Folic acid supplementation during the preconception period: A systematic review and meta-analysis.

Guidelines recommend that women take folic acid supplements in the preconception period to prevent neural tube defects (NTDs) in their offspring. Estimates of adherence to this recommendation across different countries worldwide have not been synthesized. Medline, CINAHL, and EMBASE were systematically searched to identify studies reporting the prevalence of preconception folic acid supplementation. Pooled prevalence estimates for each country (where data were available) were calculated; and differences based on demographic, methodological, and study quality characteristics were examined. Of 3372 titles and abstracts screened, 722 full-texts were reviewed and 105 articles that reported 106 estimates of preconception folic acid supplementation in 34 countries were included. Pooled prevalence estimates were 32-51% in North America, 9-78% in Europe, 21-46% in Asia, 4-34% in the Middle East, 32-39% in Australia/New Zealand, and 0% in Africa. No South American studies were identified. Higher supplementation prevalence was observed in studies that had more highly educated samples, were conducted in fertility clinics, and assessed folic acid use via self-report. Of note, only 32% and 28% of studies reported timing of folic acid use and adherence to folic acid, respectively. Preconception folic acid supplementation is highly variable worldwide and many women may not achieve sufficient folate levels to prevent NTDs. To better understand non-adherence, recommendations for future research include: more explicit reporting of methodology, more detailed assessment of folic acid use, assessment of variables potentially relevant to folic acid use, and surveillance of folic acid use in a greater diversity of countries, especially in the developing world.

The double-edged sword of vitamin D in Ireland: the need for public health awareness about too much as well as too little.

INTRODUCTION: The Institute of Medicine (IOM) 2011 on dietary references intakes for calcium and vitamin D specified that a 25-hydroxyvitamin D (25OHD) level below 30 nmol/L indicated risk of deficiency and that a level above 125 nmol/L indicated risk of harm. METHODS: We noted a high prevalence of hypovitaminosis D (23.9 %) and a substantive prevalence of hypervitaminosis D (4.8 %) in a retrospective audit of clinical samples (n = 10,181) obtained over 10 months in 2013. CONCLUSION: Hypovitaminosis D should be corrected by low dose supplementation (5 µg or 200 IU daily) with some at-risk groups needing higher doses (10 µg or 400 IU daily) based on 25OHD levels. Whereas, those taking high-dose vitamin D supplements based on mistaken beliefs about recently authorised claims of benefit for muscle function and misleading unauthorised claims need to be alerted to the potential harms of excessive supplementation.

Weaning onto solid foods: some of the challenges.

Weaning--the transition from milk to solid food--influences life-long health. Dietary challenges during weaning include providing sufficient critical nutrients such as iron with minimal added sugar and fat and no added salt. This study assessed the inclusion of iron-containing red meat in infant diets before age one year, and the Irish commercial baby food environment. Of mothers with an infant under 30 months of age who were surveyed in shopping centres in Ireland (n195), 82% (n159) reported wanting more weaning information. A quarter (n24) of infants over age 12 months (n97) received no iron-containing red meat before age one year. A scan of commercial baby foods in Ireland identified 448 products. While all complied with baby food legislation, 15% (n69) were intrinsically high in sugar and fat, or contained added salt. This study indicates the need for specific guidance on best infant feeding practice in Ireland.

Contribution of foods to trans unsaturated fatty acid intake in a group of Irish adults.

OBJECTIVE: To assess fat intake with particular focus on trans unsaturated fatty acid (TUFA) intake and the major sources of TUFA among Irish individuals using a Fat Intake Questionnaire (FIQ), designed specifically for an Irish context. SUBJECTS AND METHODS: A total of 105 healthy volunteers (43 females, 62 males; aged 23-63 years) were recruited from Dublin Airport Medical centre, Republic of Ireland. Dietary intake was assessed using an 88 food item/food group semi-quantitative FIQ, which was developed and validated for the Irish population. RESULTS: Mean energy intake was 10.6 MJ day(-1), and 34% was provided by fat. Saturated, monounsaturated, polyunsaturated, trans unsaturated fatty acids and linoleic acid contributed 13%, 10%, 6%, 2% and 5% of energy respectively. Mean TUFA intake was 5.4 g day(-1) (range 0.3-26). Margarine spreads provided the majority of TUFAs (1.93 g day(-1)), but the contribution was significantly greater for men compared with women (2.35 g day(-1) versus 1.33 g day(-1); P = 0.024). Milk and meat also contributed more to TUFA intake for men compared with women, but confectionery was a significantly greater contributor for women (8.6% versus 3.1% respectively, P = 0.01). CONCLUSIONS: Although the mean TUFA intake of the total group was 5.4 g day(-1) and was within current dietary recommendations (2% energy intake), some individuals had intakes as high as 26 g day(-1). Public health efforts are therefore required to reduce TUFA intake in those individuals with high intakes.

The effects of chondroitin sulfate supplementation on indices of muscle damage induced by eccentric arm exercise.

AIM: Delayed onset of muscle soreness (DOMS) often results from unaccustomed exercise or exercise that involves heavy eccentric loading of skeletal muscle. Chondroitin sulfate (CS) has been reported to possess anti-inflammatory and analgesic properties and has been used widely in the treatment of osteoarthritis. Based on these findings, the investigators sought to determine whether CS supplementation might reduce DOMS symptoms associated with eccentric arm exercise. METHODS: Sixteen non-resistance-trained males participated in a double-blind protocol. Subjects consumed 3,600 mg x day-1 of encapsulated CS or placebo for 14 days preceding the exercise protocol and during 48 hours of follow-up measurements. Subjects performed a maximum of 50 eccentric contractions of the elbow flexors against a resistance that was 120% of the concentric one-repetition maximum. RESULTS: Significant time effects were present for soreness, relaxed elbow extension (joint angle), and creatine kinase; all measures were significantly altered 48 hours after the exercise session. No effects were present for complement system fragment C3a and prostaglandin E2. No significant treatment or interaction effects were detected for any of the variables. CONCLUSIONS: CS supplementation was not found to be effective in the prevention of DOMS, nor did it influence biochemical indices of inflammation and muscle damage following heavy eccentric loading of the arm flexors.

Influence of iron status and iron supplements on natural killer cell activity in trained women runners.

Twenty-two trained women runners (.VO2peak 48.1 + 1.2 ml x kg -1 x min -1) were divided into an iron supplement (n = 13) or placebo group (n = 9) based on initial serum ferritin concentration (24.2 +/- 2.9 and 58.5 +/- 4.0 microg x l -1, respectively). Exercise consisted of a 35-min run (80 % .VO2peak) and was performed at week 0 (WK0), after two weeks of intensified training (WK2) and after eight weeks recovery training (WK10). The eight weeks recovery training were concomitant with subjects taking iron supplements or placebo in a double blind fashion. Concentrations of serum ferritin, serum iron and total iron binding capacity were assessed pre-exercise and complete blood count, natural killer cell activity (NKACT), and cell surface markers for CD3+, CD4+, CD3+,CD8+, CD3-, CD16+, CD56+ cells were determined both pre- and post-exercise. Serum ferritin concentrations were significantly (p < 0.05) increased on WK10 compared to WK2 (time effect). NKACT (%lysis) and NK cell number was lower (p < 0.05) at WK0 for supplement (42.9 +/- 1.9 % and 305.5 +/- 15.0 x 10 6 x l -1, respectively) compared to placebo groups (50.9 +/- 2.0 and 406.1 +/- 25.6, respectively). Two weeks of intensified training did not alter indices of host defense. In conclusion, NKACT and NK cell numbers were lower in subjects with greater body mass and lower iron stores (p < 0.05), but were not significantly altered after two weeks of intensified training or when serum ferritin levels increased.

Effect of protein supplementation and presence of an antioxidant on the development of bovine zygotes in synthetic oviduct fluid medium under high or low oxygen tension.

The aim of this study was to investigate the effect of protein supplementation of culture medium and the presence of a putative antioxidant on bovine zygote development under 5% (low) and 20% (high) O2. In Experiment 1, presumptive zygotes (n=992) were cultured in synthetic oviduct fluid (SOF) alone or supplemented with 3 mg/mL PVP, 3 mg/mL BSA (SOFB), and/or 10% FCS (SOFBF) in 5% CO2, 5% O2, 90% N2. In Experiment 2, zygotes (n=1916) were cultured in SOF, SOFB or SOFBF with or without taurine under high and low O2. In Experiment 1, presence of BSA or BSA plus FCS significantly increased the speed of development compared to SOF or SOF+PVP. Blastocyst quality was also improved, as evidenced by increased hatching rate and cell numbers. In Experiments 2, taurine had no effect on development irrespective of oxygen concentration or protein supplementation. In conclusion, the presence of protein in the culture medium and culture under reduced O2 significantly improved embryo development. Taurine had no effect on development.

Lipopolysaccharide (LPS)- and muramyl dipeptide (MDP)-induced anorexia during refeeding following acute fasting: characterization of brain cytokine and neuropeptide systems mRNAs.

We investigated the effectiveness of lipopolysaccharide (LPS) and muramyl dipeptide (MDP) administered into the brain to induce anorexia in acutely fasted Wistar rats allowed to refeed. We also assayed for changes in mRNA levels of IL-1 system components, TNF-alpha, TGF-beta1, glycoprotein 130 (gp 130), leptin receptor (OB-R), pro-opiomelanocortin (POMC), neuropeptide Y (NPY), glucocorticoid receptor (GR), and CRF receptor (CRF-R) in selected brain regions. The data show that LPS and MDP induced anorexia differentially during refeeding. LPS-induced anorexia was of a stronger magnitude and duration than that of MDP. RNase protection assays showed that LPS and MDP significantly increased the expression of IL-1beta, IL-1 receptor type I, and TNF-alpha mRNAs in the cerebellum, hippocampus, and hypothalamus; LPS was more potent in all cases. MDP treatment, on the other hand, induced a stronger increase in hypothalamic levels of IL-1 receptor antagonist (IL-1Ra) and TGF-beta1 mRNAs relative to LPS. In addition, competitive RT-PCR analysis showed that LPS induced an eleven-fold increase in IL-1alpha mRNA in the hypothalamus relative to vehicle. These findings suggest that LPS and MDP mediate anorexia through different cytokine mechanisms. A stronger up-regulation of anti-inflammatory cytokines (IL-1Ra and TGF-beta1) mRNA expression by MDP may be involved in the weaker MDP-induced anorexia relative to LPS. No significant changes were observed in the peptide components examined except for an up-regulation in cerebellar gp 130 mRNA and down-regulation of hypothalamic GR mRNA expression in response to LPS or MDP. This study shows that LPS and MDP induce anorexia in fasted rats allowed to refeed, and suggests an important role for endogenous cytokine-cytokine interactions.

Chest radiographic image quality: comparison of asymmetric screen-film, digital storage phosphor, and digital selenium drum systems--preliminary study.

Conventional screen-film radiography does not display all regions of the thorax satisfactorily. Three chest radiographic techniques display both the lung and the mediastinum with good contrast. These techniques are asymmetric screen-film (ASF), digital storage phosphor (DSP), and digital selenium drum (DSD) imaging. ASF systems use two asymmetric screen-film combinations to produce a wide-latitude image of the thorax with good contrast in the lungs. In DSP systems, image data are acquired digitally with a wide dynamic range by using the optical output of a photostimulable phosphor plate; in DSD systems, the wide-range digital image data are acquired by using the electronic charge generated on a drum coated with a thin layer of amorphous selenium. The appearance of a DSP or DSD radiograph is then determined by user-selected image processing operations: tone scaling, spatial frequency processing, and dynamic range compensation. Digital chest radiographs processed with strong regional equalization provide both excellent contrast in the lungs and effective display of the mediastinum and chest wall. At visual comparison, the high lung contrast and good mediastinal, retrocardiac, and subdiaphragmatic detail provided by the DSD method distinguish it from the other two methods.

Supplementation with beta-carotene in vivo and in vitro does not inhibit low density lipoprotein oxidation.

The inhibition of low density lipoprotein (LDL) oxidation has been postulated as one mechanism by which antioxidants may prevent the development of atherosclerosis. Available data on the ability of beta-carotene to inhibit LDL oxidation are conflicting. We examined the role of in vivo and in vitro supplementation with beta-carotene on metal ion-dependent (cupric ions, Cu2+) and metal ion-independent (2,2'-azobis[2-amidinopropane]dihydrochloride, AAPH) oxidation of LDL as measured by the formation of conjugated dienes (absorbance at 234 nm). Sixteen subjects were supplemented with 50-100 mg of beta-carotene on alternate days for 3 weeks following a week-long loading dose of 100 mg/day. Plasma beta-carotene levels rose 5.5-fold, while LDL beta-carotene levels rose 8.5-fold. Oxidation of LDL by Cu2+ or AAPH was not significantly delayed after in vivo supplementation with beta-carotene compared with baseline. For AAPH, the lag phase (in minutes) was 75 +/- 8 at baseline and 83 +/- 14 after supplementation (P = 0.07). For Cu2+, the lag phase was 172 +/- 41 at baseline and decreased to 130 +/- 24 after supplementation (P < 0.01). Similarly, no protective effect against Cu(2+)-induced oxidation was observed when beta-carotene was added to LDL in vitro. Supplementation of plasma with beta-carotene in vitro prior to LDL isolation also did not enhance LDL's resistance to Cu(2+)- or AAPH-induced oxidation, despite a 5-fold increase in LDL beta-carotene levels over vehicle control.(ABSTRACT TRUNCATED AT 250 WORDS)

The effect of folate and cobalamin on osteoarthritic hands.

OBJECTIVE: Historically diet and arthritis have been cause/effect associated but the idea is controversial with little evidence that specific diet components are effective treatment. This controlled, double-blinded, crossover study reports the effect of folate and cobalamin supplements in 26 humans diagnosed for an average 5.7 years with idiopathic osteoarthritis of the hands who had been medicated by prescribed nonsteroidal anti-inflammatory drugs (NSAID). METHODS: Subjects entered the study after a 10-day washout period from use of all anti-arthritis drugs, vitamins, and minerals. They were randomly allocated to consume daily 6400 micrograms folate or 6400 micrograms folate plus 20 micrograms cobalamin or lactose placebo each for 2 months within self-selected diets. Pain was to be medicated by acetaminophen as needed, and at the end of each phase they returned for assessment and dispensing of the next treatment. Serum folate and cobalamin, red blood cell folate, blood smears, diet records, standard rheumatology assessment and hand grip measurements were reviewed and statistically analyzed. RESULTS: For all subjects mean right and left hand grip values were higher with combined cobalamin-folate ingestion than with other "vitamin" supplements and were equivalent to NSAID use. Number of tender hand joints were greater with use of NSAID than with use of cobalamin-folate. Side effects with the vitamin combination were none; side effects of NSAID are many, and the cost of vitamins and acetaminophen also is lower. CONCLUSION: The limited number of subjects in this study demonstrates that ingestion of a prescribed cobalamin-folate supplement and acetaminophen as needed resulted in positive outcomes.

Threshold pressure training, breathing pattern, and exercise performance in chronic airflow obstruction.

The effects of six weeks of threshold pressure inspiratory muscle training (IMT) on inspiratory muscle performance, breathing pattern and exercise performance were studied in eight patients with severe airflow obstruction. The results indicated that IMT improved inspiratory muscle performance but did not affect exercise performance or breathing pattern during maximal exercise.

Acute sacral epidural abscess following local anaesthetic injection.

Spinal epidural abscesses are uncommon infections of the central nervous system. Delay in making the diagnosis increases the morbidity and mortality because irreversible neurological damage occurs during this time. We report a 45-year-old male who developed an acute sacral epidural abscess following a local anaesthetic injection given for the relief of low back pain. We believe this is the first documented case of a local anaesthetic injection causing an acute sacral epidural abscess.