health practices in pregnant women.

Are dietary vitamin D, omega-3 fatty acids and folate associated with treatment results in patients with early rheumatoid arthritis? Data from a Swedish population-based prospective study

BACKGROUND

Dietary intake of vitamin D and omega-3 fatty acids (FA) may be associated with superior response to antirheumatic treatments. In addition, dietary folate intake may be associated with worse response to methotrexate (MTX). The aim of this study was to investigate the association between dietary vitamin D, omega-3 FA, folate and treatment results of disease-modifying antirheumatic drugs (DMARDs) in patients with rheumatoid arthritis (RA).

METHODS

This prospective study was based on data from the Epidemiological Investigation of Rheumatoid Arthritis (EIRA) study, and included 727 patients with early RA from 10 hospitals in Sweden. Data on dietary vitamin D, omega-3 FA and folate intake based on food frequency questionnaires were linked with data on European League Against Rheumatism (EULAR) response after 3 months of DMARD treatment. Associations between vitamin D, omega-3 FA, folate and EULAR response were analysed with logistic regression adjusted for potential confounders.

RESULTS

The majority of patients (89.9%) were initially treated with MTX monotherapy and more than half (56.9%) with glucocorticoids. Vitamin D and omega-3 FA were associated with good EULAR response (OR 1.80 (95% CI 1.14 to 2.83) and OR 1.60 (95% CI 1.02 to 2.53), respectively). Folate was not significantly associated with EULAR response (OR 1.20 (95% CI 0.75 to 1.91)). Similar results were seen in a subgroup of patients who were initially treated with MTX monotherapy at baseline.

CONCLUSIONS

Higher intake of dietary vitamin D and omega-3 FA during the year preceding DMARD initiation may be associated with better treatment results in patients with early RA. Dietary folate intake was not associated with worse or better response to treatment, especially to MTX. Our results suggest that some nutrients may be associated with enhanced treatment results of DMARDs.

Poor infant and young child feeding practices and sources of caregivers' feeding knowledge in rural Hebei Province, China: findings from a cross-sectional survey

OBJECTIVES

To obtain a general overview of infant and young child feeding practices in one rural county in China and identify current delivery channels and challenges.

DESIGN

A cross-sectional study.

SETTING

A rural county, Zhao County, in Hebei Province, China.

PARTICIPANTS

10 clusters were first selected within each township (16 townships in total) with proportional to population size sampling. In each cluster, a name list was used to select 13 children aged 0-23 months. We interviewed caregivers of all the selected children.

PRIMARY AND SECONDARY OUTCOMES MEASURES

Coverage of infant feeding practices, reasons for low coverage of infant feeding practices and current delivery channels of infant feeding practices.

RESULTS

Findings from our survey indicated that infant feeding practices were poor. Early initiation of breastfeeding was only 22.4%, exclusive breastfeeding for 6 months was less than 10% and continued breastfeeding up to the age of two was just 38.2%. Only 32.5% of children were given iron-rich or iron-fortified foods. The leading sources of infant feeding information were family members, neighbours, friends and popular media. Only around 20% of the information came from health facilities and nearly none came from communities. Household property data showed that 99.9% of households owned televisions and 99.4% owned mobile phones. In addition, 61.2% of the households owned computers, with 54.8% having access to the internet.

CONCLUSIONS

Few caregivers of children in Zhao County received feeding information during pregnancy and after delivery. Moreover, their feeding knowledge and practices were poor. Multi-channel approaches, delivered through health facilities, community resources, popular media, the internet and mobile phones, hold potential to improve infant feeding practices and should be explored in future studies.

STRENGTHS AND LIMITATIONS

Although this study took place only within one county, a full range of globally standard feeding indicators was used to assess the feeding practices of caregivers in our study. The name lists of children in some villages may not be complete, and therefore selection bias may have occurred. Some indicators may have recall bias due to long recall time.

TRIAL REGISTRATION NUMBER

ChiCTR-PRC-11001446.

Effect of tree nuts on metabolic syndrome criteria: a systematic review and meta-analysis of randomised controlled trials

OBJECTIVE

To provide a broader evidence summary to inform dietary guidelines of the effect of tree nuts on criteria of the metabolic syndrome (MetS).

DESIGN

We conducted a systematic review and meta-analysis of the effect of tree nuts on criteria of the MetS.

DATA SOURCES

We searched MEDLINE, EMBASE, CINAHL and the Cochrane Library (through 4 April 2014).

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

We included relevant randomised controlled trials (RCTs) of ≥3 weeks reporting at least one criterion of the MetS.

DATA EXTRACTION

Two or more independent reviewers extracted all relevant data. Data were pooled using the generic inverse variance method using random effects models and expressed as mean differences (MD) with 95% CIs. Heterogeneity was assessed by the Cochran Q statistic and quantified by the I(2) statistic. Study quality and risk of bias were assessed.

RESULTS

Eligibility criteria were met by 49 RCTs including 2226 participants who were otherwise healthy or had dyslipidaemia, MetS or type 2 diabetes mellitus. Tree nut interventions lowered triglycerides (MD=-0.06 mmol/L (95% CI -0.09 to -0.03 mmol/L)) and fasting blood glucose (MD=-0.08 mmol/L (95% CI -0.16 to -0.01 mmol/L)) compared with control diet interventions. There was no effect on waist circumference, high-density lipoprotein cholesterol or blood pressure with the direction of effect favouring tree nuts for waist circumference. There was evidence of significant unexplained heterogeneity in all analyses (p<0.05).

CONCLUSIONS

Pooled analyses show a MetS benefit of tree nuts through modest decreases in triglycerides and fasting blood glucose with no adverse effects on other criteria across nut types. As our conclusions are limited by the short duration and poor quality of the majority of trials, as well as significant unexplained between-study heterogeneity, there remains a need for larger, longer, high-quality trials.

TRIAL REGISTRATION NUMBER

NCT01630980.

Lifetime alcohol use and overall and cause-specific mortality in the European Prospective Investigation into Cancer and nutrition (EPIC) study

OBJECTIVES

To investigate the role of factors that modulate the association between alcohol and mortality, and to provide estimates of absolute risk of death.

DESIGN

The European Prospective Investigation into Cancer and nutrition (EPIC).

SETTING

23 centres in 10 countries.

PARTICIPANTS

380 395 men and women, free of cancer, diabetes, heart attack or stroke at enrolment, followed up for 12.6 years on average.

MAIN OUTCOME MEASURES

20 453 fatal events, of which 2053 alcohol-related cancers (ARC, including cancers of upper aerodigestive tract, liver, colorectal and female breast), 4187 cardiovascular diseases/coronary heart disease (CVD/CHD), 856 violent deaths and injuries. Lifetime alcohol use was assessed at recruitment.

RESULTS

HRs comparing extreme drinkers (≥30 g/day in women and ≥60 g/day in men) to moderate drinkers (0.1-4.9 g/day) were 1.27 (95% CI 1.13 to 1.43) in women and 1.53 (1.39 to 1.68) in men. Strong associations were observed for ARC mortality, in men particularly, and for violent deaths and injuries, in men only. No associations were observed for CVD/CHD mortality among drinkers, whereby HRs were higher in never compared to moderate drinkers. Overall mortality seemed to be more strongly related to beer than wine use, particularly in men. The 10-year risks of overall death for women aged 60 years, drinking more than 30 g/day was 5% and 7%, for never and current smokers, respectively. Corresponding figures in men consuming more than 60 g/day were 11% and 18%, in never and current smokers, respectively. In competing risks analyses, mortality due to CVD/CHD was more pronounced than ARC in men, while CVD/CHD and ARC mortality were of similar magnitude in women.

CONCLUSIONS

In this large European cohort, alcohol use was positively associated with overall mortality, ARC and violent death and injuries, but marginally to CVD/CHD. Absolute risks of death observed in EPIC suggest that alcohol is an important determinant of total mortality.

Nutrient intake and brain biomarkers of Alzheimer's disease in at-risk cognitively normal individuals: a cross-sectional neuroimaging pilot study

OBJECTIVE

There is increasing evidence to suggest that diet, one of the most important modifiable environmental factors, may play a role in preventing or delaying cognitive decline and Alzheimer's disease (AD). This study examines the relationship between dietary nutrients and brain biomarkers of AD in cognitively normal individuals (NL) with and without AD risk factors.

DESIGN

As part of an ongoing brain imaging study, participants received clinical and laboratory examinations, a neurocognitive test battery, positron emission tomography (PET) with (11)C-Pittsburgh Compound-B (PiB; a measure of amyloid-β (Aβ) load) and (18)F-fluorodeoxyglucose (FDG; a proxy of neuronal activity), and completed semiquantitative food frequency questionnaires.

SETTING

Research centre affiliated with the Alzheimer's disease Core Center at New York University School of Medicine.

PARTICIPANTS

49 NL individuals (age 25-72 years, 69% women) with dietary information, (11)C-PiB and (18)F-FDG PET scans were examined.

RESULTS

Controlling for age and total caloric intake, higher intake of vitamin B12, vitamin D and ω-3 polyunsaturated fatty acid (PUFA) was associated with lower Aβ load in AD regions on PiB-PET, while higher intake of β-carotene and folate was associated with higher glucose metabolism on FDG-PET. β-carotene and folate were associated with reduced glucose metabolism for women, apolipoprotein E epsilon 4 (APOE4) carriers and participants with positive AD family history, but not for their risk-free counterparts. The associations of vitamin B12, vitamin D and ω-3 PUFA with PiB retention were independent of gender, APOE and family history. The identified nutrient combination was associated with higher intake of vegetables, fruit, whole grains, fish and legumes, and lower intake of high-fat dairies, meat and sweets.

CONCLUSIONS

Our data provide a potential pathophysiological mechanism for epidemiological findings showing that dietary interventions may play a role in the prevention of AD. Longitudinal studies are needed to determine whether there is a direct link between nutrient intake, brain biomarkers and risk of AD.

Study protocol for the nutritional route in oesophageal resection trial: a single-arm feasibility trial (NUTRIENT trial)

INTRODUCTION

The best route of feeding for patients undergoing an oesophagectomy is unclear. Concerns exist that early oral intake would increase the incidence and severity of pneumonia and anastomotic leakage. However, in studies including patients after many other types of gastrointestinal surgery and in animal experiments, early oral intake has been shown to be beneficial and enhance recovery. Therefore, we aim to determine the feasibility of early oral intake after oesophagectomy.

METHODS AND ANALYSIS

This study is a feasibility trial in which 50 consecutive patients will start oral intake directly following oesophagectomy. Primary outcomes will be the frequency and severity of anastomotic leakage and (aspiration) pneumonia. Clinical parameters will be registered prospectively and nutritional requirements and intake will be assessed by a dietician. Surgical complications will be registered.

ETHICS AND DISSEMINATION

Approval for this study has been obtained from the Medical Ethical Committee of the Catharina Hospital Eindhoven and the study has been registered at the Dutch Trial Register, NTR4136. Results will be published and presented at international congresses.

DISCUSSION

We hypothesise that the oral route of feeding is safe and feasible following oesophagectomy, as has been shown previously for other types of gastrointestinal surgery. It is expected that early oral nutrition will result in enhanced recovery. Furthermore, complications related to artificial feeding, such as jejunostomy tube feeding, are believed to be reduced. However, (aspiration) pneumonia and anastomotic leakage are potential risks that are carefully monitored.

TRIAL REGISTRATION NUMBER

NTR4136.

Tracing artificial trans fat in popular foods in Europe: a market basket investigation

OBJECTIVE

To minimise the intake of industrial artificial trans fat (I-TF), nearly all European countries rely on food producers to voluntarily reduce the I-TF content in food. The objective of this study was to investigate the effect of this strategy on I-TF content in prepackaged biscuits/cakes/wafers in 2012-2013 in 20 European countries.

DESIGN

The I-TF content was assessed in a market basket investigation. Three large supermarkets were visited in each capital, and in some countries, three additional ethnic shops were included.

RESULTS

A total of 598 samples of biscuits/cakes/wafers with 'partially hydrogenated vegetable fat' or a similar term high on the list of ingredients were analysed, 312 products had more than 2% of fat as I-TF, exceeding the legislatively determined I-TF limit in Austria and Denmark; the mean (SD) was 19 (7)%. In seven countries, no I-TF was found, whereas nine predominantly Eastern European countries had products with very high I-TF content, and the remaining four countries had intermediate levels. Of the five countries that were examined using the same procedure as in 2006, three had unchanged I-TF levels in 2013, and two had lower levels. The 18 small ethnic shops examined in six Western European countries sold 83 products. The mean (SD) was 23 (12)% of the fat as I-TF, all imported from countries in Balkan. In Sweden, this type of food imported from Balkan was also available in large supermarkets.

CONCLUSIONS

The findings suggest that subgroups of the population in many countries in Europe still consume I-TF in amounts that increase their risk of coronary heart disease. Under current European Union (EU) legislation, the sale of products containing I-TF is legal but conflicts with the WHO recommendation to minimise the intake of I-TF. An EU-legislative limit on I-TF content in foods is expected to be an effective strategy to achieve this goal.

Is density of neighbourhood restaurants associated with BMI in rural Chinese adults? A longitudinal study from the China Health and Nutrition Survey

OBJECTIVES

The neighbourhood availability of restaurants has been linked to the weight status. However, little is known regarding the relation between access to restaurant and obesity among the Chinese population. This study aims to explore the relationship between neighbourhood restaurant density and body mass index (BMI) in rural China.

DESIGN

A longitudinal study using data from the China Health and Nutrition Survey (CHNS) was conducted. Participants aged 18 and older from the 2004, 2006, 2009 and 2011 CHNS were recruited Separate sex-stratified random intercept-slope growth models of repeated BMI observations were estimated in the study.

SETTING

The data were derived from rural communities in nine provinces in China.

PARTICIPANTS

There were 11 835 male and 12 561 female person-years assessed in this study.

OUTCOMES

The primary outcome of this study was weight status. It is defined as a BMI value, a continuous variable which is calculated by dividing weight (kg) by the square of height (m(2)).

RESULTS

The study indicated that among men an increase of one indoor restaurant in the neighbourhood was associated with a 0.01 kg/m(2) increase in BMI, and an increase of one fixed outdoor food stall was associated with a 0.01 kg/m(2) decrease in BMI, whereas among women, an increase of one indoor restaurant in the neighbourhood was associated with a 0.005 kg/m(2) increase in BMI, and an increase of one fast-food restaurant and one fixed outdoor food stall was associated with a 0.02 and 0.004 kg/m(2) decline in BMI, respectively.

CONCLUSIONS

The density of neighbourhood restaurants was found to be significantly related to BMI in rural China. The results indicated that providing healthy food choices and developing related public health policies are necessary to tackle obesity among rural Chinese adults.

Comparing dietary patterns of depressed patients versus healthy people in a case control protocol

INTRODUCTION

Major depressive disorder is the leading cause of disability around the world. Because of the high rate of medication discontinuation by patients and the risk of recurrence, factors such as nutrition could be useful for the prevention or treatment of depression. The relationship between depression and dietary patterns has been reported in a few studies but with controversial results. Therefore, we have decided to study the possible effects of cultural, social, racial, geographic and environmental conditions on this relationship in an Iranian population.

METHODS AND ANALYSIS

In our case control protocol, 110 cases and 220 controls will be individually matched based on age, sex and area of residence. New cases of depression, based on the criteria of the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV), will be recruited from two psychiatric clinics in Tehran. Interviewers will then go to each patient's home and invite qualified individuals to participate in the study as controls. Food intakes of all participants will be obtained by semiquantitative food frequency questionnaires covering the past year; these will be transformed into actual food intake (g/day). Dietary patterns will be determined by the principal components method. Conditional logistic regression, as a multivariate analysis, will be used for assessing the relationship between dietary patterns and depression, taking into consideration the potential role of different variables. The results may help to identify differences in dietary patterns between depressed and healthy people.

ETHICS AND DISSEMINATION

The study protocol has been approved by ethics committee of Tehran University of Medical Sciences. At the beginning of the study, a written informed consent form will be signed and dated by subjects and investigators. The results will be published in due time.

Validity of instruction leaflets for parents to measure their child's weight and height at home: results obtained from a randomised controlled trial

OBJECTIVES

To compare the validity of parent-reported height, weight and body mass index (BMI) values of children (aged 4-10 years), when measured at home by means of newly developed instruction leaflets in comparison with simple estimated parental reports.

DESIGN

Randomised controlled trial with control and intervention group using simple randomisation.

SETTING

Belgian children and their parents recruited via schools (multistage cluster sampling design).

PARTICIPANTS

164 Belgian children (53% male; participation rate 62%).

INTERVENTION

Parents completed a questionnaire including questions about the height and weight of their child. Parents in the intervention group received instruction leaflets to measure their child's weight and height. Classes were randomly allocated to the intervention and control groups. Nurses measured height and weight following standardised procedures up to 2 weeks after parental reports.

OUTCOME MEASURES

Weight, height and BMI category of the child were derived from the index measurements and the parental reports.

RESULTS

Mean parent-reported weight was slightly more underestimated in the intervention group than in the control group relative to the index weights. However, for all three parameters (weight, height and BMI), correlations between parental reports and nurse measurements were higher in the intervention group. Sensitivity for underweight and overweight/obesity was respectively, 75% and 60% in the intervention group, and 67% and 43% in the control group. Weighed κ for classifying children in the correct BMI category was 0.30 in the control group and was 0.51 in the intervention group.

CONCLUSIONS

Although mean parent-reported weight was slightly more underestimated in the intervention than in the control group, correlations were higher and there was considerably less misclassification into valid BMI categories for the intervention group. This pattern suggests that most of the parental deviations from the index measurements were probably due to random errors of measurement and that diagnostic measures could improve by encouraging parents to measure their children's weight and height at home by means of instruction leaflets.

Salt intake assessed by 24 h urinary sodium excretion in a random and opportunistic sample in Australia

OBJECTIVE

The gold standard method for measuring population sodium intake is based on a 24 h urine collection carried out in a random population sample. However, because participant burden is high, response rates are typically low with less than one in four agreeing to provide specimens. At this low level of response it is possible that simply asking for volunteers would produce the same results.

SETTING

Lithgow, New South Wales, Australia.

PARTICIPANTS

We randomly selected 2152 adults and obtained usable 24 h urine samples from 306 (response rate 16%). Specimens were also collected from a further 113 volunteers. Estimated salt consumption and the costs for each strategy were compared.

RESULTS

The characteristics of the 'random' and 'volunteer' samples were moderately different in mean age 58 (SD 14.6 vs 49(17.7) years, respectively; p<0.001) as well as self-reported alcohol use, tobacco use, history of hypertension and prescription drug use (all p<0.04). Overall crude mean 24 h urinary salt excretion was 8.9(3.6) g/day in the random sample vs 8.5(3.3) g/day for the volunteers (p=0.42). Corresponding age-adjusted and sex-adjusted estimates were 9.2(3.3) and 8.8(3.4) g/day (p=0.29). Estimates for men 10.3(3.8) vs 9.6(3.3) g/day; (p=0.26) and women 7.6(3) vs 7.9(3.2) g/day; (p=0.43) were also similar for the two samples, as was salt excretion across age groups (p=0.72). The cost of obtaining each 24 h urine sample was two times greater for the random compared to volunteer samples ($A62 vs $A31).

CONCLUSIONS

The estimated salt consumption derived from the two samples was comparable and was not substantively different to estimates obtained from other surveys. In countries where salt is pervasive and cannot easily be avoided, estimates of consumption obtained from volunteer samples may be valid and less costly.

Global, regional and national sodium intakes in 1990 and 2010: a systematic analysis of 24 h urinary sodium excretion and dietary surveys worldwide

OBJECTIVES

To estimate global, regional (21 regions) and national (187 countries) sodium intakes in adults in 1990 and 2010.

DESIGN

Bayesian hierarchical modelling using all identifiable primary sources.

DATA SOURCES AND ELIGIBILITY

We searched and obtained published and unpublished data from 142 surveys of 24 h urinary sodium and 103 of dietary sodium conducted between 1980 and 2010 across 66 countries. Dietary estimates were converted to urine equivalents based on 79 pairs of dual measurements.

MODELLING METHODS

Bayesian hierarchical modelling used survey data and their characteristics to estimate mean sodium intake, by sex, 5 years age group and associated uncertainty for persons aged 20+ in 187 countries in 1990 and 2010. Country-level covariates were national income/person and composition of food supplies.

MAIN OUTCOME MEASURES

Mean sodium intake (g/day) as estimable by 24 h urine collections, without adjustment for non-urinary losses.

RESULTS

In 2010, global mean sodium intake was 3.95 g/day (95% uncertainty interval: 3.89 to 4.01). This was nearly twice the WHO recommended limit of 2 g/day and equivalent to 10.06 (9.88-10.21) g/day of salt. Intake in men was ∼10% higher than in women; differences by age were small. Intakes were highest in East Asia, Central Asia and Eastern Europe (mean >4.2 g/day) and in Central Europe and Middle East/North Africa (3.9-4.2 g/day). Regional mean intakes in North America, Western Europe and Australia/New Zealand ranged from 3.4 to 3.8 g/day. Intakes were lower (<3.3 g/day), but more uncertain, in sub-Saharan Africa and Latin America. Between 1990 and 2010, modest, but uncertain, increases in sodium intakes were identified.

CONCLUSIONS

Sodium intakes exceed the recommended levels in almost all countries with small differences by age and sex. Virtually all populations would benefit from sodium reduction, supported by enhanced surveillance.

Joint effects of serum ferritin and body mass index on the risk of coronary artery disease: a case-control study

OBJECTIVES

Serum ferritin and body mass index (BMI) have been reportedly associated with coronary artery disease (CAD) risk. The aim of the present study was to explore the interaction between serum ferritin and BMI on CAD risk.

DESIGN

Hospital-based case-control study.

SETTING

Patients with CAD and the controls were recruited from Qilu Hospital, Shandong University.

PARTICIPANTS

258 CAD cases and 282 healthy controls.

METHODS

Multiplicative interaction was assessed through a cross-product interaction term in a multivariate logistic regression model. The effect of serum ferritin and BMI were evaluated per 50 µg/L and per 2 kg/m(2), respectively. The presence of additive interaction between serum ferritin and BMI was evaluated by calculation of the relative excess risk due to interaction (RERI), attributable proportion due to interaction (AP) and synergy index (S).

RESULTS

The ORs and 95% CI of the serum ferritin-BMI product term on a multiplicative scale in the univariate and multivariate models were 0.943 (0.904 to 0.984) and 1.004 (0.951 to 1.059), respectively. There was also evidence for interaction on an additive scale; the RERI (95% CI), AP (95% CI) and S (95% CI) in the univariate model were 0.314 (0.026 to 1.506), 0.107 (0.017 to 0.241) and 1.194 (1.053 to 1.406), respectively. After adjusting for the potential confounders, the estimates and 95% CIs for the aforementioned three measures were 0.004 (-0.016 to 0.311), 0.004 (-0.016 to 0.191) and 1.039 (0.774 to 1.285), respectively.

CONCLUSIONS

Serum ferritin and BMI had an additive interaction on the risk of CAD in Chinese population. Further investigations with big sample size are necessary for confirming this additive interaction.

Design of a randomised controlled trial of adapted physical activity during adjuvant treatment for localised breast cancer: the PASAPAS feasibility study

INTRODUCTION

After a diagnosis of localised breast cancer, overweight, obesity and weight gain are negatively associated with prognosis. In contrast, maintaining an optimal weight through a balanced diet combined with regular physical activity appears to be effective protective behaviour against comorbidity or mortality after a breast cancer diagnosis. The primary aim of the Programme pour une Alimentation Saine et une Activité Physique Adaptée pour les patientes atteintes d'un cancer du Sein (PASAPAS) randomised controlled trial is to evaluate the feasibility of implementing an intervention of adapted physical activity (APA) for 6 months concomitant with the prescription of a first line of adjuvant chemotherapy. Secondary aims include assessing the acceptability of the intervention, compliance to the programme, process implementation, patients' satisfaction, evolution of biological parameters and the medicoeconomic impact of the intervention.

METHODS AND ANALYSIS

The study population consists of 60 women eligible for adjuvant chemotherapy after a diagnosis of localised invasive breast cancer. They will be recruited during a 2-year inclusion period and randomly allocated between an APA intervention arm and a control arm following a 2:1 ratio. All participants should benefit from personalised dietetic counselling and patients allocated to the intervention arm will be offered an APA programme of two to three weekly sessions of Nordic walking and aerobic fitness. During the 6-month intervention and 6-month follow-up, four assessments will be performed including blood draw, anthropometrics and body composition measurements, and questionnaires about physical activity level, diet, lifestyle factors, psychological criteria, satisfaction with the intervention and medical data.

ETHICS AND DISSEMINATION

The study was approved by the French Ethics Committee (Comité de Protection des Personnes Sud-Est IV) and the national agencies for biomedical studies and for privacy. All participants will give written informed consent. The study findings will be disseminated through the scientific public and serve as a foundation for future randomised controlled trials of efficacy.

Effect of ω-3 fatty acid supplementation on endothelial function, endogenous fibrinolysis and platelet activation in patients with a previous myocardial infarction: a randomised controlled trial

OBJECTIVE

The mechanisms through which ω-3 fatty acids reduce adverse cardiac events remain uncertain. We aimed to investigate the effect of ω-3 fatty acid supplementation on endothelial vasomotor function, endogenous fibrinolysis, and platelet and monocyte activation in patients with coronary heart disease.

DESIGN

Randomised, double-blind, placebo-controlled, cross-over trial.

SETTING

Academic cardiac centre.

PARTICIPANTS

20 male patients with a previous myocardial infarction.

INTERVENTION

ω-3 Fatty acid supplementation (2 g/day for 6 weeks) versus olive oil placebo.

OUTCOME MEASURES

Peripheral blood was taken for analysis of platelet and monocyte activation, and forearm blood flow (FBF) was assessed in a subset of 12 patients during intrabrachial infusions of acetylcholine, substance P and sodium nitroprusside. Stimulated plasma tissue plasminogen activator (t-PA) concentrations were measured during substance P infusion.

RESULTS

All vasodilators caused dose-dependent increases in FBF (p<0.0001). ω-3 Fatty acid supplementation did not affect endothelium-dependent vasodilation with acetylcholine and substance P compared with placebo (p=0.5 and 0.9). Substance P caused a dose-dependent increase in plasma t-PA concentrations (p<0.0001), which was not affected by ω-3 fatty acid supplementation (p=0.9). ω-3 Fatty acids did not affect platelet-monocyte aggregation, platelet P-selectin or CD40L, or monocyte CD40.

CONCLUSIONS

We have demonstrated that dietary supplementation with ω-3 fatty acids does not affect endothelial vasomotor function, endothelial t-PA release, or platelet and monocyte activation in patients with coronary heart disease. Cardiac benefits conferred by ω-3 fatty acids in coronary heart disease are unlikely to be mediated through effects on these systems.

Quality of newborn care: adherence to guidelines for parenteral nutrition in preterm infants in four European countries

OBJECTIVE

The level of adherence to guidelines should be explored particularly in preterm infants for whom poor nutrition has major effects on outcomes in later life. The objective was to evaluate compliance to international guidelines for parenteral nutrition (PN) in preterm infants across neonatal intensive care units (NICUs) of four European countries.

DESIGN

Clinical practice survey by means of a questionnaire addressing routine PN protocols, awareness and implementation of guidelines.

SETTING

NICUs in the UK, Italy, Germany and France.

PARTICIPANTS

One senior physician per unit; 199 units which represent 74% of the NICUs of the four countries.

PRIMARY OUTCOME MEASURE

Adherence of unit protocol to international guidelines.

SECONDARY OUTCOME MEASURE

Factors that influence adherence to guidelines.

RESULTS

80% of the respondents stated that they were aware of some PN clinical practice guidelines. For amino acid infusion (AA), 63% of the respondents aimed to initiate AA on D0, 38% aimed to administer an initial dose ≥1.5 g/kg/day and 91% aimed for a target dose of 3 or 4 g/kg/day, as recommended. For parenteral lipids, 90% of the respondents aimed to initiate parenteral lipids during the first 3 days of life, 39% aimed to use an initial dose ≥1.0 g/kg/day and 76% defined the target dose as 3-4 g/kg/day, as recommended. Significant variations in PN protocols were observed among countries, but the type of hospital or the number of admissions per year had only a marginal impact on the PN protocols.

CONCLUSIONS

Most respondents indicated that their clinical practice was based on common guidelines. However, the initiation of PN is frequently not compliant with current recommendations, with the main differences being observed during the first days of life. Continuous education focusing on PN practice is needed, and greater efforts are required to disseminate and implement international guidelines.

Prediction of initiation and cessation of breastfeeding from late pregnancy to 16 weeks: the Feeding Your Baby (FYB) cohort study

OBJECTIVE

To derive prediction models for both initiation and cessation of breastfeeding using demographic, psychological and obstetric variables.

DESIGN

A prospective cohort study.

SETTING

Women delivering at Ninewells Hospital, Dundee, UK.

DATA SOURCES

Demographic data and psychological measures were obtained during pregnancy by questionnaire. Birth details, feeding method at birth and at hospital discharge were obtained from the Ninewells hospital database, Dundee, UK. Breastfeeding women were followed up by text messages every 2 weeks until 16 weeks or until breastfeeding was discontinued to ascertain feeding method and feeding intentions.

PARTICIPANTS

Pregnant women over 30 weeks gestation aged 16 years and above, living in Dundee, booked to deliver at Ninewells Hospital, Dundee, and able to speak English.

MAIN OUTCOME MEASURE

Initiation and cessation of breastfeeding.

RESULTS

From the total cohort of women at delivery (n=344) 68% (95% CI 63% to 73%) of women had started breastfeeding at discharge. Significant predictors of initiating breastfeeding were older age, parity, greater intention to breastfeed from a Theory of Planned Behaviour (TPB)-based questionnaire, higher Iowa Infant Feeding Assessment Scale (IIFAS) score as well as living with a husband or partner. For the final model, the AUROC was 0.967. For those who initiated breastfeeding (n=233), the strongest predictors of stopping were low intention to breastfeed from TPB, low IIFAS score and non-managerial/professional occupations.

CONCLUSIONS

The findings from this study will be used to inform the protocol for an intervention study to encourage and support prolonged breastfeeding as intentions appear to be a key intervention focus for initiation. The predictive models could be used to identify women at high risk of not initiating and also women at high risk of stopping for interventions to improve the longevity of breastfeeding.

A cross-sectional study of Jamaican adolescents' risk for type 2 diabetes and cardiovascular diseases

OBJECTIVES

To compare obese versus non-obese Jamaican adolescents' risk for type 2 diabetes (T2D) and cardiovascular diseases (CVDs); and to explore a suitable and economical method of screening for these risk factors in the school settings.

DESIGN

A descriptive cross-sectional study of adolescents' risk for T2D and CVD. All the participants were examined at their respective schools.

SETTING

Jamaica, West Indies.

POPULATION

276 Jamaican adolescents aged 14-19 years, randomly selected from grades 9 to 12 from 10 high schools on the island and included both boys and girls. All ethnicities on the island were represented.

MAIN OUTCOME MEASURES

High fasting blood glucose, total cholesterol, glycated haemoglobin (HbA1c), blood pressure, body mass index (BMI), waist circumference, waist-to-hip ratio, family history of obesity, T2D and CVDs, low physical activity, and presence of Acanthosis Nigricans. All blood measures were analysed using the finger prick procedure.

RESULTS

Waist circumference, waist-to-hip ratio, Acanthosis Nigricans, total cholesterol, family history of T2D and blood pressure were the strongest predictors of BMI (p=0.001). Over one-third of the participants were overweight. Jamaican adolescent females had a significantly higher number of risk factors and were less physically active than males (p<0.05). Over 80% of participants reported ≥3 risk factors for T2D and CVD. Participants with BMI ≥25 reported five or more risk factors. One-third of the overweight participants were classified with metabolic syndrome.

CONCLUSIONS

Jamaican adolescents are at risk of T2D and CVD. Family history of disease and anthropometric measures identified more participants at risk than did the blood measures. Jamaican adolescent females reported more risk factors for T2D and CVD as compared to males. Collection of this type of data was feasible within the school settings. All data were collected in 1 day per school. Intervention measures are needed to educate Jamaican adolescents to reduce overweight and subsequently the risk factors.

Participants' perspectives on making and maintaining behavioural changes in a lifestyle intervention for type 2 diabetes prevention: a qualitative study using the theory domain framework

OBJECTIVES

In a qualitative substudy, we sought to elicit participants' perspectives of their behavioural change and maintenance of new behaviours towards intervention optimisation.

SETTING

The intervention was delivered in leisure and community settings in a local authority, which according to the UK government statistics ranks as 1 of the 10 most socioeconomically deprived areas in England.

PARTICIPANTS

We recruited 218 adults aged 40-65 years at elevated risk of type 2 diabetes (Finnish Diabetes Risk Score≥11) to the intervention. Follow-up at 12 months was completed by 134 (62%). We recruited 15 participants, purposively sampled for physical activity increase, to the qualitative substudy.

INTERVENTION

Lifestyle intervention can prevent type 2 diabetes, but translation to service provision remains challenging. The 'New life, New you' intervention aimed to promote physical activity, healthy eating and weight loss, and included supervised group physical activity sessions. Behavioural change and weight loss at 12-month follow-up were encouraging.

DESIGN

We conducted 15 individual semistructured interviews. The Framework approach, with a comparison of emerging themes, was used in analysis of the transcribed data and complemented by the Theory Domains Framework.

RESULTS

Themes emerging from the data were grouped as perceptions that promoted initiating, enacting and maintaining behavioural change. The data were then categorised in accordance with the Theory Domains Framework: intentions and goals; reinforcement; knowledge; social role and identity; social influences; skills and beliefs about capabilities; behavioural regulation, memory, emotion, attention and decision processes and environmental context and resources. Participant perceptions of intervention features that facilitated behavioural change processes were then similarly analysed.

CONCLUSIONS

Social influences, reference to social role and identity (eg, peer support), and intentions and goals (eg, to lose weight) were dominant themes across the three phases of behavioural change. Reinforcement, regulation and decision processes were more evident in the maintenance phase. The socioeconomic status of participants was reflected in the environmental context and resource theme. Analysis of phases and theoretical domains of behavioural change added depth and utility to inform intervention optimisation. We will develop the intervention with improved peer support and explicit monitoring of the behavioural change techniques used, prior to a definitive trial.

Can nutrition be promoted through agriculture-led food price policies? A systematic review

OBJECTIVE

To systematically review the available evidence on whether national or international agricultural policies that directly affect the price of food influence the prevalence rates of undernutrition or nutrition-related chronic disease in children and adults.

DESIGN

Systematic review.

SETTING

Global.

SEARCH STRATEGY

We systematically searched five databases for published literature (MEDLINE, EconLit, Agricola, AgEcon Search, Scopus) and systematically browsed other databases and relevant organisational websites for unpublished literature. Reference lists of included publications were hand-searched for additional relevant studies. We included studies that evaluated or simulated the effects of national or international food-price-related agricultural policies on nutrition outcomes reporting data collected after 1990 and published in English.

PRIMARY AND SECONDARY OUTCOMES

Prevalence rates of undernutrition (measured with anthropometry or clinical deficiencies) and overnutrition (obesity and nutrition-related chronic diseases including cancer, heart disease and diabetes).

RESULTS

We identified a total of four relevant reports; two ex post evaluations and two ex ante simulations. A study from India reported on the undernutrition rates in children, and the other three studies from Egypt, the Netherlands and the USA reported on the nutrition-related chronic disease outcomes in adults. Two of the studies assessed the impact of policies that subsidised the price of agricultural outputs and two focused on public food distribution policies. The limited evidence base provided some support for the notion that agricultural policies that change the prices of foods at a national level can have an effect on population-level nutrition and health outcomes.

CONCLUSIONS

A systematic review of the available literature suggests that there is a paucity of robust direct evidence on the impact of agricultural price policies on nutrition and health.

Evidence of overtesting for vitamin D in Australia: an analysis of 4.5 years of Medicare Benefits Schedule (MBS) data

OBJECTIVE

To comprehensively examine pathology test utilisation of 25-hydroxyvitamin D (25(OH)D) testing in each state of Australia to determine the cost impact and value and to add evidence to enable the development of vitamin D testing guidelines.

DESIGN

Longitudinal analysis of all 25(OH)D pathology tests in Australia.

SETTING

Primary and Tertiary Care.

MEASUREMENTS

The frequency of 25(OH)D testing between 1 April 2006 and 30 October 2010 coded for each individual by provider, state and month between 2006 and 2010. Rate of tests per 100 000 individuals and benefit for 25(OH)D, full blood count (FBC) and bone densitometry by state and quarter between 2000 and 2010.

RESULTS

4.5 million tests were performed between 1 April 2006 and 30 October 2010. 42.9% of individuals had more than one test with some individuals having up to 79 tests in that period. Of these tests, 80% were ordered by general practitioners and 20% by specialists. The rate of 25(OH)D testing increased 94-fold from 2000 to 2010. Rate varied by state whereby the most southern state represented the highest increase and northern state the lowest increase. In contrast, the rate of a universal pathology test such as FBC remained relatively stable increasing 2.5-fold. Of concern, a 0.5-fold (50%) increase in bone densitometry was seen.

CONCLUSIONS

The marked variation in the frequency of testing for vitamin D deficiency indicates that large sums of potentially unnecessary funds are being expended. The rate of 25(OH)D testing increased exponentially at an unsustainable rate. Consequences of such findings are widespread in terms of cost and effectiveness. Further research is required to determine the drivers and cost benefit of such expenditure. Our data indicate that adoption of specific guidelines may improve efficiency and effectiveness of 25(OH)D testing.

Vitamin C may alleviate exercise-induced bronchoconstriction: a meta-analysis

OBJECTIVE

To determine whether vitamin C administration influences exercise-induced bronchoconstriction (EIB).

DESIGN

Systematic review and meta-analysis.

METHODS

MEDLINE and Scopus were searched for placebo-controlled trials on vitamin C and EIB. The primary measures of vitamin C effect used in this study were: (1) the arithmetic difference and (2) the relative effect in the postexercise forced expiratory volume in 1 s (FEV1) decline between the vitamin C and placebo periods. The relative effect of vitamin C administration on FEV1 was analysed by using linear modelling for two studies that reported full or partial individual-level data. The arithmetic differences and the relative effects were pooled by the inverse variance method. A secondary measure of the vitamin C effect was the difference in the proportion of participants suffering from EIB on the vitamin C and placebo days.

RESULTS

3 placebo-controlled trials that studied the effect of vitamin C on EIB were identified. In all, they had 40 participants. The pooled effect estimate indicated a reduction of 8.4 percentage points (95% CI 4.6 to 12) in the postexercise FEV1 decline when vitamin C was administered before exercise. The pooled relative effect estimate indicated a 48% reduction (95% CI 33% to 64%) in the postexercise FEV1 decline when vitamin C was administered before exercise. One study needed imputations to include it in the meta-analyses, but it also reported that vitamin C decreased the proportion of participants who suffered from EIB by 50 percentage points (95% CI 23 to 68); this comparison did not need data imputations.

CONCLUSIONS

Given the safety and low cost of vitamin C, and the positive findings for vitamin C administration in the three EIB studies, it seems reasonable for physically active people to test vitamin C when they have respiratory symptoms such as cough associated with exercise. Further research on the effects of vitamin C on EIB is warranted.

Surveys of the salt content in UK bread: progress made and further reductions possible

OBJECTIVES

To explore the salt reductions made over time in packaged bread sold in the UK, the biggest contributor of salt to the UK diet.

STUDY DESIGN

Cross-sectional surveys were carried out on the salt content of breads available in UK supermarkets in 2001(40 products), 2006 (138) and 2011 (203).

MAIN OUTCOME MEASURES

The primary outcome measure was the change in salt content per 100 g over time. Further measures included the proportion of products meeting salt targets and differences between brands and bread types.

RESULTS

The average salt level of bread was 1.23±0.19 g/100 g in 2001, 1.05±0.16 in 2006 and 0.98±0.13 in 2011. This shows a reduction in salt/100 g of ≈20% between 2001 and 2011. In the 18 products which were surveyed in all 3 years, there was a significant reduction of 17% (p<0.05). Supermarket own brand bread was found to be lower in salt compared with branded bread (0.95 g/100 g compared with 1.04 g/100 g in 2011). The number of products meeting the 2012 targets increased from 28% in 2001 to 71% in 2011 (p<0.001).

CONCLUSIONS

This study shows that the salt content of bread has been progressively reduced over time, contributing to the evidence base that a target-based approach to salt reduction can lead to reductions being made. A wide variation in salt levels was found with many products already meeting the 2012 targets, indicating that further reductions can be made. This requires further progressive lower targets to be set, so that the UK can continue to lead the world in salt reduction and save the maximum number of lives.

The developmental origins of ageing: study protocol for the Dutch famine birth cohort study on ageing

INTRODUCTION

Evidence from animal studies suggest that the rate of ageing may be influenced not only by genetic and lifestyle factors, but also by the prenatal environment. We have previously shown that people who were exposed to famine during early gestation performed worse on a selective attention task, which may be a first sign of cognitive decline, and were on average 3 years younger at the time of coronary artery disease diagnosis. Women in this group seem to die at a younger age. We hypothesise that an accelerated ageing process, set in motion by the poor prenatal environment, underlies these findings.

METHODS AND ANALYSIS

The Dutch Famine Birth Cohort consists of 2414 men and women born in Amsterdam as term singletons around the time of the Dutch famine. In a subsample of 150 cohort members, who now are about 68 years of age, we are currently measuring cognitive decline and the incidence of white matter hyperintensities and cerebral microbleeds (through MRI), incidence of fractures, grip strength and physical performance, visual acuity and incidence of cataract operations. In this same subgroup, we will assess telomere length, oxidative stress and inflammatory status as potential underlying mechanisms. Furthermore, in the entire cohort, we will assess mortality as well as hospital admissions for age-related diseases up to the age of 68 years.

ETHICS AND DISSEMINATION

The study was approved by the local medical ethics committee (Academic Medical Centre, University of Amsterdam) and is being carried out in agreement with the Declaration of Helsinki. All participants give written informed consent. Study findings will be widely disseminated to the scientific public as well as to the medical society and general public.

Factors associated with breastfeeding in England: an analysis by primary care trust

OBJECTIVES

To identify the sociodemographic factors associated with variation in area-based breastfeeding in England; to calculate the predicted breastfeeding rates adjusted for sociodemographic variations.

DESIGN

Ecological analysis of routine data using random effects logistic regression.

SETTING

All 151 primary care trusts (PCTs) in England 2010-2011.

OUTCOME MEASURES

PCT level data on breastfeeding: initiation, any and exclusive breastfeeding at 6-8 weeks.

RESULTS

There was considerable variation in breastfeeding across PCTs (breastfeeding initiation mean 72%, range 39-93%; any breastfeeding at 6-8 weeks mean 45%, range 19-83%; exclusive breastfeeding at 6-8 weeks mean 32%, range 14-58%), with London PCTs reporting markedly higher rates. Maternal age was strongly associated with area-based breastfeeding, with a 4-6% increase in odds of breastfeeding associated with a unit increase in the percentage of older mothers. Outside London, the proportion of the local population from a Black and Minority Ethnic (BME) background, compared with those from a White British background, was associated with higher breastfeeding (1-3% increase in odds per unit increase in the proportion from a BME background). Area-based deprivation was associated with reduced odds of breastfeeding (21-32% reduced odds comparing most deprived quintile to least deprived quintile). Weaker associations were observed between sociodemographic factors and breastfeeding in London PCTs. Very few PCTs reported breastfeeding figures substantially above or below the national average, having adjusted for variations in sociodemographic factors.

CONCLUSIONS

Our results show striking associations between sociodemographic factors and breastfeeding at the area level, with much of the variation in breastfeeding rates explained by the sociodemographic profile. The sociodemographic context of breastfeeding is clearly important at the area level as well as the individual level. Our findings can be used to inform decision-making relating to local priorities and service provision.

Case-control and prospective studies of dietary α-linolenic acid intake and prostate cancer risk: a meta-analysis

OBJECTIVE

α-Linolenic acid (ALA) is considered to be a cardioprotective nutrient; however, some epidemiological studies have suggested that dietary ALA intake increases the risk of prostate cancer. The main objective was to conduct a systematic review and meta-analysis of case-control and prospective studies investigating the association between dietary ALA intake and prostate cancer risk.

DESIGN

A systematic review and meta-analysis were conducted by searching MEDLINE and EMBASE for relevant prospective and case-control studies.

INCLUDED STUDIES

We included all prospective cohort, case-control, nested case-cohort and nested case-control studies that investigated the effect of dietary ALA intake on the incidence (or diagnosis) of prostate cancer and provided relative risk (RR), HR or OR estimates.

PRIMARY OUTCOME MEASURE

Data were pooled using the generic inverse variance method with a random effects model from studies that compared the highest ALA quantile with the lowest ALA quantile. Risk estimates were expressed as RR with 95% CIs. Heterogeneity was assessed by χ(2) and quantified by I(2).

RESULTS

Data from five prospective and seven case-control studies were pooled. The overall RR estimate showed ALA intake to be positively but non-significantly associated with prostate cancer risk (1.08 (0.90 to 1.29), p=0.40; I(2)=85%), but the interpretation was complicated by evidence of heterogeneity not explained by study design. A weak, non-significant protective effect of ALA intake on prostate cancer risk in the prospective studies became significant (0.91 (0.83 to 0.99), p=0.02) without evidence of heterogeneity (I(2)=8%, p=0.35) on removal of one study during sensitivity analyses.

CONCLUSIONS

This analysis failed to confirm an association between dietary ALA intake and prostate cancer risk. Larger and longer observational and interventional studies are needed to define the role of ALA and prostate cancer.

Soft drink intake and progression of radiographic knee osteoarthritis: data from the osteoarthritis initiative

OBJECTIVES

We examine the prospective association of soft drink consumption with radiographic progression of knee osteoarthritis (OA).

DESIGN

Prospective cohort study.

SETTING

This study used data from the osteoarthritis initiative (OAI).

PARTICIPANTS

In OAI, 2149 participants with radiographic knee OA and having dietary data at baseline were followed up to 12, 24, 36 and 48 months.

MEASURES

The soft drink consumption was assessed with a Block Brief Food Frequency Questionnaire completed at baseline. To evaluate knee OA progression, we used quantitative medial tibiofemoral joint space width (JSW) based on plain radiographs. The multivariate linear models for repeated measures were used to test the independent association between soft drink intake and the change in JSW over time, while adjusting for body mass index and other potential confounding factors.

RESULTS

In stratified analyses by gender, we observed a significant dose-response relationship between baseline soft drink intake and adjusted mean change of JSW in men. With increasing levels of soft drink intake (none, ≤1, 2-4 and ≥5 times/week), the mean decreases of JSW were 0.31, 0.39, 0.34 and 0.60 mm, respectively. When we further stratified by obesity, a stronger dose-response relationship was found in non-obese men. In obese men, only the highest soft drink level (≥5 times/week) was associated with increased change in JSW compared with no use. In women, no significant association was observed.

CONCLUSIONS

Our results suggest that frequent consumption of soft drinks may be associated with increased OA progression in men. Replication of these novel findings in other studies demonstrating the reduction in soft drink consumption leads to delay in OA progression is needed.