Meal-Based Intervention on Health Promotion in Middle-Aged Women: A Pilot Study.

Middle-aged women belong to a risk group for metabolic dysregulation and menopausal symptoms, mainly due to a dramatic hormonal shift. Supplementation with functional compounds or a single nutrient has been dominantly explored as a nutritional approach for improving aging-related health parameters. However, a meal-based approach might be another strategy for promoting the overall health of the target population. This pilot study aimed to develop a meal-based intervention for middle-aged women and to evaluate its potential health benefits. Considering the nutrient intake status of Korean middle-aged women, diets enriched with four major nutrients (isoflavone, omega-3, fiber, and calcium) were designed and provided to forty-nine women aged 50 to 65 with mild levels of menopausal symptoms for 8 weeks. In the post-intervention phase, they showed reduced body weight and body fat, and improved biochemical metabolic parameters with decreased levels of cholesterol, low-density lipoprotein-cholesterol, ApoB, and fasting insulin. Moreover, bone resorption markers and menopause symptoms were lower in the post-intervention phase. In conclusion, the meal-based intervention might be a prominent strategy for overall health promotion in relatively healthy middle-aged women and further investigation is needed to test its efficacy with a randomized controlled study.

Impact of an Educational Program on Behavioral Changes toward Environmental Health among Laotian Students.

This study evaluates the effect of an integrated health care educational program on several behavioral changes related to environmental health among Laotian students. Students in the experimental group received education concerning environmental health-related issues, including air pollution and chemical exposure. Analyses of covariance (ANCOVA) and paired t-tests were conducted for the statistical analysis of the pre- and post-survey scores. The post-test scores of the experimental group regarding their risk perception and information-seeking behaviors towards air pollution and chemical exposure were higher than those of the control group after controlling for the pre-test scores. Moreover, in the experimental group, the girls' risk perception scores significantly increased after receiving the education, which was not observed in the control group. The risk perception score among non-drinking students also significantly increased after the program. These results indicate that the education program effectively enhanced the students' risk perception, especially that of girls and nondelinquent students.

Metabolic syndrome, metabolic components, and their relation to the risk of pancreatic cancer.

BACKGROUND: Components of the metabolic syndrome (MetS), such as elevated fasting glucose levels and abdominal obesity, have been suggested as potential risk factors for pancreatic cancer. However, data are still insufficient to assure the influence of MetS on incident pancreatic cancer. The objective of the current study was to investigate the association between MetS, metabolic components, and the risk of pancreatic cancer. METHODS: In the Korea National Health Information Database, 223,138 individuals who were without pancreatic cancer in 2009 were enrolled and followed until 2013. They were categorized into 4 groups according to the number of baseline metabolic components (0, 1, 2, 3, and 4-5). A multivariate Cox proportional hazard model was used to calculate the adjusted hazard ratios (HRs) and 95% CIs for incident pancreatic cancer according to the presence of MetS and the number of metabolic components. In addition, the risk of pancreatic cancer was evaluated in individuals who had a single metabolic component. RESULTS: The presence of MetS was significantly associated with incident pancreatic cancer (adjusted HR, 1.47; 95% CI, 1.19-1.81). The group with 4 or 5 baseline metabolic components had a higher risk of pancreatic cancer than the other groups (0 components: reference category; 1 component: adjusted HR, 0.94 [95% CI, 0.61-1.45]; 2 components: adjusted HR, 1.03 [95% CI, 0.68-1.56]; 3 components: adjusted HR, 1.35 [95% CI, 0.89-2.04]; 4-5 components: adjusted HR, 1.64 [95% CI, 1.06-2.51]). Regarding associations between the individual metabolic components and pancreatic cancer, no metabolic component alone had a statistically significant association with pancreatic cancer. CONCLUSIONS: MetS is a potential risk factor for pancreatic cancer. The presence of ≥4 metabolic components leads to a higher risk of pancreatic cancer even within categories of the MetS.

Association of maternal omega-6 fatty acid intake with infant birth outcomes: Korean Mothers and Children's Environmental Health (MOCEH).

BACKGROUND: Maternal fatty acids (FAs) intake has an effect on birth weight, birth length, and gestational age, as fetal development is entirely dependent on the maternal essential FA supply. This study aimed to identify the association between the maternal intake of FAs and birth outcomes among pregnant women who participated in the Mothers and Children's Environmental Health (MOCEH) prospective cohort study in South Korea. METHODS: A total of 1407 pregnant women, aged 30.2 ± 3.7 years, at 12 to 28 weeks' gestation were recruited between August 2006 and December 2010. Their dietary intake during pregnancy was investigated by the 1-day 24-h dietary recall method. The pregnancy outcome data-namely infant's gestational age, birth weight, and birth length-were analyzed for their associations with their mothers' intake of FAs. RESULTS: When adjusted for confounding factors, multiple regression analysis revealed adverse effects on birth weight (P = 0.031) and birth length (P = 0.025) with high maternal intake of omega-6 FAs. In the multiple logistic regression analysis, the odds ratio (OR) for the risk of being below the 10th percentile for birth weight was higher in the highest quintile (Q5) compared to the lowest quintile (Q1) of omega-6 FA intake levels (OR = 2.444; 95% CI = 1.038-5.751; P for trend = 0.010). Also, the OR for being above the 90th percentile of birth length was lower in the highest quintile (Q5) compared to that in the lowest quintile (Q1) of omega-6 FA intake (OR = 0.432; 95% CI = 0.211-0.884; P for trend = 0.020). However, the maternal intake of omega-3 FAs was not related to gestational age, birth weight, or birth length. CONCLUSIONS: A high maternal omega-6 FA intake was negatively associated with birth weight and birth length.

Association of mid-pregnancy antioxidative vitamin and oxidative stress levels with infant growth during the first 3 years of life.

OBJECTIVE: Numerous studies have revealed the impacts of maternal nutritional status on subsequent birth outcome, but much less is known about the long-term impacts on infant growth after birth. We investigated the association between maternal micronutrient levels/oxidative stress status in pregnancy and infant growth during the first 3 years of life. DESIGN: Prospective cohort study. SETTING: The Ewha Birth & Growth Cohort study was constructed for women who had been recruited between 24 and 28 weeks' gestation and their offspring at Ewha Womans University Hospital. SUBJECTS: Maternal serum vitamin and urinary oxidative stress levels were measured, and infant weight, height, and head circumference were measured repeatedly at birth and at 6, 12, 18, 24, and 36 months of age. RESULTS: Maternal vitamins A and C were positively associated with infant head circumference and infant weight, respectively, during the first 3 years of life, even after controlling for potential confounding factors. But, maternal oxidative stress was not related to infant growth. CONCLUSIONS: The effects of maternal vitamin levels on subsequent infant growth during the first 3 years of life necessitate interventions to supplement antioxidative vitamins during pregnancy.

Effect of hemoglobin adjustment on the precision of mercury concentrations in maternal and cord blood.

The cord-blood mercury concentration is usually considered the best biomarker in regard to developmental methylmercury neurotoxicity. However, the mercury concentration may be affected by the binding of methylmercury to hemoglobin and perhaps also selenium. As cord-blood mercury analyses appear to be less precise than suggested by laboratory quality data, we studied the interrelationships of mercury concentrations with hemoglobin in paired maternal and cord blood samples from a Faroese birth cohort (N=514) and the Mothers and Children's Environmental Health study in Korea (n=797). Linear regression and structural equation model (SEM) analyses were used to ascertain interrelationships between the exposure biomarkers and the possible impact of hemoglobin as well as selenium. Both methods showed a significant dependence of the cord-blood concentration on hemoglobin, also after adjustment for other exposure biomarkers. In the SEM, the cord blood measurement was a less imprecise indicator of the latent methylmercury exposure variable than other exposure biomarkers available, and the maternal hair concentration had the largest imprecision. Adjustment of mercury concentrations both in maternal and cord blood for hemoglobin improved their precision, while no significant effect of the selenium concentration in maternal blood was found. Adjustment of blood-mercury concentrations for hemoglobin is therefore recommended.

Maternal iron intake at mid-pregnancy is associated with reduced fetal growth: results from Mothers and Children's Environmental Health (MOCEH) study.

BACKGROUND: Iron supplementation is a common recommendation for pregnant women to prevent iron deficiency during pregnancy. There is an increasing concern about excessive iron consumption as a general iron prophylaxis by pregnant women without any due consideration about their dietary iron intake or iron status. Our present study investigated the association between total iron intake from diet and supplements and fetal growth in 337 pregnant women at mid-pregnancy in South Korea. METHODS: Iron intake from diet and supplements was examined by a 24-hour recall method. Subjects were divided into three groups based on tertiles of total iron intake levels. Fetal biometry was assessed by ultrasonography at mid-pregnancy. RESULTS: About 99% of the non-supplement users had iron intake below the recommended nutrient intake (RNI) for pregnant women (24 mg), whereas 64.9% of supplement users had iron intake above the upper level (UL) (45 mg). In the babies of mothers in the third tertile of iron intake (>17.04 mg), biparietal diameter, abdominal circumference, and femur length were lower by 0.41 cm (P =0.019), 0.41 cm (P = 0.027), and 0.07 cm (P = 0.051), respectively, than the babies of mothers in the second tertile of iron intake (11.49 ~ 17.04 mg). CONCLUSION: These results suggest that excessive maternal iron intake at mid-pregnancy is associated with reduced fetal growth. Iron supplementation for pregnant women should be individualized according to their iron status. Appropriate diet education is needed for pregnant women so that they can consume adequate amounts of iron from food and supplements.

Relationship between maternal sodium intake and blood lead concentration during pregnancy.

Pb is released from bone stores during pregnancy, which constitutes a period of increased bone resorption. A high Na intake has been found to be negatively associated with Ca and adversely associated with bone metabolism. It is possible that a high Na intake during pregnancy increases the blood Pb concentration; however, no previous study has reported on the relationship between Na intake and blood Pb concentration. We thus have investigated this relationship between Na intake and blood Pb concentrations, and examined whether this relationship differs with Ca intake in pregnant Korean women. Blood Pb concentrations were analysed in 1090 pregnant women at mid-pregnancy. Dietary intakes during mid-pregnancy were estimated by a 24 h recall method covering the use of dietary supplements. Blood Pb concentrations in whole-blood samples were analysed using graphite furnace atomic absorption spectrophotometry. Multiple regression analysis performed after adjustment for covariates revealed that maternal Na intake was positively associated with blood Pb concentration during pregnancy, but only when Ca intake was below the estimated average requirement for pregnant Korean women (P= 0·001). The findings of the present study suggest that blood Pb concentration during pregnancy could be minimised by dietary recommendations that include decreased Na and increased Ca intakes.

Birth weight of Korean infants is affected by the interaction of maternal iron intake and GSTM1 polymorphism.

Excessive iron consumption during pregnancy can lead to increased oxidative stress in the maternal body, which may result in adverse pregnancy outcomes. Glutathione S-transferases (GSTs) originate from a superfamily of detoxifying enzymes that play a role in reducing xenobiotic compounds and oxidative stress. The aim of this study was to determine the relationship among GST gene expression, maternal iron intake during pregnancy, and neonatal birth weight. The study participants were 1087 Korean gravidas and their newborns recruited for the Mothers and Children's Environmental Health study between 2006 and 2010. A 24-h dietary recall interview was conducted to estimate iron intake; additional intake through nutritional supplements was thoroughly investigated. Deletion polymorphisms of GSTM1 and GSTT1 were genotyped using PCR. Dietary iron consumption during pregnancy was positively associated with birth weight in pregnant women who were GSTM1-present after adjustment for the following covariates: maternal age, prepregnancy BMI, mother's education level, log-transformed urinary cotinine level, infant gender, gestational age at term, log-transformed energy intake, parity, and the use of folic acid supplements (P < 0.05). There were interactions between the GSTM1 genotype and iron intakes from animal foods (P < 0.05), diet (P < 0.05), and diet with supplements (P < 0.05). No relationship was found between maternal iron intake and birth weight for the GSTT1 polymorphism. This study demonstrates that increased iron consumption during pregnancy may improve infant birth weight for mothers who are GSTM1-present, but it might not be beneficial for mothers with the GSTM1-null genotype.

[Psychological health in residents participating in clean-up works of Hebei Spirit oil spill].

OBJECTIVES: Our objective was to examine and evaluate the psychological health of the residents of Taean during the cleanup of the Hebei Spirit (HS) oil spill and to review some factors associated with the results. METHODS: A community survey of 71 men and women was conducted 8 weeks after the HS oil spill. Questionnaires used were the PWI (Psychological Well-being Index) scale for psychosocial distress, the CES-D (Center for Epidemiologic Studies-Depression) scale for depressive symptoms, and a questionnaire created to assess suicidal impulses. RESULTS: The overall prevalence of high-risk psychosocial distress among the study group was 64.2%. The percentages of respondents with scores on the CES-D Scale above 16 and above 21 were 77.6% and 62.7%, respectively. The percentage of respondents categorized as having suicidal impulses was 18.3%. When compared with unexposed groups in the general population taken from various sources, the residents of Taean were 6.5 times as likely to have high stress and 9.4-9.7 times as likely to be depressed. No significant difference in the rate of suicidal impulse was found between the residents of Taean and the general population. Factors associated with high stress, depression, and suicidal impulses were age, a change in income, educational level, number of days working on the cleanup, and positive responses to questions about "affected daily activity" and "hospital visit due to work on cleanup." CONCLUSIONS: The results suggest that the HS oil spill had a significant impact on the psychological health of residents of Taean, but the comparability of the unexposed groups is a limitation of the study.

[The effects of wearing protective devices among residents and volunteers participating in the cleanup of the Hebei Spirit oil spill].

OBJECTIVES: To assess the protective effects of wearing protective devices among the residents and volunteers who participated in the cleanup of the Hebei Spirit oil spill. METHODS: A total of 288 residents and 724 volunteers were surveyed about symptoms, whether they were wearing protective devices and potential confounding variables. The questionnaires were administered from the second to the sixth week following the accident. Spot urine samples were collected and analyzed for metabolites of 4 volatile organic compounds (VOCs), 2 polycyclic aromatic hydrocarbons (PAHs), and 6 heavy metals. The association between the wearing of protective devices and various symptoms was assessed using a multiple logistic regression adjusted for confounding variables. A multiple generalized linear regression model adjusted for the covariates was used to test for a difference in least-square mean concentration of urinary biomarkers between residents who wore protective devices and those who did not. RESULTS: Thirty nine to 98% of the residents and 62-98% of volunteers wore protective devices. Levels of fatigue and fever were higher among residents not wearing masks than among those who did wear masks (odds ratio 4.5; 95% confidence interval 1.23-19.86). Urinary mercury levels were found to be significantly higher among residents not wearing work clothes or boots (p<0.05). CONCLUSIONS: Because the survey was not performed during the initial high-exposure period, no significant difference was found in metabolite levels between people who wore protective devices and those who did not, except for mercury, whose biological half-life is more than 6 weeks.

[BTEX exposure and its health effects in pregnant women following the Hebei Spirit oil spill].

OBJECTIVES: We evaluated the health effects of exposure to BTEX (Benzene, Toluene, Ethylbenzene, m,p-Xylene, o-Xylene) in the Taean area after the Hebei Spirit oil spill. METHODS: We used a questionnaire survey to look for health effects among 80 pregnant women 2 to 3 months following the Hebei Spirit oil spill. Their BTEX exposures were estimated using the CALPUFF method. We then used a multiple logistic regression analysis to evaluate the effects of BTEX exposure on the women's health effets. RESULTS: Pregnant women who lived near the accident site reported more symptoms of eye irritation and headache than those who lived farther from the site. There was a trend of decreasing symptoms with an increase in distance from the spill site. Pregnant women exposed to higher ambient cumulative levels of Xylene were significantly more likely to report symptoms of the skin (OR 8.01 95% CI=1.74-36.76) in the first day after the accident and significantly more likely to report abdominal pain (OR 3.86 95% CI=1.02-14.59 for Ethylbenzene, OR 6.70 95% CI=1.82-24.62 for Xylene) during the 1st through 4th days following the accident. CONCLUSIONS: This study suggests that exposure to BTEX from an oil spill is correlated with an increased risk of health effects among pregnant women. This implies the need to take proper measures, including the development of a national policy for environmental health emergencies and a plan for studying the short- and long-term chronic health effects associated with such spills.

Association of antioxidant vitamins and oxidative stress levels in pregnancy with infant growth during the first year of life.

OBJECTIVE: Whereas there are numerous reports in the literature relating the impact of maternal nutritional status on subsequent birth outcome, much less is known about the long-term impact on infant growth after birth. Therefore, we conducted a prospective cohort study to investigate the association of maternal micronutrient status (vitamins A, C and E, folate) and oxidative stress status in pregnancy with infant growth during the first year of life. DESIGN: Prospective cohort study. SETTING: Outpatient clinic of obstetrics, Ewha Womans University Hospital, Seoul, South Korea. SUBJECTS AND METHODS: Two groups were constructed for this study - the Ewha pregnancy cohort (n = 677) and the infant growth cohort comprising follow-up live newborns of all the recruited pregnant women (n = 317). Maternal serum vitamin and urinary oxidative stress levels were collected and infant weights and heights were measured at birth and at 6 and 12 months after birth. RESULTS: Division of the subjects into folate-deficient and normal groups revealed that infant weight and height at 0, 6 and 12 months were adversely affected by folate deficiency. High maternal vitamin C was associated with increased infant weight and height at birth and after birth. CONCLUSION: Our findings indicate the importance of preventing folate deficiency and supplementing vitamin C during pregnancy.