Health authorities in numerous countries recommend periconceptional folic acid to pregnant women to prevent neural tube defects. The objective of this study was to examine the association of folic acid supplementation during different periods of pregnancy and of dietary folate intake with the risk of spontaneous preterm delivery (PTD).
The Norwegian Mother and Child Cohort Study is a population-based prospective cohort study. A total of 65,668 women with singleton pregnancies resulting in live births in 1999–2009 were included. Folic acid supplementation was self-reported from 26 weeks before pregnancy until week 24 during pregnancy. At gestational week 22, the women completed a food frequency questionnaire, which allowed the calculation of their average total folate intake from foods and supplements for the first 4–5 months of pregnancy. Spontaneous PTD was defined as the spontaneous onset of delivery between weeks 22+0 and 36+6 (n = 1,628).
The median total folate intake was 266 μg/d (interquartile range IQR 154–543) in the overall population and 540 μg/d (IQR 369–651) in the supplement users. Eighty-three percent reported any folic acid supplementation from <8 weeks before to 24 weeks after conception while 42% initiated folic acid supplementation before their pregnancy. Cox regression analysis showed that the amount of folate intake from the diet (hazard ratio HR 1.16; confidence interval CI 0.65-2.08) and from the folic acid supplements (HR 1.04; CI 0.95-1.13) was not significantly associated with the risk of PTD. The initiation of folic acid supplementation more than 8 weeks before conception was associated with an increased risk for PTD (HR 1.19; CI 1.05-1.34) compared to no folic acid supplementation pre-conception. There was no significant association with PTD when supplementation was initiated within 8 weeks pre-conception (HR 1.01; CI 0.88-1.16). All analyses were adjusted for maternal characteristics and socioeconomic, health and dietary variables.
Our findings do not support a protective effect of dietary folate intake or folic acid supplementation on spontaneous PTD. Pre-conceptional folic acid supplementation starting more than 8 weeks before conception was associated with an increased risk of PTD. These results require further investigation before discussing an expansion of folic acid supplementation guidelines.
Pregnancy; Preterm delivery; Preterm birth; Gestational length; Folate; Folic acid supplementation
Adequate amounts of nutrients during pregnancy are essential for maternal, fetal and child health. This study was conducted to investigate the intakes of iron and folate and the effect of supplements on anemia status during pregnancy. One hundred sixty five pregnant women completed questionnaires which included food frequencies and supplement use, and blood tests for hematologic indices. Pregnant women were divided into four groups based on the type of supplements; single nutrient group (S), multivitamins & minerals group (M), Single nutrient + multivitamins & minerals group (S+M), and no supplement group (N). Mean iron intake was 11.1 mg from food (46.3% of Recommended Nutrient Intakes, RNIs) and 66.8 mg from supplements. Mean folate intake was 231.2 µg from food (38.5% of RNI) and 822.7 µg from supplements. In the N group, the subjects who consumed iron and folate less than EAR were 85.7% and 95.2%, respectively. The subjects consumed iron more than UL were 81.0% in the S group, 88.9% in the M group, and 97.4% in the S+M group, and the subjects consumed folate more than UL were 4.8% in the S group, 1.6% in the M group, and 25.6% in the S+M group. The mean values of hemoglobin and hemotocrit in the M group were significantly higher than those in the N group. Despite the relatively high socio-economic status of the participants, overall intakes of iron and folate from food were far below the RNIs, suggesting that a supplement is needed for adequate nutritional status during pregnancy. A multivitamin supplement seems to be more effective than a single nutrient supplement such as iron or folic acid in the prevention of anemia. Further research is required to define the appropriate amount of supplemental iron and folic acid for Korean pregnant women.
Iron; Folate; Dietary supplements; Anemia; Pregnant women
Little is known about the consumption of organic food during pregnancy. The aim of this study was to describe dietary characteristics associated with frequent consumption of organic food among pregnant women participating in the Norwegian Mother and Child Cohort Study (MoBa).
The present study includes 63 808 women who during the years 2002–2007 answered two questionnaires, a general health questionnaire at gestational weeks 15 and a food frequency questionnaire at weeks 17-22. The exploration of food patterns by Principal component analyses (PCA) was followed by ANOVA analyses investigating how these food patterns as well as intake of selected food groups were associated with consumption of organic food.
The first principal component (PC1) identified by PCA, accounting for 12% of the variation, was interpreted as a ‘health and sustainability component’, with high positive loadings for vegetables, fruit and berries, cooking oil, whole grain bread and cereal products and negative loadings for meat, including processed meat, white bread, and cakes and sweets. Frequent consumption of organic food, which was reported among 9.1% of participants (n = 5786), was associated with increased scores on the ‘health and sustainability component’ (p < 0.001). The increase in score represented approximately 1/10 of the total variation and was independent of sociodemographic and lifestyle characteristics. Participants with frequent consumption of organic food had a diet with higher density of fiber and most nutrients such as folate, beta-carotene and vitamin C, and lower density of sodium compared to participants with no or low organic consumption.
The present study showed that pregnant Norwegian women reporting frequent consumption of organically produced food had dietary pattern and quality more in line with public advice for healthy and sustainable diets. A methodological implication is that the overall diet needs to be included in future studies of potential health outcomes related to consumption of organic food during pregnancy.
To evaluate the intake of micronutrients from the diet and from supplements in users and non-users of dietary supplements, respectively, in a representative sample of the Danish adult population. A specific objective was to identify the determinants of supplement use.
A cross-sectional representative national study of the intake of vitamins and minerals from the diet and from dietary supplements.
The Danish National Survey of Dietary Habits and Physical Activity, 2000–2004. Participants (n=4,479; 53% females) aged 18–75 years gave information about the use of dietary supplements in a personal interview. The quantification of the micronutrient contribution from supplements was estimated from a generic supplement constructed from data on household purchases. Nutrient intakes from the diet were obtained from a self-administered 7-day pre-coded dietary record. Median intakes of total nutrients from the diets of users and non-users of supplements were analysed using the Wilcoxon rank-sum test.
Sixty percent of females and 51% of males were users of supplements. With the exception of vitamin D, the intake of micronutrients from the diet was adequate at the group level for all age and gender groups. Among females in the age group 18–49 years, the micronutrient intake from the diet was significantly higher compared with the non-users of dietary supplements. The use of dietary supplements increased with age and with ‘intention to eat healthy.’
Intake of micronutrients from the diet alone was considered adequate for both users and non-users of dietary supplements. Younger females who were supplement users had a more micronutrient-dense diet compared to non-users.
vitamins; minerals; food supplements; adults
Although many patients take antioxidant dietary supplements during breast cancer treatment, the benefits of such supplementation are unproven. We analyzed the prevalence of and factors associated with antioxidant supplement use during breast cancer treatment among women who participated in the Long Island Breast Cancer Study Project.
In 2002–2004, women with breast cancer (BC) who had participated in the 1996–1997 case-control study were invited to participate in a follow-up interview. We defined antioxidant supplement use as any self-reported intake of supplemental vitamin C, vitamin E, beta-carotene, or selenium, in individual supplements or multivitamins.
Follow-up interview participants were younger, more predominantly white, and of higher socioeconomic status, than women who did not respond. Among 764 participants who completed the follow-up interview, 663 (86.8%) reported receiving adjuvant treatment for their BC. Of these 663 women, 401 (60.5%) reported using antioxidants during adjuvant treatment: 120/310 (38.7%) during chemotherapy, 196/464 (42.2%) during radiation, and 286/462 (61.9%) during tamoxifen therapy. Of the 401 antioxidant users, 278 (69.3%) used high doses (doses higher than those contained in a Centrum multivitamin). Factors associated with high antioxidant supplement use during treatment were higher fruit and vegetable intake at diagnosis (RR 1.71, 95% CI 1.13–2.59), tamoxifen use (RR 3.66, 95% CI 2.32–5.78), ever using herbal products (RR 3.49, 95% CI 2.26–5.38), and ever engaging in mind-body practices (RR 1.72, 95% CI 1.13–2.64).
Given the common use of antioxidant supplements during BC treatment, often at high doses and in conjunction with other complementary therapies, future research should address the effects of antioxidant supplementation on BC outcomes.
antioxidants; dietary supplements; breast cancer; chemotherapy; radiation therapy; hormonal therapy
Folate supplementation is recommended for pregnant women to reduce the risk of congenital malformations. Maternal intake of folate supplements during pregnancy might also influence childhood immune phenotypes via epigenetic mechanisms.
To investigate the relationship between folate supplements in pregnancy and risk of lower respiratory tract infections and wheeze in children through 18 months of age.
In the Norwegian Mother and Child Cohort Study, questionnaire data collected at several time points in pregnancy and after birth, from 32,077 children born between 2000 and 2005, were used to assess effects of folate supplements during pregnancy on respiratory outcomes up to 18 months of age, accounting for other supplements in pregnancy and supplementation in infancy.
Folate supplements in the first trimester were associated with increased risk of wheeze and respiratory tract infections up to 18 months of age. Adjusting for exposure later in pregnancy and in infancy, the relative risk of wheeze for children exposed to folic acid supplements in the first trimester was 1.06 (95% confidence interval: 1.03, 1.10), for lower respiratory tract infections the relative risk was 1.09 (95% confidence interval: 1.02, 1.15), and for hospitalizations for lower respiratory tract infections the relative risk was 1.24 (95% confidence interval: 1.09, 1.41).
Folic acid supplements in pregnancy were associated with a slightly increased risk of wheeze and lower respiratory tract infections up to 18 months of age. Results support possible epigenetic influences of methyl donors in maternal diet during pregnancy on respiratory health in children.
Dietary Supplements; Folic acid; Pregnancy; Respiratory Tract Infections; Wheezing
Low intake of nutrients is associated with poor health outcomes. Therefore, we examined the contribution of dietary supplementation to meeting recommended dietary intakes of calcium, magnesium, potassium and vitamin C in participants of the Multi-Ethnic Study of Atherosclerosis (MESA), a cohort of Caucasian, African-American, Hispanic and Chinese participants ages 45-84 years. We also assessed the prevalence of intakes above Tolerable Upper Intake Levels (ULs).
At the baseline exam in 2000-01, 2,938 men and 3,299 women completed food-frequency questionnaires and provided information about dietary supplementation. We used relative risk regression to estimate the probability of meeting RDAs or AIs in supplement-users vs. non-users and Fisher's exact tests to compare the proportion of those exceeding ULs between the two groups. RDAs, AIs, and ULs were defined by the National Academy of Sciences Food and Nutrition Board's Dietary Reference Intakes (DRIs).
After adjustment for age and education, the relative risk (RR) of meeting RDAs or AIs in supplement-users vs. nonusers ranged from 1.9 (1.6, 2.3) in Caucasian men to 5.7 (4.1, 8.0) in African American women for calcium, from 2.5 (1.9, 3.3) in Hispanic men to 5.2 (2.4, 11.2) in Chinese men for magnesium, and from 1.4 (1.3, 1.5) in African American women to 2.0 (1.7, 2.2) in Chinese men for vitamin C. The RRs for meeting RDAs for calcium differed significantly by ethnicity (p<0.021) and gender (p<0.001), by ethnicity for magnesium (p=0.001). The RR for each gender/ethnicity strata was close to 1 and did not reach statistical significance at alpha=0.05 for potassium. For calcium, 15% of high-dose supplement-users exceeded the UL compared with only 2.1% of nonusers. For vitamin C, the percentages were 6.6% and 0%, and for magnesium, 35.3% and 0% (p<0.001 for all).
Although supplement use is associated with meeting DRI guidelines for calcium, vitamin C and magnesium, many adults are not meeting the DRI guidelines even with the help of dietary supplements, and the effect of supplementation can vary according to ethnicity and gender. However, supplementation was not significantly associated with meeting DRIs for potassium. Also, high-dose supplement use is associated with intakes above ULs for calcium, magnesium and vitamin C.
Dietary supplements; micronutrient intake; race; ethnicity; gender
The Supplement Reporting (SURE) study is one of the first to systematically examine the accuracy of collection of dietary supplement use data for population-based studies of diet. In 2005–2007, the SURE study collected data from 444 participants in Hawaii and Los Angeles. Several methods of collecting data were compared, including an inventory of supplements, a recall, a daily diary, and a one-page supplement frequency questionnaire. Considerable effort was put into developing an extensive supplement composition database. To quantify intakes, we extended the existing supplement composition table (SCT) used at the Cancer Research Center of Hawaii. The original SCT contained default codes for multivitamin/multimineral products to be used when insufficient detail was available to assign an existing code. However, the default concept needed to be expanded for the SURE study to include additional multivitamin/multimineral default codes, as well as single nutrients and other components. Approximately 1800 new codes were created, including 211 new default codes. Roughly 130 nutrients and 870 other components were included in the SCT at the conclusion of the study. To accurately quantify intakes from supplements, it is crucial to maintain a comprehensive supplement composition database. Future improvements to our SCT include incorporation of analytic values from the US Department of Agriculture to replace composition data taken from supplement labels.
Dietary supplements; Supplement database; Nutrient composition; Supplement composition; Multivitamins; Default values; SURE study; Food composition data; Food data management
Although it is widely known that use of dietary supplements is common in the United States, little is known about use patterns among older Americans. The authors examined trends in dietary supplement use and its contribution to total nutrient intake in the Iowa Women's Health Study cohort in 1986 (baseline) and 2004 (follow-up). The proportion of women who reported using dietary supplements increased substantially between baseline (66%) and follow-up (85%). Moreover, a substantial proportion of women reported using multiple dietary supplements, with 27% using 4 or more products in 2004. Dietary supplements contributed substantially to total intake of many nutrients at baseline, and their contribution became relatively greater at follow-up for most nutrients examined. For most nutrients, no decline in intake was observed, as might have been expected in an aging cohort. Rather, intake of many nutrients increased, primarily because of the rising use of dietary supplements. Use of dietary supplements by older individuals is of particular importance because of the potential benefits of maintaining nutrient intake levels despite potentially declining food intake. However, possible risks from obtaining a large proportion of purified nutrients from dietary supplements rather than deriving them from foods should be studied.
aged; dietary supplements; women
The influence of vitamin supplements on risk for breast cancer is unclear. Also the interactive effects of vitamins from dietary and supplemental sources are unknown. This study investigated the association between self-reported vitamin supplement use (A, B, C, E and multivitamin) and breast cancer among urban Chinese women. It also examined the combined effect of vitamin supplements in relation to particular dietary vitamin intakes on breast cancer risk.
Study subjects were identified from The Shanghai Breast Cancer Study (SBCS) and was a population-based case-control study conducted in Shanghai in 1996-1998 (Phase I) and 2002-2004 (Phase II). Participants were aged 25 to 64 and 20 to 70 years for phase I and for phase II, respectively. The analyses included 3,454 incident breast cancer cases and 3,474 controls. Unconditional logistic regression models were used to determine adjusted odds ratios (ORs) for breast cancer risk associated with vitamin supplement use.
Overall, the breast cancer risk was not related to intakes of any vitamin supplement. However, an approximately 20% reduction in breast cancer risk was observed with use of vitamin E supplement among women with low-dietary vitamin E intake (OR=0.8; 95% confidence interval (CI), 0.6-0.9) with a significant does-response inverse association (P trend =0.01 for duration). Modest risk reduction was observed among vitamin B supplement users with low dietary intake of the same vitamin (OR=0.9; 95% CI, 0.6-1.0). However, vitamin B supplement was adversely associated with breast cancer risk among those with high dietary vitamin B intake with a significant dose-response effect (P trend =0.04 for duration).
This study suggests that vitamins E and B supplement may confer a prevention of breast cancer among women who have low dietary intake of those vitamins.
antioxidants; breast cancer epidemiology; dietary supplements; vitamins
More than half of US adults use dietary supplements. Some reports suggest that supplement users have higher vitamin intakes from foods than nonusers, but this observation has not been examined using nationally representative survey data.
The purpose of this analysis was to examine vitamin intakes from foods by supplement use and how dietary supplements contribute to meeting or exceeding the Dietary Reference Intakes for selected vitamins using data from the National Health and Nutrition Examination Survey among adults (aged ≥19 years) in 2003–2006 (n=8,860).
Among male users, mean intakes of folate and vitamins A, E, and K from food sources were significantly higher than among nonusers. Among women, mean intakes of folate and vitamins A, C, D, and E from foods were higher among users than nonusers. Total intakes (food and supplements) were higher for every vitamin we examined among users than the dietary vitamin intakes of nonusers. Supplement use helped lower the prevalence of intakes below the Estimated Average Requirement for every vitamin we examined, but for folic acid and vitamins A, B-6, and C, supplement use increased the likelihood of intakes above the Tolerable Upper Intake Level.
Supplement use was associated with higher mean intakes of some vitamins from foods among users than nonusers, but it was not associated with the prevalence of intakes less than the Estimated Average Requirement from foods. Those who do not use vitamin supplements had significantly higher prevalence of inadequate vitamin intakes; however, the use of supplements can contribute to excess intake for some vitamins.
Dietary supplements; NHANES; Vitamins; Users and non-users of supplements
Objective To explore the role of folic acid supplements, dietary folates, and multivitamins in the prevention of facial clefts.
Design National population based case-control study.
Setting Infants born 1996-2001 in Norway.
Participants 377 infants with cleft lip with or without cleft palate; 196 infants with cleft palate alone; 763 controls.
Main outcome measures Association of facial clefts with maternal intake of folic acid supplements, multivitamins, and folates in diet.
Results Folic acid supplementation during early pregnancy (≥400 µg/day) was associated with a reduced risk of isolated cleft lip with or without cleft palate after adjustment for multivitamins, smoking, and other potential confounding factors (adjusted odds ratio 0.61, 95% confidence interval 0.39 to 0.96). Independent of supplements, diets rich in fruits, vegetables, and other high folate containing foods reduced the risk somewhat (adjusted odds ratio 0.75, 0.50 to 1.11). The lowest risk of cleft lip was among women with folate rich diets who also took folic acid supplements and multivitamins (0.36, 0.17 to 0.77). Folic acid provided no protection against cleft palate alone (1.07, 0.56 to 2.03).
Conclusions Folic acid supplements during early pregnancy seem to reduce the risk of isolated cleft lip (with or without cleft palate) by about a third. Other vitamins and dietary factors may provide additional benefit.
This study was performed to compare the dietary food and nutrient intakes according to supplement use in pregnant and lactating women in Seoul. The subjects were composed of 201 pregnant and 104 lactating women, and their dietary food intake was assessed using the 24-h recall method. General information on demographic and socioeconomic factors, as well as health-related behaviors, including the use of dietary supplements, were collected. About 88% and 60% of the pregnant and lactating women took dietary supplements, respectively. The proportion of dietary supplements used was higher in pregnant women with a higher level of education. After adjusting for potential confounders, among the pregnant women, supplement users were found to consume 45% more vegetables, and those among the lactating women were found to consume 96% more beans and 58% more vegetables. The intakes of dietary fiber and β-carotene among supplement users were higher than those of non-users, by 23% and 39%, respectively. Among pregnant women, the proportion of women with an intake of vitamin C (from diet alone) below the estimated average requirements (EAR) was lower among supplement users [users (44%) vs. non-users (68%)], and the proportion of lactating women with intakes of iron (from diet alone) below the EAR was lower among supplement users [usesr (17%) vs. non-users (38%)]. These results suggest that among pregnant and lactating women, those who do not use dietary supplements tend to have a lower intake of healthy foods, such as beans and vegetables, as well as a lower intake of dietary fiber and β-carotene, which are abundant in these foods, and non-users are more likely than users to have inadequate intake of micro-nutrient such as vitamin C and iron.
Dietary intake; supplement; pregnant women; lactating women
To investigate association between breast cancer risk and nutrients intake in Korean women, a case-control study was carried out, at Seoul, Korea. Incident cases (n=224) were identified through the cancer biopsy between February 1999 and December 2000 at two University hospitals in Seoul. Hospital-based controls (n=250) were selected from patients in the same hospitals, during the same periods. Food intake was investigated semiquantitative frequency questionnaire (98 items) by trained dietitian. Subjects were asked to indicate the average food intake and vitamin supplement for a 12 months period of 3-yr prior to the baseline phase. In investigation of vitamin supplement use, subjects were asked the average frequency of use, duration, dose and the brand name of vitamin supplement (multivitamins, vitamin A, vitamin C and vitamin E). And nutrients were calorie adjusted by the residuals method. In this study, higher breast cancer risk incidence was not observed with higher intake of total fat and saturated fatty acids, however statistically significant trends with breast cancer incidence for total saturated fatty acids were found (ptrend=0.0458). In analyses of vitamins, beta-carotene and vitamin C were significantly associated with decreasing risk of breast cancer. In analyses, results from dietary plus supplement of vitamin was not associated with breast cancer risk in this study. In conclusion, our findings suggest that antioxidant vitamins such as beta-carotene and vitamin C intake could lower the breast cancer risk in Korean women.
Background. Pregnant and breastfeeding women are at risk for folate deficiency. Folate supplementation has been shown to be associated with enhanced markers of folate status. However, dose-response analyses for adult women are still lacking. Objective. To assess the dose-response relationship between total folate intake (folic acid plus dietary folate) and markers of folate status (plasma/serum folate, red blood cell folate, and plasma homocysteine); to evaluate potential differences between women in childbearing age, pregnant and lactating women. Methods. Electronic literature searches were carried out on three databases until February 2010. The overall pooled regression coefficient (β) and SE(β) were calculated using meta-analysis on a double-log scale.
Results. The majority of data was based on nonpregnant, nonlactating women in childbearingage. The pooled estimate of the relationship between folate intake and serum/plasma folate was 0.56 (95% CI = 0.40–0.72, P < 0.00001); that is, the doubling of folate intake increases the folate level in serum/plasma by 47%. For red blood cell folate, the pooled-effect estimate was 0.30 (95% CI = 0.22–0.38, P < 0.00001), that is, +23% for doubling intake. For plasma-homocysteine it was –0.10 (95% = –0.17 to –0.04, P = 0.001), that is, –7% for doubling the intake. Associations tended to be weaker in pregnant and lactating women. Conclusion. Significant relationships between folate intake and serum/plasma folate, red blood cell folate, and plasma homocysteine were quantified. This dose-response methodology may be applied for setting requirements for women in childbearing age, as well as for pregnant and lactating women.
Concerns about reproductive and developmental health risks of exposure to organophosphate (OP) pesticides, phthalates, and bisphenol A (BPA) among the general population are increasing. Six dialkyl phosphate (DAP) metabolites, 3,5,6-trichloro-2-pyridinol (TCPy), BPA, and fourteen phthalate metabolites were measured in 10 pooled urine samples representing 110 pregnant women who participated in the Norwegian Mother and Child Birth Cohort (MoBa) study in 2004. Daily intakes were estimated from urinary data and compared with reference doses (RfDs) and daily tolerable intakes (TDIs). The MoBa women had a higher mean BPA concentration (4.50 μg/L) than the pregnant women in the Generation R Study (Generation R) in the Netherlands and the National Health and Nutrition Examination Survey (NHANES) in the United States. The mean concentration of total DAP metabolites (24.20 μg/L) in MoBa women was higher than that in NHANES women but lower than that in Generation R women. The diethyl phthalate metabolite mono-ethyl phthalate (MEP) was the dominant phthalate metabolite in all three studies, with the mean concentrations of greater than 300 μg/L. The MoBa and Generation R women had higher mean concentrations of mono-n-butyl phthalate (MnBP) and mono-isobutyl phthalate (MiBP) than the NHANES women. The estimated average daily intakes of BPA, chlorpyrifos/chlorpyrfios-methyl and phthalates in MoBa (and the other two studies) were below the RfDs and TDIs. The higher levels of metabolites in the MoBa participants may have been from intake via pesticide residues in food (organophosphates), consumption of canned food, especially fish/seafood (BPA), and use of personal care products (selected phthalates).
Organophosphate (OP) pesticides; Bisphenol A (BPA); Phthalates; Biological monitoring; Environmental Exposure
Background: Animal models show that periconceptional supplementation with folic acid, vitamin B-12, choline, and betaine can induce differences in offspring phenotype mediated by epigenetic changes in DNA. In humans, altered DNA methylation patterns have been observed in offspring whose mothers were exposed to famine or who conceived in the Gambian rainy season.
Objective: The objective was to understand the seasonality of DNA methylation patterns in rural Gambian women. We studied natural variations in dietary intake of nutrients involved in methyl-donor pathways and their effect on the respective metabolic biomarkers.
Design: In 30 women of reproductive age (18–45 y), we monitored diets monthly for 1 y by using 48-h weighed records to measure intakes of choline, betaine, folate, methionine, riboflavin, and vitamins B-6 and B-12. Blood biomarkers of these nutrients, S-adenosylhomocysteine (SAH), S-adenosylmethionine (SAM), homocysteine, cysteine, and dimethylglycine were also assessed monthly.
Results: Dietary intakes of riboflavin, folate, choline, and betaine varied significantly by season; the most dramatic variation was seen for betaine. All metabolic biomarkers showed significant seasonality, and vitamin B-6 and folate had the highest fluctuations. Correlations between dietary intakes and blood biomarkers were found for riboflavin, vitamin B-6, active vitamin B-12 (holotranscobalamin), and betaine. We observed a seasonal switch between the betaine and folate pathways and a probable limiting role of riboflavin in these processes and a higher SAM/SAH ratio during the rainy season.
Conclusions: Naturally occurring seasonal variations in food-consumption patterns have a profound effect on methyl-donor biomarker status. The direction of these changes was consistent with previously reported differences in methylation of metastable epialleles. This trial was registered at www.clinicaltrials.gov as NCT01811641.
QUESTION Now that flour and pasta have been fortified with folic acid in Canada, do I still need to recommend folic acid supplements to my patients who are of child-bearing age? If I should recommend supplements, when should I recommend them, and what is an appropriate dose?
ANSWER Non-pregnant women should consume 400 μg of folic acid daily, and pregnant women should consume 600 μg of folic acid daily. Mean intakes of folate in Canada before fortification were around 200 μg/d or less. Fortification increased intake of folic acid by up to 100 μg/d. You should discuss the importance of folic acid with your patients who are planning pregnancy; it is recommended that a folic acid supplement or prenatal multivitamin containing at least 400 μg of folic acid be consumed daily. The upper limit for folic acid is 1 mg/d. Women in intermediate- to high-risk categories for neural tube defects, such as a previous neural tube defect–affected pregnancy, should take 4 to 5 mg of folic acid daily.
Limited data are available on the source of usual nutrient intakes in the United States. This analysis aimed to assess contributions of micronutrients to usual intakes derived from all sources (naturally occurring, fortified and enriched, and dietary supplements) and to compare usual intakes to the Dietary Reference Intake for U.S. residents aged ≥2 y according to NHANES 2003–2006 (n = 16,110). We used the National Cancer Institute method to assess usual intakes of 19 micronutrients by source. Only a small percentage of the population had total usual intakes (from dietary intakes and supplements) below the estimated average requirement (EAR) for the following: vitamin B-6 (8%), folate (8%), zinc (8%), thiamin, riboflavin, niacin, vitamin B-12, phosphorus, iron, copper, and selenium (<6% for all). However, more of the population had total usual intakes below the EAR for vitamins A, C, D, and E (34, 25, 70, and 60%, respectively), calcium (38%), and magnesium (45%). Only 3 and 35% had total usual intakes of potassium and vitamin K, respectively, greater than the adequate intake. Enrichment and/or fortification largely contributed to intakes of vitamins A, C, and D, thiamin, iron, and folate. Dietary supplements further reduced the percentage of the population consuming less than the EAR for all nutrients. The percentage of the population with total intakes greater than the tolerable upper intake level (UL) was very low for most nutrients, whereas 10.3 and 8.4% of the population had intakes greater than the UL for niacin and zinc, respectively. Without enrichment and/or fortification and supplementation, many Americans did not achieve the recommended micronutrient intake levels set forth in the Dietary Reference Intake.
To examine cytomegalovirus (CMV) seroprevalence and associated risk factors for CMV seropositivity in pregnant Norwegian women.
The Norwegian Mother and Child Cohort Study (MoBa) in addition to two random samples of pregnant women from Sør-Trøndelag County in Norway.
Study group 1 were 1000 pregnant women, randomly selected among 46 127 pregnancies in the MoBa (1999–2006) at 17/18 week of gestation. Non-ethnic Norwegian women were excluded. Study groups 2 (n=1013 from 1995) and 3 (n=979 from 2009) were pregnant women at 12 weeks of gestation from Sør-Trøndelag County.
CMV seropositivity in blood samples from pregnant Norwegian women.
CMV-IgG antibodies were detected in 59.9% and CMV-IgM antibodies in 1.3% of pregnant Norwegian women in study group 1. Women from North Norway demonstrated a higher CMV-IgG seroprevalence (72.1%) than women from South Norway (58.5%) (OR 1.83, 95% CI 1.17 to 2.88). The CMV-IgG seroprevalence was higher among women with low education (70.5%) compared to women with higher education (OR 2.20, 95% CI 1.24 to 3.90). Between 1995 and 2009 the CMV-IgG seroprevalence increased from 63.1% to 71.4% in pregnant women from Sør-Trøndelag County (study groups 2 and 3; p<0.001). The highest CMV-IgG seroprevalence (79.0%) was observed among the youngest pregnant women (<25 years) from Sør-Trøndelag County in 2009 (study group 3).
The CMV-IgG seroprevalence of pregnant Norwegian women varies with geographic location and educational level. Additionally, the CMV-IgG seroprevalence appears to have increased over the last years, particularly among young pregnant women.
The Nutrient Data Laboratory of the United States Department of Agriculture (USDA) is collaborating with the Office of Dietary Supplements (ODS), the National Center for Health Statistics (NCHS), and other government agencies to design and populate a dietary supplement ingredient database (DSID). This analytically based, publicly available database will provide reliable estimates of vitamin and mineral content of dietary supplement (DS) products. The DSID will initially be populated with multivitamin/mineral (MVM) products because they are the most commonly consumed supplements. Challenges associated with the analysis of MVMs were identified and investigated. A pilot study addressing the identification of appropriate analytical methods, sample preparation protocols, and experienced laboratories for the analysis of 12 vitamins and 11 minerals in adult MVM supplement products was completed. Preliminary studies support the development of additional analytical studies with results that can be applied to the DSID. Total intakes from foods and supplements are needed to evaluate the associations between dietary components and health. The DSID will provide better estimates of actual nutrient intake from supplements than databases that rely on label values alone.
Dietary supplements; Analytical database; DSID; Multivitamin; Pilot study; Nutrients
Information on dietary supplement (DS) use during pregnancy is largely lacking. Besides, little is known about the share of DS use as self-medication versus such use following a physician's advice/prescription. Our aim was to evaluate DS use and its socioeconomic, lifestyle and dietary correlates among pregnant women participating in the French NutriNet-Santé cohort study.
Data were collected by self-administered web-based questionnaires. Food intake was assessed by repeated 24 h dietary records. 903 pregnant women provided data on their DS use (both “regular” DS and medication containing mainly vitamins/minerals). Supplement users were compared to non-users by unconditional logistic regression.
DS use—in general and as regards folic acid in particular—was positively correlated with age, being primiparous, having higher income and belonging to a higher socioprofessional category. DS users had significantly higher dietary intakes of most vitamins and minerals. The proportion of DS users (e.g., those reporting use at least three days a week) increased significantly with the trimester of pregnancy (58.0%, 62.2% and 74.5%, respectively). 50.2% of women in their 1st trimester used folic acid. The proportion of iron users tripled from the 1st to the 3rd trimester (18.5 to 63.9%). DS use was prescribed or recommended by a physician in 86.7% of the cases.
This study provided new and detailed information on DS use and its correlates during pregnancy. Even in this relatively well-educated population, folic acid supplementation at the beginning of pregnancy was inadequate and was associated with socioeconomic and demographic disparities.
Dietary fat intake is extremely low in most communities with vitamin A deficiency. However, its role in vitamin A status of pregnant and lactating women is poorly understood. The aim of the study was to examine the effect of supplementing women with fat from mid-/late pregnancy until six months postpartum on their vitamin A status and that of their infants. Women recruited at 5-7 months of gestation were supplemented daily with 20 mL of soybean-oil (n=248) until six months postpartum or received no supplement (n=251). Dietary fat intake was assessed by 24-hour dietary recall at enrollment and at 1, 3 and 6 months postpartum. Concentrations of maternal plasma retinol, β-carotene, and lutein were measured at enrollment and at 1, 3 and 6 months postpartum, and those of infants at six months postpartum. Concentration of breastmilk retinol was measured at 1, 3 and 6 months postpartum. The change in concentration of plasma retinol at three months postpartum compared to pregnancy was significantly higher in the supplemented compared to the control women (+0.04 vs -0.07 μmol/L respectively; p<0.05). Concentrations of plasma β-carotene and lutein declined in both the groups during the postpartum period but the decline was significantly less in the supplemented than in the control women at one month (β-carotene -0.07 vs -0.13 μmol/L, p<0.05); lutein -0.26 vs -0.49 μmol/L, p<0.05) and three months (β-carotene -0.04 vs -0.08 μmol/L, p<0.05; lutein -0.31 vs -0.47 μmol/L, p<0.05). Concentration of breastmilk retinol was also significantly greater in the supplemented group at three months postpartum than in the controls (0.68±0.35 vs 0.55±0.34 μmol/L respectively, p<0.03). Concentrations of infants’ plasma retinol, β-carotene, and lutein, measured at six months of age, did not differ between the groups. Fat supplementation during pregnancy and lactation in women with a very low intake of dietary fat has beneficial effects on maternal postpartum vitamin A status.
Community-based studies; Fat supplementation; Infant; Postpartum;Pregnancy; Vitamin A; Vitamin A deficiency; Bangladesh
To examine if children use supplements to fill gaps in nutritionally inadequate diets or whether supplements contribute to already adequate or excessive micronutrient intakes from foods.
Data were analyzed for children (2–18 y) from the NHANES 2003–2006, a nationally representative, cross-sectional survey (n=7,250). Diet was assessed using two 24-hour recalls, and dietary supplement use was assessed with a 30-day questionnaire.
Prevalence of supplements use was 21% (< 2 y) and 42% (2–8 y). Supplement users had higher micronutrient intakes than nonusers. Calcium and vitamin D intakes were low for all children. Inadequate intakes of phosphorus, copper, selenium, folate, and vitamins B-6 and B-12 were minimal from foods alone among 2–8 y olds. However, among 9–18 y olds, a higher prevalence of inadequate intakes of magnesium, phosphorus, and vitamins A, C, and E were observed. Supplement use increased the likelihood of intakes above the Upper Tolerable Intake Level for iron, zinc, copper, selenium, folic acid, and vitamins A and C.
Even with the use of supplements, more than a one-third of children failed to meet calcium and vitamin D recommendations. Children 2–8 y had nutritionally adequate diets regardless of supplement use. However, in children older than 8 y dietary supplements added micronutrients to diets that would have otherwise been inadequate for magnesium, phosphorus, vitamins A,C, and E. Supplement use contributed to the potential for excess intakes of some nutrients. These findings may have implications for reformulating dietary supplements for children.
children; NHANES; dietary supplement; users and non-users of supplements
Pregnant women and infants are exceptionally vulnerable to iodine deficiency. The aims of the present study were to estimate iodine intake, to investigate sources of iodine, to identify predictors of low or suboptimal iodine intake (defined as intakes below 100 μg/day and 150 μg/day) in a large population of pregnant Norwegian women and to evaluate iodine status in a sub-population. Iodine intake was calculated based on a validated Food Frequency Questionnaire in the Norwegian Mother and Child Cohort. The median iodine intake was 141 μg/day from food and 166 μg/day from food and supplements. Use of iodine-containing supplements was reported by 31.6%. The main source of iodine from food was dairy products, contributing 67% and 43% in non-supplement and iodine-supplement users, respectively. Of 61,904 women, 16.1% had iodine intake below 100 μg/day, 42.0% had iodine intake below 150 μg/day and only 21.7% reached the WHO/UNICEF/ICCIDD recommendation of 250 μg/day. Dietary behaviors associated with increased risk of low and suboptimal iodine intake were: no use of iodine-containing supplements and low intake of milk/yogurt, seafood and eggs. The median urinary iodine concentration measured in 119 participants (69 μg/L) confirmed insufficient iodine intake. Public health strategies are needed to improve and secure the iodine status of pregnant women in Norway.
iodine; pregnancy; prospective cohort; food frequency questionnaire; the Norwegian Mother and Child Cohort Study (MoBa)