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We aimed to study supplement use in relation to dietary intake among pregnant women in Sweden, and adherence to the Nordic Nutrition Recommendations among supplement and non-supplement users. Pregnant women were recruited at registration to antenatal care in 20132014. In third trimester, supplement use was collected using a questionnaire, and dietary intake was collected using a FFQ. The majority (64 %) of the 1044 women reported use of one or more supplements. Among all, 023 % reported dietary intakes above recommended intake (RI) of vitamin D, folate, Fe and Se. Median dietary intakes of thiamine (1·4 v. 1·3 mg P = 0·013), phosphorus (1482 v. 1440 mg P = 0·007), folate (327 v. 316 µg P = 0·02), Fe (12 v. 11·5 mg P = 0·009), Mg (361 v. 346 mg P < 0·001) and Zn (10·7 v. 10·4 mg P = 0·01) were higher among supplement users compared with non-users. Larger proportions of supplement users than non-users adhered to RI of dietary intakes of thiamine (42 % v. 35 % P = 0·04) and Mg (75 % v. 69 % P = 0·05). Among non-users, a minority had dietary intakes above RI for vitamin D (6 %), folate (10 %) and Fe (21 %). The majority (75100 %) of supplement users had total intakes above RI for most nutrients. In conclusion, supplement use contributed substantially to reaching RI for vitamin D, folate and Fe. Supplement users had a higher dietary intake of several nutrients than non-users. This highlights that non-supplement users are at risk of inadequate nutrient intakes during pregnancy, suggesting a need for heightened awareness of nutritional adequacy for pregnant women.
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Suplementos Nutricionais , Vitaminas , Feminino , Humanos , Gravidez , Suécia , Ingestão de Alimentos , Ácido Fólico , Vitamina D , Tiamina , Dieta , Necessidades NutricionaisRESUMO
Background: Food frequency questionnaire (FFQ) is the most frequently used dietary assessment method in estimating dietary intakes in epidemiological studies. Aim: This study aimed to assess the relative validity of a semiquantitative FFQ in evaluating dietary intake among pregnant women in the United Arab Emirates. Methods: Within the Mutaba'ah study, a subsample of 111 pregnant women completed a semiquantitative FFQ and a single 24-hour dietary recall (24-HDR) regarded as the reference method. Absolute and energy-adjusted nutrient and food intakes between the FFQ and 24-HDR were compared using the Wilcoxon signed ranks test, correlations, Bland-Altman analysis, cross-classification, and weighted kappa analysis. Results: There were no significant differences in reported absolute intakes between the FFQ and 24-HDR for carbohydrates, whole grains, white meat, beta-carotene, vitamin K, sodium, and selenium. Spearman's correlation coefficients between the FFQ and 24-HDR ranged from 0.09 (trans fatty acids) to 0.5 (potassium) for absolute intakes. Correlation decreased after energy adjustment. Bland-Altman analysis showed that the FFQ overestimated intakes compared with 24-HDR and that the limits of agreement were wide. The average percentage of pregnant women classified into the same or adjacent quartile of intake by both methods was 73%. Weighted kappa values ranged from -0.02 (white meat) to 0.33 (magnesium). Conclusion: Our findings showed that the semi-quantitative FFQ is a useful tool in ranking pregnant women from the Emirati population according to their dietary intake. However, the validity of some estimated intakes was poor; hence, certain intakes should be interpreted with caution.
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BACKGROUND: The relationship between maternal vitamin D status in pregnancy and the development of atopic diseases in the offspring has been frequently studied, but with contradictory results. Previous studies have found an inverse relation between maternal vitamin D in pregnancy and the risk of atopic diseases in the child. In contrast, others have found a higher maternal 25OHD to be related to a higher risk of atopic diseases. Thus, the aim was to investigate the associations between maternal vitamin D status and intake in pregnancy with asthma, eczema and food allergies in the children up to 5 years. In addition, effect modification by reported atopic heredity was studied. METHODS: Participants in the GraviD study had 25-hydroxyvitamin D (25OHD) analyzed in serum in early (T1) and late (T3) pregnancy. Maternal dietary vitamin D intake was estimated from a short food frequency questionnaire and supplement use by questionnaires. At 5 years of age the child´s history of asthma, eczema and food allergy, including atopic heredity, was reported by questionnaire. Multivariable logistic regression was used. RESULTS: The cumulative incidence of asthma was 13%, eczema 22%, and food allergy 18%. Only among children without reported atopic heredity, maternal 25OHD of 50-75 nmol/L in T1 was associated with lower odds of asthma (OR 0.271, 95% CI 0.127-0.580), compared to maternal 25OHD > 75 nmol/L. Additionally in these children, maternal 25OHD in T3 (continuous) was associated with asthma (OR 1.014, 95% CI 1.002-1.009), and dietary vitamin D intake with eczema (OR 1.141, 95% CI 1.011-1.288). CONCLUSIONS: Among children without reported atopic heredity, higher maternal vitamin D status and intake during pregnancy was associated with increased risk of reported atopic disease.
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Asma , Eczema , Hipersensibilidade Alimentar , Hereditariedade , Asma/complicações , Asma/epidemiologia , Criança , Eczema/induzido quimicamente , Eczema/epidemiologia , Feminino , Hipersensibilidade Alimentar/complicações , Hipersensibilidade Alimentar/epidemiologia , Humanos , Gravidez , Vitamina D , VitaminasRESUMO
INTRODUCTION: Breastfed infants depend on breast-milk iodine for growth and brain development, as iodine is a trace element important for thyroid hormone production. Iodine need is higher during lactation; hence, mothers and children are at risk of iodine deficiency. We aimed to explore maternal iodine and thyroidal status during lactation. MATERIAL AND METHODS: Pregnant women were recruited in Gothenburg, southwest Sweden. Maternal urine and serum were collected at pregnancy week 35-37 (n = 84) and 0.5, 4, and 12 months postpartum. Seventy mothers provided breast milk at 0.5 months. RESULTS: Median (interquartile range) breast-milk iodine concentration was 90 (66-116) µg/L. About 58% had breast-milk iodine concentration <100 µg/L. Iodine supplement users (n = 13) had higher breast-milk iodine concentration than non-users (n = 49) (140 µg/L vs 71 µg/L, P = .001). Exclusively breastfeeding women at 4 months postpartum (n = 57) had lower median urinary iodine concentration (85 µg/L vs 133 µg/L, P = .004) and higher thyroglobulin serum concentration (22.3 µg/L vs 11.8 µg/L, P = .032) than non-exclusively breastfeeding women (n = 25). Concentrations of thyroid hormones were unaffected. CONCLUSIONS: This pilot study suggests that lactating women in southwest Sweden present mildly inadequate iodine intake, mainly among non-iodine supplement users and exclusively breastfeeding mothers. Studies on the coverage of the iodine fortification program in breastfeeding women are warranted.
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Iodo/deficiência , Lactação , Leite Humano/química , Adulto , Feminino , Humanos , Projetos Piloto , Gravidez , Estudos Prospectivos , SuéciaRESUMO
BACKGROUND: The aim of this work was to study potential gender differences in perceived food healthiness and food avoidance in a population-representative sample of the Swedish adult population. METHODS: A questionnaire regarding diet and health was posted to 2000 randomly selected residents in Sweden, aged 20-65 years. Questions were posed regarding which foods or food components the participants avoided due to perceived unhealthiness and how healthy they believed the food items to be. The pre-specified food components included sugar, carbohydrate, gluten, lactose, dairy, fat, saturated fat, red meat, white flour, salt, alcohol and food additives (specifically glutamate, sweetening, preservative and coloring agents). Chi square tests were used to study differences in perceived food healthiness and food avoidance depending on gender. RESULTS: Around 50% reported avoidance of sugar (51.6%) and sweeting agents (45.2%), whereas fewer reported avoidance of saturated fat (16.8%) and salt (10.6%). Women were more likely than men to avoid gluten (AOR [95% CI] 2.84 [1.33-6.05]), red meat (3.29 [1.86-5.80]), white flour (2.64 [1.65-4.21]), preservatives (1.7 [1.07-2.70]) and coloring agents (2.10 [1.29-3.41]) due to perceived unhealthiness. Gender differences were also apparent in perceived healthiness of sugar, gluten, dairy, red meat, white flour, alcohol and food additives, where women tended to be more negative than men in their attitudes. Women more often said to read new findings in media about diet (16% vs 9%, p = 0.029) and prioritize a healthy lifestyle (35% vs 25%, p = 0.015). More than a third of both women and men reported worrying over the healthiness of their diet, and a higher proportion of women than men (18% vs 11%, p = 0.015) agreed with the statement that they were often anxious over having an unhealthy diet. CONCLUSIONS: Women in this population-based study of residents in Sweden were more likely than men to avoid eating gluten, red meat, white flour and food additives due to perceived unhealthiness, and reported more diet and health related anxiety. Future research to identify effective ways of promoting healthy eating for both women and men, while minimizing diet-health related anxiety, is highly warranted.
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Dieta , Alimentos , Adulto , Estudos Transversais , Feminino , Humanos , Masculino , Fatores Sexuais , SuéciaRESUMO
OBJECTIVES: The aim of this prospective cohort study was to investigate the associations between maternal vitamin D status in late pregnancy and emergency caesarean section (EMCS) and birth asphyxia, in a population based sample of women in Sweden. METHODS: Pregnant women were recruited at the antenatal care in Sweden and 1832 women were included after exclusion of miscarriages, terminated pregnancies and missing data on vitamin D status. Mode of delivery was retrieved from medical records. EMCS was defined as caesarean section after onset of labour. Birth asphyxia was defined as either 5 min Apgar score < 7 or arterial umbilical cord pH < 7.1. Serum was sampled in the third trimester of pregnancy (T3) and 25-hydroxyvitamin D (25OHD) was analysed by liquid chromatography tandem mass spectrometry. Vitamin D deficiency was defined as 25OHD < 30 nmol/L, and associations were studied using logistic regression analysis and expressed as adjusted odds ratios (AOR). RESULTS: In total, 141 (7.7%) women had an EMCS and 58 (3.2%) children were born with birth asphyxia. Vitamin D deficiency was only associated with higher odds of EMCS in women without epidural anaesthesia (AOR = 2.01, p = 0.044). Vitamin D deficiency was also associated with higher odds of birth asphyxia (AOR = 2.22, p = 0.044). CONCLUSIONS FOR PRACTICE: In this Swedish prospective population-based cohort study, vitamin D deficiency in late pregnancy was associated with doubled odds of birth asphyxia and with EMCS in deliveries not aided by epidural anaesthesia. Prevention of vitamin D deficiency among pregnant women may reduce the incidence of EMCS and birth asphyxia. The mechanism behind the findings require further investigation.
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Asfixia/etiologia , Cesárea/estatística & dados numéricos , Complicações na Gravidez/etiologia , Deficiência de Vitamina D/complicações , Adulto , Asfixia/fisiopatologia , Cesárea/métodos , Distribuição de Qui-Quadrado , Estudos de Coortes , Feminino , Humanos , Saúde do Lactente , Recém-Nascido , Razão de Chances , Gravidez , Complicações na Gravidez/epidemiologia , Estudos Prospectivos , Suécia/epidemiologia , Deficiência de Vitamina D/epidemiologiaRESUMO
BACKGROUND: Investment in research is high on the agenda of many countries in recognition of the fact that research is important for the development of society. Doctoral students have a vital role and represent a substantial part of this investment. It is therefore imperative to reduce the risk of students dropping out from doctoral studies. The aim of this qualitative study was to gain deeper insight into the working conditions of, and obstacles and opportunities for, doctoral students at an institute of medicine in Sweden. METHODS: Semi-structured interviews were conducted in 2013 with 17 doctoral students-of varying genders, professions and fields of research-from the Institute of Medicine, Sahlgrenska Academy, at the University of Gothenburg, Sweden. The recorded interviews were transcribed and analysed using systematic text condensation. RESULTS: Four categories emerged from the data. They were: Safety, Frustrating Structures, Others - not me, and the future. They included positive as well as negative perceptions. Among the positive perceptions were recognition of the importance of the supervisor, as well as secure conditions, and personal development. Frustrating structures in the academic culture, stress and differences in career building constituted the negative points. CONCLUSIONS: Our findings suggest that there is a need for structures within the university that support doctoral students who feel they are not receiving the assistance they need, who believe they have unreasonable working conditions, or who may need to change supervisors in order to complete their graduate research studies. Our study also highlights the fact that supervisors have a major influence on the work environment of doctoral students, and that the general and academic perception of the research area likewise has an effect on the successful completion of the research project and dissertation. Providing leadership training for supervisors could be an important measure that may help improve conditions for the doctoral students they supervise.
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Pesquisa Biomédica/educação , Educação de Pós-Graduação em Medicina/normas , Docentes de Medicina , Pesquisadores/psicologia , Estudantes de Medicina/psicologia , Local de Trabalho/psicologia , Atitude do Pessoal de Saúde , Currículo , Feminino , Humanos , Entrevistas como Assunto , Masculino , Pesquisa Qualitativa , Meio Social , Suécia , Orientação Vocacional/normasRESUMO
Sociodemographic factors have been associated with dietary supplement use among pregnant women but few data exist in a Swedish population. This study aimed to identify factors associated with overall supplement use as well as use of folic acid, vitamin D and n-3 in early pregnancy. Women in the first trimester of pregnancy were included at registration to the antenatal care in 2013-2014 (n 2109). Information regarding supplement use as well as sociodemographic and anthropometric data were obtained from questionnaires and medical records. Multivariable logistic regression analysis was performed to determine the relationship between sociodemographic variables and supplement use. A total of 78 % of the participants reported using at least one dietary supplement in the first trimester. Folic acid supplement use was reported by 74 %, vitamin D supplement use by 43 % and n-3 supplement use by <5 %. Use of any type of supplement in early pregnancy was related to gestational age, parity, birthplace, education and employment. Folic acid supplement use was related to gestational age, parity, birthplace, income, education and employment. Vitamin D supplement use was related to gestational age, birthplace and education. In conclusion, in the first trimester of pregnancy, folic acid supplements were used by three in four women, while vitamin D supplements were used by less than half of the women. The results of this study show a socioeconomic disparity between supplement users and non-users which may have a negative impact on the health of future generations.
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Suplementos Nutricionais/estatística & dados numéricos , Ácido Fólico/uso terapêutico , Complexo Vitamínico B/uso terapêutico , Adulto , Estudos de Coortes , Feminino , Disparidades nos Níveis de Saúde , Disparidades em Assistência à Saúde , Humanos , Gravidez , Primeiro Trimestre da Gravidez , Terceiro Trimestre da Gravidez , Classe Social , Inquéritos e Questionários , SuéciaRESUMO
BACKGROUND: We investigated the associations between vitamin D status in early and late pregnancy with neonatal small for gestational age (SGA), low birth weight (LBW) and preterm delivery. Furthermore, associations between vitamin D status and pregnancy loss were studied. METHODS: Serum 25-hydroxyvitamin D (25OHD) was sampled in gestational week ≤ 16 (trimester 1 (T1), N = 2046) and > 31 (trimester 3 (T3), N = 1816) and analysed using liquid chromatography tandem mass spectrometry. Pregnant women were recruited at antenatal clinics in south-west Sweden at latitude 57-58°N. Gestational and neonatal data were retrieved from medical records. Multiple gestations and terminated pregnancies were excluded from the analyses. SGA was defined as weight and/or length at birth < 2 SD of the population mean and LBW as < 2500 g. Preterm delivery was defined as delivery < 37 + 0 gestational weeks and pregnancy loss as spontaneous abortion or intrauterine fetal death. Associations between neonatal outcomes and 25OHD at T1, T3 and change in 25OHD (T3-T1) were studied using logistic regression. RESULTS: T1 25OHD was negatively associated with pregnancy loss and 1 nmol/L increase in 25OHD was associated with 1% lower odds of pregnancy loss (OR 0.99, p = 0.046). T3 25OHD ≥ 100 nmol/L (equal to 40 ng/ml) was associated with lower odds of SGA (OR 0.3, p = 0.031) and LBW (OR 0.2, p = 0.046), compared to vitamin D deficiency (25OHD < 30 nmol/L, or 12 ng/ml). Women with a ≥ 30 nmol/L increment in 25OHD from T1 to T3 had the lowest odds of SGA, LBW and preterm delivery. CONCLUSIONS: Vitamin D deficiency in late pregnancy was associated with higher odds of SGA and LBW. Lower 25OHD in early pregnancy was only associated with pregnancy loss. Vitamin D status trajectory from early to late pregnancy was inversely associated with SGA, LBW and preterm delivery with the lowest odds among women with the highest increment in 25OHD. Thus, both higher vitamin D status in late pregnancy and gestational vitamin D status trajectory can be suspected to play a role in healthy pregnancy.
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Recém-Nascido Pequeno para a Idade Gestacional , Complicações na Gravidez , Nascimento Prematuro/epidemiologia , Cuidado Pré-Natal , Deficiência de Vitamina D , Vitamina D/análogos & derivados , Adulto , Peso ao Nascer , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Gravidez , Complicações na Gravidez/diagnóstico , Complicações na Gravidez/epidemiologia , Trimestres da Gravidez/sangue , Cuidado Pré-Natal/métodos , Cuidado Pré-Natal/estatística & dados numéricos , Fatores de Risco , Estatística como Assunto , Suécia/epidemiologia , Vitamina D/sangue , Deficiência de Vitamina D/diagnóstico , Deficiência de Vitamina D/epidemiologiaRESUMO
Metabolite changes in plant leaves during exposure to low temperatures involve re-allocation of a large number of metabolites between sub-cellular compartments. Therefore, metabolite determination at the whole cell level may be insufficient for interpretation of the functional significance of cellular compounds. To investigate the cold-induced metabolite dynamics at the level of individual sub-cellular compartments, an integrative platform was developed that combines quantitative metabolite profiling by gas chromatography coupled to mass spectrometry (GC-MS) with the non-aqueous fractionation technique allowing separation of cytosol, vacuole and the plastidial compartment. Two mutants of Arabidopsis thaliana representing antipodes in the diversion of carbohydrate metabolism between sucrose and starch were compared to Col-0 wildtype before and after cold acclimation to investigate interactions of cold acclimation with subcellular re-programming of metabolism. A multivariate analysis of the data set revealed dominant effects of compartmentation on metabolite concentrations that were modulated by environmental condition and genetic determinants. While for both, the starchless mutant of plastidial phospho-gluco mutase (pgm) and a mutant defective in sucrose-phosphate synthase A1, metabolic constraints, especially at low temperature, could be uncovered based on subcellularly resolved metabolite profiles, only pgm had lowered freezing tolerance. Metabolic profiles of pgm point to redox imbalance as a possible reason for reduced cold acclimation capacity.
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Aclimatação , Arabidopsis/metabolismo , Arabidopsis/fisiologia , Temperatura Baixa , Arabidopsis/genética , Análise por Conglomerados , Congelamento , Genótipo , Glucosiltransferases/metabolismo , Metaboloma , Mutação/genética , Análise de Componente Principal , Amido/metabolismo , Frações Subcelulares/metabolismoRESUMO
During lactation, areal (a) and volumetric (v) bone mineral density (BMD) are known to temporarily decrease. Factors that affect skeletal changes postpartum are not fully elucidated. The aim was to study determinants of the previously observed changes in aBMD at lumbar spine, and cortical vBMD, microstructure and dimensions at ultra-distal tibia postpartum. Women (25-40 years) were studied longitudinally at 2 weeks (baseline) and 4 months (n 81), 12 months (n 79) and 18 months (n 58) postpartum. At each visit, blood samples were collected, body weight and height were measured and information about lactation habits, oestrogen contraceptives and physical activity was obtained. Ca intake was measured using 4-d food diaries at 4 months postpartum. Serum 25-hydroxyvitamin D (25OHD) was analysed by liquid chromatography-tandem MS. Skeletal changes were assessed with dual-energy X-ray absorptiometry and high-resolution peripheral quantitative computed tomography. Mean baseline BMI was 24·8 (sd 3·1) kg/m2. Median (quartiles 1-3) duration of total lactation was 8·1 (6·8-10·4) months. Longer duration of full lactation was associated with larger decreases of lumbar spine aBMD and tibia vBMD and microstructure. Higher baseline body weight was associated with smaller decreases in tibia vBMD and microstructure. Higher Ca intake was associated with smaller decreases in tibia cortical vBMD and thickness. Higher baseline 25OHD was only associated with larger decreases in lumbar spine aBMD. In conclusion, lactation and body weight were the main determinants of skeletal changes during the first 18 months postpartum. Ca intake and serum concentrations of 25OHD appear to have different associations with cortical and trabecular bone.
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Low vitamin D status has been associated with unfavourable health outcomes. Postpartum, it is speculated that maternal vitamin D status decreases due to transfer of vitamin D from mother to child through breast milk. A few studies have investigated changes in maternal vitamin D postpartum and possible determinants. Thus, the aims of the present study were to determine changes in serum concentrations of 25-hydroxyvitamin D (25(OH)D) between 2 weeks and 12 months postpartum in Swedish women and to evaluate lactation and other determinants for changes in 25(OH)D concentration postpartum. In total, seventy-eight women were studied at 2 weeks, 4 months and 12 months postpartum. Data collection included measurements of weight and height as well as information about lactation, sun exposure, use of oestrogen contraceptives and physical activity level. Blood samples were collected and serum 25(OH)D levels were analysed using liquid chromatography-tandem MS. Dietary intake of vitamin D was recorded using 4-d food diaries. For all the women studied, mean serum 25(OH)D did not change between 2 weeks and 12 months postpartum (67 (SD 23) v. 67 (SD 19) nmol/l). No association was found between lactation and changes in serum 25(OH)D concentration postpartum. Significant determinants for postpartum changes in 25(OH)D concentration were use of vitamin D supplements (P=0·003), use of oestrogen contraceptives (P=0·013) and season (P=0·005). In conclusion, no changes were observed in 25(OH)D concentrations during the 1st year postpartum in these women and no association was found between lactation and changes in 25(OH)D concentration postpartum. The main determinants for the variation in changes in 25(OH)D concentrations postpartum were use of vitamin D supplements, use of oestrogen contraceptives and season.
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Vitamina D/sangue , Adulto , Registros de Dieta , Suplementos Nutricionais , Feminino , Humanos , Lactação , Modelos Lineares , Leite Humano/química , Análise Multivariada , Período Pós-Parto/sangue , Estações do Ano , Luz Solar , Suécia/epidemiologia , Deficiência de Vitamina D/sangue , Deficiência de Vitamina D/epidemiologia , População BrancaRESUMO
BACKGROUND: Sweden has the second highest incidence of type 1 diabetes in the world. Nutritional aspects in utero and in infancy affect the development. We conducted a survey to determine whether reported maternal use of vitamin D-containing micronutrient supplements during pregnancy was associated with the risk of developing type 1 diabetes in the child. METHODS: This report was based on data from the ABIS (All Babies In Southeast Sweden) study, with questionnaire data on 16 339 mother and infant pairs at birth and at 1-yr of age (n = 10 879), of whom 108 children were registered with type 1 diabetes before 14-16 yr of age. The questions 'during pregnancy, did you take any vitamin/mineral supplements?' and 'if yes, which? (open answer)' in addition to other lifestyle questions were answered. Logistic regression was performed with onset of type 1 diabetes as the dependent variable and vitamin D supplementation use as the independent variable, adjusted for relevant factors. RESULTS: Vitamin D supplementation during pregnancy was consumed by 9.3% of mothers whose children later got type1 diabetes and among 11.3% of those mothers whose children did not get type 1 diabetes (p = 0.532). No significant association was found between reported supplement intake of vitamin D during pregnancy and risk of type 1 diabetes, even when adjusting for factors which could influence the association. CONCLUSION: Maternal use of vitamin D-containing multivitamin supplements during pregnancy was not related to the risk of developing type 1 diabetes in children before 14-16 yr of age in Southeast of Sweden.
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Diabetes Mellitus Tipo 1/epidemiologia , Suplementos Nutricionais , Fenômenos Fisiológicos da Nutrição Materna , Efeitos Tardios da Exposição Pré-Natal/epidemiologia , Vitamina D/administração & dosagem , Vitaminas/administração & dosagem , Adolescente , Adulto , Suplementos Nutricionais/efeitos adversos , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Gravidez , Fatores de Risco , Suécia/epidemiologia , Vitamina D/efeitos adversos , Vitaminas/efeitos adversos , Adulto JovemRESUMO
Many German municipalities are developing retail concepts for retail management and taking stock of the food supply is one of the standard tools. A distance-based indicator is commonly used, which measures the degree of supply based on linear distances between the place of residence and the nearest place of purchase. Beyond this distance, however, access to food is influenced by other spatiophysical and socioeconomic factors. So far, these have hardly been considered. Inadequate access to food is not only problematic from a health perspective, but also because of the social function of food as an important field of social participation. Difficult access to food especially affects people in precarious circumstances, who are already restricted in their participation in society. This article therefore presents a model that theoretically informed, comprehensively and systematically captures the spatiophysical and socioeconomic embedding of food access. Based on selected results of a study that was carried out in Bremen using this approach, this article shows the access barriers that affect residents of two districts that are considered to be well supplied. The primary goal of this article is to raise awareness of the complex issue of food access. Finally, approaches that retail and other municipal initiatives can use to improve access to food are also named.
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Nutrient requirements vary across the reproductive cycle, but research on changes in nutritional intake and quality from pregnancy to beyond the lactation period is limited. Thus, we aimed to study nutritional intake and quality changes, among Swedish pregnant participants from late pregnancy to 18 months postpartum and to study the determinants of nutritional quality changes. Participants (n = 72) were studied longitudinally from the third trimester of pregnancy and postpartum (2 weeks 4, 12, and 18 months postpartum). At each visit, participant characteristics and 4-day food diaries were collected. Nutritional quality was assessed by energy adjusted Nutrient Rich Food Index 11.3. Linear mixed models were used to analyze the determinants of change in nutritional quality. Intakes of carbohydrate energy percentage (E%), fiber, vitamin A, vitamin C, and potassium were higher in the third trimester compared to postpartum, whereas intakes of E% protein and monounsaturated fat were lower. Adherence to recommended intakes was low at all study visits for saturated fat (4%-11%), fiber (15%-39%), vitamin D (8%-14%), folate (0%-2%), and iron (6%-21%). Overall, nutritional quality did not differ significantly from third trimester to postpartum. Shorter duration (<4 months) of lactation was negatively related to nutritional quality changes, whereas higher age was positively related to changes. In conclusion, nutritional intake from pregnancy to postpartum changed, whereas quality remained relatively stable, with age and lactation duration as determinants. Identification of people at risk of adverse dietary changes from pregnancy to the postpartum period should be further addressed in future larger and more diverse study populations.
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Silicon (Si) may be a mineral beneficial for bone health. Pregnancy and lactation have major impacts on maternal bone metabolism as bone minerals, including calcium (Ca), are required for growth of the foetus and for milk production. Like urinary Ca excretion, Si excretion has been reported to be high in pregnant women, but there are no data post-partum and during lactation. The aim of the present study was to investigate the urinary excretion of Si (U-Si), from the third trimester of pregnancy until 18 months post-partum, and in relation to the length of lactation, to determine if changes in U-Si are associated with changes in areal bone mineral density (aBMD). This longitudinal study included 81 pregnant women, of whom 56 completed the study. Spot urine samples were collected at the third trimester and at 0.5, 4, 12, and 18 months post-partum and were analysed for Si and Ca by ICP-OES. The aBMD was measured post-partum at lumbar spine and femoral neck by dual-energy x-ray absorptiometry. Women lactating for 4-8.9 and ≥ 9 months had significantly higher U-Si at 4 months post-partum, compared with the third trimester. No significant longitudinal differences in U-Si were found after correcting for creatinine. Changes in U-Si and in aBMD were not correlated, except at the lumbar spine from 0.5 to 12 months post-partum in the women lactating for 4-8.9 months. Taken together, our results suggest that there is a possibility that U-Si increases post-partum in women lactating for 4 months or longer, although it is not related to changes in aBMD.
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Background: Alterations in body weight and composition are common in patients with chronic obstructive pulmonary disease (COPD) and are independent predictors for morbidity and mortality. Low vitamin D status is also more prevalent in patients with COPD compared to controls and has been related to lower lung function, muscle atrophy and impaired musculoskeletal function. This study aimed to evaluate the association between vitamin D levels and status with body composition (BC), as well as with its changes over time. Patients and Methods: Patients with COPD and controls without COPD, participating in the Individualized COPD Evaluation in relation to Ageing (ICE-Age) study, a prospective observational study, were included. Plasma 25-hydroxyvitamin D (25(OH)D) was measured at baseline and BC was measured by dual-energy X-ray absorptiometry scan, at baseline and after two years of follow-up. Multiple linear regression analyses were performed to assess the relationships between 25(OH)D (nmol/l) and longitudinal changes in BMI, fat-free mass index (FFMI), fat mas index (FMI) and bone mineral density (BMD). Results: A total of 192 patients with COPD (57% males, mean ± SD age, 62 ± 7, FEV1, 49 ± 16% predicted) and 199 controls (45% males, mean ± SD age 61 ± 7) were included in this study. Vitamin D levels were significantly lower in patients with COPD (64 ± 26 nmol/L, 95% CI 60-68 nmol/L versus 75 ± 25 nmol/L, 95% CI 72-79 nmol/L) compared to controls. Both patients and controls presented a significant decline in FFMI and T-score hip, but vitamin D level or status did not determine differences in BC or changes in BC over time in either COPD or controls. Conclusion: Vitamin D status was not associated with BC or longitudinal changes in BC. However, vitamin D insufficiency and low BMD were more prevalent in patients with COPD compared to controls.
Assuntos
Absorciometria de Fóton , Biomarcadores , Composição Corporal , Densidade Óssea , Pulmão , Doença Pulmonar Obstrutiva Crônica , Deficiência de Vitamina D , Vitamina D , Humanos , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Doença Pulmonar Obstrutiva Crônica/sangue , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Masculino , Feminino , Estudos Prospectivos , Pessoa de Meia-Idade , Vitamina D/sangue , Vitamina D/análogos & derivados , Idoso , Deficiência de Vitamina D/sangue , Deficiência de Vitamina D/fisiopatologia , Deficiência de Vitamina D/epidemiologia , Deficiência de Vitamina D/complicações , Fatores de Tempo , Pulmão/fisiopatologia , Pulmão/diagnóstico por imagem , Estudos de Casos e Controles , Biomarcadores/sangue , Estudos Longitudinais , Modelos Lineares , Fatores de Risco , Volume Expiratório Forçado , Índice de Massa CorporalRESUMO
Low vitamin D levels are common in Chronic Obstructive Pulmonary Disease (COPD) and have been associated with various adverse COPD-related outcomes. Recent data on vitamin D status in representative COPD cohorts in Scandinavia is lacking. This study aimed to assess vitamin D status and determinants of vitamin D insufficiency in patients with COPD who were attending a specialist secondary care COPD clinic in Southwestern Sweden. All patients who visited the COPD clinic for their first medical visit during two periods, 2017−2018 and 2021, were included in this observational study. Measurements of 25-Hydroxyvitamin D (25(OH)D), clinical data and documentation of supplements containing vitamin D were collected retrospectively from patients' medical records. Multivariable logistic regression analysis was performed to identify determinants of the primary outcome, vitamin D insufficiency (25(OH)D < 50 nmol/L). A total of 667 patients were included, and 33% had vitamin D insufficiency. The median 25(OH)D was 62 nmol/L (43.5−83.1 nmol/L). Vitamin D insufficiency was related to the male gender, current smoking habits, a lack of supplements containing vitamin D and the winter season for blood sampling. In conclusion, vitamin D insufficiency is common in patients with COPD. Men had significantly lower levels of vitamin D but took vitamin D-containing supplements less frequently compared to women. Our findings can help clinicians to identify patients who are at risk of vitamin D insufficiency and allow correction with supplementation where appropriate.
Assuntos
Doença Pulmonar Obstrutiva Crônica , Deficiência de Vitamina D , Humanos , Masculino , Feminino , Estudos Retrospectivos , Fatores Sexuais , Vitamina D , Vitaminas , Suplementos Nutricionais , Estações do AnoRESUMO
There is a lack of research on women with infertility in the northern latitudes, where vitamin D insufficiency is high. Therefore, this study aimed to assess the prevalence and determinants of vitamin D insufficiency (serum 25(OH)D concentration < 50 nmol/L) among women undergoing in vitro fertilization (IVF) treatment. Thus, 265 women scheduled for IVF/intracytoplasmic sperm injection (ICSI) between September 2020 and August 2021 at Sahlgrenska University Hospital in Gothenburg, Sweden, were included. Data on serum 25(OH)D concentration, vitamin D intake, and sun exposure were collected via questionnaires and blood samples. Approximately 27% of the women had 25(OH)D insufficiency, which was associated with longer infertility duration. The likelihood of insufficiency was higher among women from non-Nordic European countries (OR 2.92, 95% CI 1.03-8.26, adjusted p = 0.043), the Middle East (OR 9.90, 95% CI 3.32-29.41, adjusted p < 0.001), and Asia (OR 5.49, 95% CI 1.30-23.25, adjusted p = 0.020) than among women from Nordic countries. Women who did not use vitamin D supplements were more likely to have insufficiency compared with supplement users (OR 3.32, 95% CI 1.55-7.10, adjusted p = 0.002), and those who avoided sun exposure had higher odds of insufficiency compared to those who stayed "in the sun all the time" (OR 3.24, 95% CI 1.22-8.62, adjusted p = 0.018). Women with infertility in northern latitudes and those from non-Nordic countries who avoid sun exposure and do not take vitamin supplements have a higher prevalence of 25(OH)D insufficiency and longer infertility duration.
Assuntos
Infertilidade , Deficiência de Vitamina D , Humanos , Masculino , Feminino , Vitamina D , Suécia/epidemiologia , Prevalência , Sêmen , Vitaminas , Infertilidade/epidemiologia , Infertilidade/terapia , Suplementos Nutricionais , Fertilização in vitro , Deficiência de Vitamina D/epidemiologia , Estações do AnoRESUMO
Background: Norwegian data on vitamin D status among pregnant women indicate a moderate to high prevalence of insufficient vitamin D status (25-hydroxyvitamin D (25OHD) concentrations ≤50 nmol/L). There is a lack of population-based research on vitamin D intake and determinants of 25OHD in pregnant women from northern latitudes. The aims of this study were (1) to evaluate total vitamin D intake from both diet and supplements, (2) to investigate determinants of vitamin D status, and (3) to investigate the predicted response in vitamin D status by total vitamin D intake, in pregnant Norwegian women. Methods: In total, 2,960 pregnant women from The Norwegian Environmental Biobank, a sub-study within The Norwegian Mother, Father and Child Cohort Study (MoBa), were included. Total vitamin D intake was estimated from a food frequency questionnaire in gestational week 22. Concentrations of plasma 25OHD was analyzed by automated chemiluminescent microparticle immunoassay method in gestational week 18. Candidate determinant variables of 25OHD were chosen using stepwise backward selection and investigated using multivariable linear regression. Predicted 25OHD by total vitamin D intake, overall and stratified by season and pre-pregnancy BMI, was explored using restricted cubic splines in an adjusted linear regression. Results: Overall, about 61% of the women had a total vitamin D intake below the recommended intake. The main contributors to total vitamin D intake were vitamin D supplements, fish, and fortified margarine. Higher 25OHD concentrations were associated with (in descending order of the beta estimates) summer season, use of solarium, higher vitamin D intake from supplements, origin from high income country, lower pre-pregnancy BMI, higher age, higher vitamin D intake from foods, no smoking during pregnancy, higher education and energy intake. During October-May, a vitamin D intake according to the recommended intake was predicted to reach sufficient 25OHD concentrations >50 nmoL/L. Conclusion: The findings from this study highlight the importance of the vitamin D intake, as one of few modifiable determinants, to reach sufficient 25OHD concentrations during months when dermal synthesis of vitamin D is absent.