Breastmilk fatty acids in relation to sensitization - the ALADDIN birth cohort.

BACKGROUND: Breastmilk fatty acids (FAs) have been associated with childhood allergic disease. Children of families with an anthroposophic lifestyle have a low prevalence of sensitization compared to reference groups. This study aimed to investigate whether the lower prevalence of sensitization among these children can be explained by the differences in breastmilk FA composition. METHODS: The prospective birth cohort ALADDIN included 330 children from anthroposophic, partly anthroposophic and nonanthroposophic families recruited between 2004 and 2007 in Sweden. In total, 245 breastmilk samples, collected at 2 months of age, were analysed for FA composition. Allergen-specific IgE levels against seven common allergens were measured in the blood samples at the ages of 6, 12 and 24 months. Data were analysed longitudinally using generalized estimating equations. RESULTS: An inverse association was observed between total concentration of omega-3 PUFA in breastmilk and sensitization in the child up to 24 months of age (highest vs lowest quartile, RRadj 0. 49, 95% CI 0.23-1.05, P for trend 0.024). No associations were observed between omega-6 PUFAs or ruminant FAs and sensitization. Overall, we observed 56% lower risks of sensitization among the anthroposophic group compared to the nonanthroposophic group (RRadj 0.44, 95% CI 0.21-0.90). This association remained largely unchanged when breastmilk omega-3 PUFA was included in the model. CONCLUSION: Our results indicate that a higher concentration of omega-3 PUFAs in breastmilk may be associated with a reduced risk of sensitization up to 24 months of age; however, this did not explain the lower risk of sensitization among children of anthroposophic families.

Differences in exosome populations in human breast milk in relation to allergic sensitization and lifestyle.

BACKGROUND: Breast-feeding has many beneficial effects on the developing immune system of the newborn. Breast milk contains immunoregulatory factors, such as nano-sized vesicles named exosomes. This study aimed at characterizing breast milk exosomes from human early milk and mature milk and to investigate whether allergic sensitization and an anthroposophic lifestyle could influence the exosome profile. METHODS: Breast milk was collected from 22 mothers at day 3-8 and from 61 mothers at 2 months postpartum, all part of the ALADDIN birth cohort. Isolated exosomes were captured on anti-MHC-class II- or anti-CD63 beads and analyzed by flow cytometry. Exosomal phenotype was related to lifestyle and allergic sensitization of the mothers, and sensitization of the child at 2 years of age. RESULTS: We found a higher content of exosomes in early milk compared with mature milk. Early milk exosomes were enriched in HLA-DR molecules and displayed significantly lower levels of HLA-ABC compared with those in mature milk. Phenotypically different subpopulations of exosomes were found in mature milk. Significantly lower levels of MUC1 were detected on CD63-enriched exosomes from sensitized mothers compared with nonsensitized. Furthermore, women with an anthroposophic lifestyle had significantly lower MUC1 expression on their HLA-DR-enriched milk exosomes and up-regulated levels of CD63 on CD63-enriched exosomes compared with nonanthroposophic mothers. Notably, mothers whose children developed sensitization had an increased amount of HLA-ABC on their milk exosomes enriched for CD63. CONCLUSIONS: The phenotype of exosomes in breast milk varies with maternal sensitization and lifestyle, which might influence allergy development in the child.

Protein biomarkers in vernix with potential to predict the development of atopic eczema in early childhood.

BACKGROUND: Atopic eczema (AE) is a chronic inflammatory skin disease, which has increased in prevalence. Evidence points toward lifestyle as a major risk factor. AE is often the first symptom early in life later followed by food allergy, asthma, and allergic rhinitis. Thus, there is a great need to find early, preferentially noninvasive, biomarkers to identify individuals that are predisposed to AE with the goal to prevent disease development. OBJECTIVE: To investigate whether the protein abundances in vernix can predict later development of AE. METHODS: Vernix collected at birth from 34 newborns within the Assessment of Lifestyle and Allergic Disease During INfancy (ALADDIN) birth cohort was included in the study. At 2 years of age, 18 children had developed AE. Vernix proteins were identified and quantified with liquid chromatography coupled to tandem mass spectrometry. RESULTS: We identified and quantified 203 proteins in all vernix samples. An orthogonal projections to latent structures-discriminant analysis (OPLS-DA) model was found with R(2) = 0.85, Q(2) = 0.39, and discrimination power between the AE and healthy group of 73.5%. Polyubiquitin-C and calmodulin-like protein 5 showed strong negative correlation to the AE group, with a correlation coefficient of 0.73 and 0.68, respectively, and a P-value of 8.2 E-7 and 1.8 E-5, respectively. For these two proteins, the OPLS-DA model showed a prediction accuracy of 91.2%. CONCLUSION: The protein abundances in vernix, and particularly that of polyubiquitin-C and calmodulin-like protein 5, are promising candidates as biomarkers for the identification of newborns predisposed to develop AE.

[Phlebology in German departments of dermatology. An analysis on behalf of the German Society of Phlebology]. / Phlebologie an deutschen Hautkliniken. Eine Bestandsaufnahme im Auftrag der Deutschen Gesellschaft für Phlebologie.

BACKGROUND: Phlebologic diseases have become extremely common and have major socio-economic impact. However, the percentage of dermatologists working in phlebology appears to be decreasing according to the data of the German Society of Phlebology (DGP). METHODS: To investigate the reasons for this development, we--on behalf of the DGP--sent a questionnaire to 120 German Departments of Dermatology in autumn 2012. RESULTS: In 76 returned questionnaires, the number of physicians with additional fellowship training in phlebology averaged 1.5; the average number of those who fulfill the criteria for training fellows in phlebology was 0.9. In 71.1 % of the departments there was a phlebologist. A special phlebologic outpatient clinic existed in 73.7 % of the departments. Sonography with Doppler (89.5 %) and duplex (86.8 %) was used as the most frequent diagnostic tool. For therapy, compression (94.7 %), sclerotherapy (liquid 78.9 %, foam 63.2 %, catheter 18.4 %), endoluminal thermic procedures (radio wave 28.9 %, laser 17.1 %) and surgery (especially crossectomy and stripping 67.1 %, phlebectomy of tributaries 75 %) were used. The average number of treatments was very heterogenous in the different departments. CONCLUSIONS: Phlebology definitely plays an important role in dermatology. Most departments fulfill the formal criteria for the license to conduct advanced training in phlebology. A wide spectrum of phlebological diagnostic and therapeutic procedures is available.

The effect of intra-articular extended-release triamcinolone acetonide on OARSI-recommended physical performance measures in adults with bilateral symptomatic knee osteoarthritis.

Objective: While the effect of triamcinolone acetonide extended-release (TA-ER) on reducing knee osteoarthritis (OA) pain has been reported, the effects on physical performance are incompletely understood. This open label clinical trial systematically evaluated the effects of intra-articular TA-ER on physical performance, self-reported function, and quality of life in participants with bilateral symptomatic knee OA 6, 12 (primary) and 24 weeks following bilateral injection of TA-ER (32 â€‹mg). Methods: Seventy participants were enrolled (61.4% women; age 64.0 â€‹± â€‹11.7; BMI 31.8 â€‹± â€‹5.7 â€‹kg/m2). Physical performance was measured by 30-s chair stand test, 40 â€‹m fast paced walk test (FPWT), and stair negotiation test at baseline and each follow-up visit. Physical function and quality of life (QOL) were measured with the Knee Injury and Osteoarthritis Outcome Score (KOOS-PS) and pain was measured with numeric rating scale (NRS). Results: In comparison with baseline, self-reported pain, function, and quality of life were improved at each follow-up through 24 weeks and the number of chair-stands significantly improved following treatment by (mean â€‹± â€‹SE) 1.9 â€‹± â€‹0.6 â€‹at 6-week (p â€‹= â€‹0.0048) and by 1.8 â€‹± â€‹0.5 â€‹at 12-week follow-up (p â€‹= â€‹0.0011) but was not statistically significant at 24-week follow-up (0.6 â€‹± â€‹0.6; p â€‹= â€‹0.4711). Stair negotiation times were 7.2 â€‹± â€‹3.7, 7.1 â€‹± â€‹3.8, and 5.4 â€‹± â€‹4.0 â€‹s lower at the three respective follow-up timepoints, although these changes did not reach statistical significance (p â€‹= â€‹0.0530, p â€‹= â€‹0.0599, and p â€‹= â€‹0.1793 respectively). The 40m-FPWT time did not significantly improve. Conclusion: These data indicate improvement in chair stand performance through 12 weeks post-injection and sustained improvement in participant-reported physical function through 24-week follow-up in adults with bilateral painful knee OA treated with TA-ER.

Lifestyle factors and sensitization in children - the ALADDIN birth cohort.

BACKGROUND: Several cross-sectional studies indicate that an anthroposophic lifestyle reduces the risk of allergy in children. We initiated the Assessment of Lifestyle and Allergic Disease During Infancy (ALADDIN) birth cohort to elucidate the role of specific factors supposed to mediate this effect. The aims of this study are to describe the ALADDIN cohort and to report patterns of exposure and allergic sensitization during the first years of life. METHODS: The ALADDIN study is a prospective birth cohort study of 330 children from families with an anthroposophic, partly anthroposophic, or nonanthroposophic lifestyle. The children and their parents were following an extensive data collection scheme, including repeated questionnaires and biological samples. Blood samples were collected from the parents and from the child at birth as well as at 6, 12, and 24 months of age. RESULTS: Several lifestyle factors differed between the groups, such as diet, medication, and place of delivery. Children of families with an anthroposophic lifestyle had a markedly decreased risk of sensitization during the first 2 years of life compared with children of nonanthroposophic families with adjusted OR 0.25 (95% CI 0.10-0.64) and P-value 0.004. A similar situation held true for children from families with a partly anthroposophic lifestyle, adjusted OR 0.31 (95% CI 0.15-0.54), and P-value 0.002. CONCLUSIONS: The anthroposophic lifestyle comprises several factors of interest for allergy development and is here shown to be associated with reduced risk of IgE sensitization already in infancy. Identifying the factors responsible for this association would be of significant clinical importance.

Lifestyle and parental allergen sensitization are reflected in the intrauterine environment at gene expression level.

BACKGROUND: Environmental factors, including the intrauterine environment, can influence the risk of allergy development. In the present study, we investigated whether lifestyle and parental allergen sensitization status are reflected at gene expression level in the intrauterine environment. METHODS: mRNA expression of 17 genes was determined by means of quantitative real-time PCR in term placenta of 36 families participating in the ALADDIN study (Assessment of Lifestyle and Allergic Disease During Infancy). Data were analysed using a linear regression model to estimate the influence of lifestyle and parental allergen sensitization on the relative mRNA expression levels. Immunohistochemistry on placenta biopsies was used to verify protein expression. RESULTS: Significant differences in mRNA expression levels were detected at the foetal side of the placenta, where CD14 was expressed at higher levels in placentas from families living on a farm compared to not living on a farm, and IL-12(p40) was expressed at lower levels when the father was sensitized compared to nonsensitized. At the maternal side of the placenta, higher expression of STAT4 and lower expression of GATA3 were detected in families with sensitized compared to nonsensitized mothers, and IL-12(p40) was lower expressed when the families were living on a farm compared to not living on a farm. Immunohistochemistry performed for STAT4 and GATA3 showed that protein and mRNA levels correlated well. CONCLUSION: Living on a farm and parental allergen sensitization are reflected in the intrauterine environment at the gene expression level.

Evidence for allergen-specific IgE of maternal origin in human placenta.

BACKGROUND: Immunoglobulin E (IgE) has been identified on macrophage-like cells in the villi of human placenta, irrespective of the serum IgE levels or allergy status of the mother. The origin of placental IgE is debated and it is not known if it is spontaneously produced, so-called 'natural IgE', or if it has any specificity for certain allergens. The aim of this study was to investigate if placental IgE originates from mother or child and to analyse its specificity. METHODS: Immunoglobulin E was eluted from placenta by lowering the pH. Total and allergen-specific IgEs were measured in placenta eluate, maternal and cord blood plasma by means of ImmunoCAP (Phadia AB). The levels of natural antibodies were determined with an anti-phosphorylcholine (PC) enzyme-linked immunosorbent assay, as natural IgE has been shown in one previous publication with this assay. RESULTS: Detectable amounts of IgE were eluted from 11/12 full-term placentas. Natural (anti-PC) IgE antibodies were detected in low amounts in maternal plasma but not in the placental eluate or in cord blood plasma. There was a significant correlation between the amount of total IgE eluted from placenta and the levels of total IgE in maternal plasma; however, not between maternal and cord blood plasma. Allergen-specific IgE was only found in placental eluates from mothers with specific IgE towards these allergens. Furthermore, there was a significant correlation between the amount of allergen-specific IgE eluted from placenta and the levels of allergen-specific IgE in maternal plasma. Allergen-specific IgE could not be detected in cord blood. CONCLUSION: These results suggest a maternal origin of placental IgE, which can be allergen-specific.

A trial with N-carbamylglutamate may not detect all patients with NAGS deficiency and neonatal onset.

N-acetylglutamate synthase (NAGS) deficiency is a rare urea cycle disorder. An effective treatment, N-carbamoyl-L-glutamic acid (NCGA), is now available, increasing the importance of identifying and treating these patients early. We describe a case with genetically verified NAGS deficiency and neonatal onset of severe hyperammonaemia. The ammonia levels increased above 1400 micromol/L. The patient did not respond to NCGA treatment during the first 15 h, indicating that a delayed response or no response cannot be used as a safe indicator for excluding NAGS deficiency in the acute situation. Hence, conventional treatment should not be delayed by a diagnostic procedure, such as a loading test. Furthermore, at 3 years of age this patient has normal psychomotor development, underlining the possibility of a favourable outcome despite markedly elevated ammonia levels, coma, and seizures in the neonatal period. Including NCGA early in the treatment of patients with hyperammonaemia may be of clinical importance. In order to detect patients with NAGS deficiency and neonatal onset and to optimize care, it is important to use the available treatment strategies to reduce plasma ammonia concentrations without delay. We propose the use of combined symptomatic treatment, i.e. glucose infusion, sodium benzoate, arginine or citrulline, and when indicated haemodialysis, as well as NCGA treatment in all neonates presenting with severe hyperammonaemia. The treatment should be continued until laboratory investigations are complete or indicate another disorder.

Family conditions and dietary control in phenylketonuria.

OBJECTIVE: This investigation is an attempt to describe coping with phenylketonuria (PKU) in order to understand some aspects underlying good compliance. METHODS: The coping concept was applied to PKU in two questionnaires. Self- and parental ratings were combined with assessments of phenylalanine levels and the severity of the disease. All Swedish patients with PKU born in 1980-91, a total of 53 children and youths with their parents, were invited to participate in the study and 41 (77%) of them did so. RESULTS: The patients turned out to have good compliance with the diet. The main result was that patients with separated or divorced parents were more likely to have higher phenylalanine levels and this association was not diminished by adjustment for the potential confounding factors. CONCLUSION: Patients' need for support must be judged individually according to different family conditions.

Enhanced osteoblastic differentiation and bone formation in co-culture of human bone marrow mesenchymal stromal cells and peripheral blood mononuclear cells with exogenous VEGF.

BACKGROUND: Despite recent advances in bone tissue engineering, efficient bone formation and vascularization remains a challenge for clinical applications. HYPOTHESIS: The aim of this study was to investigate if the osteoblastic differentiation of human mesenchymal stromal cells (MSCs) can be enhanced by co-culturing them with peripheral blood (PB) mononuclear cells (MNCs), with and without vascular endothelial growth factor (VEGF), a coupling factor of bone formation and angiogenesis. MATERIALS AND METHODS: Human bone marrow (BM) derived MSCs were co-cultured with PB-MNCs in osteogenic medium with or without VEGF. Osteoblastic differentiation and mineral deposition were studied by staining for alkaline phosphatase (ALP), and von Kossa, respectively, and measurements for ALP activity and calcium concentration (Ca). Cell proliferation was assayed with Alamar blue. The mechanism(s) were further studied by Transwell(®) cell culture experiments. RESULTS: Both ALP and mineralization (von Kossa and Ca) were significantly higher in the MSC-MNC co-cultures compared to plain MSC cultures. VEGF alone had no effect on osteoblastic differentiation of MSCs, but further enhanced differentiation in co-culture settings. The mechanism was shown to require cell-cell contact between MSCs and MNCs and the factors contributing to further differentiation appear to be soluble. No differences were observed in cell proliferation. CONCLUSION: Our study demonstrates that the in vitro ALP activity and mineralization of human BM-MSCs is more efficient in the presence of PB-MNCs, and exogenously added VEGF further enhances the stimulatory effect. This indicates that PB-MNCs could be a potential cell source in development of co-culture systems for novel tissue engineering applications for enhanced bone healing.

Increased incidence of chronic GvHD and CMV disease in patients with vitamin D deficiency before allogeneic stem cell transplantation.

Vitamin D has emerged as a central player in the immune system, with its deficiency being implicated in the pathogenesis of several autoimmune diseases, including chronic GvHD. This is a retrospective cohort analysis of 166 patients, who underwent allogeneic hematopoietic stem cell transplantation (HSCT) at the Karolinska University Hospital, evaluating GvHD, graft failure, infectious complications and survival after HSCT in relation to pre-transplantation vitamin D levels. Most of the patients were deficient in vitamin D before HSCT (median 42 nmol/L). In multivariate analysis, vitamin D level before HSCT was identified as a significant independent risk factor for development of cGvHD. The increased incidence of cGvHD was not coupled to better disease-free survival; instead there was a trend towards lower overall survival in the vitamin D-deficient patients. In addition, we found a significant correlation between vitamin D deficiency and incidence of CMV disease, with no case of CMV disease occurring in patients with sufficient levels of vitamin D before HSCT. Our results support a role of vitamin D in immune tolerance following HSCT. These findings could be highly relevant for the care of HSCT patients, and prospective, randomized studies on the effect of vitamin D supplementation are therefore needed.

Improved final height in girls with Turner's syndrome treated with growth hormone and oxandrolone.

The spontaneous growth process in Turner's syndrome is characterized by a progressive decline in height velocity during childhood and no pubertal growth spurt. Therefore, therapy aimed at improving height during childhood as well as increasing final height is desirable for most girls with Turner's syndrome. Forty-five girls with Turner's syndrome, 9-16 yr of age (mean age, 12.2 yr), were allocated to three study groups. Group 1 (n = 13) was initially treated with oxandrolone alone; after 1 yr of treatment, GH without (group 1a; n = 6) or with (group 1b; n = 7) ethinyl estradiol was added. Group 2 (n = 17) was treated with GH plus oxandrolone. Group 3 (n = 15) was treated with GH, oxandrolone, and ethinyl estradiol. The dosage were: GH, 0.1 IU/kg.day; oxandrolone, 0.05 mg/kg.day; and ethinyl estradiol, 100 ng/kg.day. A height of 150 cm or more was achieved in 61%, 75%, and 60% of the girls in groups 1, 2, and 3, respectively. The most impressive increase in height was seen in group 2. In this group the mean final height was 154.2 cm (SD = 6.6), which is equivalent to a mean net gain of 8.5 cm (SD = 4.6) over the projected final height. In group 3, in which ethinyl estradiol was included from the start of therapy, the initially good height velocity decelerated after 1-2 yr of treatment. Their mean final height was 151.1 (SD = 4.6) cm, equivalent to a mean net gain of 3.0 cm (SD = 3.8). A similar growth-decelerating effect of ethinyl estradiol was seen in group 1b. We conclude that in girls with Turner's syndrome who are older than 9 yr of age, treatment with GH in combination with oxandrolone results in significant growth acceleration, imitating that in normal puberty, leading to a more favorable height during childhood. This mode of treatment also results in a significantly increased final height, permitting a great number of the girls to attain a final height of more than 150 cm. However, early addition of estrogen decelerates the height velocity and reduces the gain in height.

Reconstruction of the carbon balance for microsites in a boreal oligotrophic pine fen, Finland.

Carbon dioxide (CO2) exchange was studied at flark (minerotrophic hollow), lawn and hummock microsites in an oligotrophic boreal pine fen. Statistical response functions were constructed for the microsites in order to reconstruct the annual CO2 exchange balance from climate data. Carbon accumulation was estimated from the annual net CO2 exchange, methane (CH4) emissions and leaching of carbon. Due to high water tables in the year 1993, the average carbon accumulation at the flark, Eriophorum lawn, Carex lawn and hummock microsites was high, 2.91, 6.08, 2.83 and 2.66 mol C m-2, respectively, and for the whole peatland it was 5.66 mol m-2 year-1. During the maximum primary production period in midsummer, hummocks with low water tables emitted less methane than predicted from the average net ecosystem exchange (NEE), while the Carex lawns emitted slightly more. CH4 release during that period corresponded to 16% of the contemporary NEE. Annual C accumulation rate did not correlate with annual CH4 release in the microsites studied, but the total community CO2 release seemed to be related to CH4 emissions in the wet microsites, again excluding the hummocks. The dependence of CO2 exchange dynamics on weather events suggests that daily balances in C accumulation are labile and can change from net carbon uptake to net release, primarily in high hummocks on fens under warmer, drier climatic conditions.

Health economic analysis of the Swedish neonatal metabolic screening programme. A method of optimizing routines.

A benefit-cost analysis was carried out to optimize the routines for neonatal metabolic screening. The basis of the study was provided by results of the Swedish neonatal screening programme from 1965 to 1979. During this period over one million infants were screened by the Guthrie test for phenylketonuria and galactosaemia, and for limited periods also for tyrosinaemia, homocystinuria and histidinaemia. The benefit-cost ratio was calculated for combinations of different screening tests, recall routines, and varying degrees of coverage. The largest benefit-cost ratio was obtained with combined screening for phenylketonuria and galactosaemia, using a borderline blood phenylalanine level of 0.50 mmol/L in the Guthrie test for phenylketonuria. However, the inaccuracy of this test necessitated the use of a lower blood phenylalanine level of 0.25 mmol/L and the acceptance of a lower benefit-cost ratio. An increase in the present 98% coverage of newborns by the screening programme was found to be an effective means of improving the benefit-cost ratio in the present programme.

Concentrations of organic acids in the urine of healthy newborn children.

Urine concentrations of organic acids were determined by a gas chromatographic technique in healthy, full-term neonates at the ages of 2 and 5 days. Significant reductions in the interindividual variation were obtained by relating the levels of organic acids to urine creatinine concentration or osmolality. Citrate was the predominant organic anion found. Urine concentrations of fumarate, 3-hydroxy-3-methylglutarate, adipate, and suberate decreased during the first week of life, and their concentrations were significantly intercorrelated. It is suggested that these findings reflect the predominantly fat-utilising, hyperketonaemic state during the first days of life. The urine concentrations of the aromatic end-products, p-hydroxyphenylacetate and hippurate, increased during the first week of life, probably as an effect of dietary factors. It is concluded that analysis of intermediary organic acids in urine could be of value in the assessment of the metabolic state in neonates.

Greenhouse gases in non-oxygenated and artificially oxygenated eutrophied lakes during winter stratification.

Concentrations of dissolved methane (CH4), carbon dioxide (CO2), and nitrous oxide (N2O) were measured in the water columns of non-oxygenated and artificially oxygenated, ice-covered eutrophied lakes in the mid-boreal zone in Finland during late winter 1997 and 1999. Sampling was conducted during winter stratification, the critical period for oxygen (O2) deficiency in seasonally ice-covered, thermally stratified lakes. Oxygen concentrations were maintained at least at a moderate level throughout the oxygenated water columns, whereas the non-oxygenated columns suffered anoxic hypolimnia. The mean concentrations of dissolved CH4 exceeding the atmospheric equilibrium were greater in the non-oxygenated water columns (20.6-154 microM) than in the oxygenated ones (0.01-1.41 microM). In contrast, the mean excess CO2 concentrations varied less between the non-oxygenated and oxygenated sites (0.28-0.47 and 0.25-0.31 mM, respectively). Oxygenated water columns had greater mean excess concentrations of N2O (0.018-0.032 microM) than the non-oxygenated ones (0.005-0.024 microM). If the accumulated greenhouse gas stores in the water columns during winter are assumed to be released to the atmosphere during the spring overturn, the global warming potentials (GWP, time horizon 100 yr) of these potential emissions at the non-oxygenated, eutrophic study sites ranged from 177 to 654 g CO2 equivalent (CO2-e) m-2 compared with 144 to 173 g CO2-e m-2 at the oxygenated sites. The increase in the accumulation of CH4 was the main reason for the higher GWP of the non-oxygenated sites. Anthropogenic eutrophication of lake ecosystems can generate increased CH4 emissions due to associated O2 depletion of their sediment and water column.

Income taxes and the timing of marital decisions.

"In this paper we estimate the impact of the [U.S.] federal individual income tax on the timing of marital decisions.... Using household data from the Panel Study on Income Dynamics, we estimate various models of the probability of delaying marriage as a function of the change in tax burden caused by marriage (as well as several other variables). We find that there is a significant positive relationship between the marriage penalty in a year and the probability of delaying marriage until the following year. The magnitude of the effect, however, is small."

Does the income tax affect marital decisions?

"This paper discusses new empirical evidence on the role of income tax incentives in marital decisions [in the United States]. Time-series evidence suggests that taxes have a small but statistically significant effect on the aggregate marriage rate; however, this evidence is sensitive to the time period and the measure of marriage. Additional evidence, based on household longitudinal data, indicates that the probability of marriage falls and that of divorce rises with an increase in the so-called marriage tax, and that the timing of marriage (though not of divorce) is also affected by taxes. In short, there is strong evidence that taxes affect some marital decisions."