Iodine status during pregnancy and lactation: a pilot study in the Netherlands.

BACKGROUND: Iodine deficiency occurs in West European countries. Iodine is important for brain development of the foetus and infant. The current iodine status of pregnant and lactating Dutch women is unknown. METHODS: In a pilot study we examined the iodine status of 36 women. From 20 gestational weeks (GW) until 4 weeks postpartum, they ingested 150 µg iodine/day in the form of a multivitamin supplement for pregnant and lactating women. Twenty-four hour urine samples were collected at 20 and 36 GW and at 4 weeks postpartum. A breast milk sample was collected at 4 weeks postpartum. Iodine concentrations were analysed by inductively coupled plasma-mass spectrometry. Cut-off values for the urinary iodine concentration (UIC) for pregnant and lactating women are 150 and 100 µg/l, respectively. Adequate intakes (AI) of iodine for infants aged 0-6 months are 1.1 µmol/l (Institute of Medicine recommendations) or 0.5 µmol/l (Nordic Councilrecommendations). RESULTS: The median UICs (percentages below cut-off) were 102 µg/l (83%) at 20 GW, 144 µg/l (56%) at 36 GW and 112 µg/l (40%) at 4 weeks postpartum. The median breast milk iodine concentration was 1.2 µmol/l (range 0.5-3.0); 33% and 0% of the infants had estimated iodine intakes below the IOM-AI and Nordic-AI, respectively. CONCLUSION: This pilot study suggested a high prevalence of iodine deficiency during pregnancy. Daily supplementation of 150 µg iodine from 20 GW might be insufficient to reach maternal iodine adequacy. The median breast milk iodine concentration seems adequate. Further studies, using a representative sample of the Dutch population, are needed to establish the current Dutch iodine status of pregnant and lactating women.

Fish oil supplemental dose needed to reach 1g% DHA+EPA in mature milk.

INTRODUCTION: Erythrocyte (RBC) DHA+EPA is considered optimal at 8g%. Mothers with lifetime high fish intakes exhibiting this status produce milk with about 1g% DHA+EPA. We established DHA+EPA supplemental dosages needed to augment RBC DHA+EPA to 8g% and milk DHA+EPA to 1g%. MATERIALS AND METHODS: Pregnant women were randomly allocated to DHA+EPA dosages of: 225+90 (n=9), 450+180 (n=9), 675+270 (n=11) and 900+360 (n=7) mg/day. Samples were collected at 20 and 36 gestational weeks and 4 weeks postpartum. RESULTS: Linear regression revealed needed dosages rounded at 750mg/day to reach 8g% RBC DHA+EPA and 1000mg/day for 1g% milk DHA+EPA. RBC DHA+EPA increment depended on baseline values. There was no effect on milk AA, but milk EPA/AA ratio increased. CONCLUSION: Women with an RBC DHA+EPA status of 5.5g% need 750 and 1000mg DHA+EPA/day to reach 8g% RBC DHA+EPA at the pregnancy end and 1g% mature milk DHA+EPA, respectively.

Mildly abnormal general movement quality in infants is associated with higher Mead acid and lower arachidonic acid and shows a U-shaped relation with the DHA/AA ratio.

We showed that docosahexaenoic acid (DHA) supplementation during pregnancy and lactation was associated with more mildly abnormal (MA) general movements (GMs) in the infants. Since this finding was unexpected and inter-individual DHA intakes are highly variable, we explored the relationship between GM quality and erythrocyte DHA, arachidonic acid (AA), DHA/AA and Mead acid in 57 infants of this trial. MA GMs were inversely related to AA, associated with Mead acid, and associated with DHA/AA in a U-shaped manner. These relationships may indicate dependence of newborn AA status on synthesis from linoleic acid. This becomes restricted during the intrauterine period by abundant de novo synthesis of oleic and Mead acids from glucose, consistent with reduced insulin sensitivity during the third trimester. The descending part of the U-shaped relation between MA GMs and DHA/AA probably indicates DHA shortage next to AA shortage. The ascending part may reflect a different developmental trajectory that is not necessarily unfavorable.

Supplementation of a low dose of DHA or DHA+AA does not prevent peripartum depressive symptoms in a small population based sample.

BACKGROUND: The decrease of maternal docosahexaenoic (DHA) status during pregnancy has been associated with postpartum depression, especially in women with a low intake of DHA. Since the DHA intake in the Netherlands is low, we investigated whether supplementation of low doses of DHA or DHA plus arachidonic acid (AA) during pregnancy and lactation could prevent depressive symptoms and sleep disturbances in this period. METHODS: Women were supplemented daily with placebo, DHA (220 mg) or DHA+AA (220 mg each) from week 16 of pregnancy till three months postpartum. Fatty acid analyses were performed in the available plasma samples at 16 and 36 weeks of pregnancy. Depressive symptoms were measured in weeks 16 and 36 of pregnancy and six weeks postpartum using EPDS and within one week postpartum using a blues questionnaire. RESULTS: 119 women completed the study. The average frequency of fish intake was low, 0.94 times per week, and did not differ between the groups. The supplementation groups did not differ in mean EPDS scores or changes in EPDS scores, nor in incidence or severity of postpartum blues. Red blood cell DHA, AA and DHA/AA ratio did not correlate with EPDS or blues scores. Indices of sleep quality did not differ between the groups. CONCLUSION: Supplementation of 220 mg/day DHA or DHA+AA (220 mg/day each) does not prevent peri-partum depressive symptoms, in a population based sample with low background DHA intake. TRIAL REGISTRATION: ISRCTN Register nr. ISRCTN58176213.

Vitamin D(3) and vitamin K(1) supplementation of Dutch postmenopausal women with normal and low bone mineral densities: effects on serum 25-hydroxyvitamin D and carboxylated osteocalcin.

OBJECTIVE: Improvement of vitamin D and K status of about 60 -y-old postmenopausal Dutch women. DESIGN: In a randomized study postmenopausal women with normal (T-score >-1; n=96) and low (T-score< or =-1; n=45) bone mineral density (BMD) of the lumbar spine, were supplemented with 350-400 IU vitamin D(3), 80 microg vitamins K(1) vitamins K(1)+D(3), or placebo for 1 y. Serum 25-hydroxyvitamin D [25(OH)D] and percentage carboxylated osteocalcin (%carbOC) were measured at baseline and after 3, 6 and 12 months. RESULTS: Baseline %carbOC of the entire study population was positively correlated with BMD of the lumbar spine and femoral neck. Correspondingly, women with low BMD had lower %carbOC at baseline than women with normal BMD but this difference disappeared after 1 y of supplementation with vitamin K(1) ((mean+/-s.d.) 68+/-11% (95% CI, 64. 5-71.2%) vs 72+/-6% (95% CI, 70.1-72.9%), respectively). One year of supplementation with vitamin D(3) showed maximum increases in 25(OH)D of 33+/-29% (95% CI, 24.8-41.8%) and 68+/-58% (95% CI, 50.1-84.6%) in women with normal and low BMD, respectively. During winter, however, a 29% decline in maximum 25(OH)D levels was not prevented in women with low BMD. CONCLUSION: Daily supplementation of Dutch postmenopausal women with >400 IU vitamin D(3) is indicated to prevent a winter decline in 25(OH)D and to control serum parathyroid hormone levels. Daily supplementation with 80 microg vitamin K(1) seems to be necessary to reach premenopausal %carbOC levels. A stimulatory effect of calcium and/or vitamin D on %carbOC cannot be excluded. European Journal of Clinical Nutrition (2000) 54, 626-631.

Mineral, amino acid, and hormonal composition of chicken eggshell powder and the evaluation of its use in human nutrition.

Chicken eggshell powder (ESP) might be an attractive source of Ca for human nutrition. To study its nutritional value, we analyzed minerals, amino acids, and hormones in commercially available Slovakian ESP. The mineral composition was compared with three Dutch ESP samples that differed in feed and housing, a Japanese ESP, refined CaCO3, and an oyster shell supplement. Chicken eggshell powder contains high levels of Ca (mean +/- SD/g EPS: 401+/-7.2 mg) and Sr (372+/-161 microg) when compared with recommended or estimated daily intakes for humans 51 to 70 yr of age. Levels of potentially toxic Pb, Al, Cd, and Hg were very low as were levels of V, B, Fe, Zn, P, Mg, N, F, Se, Cu, and Cr. Large differences in the levels of F, Se, Cu, Cr, and Sr in the Dutch and Slovakian ESP indicated a strong influence of feed and environment. The small protein fraction of ESP contains high levels of Gly and Arg. Furthermore, small amounts of transforming growth factor-beta1 (0.75 to 7.28 ng/g ESP), calcitonin (10 to 25 ng/g ESP), and progesterone (0.30 to 0.33 ng/g ESP) were detected. Estradiol-17beta and calcitriol were below the detection limit of the methods used. Compared with ESP, refined CaCO3 was found to contain increased levels of Cd, and the oyster shell supplement showed increased levels of Al and Cd. Therefore, ESP seems to have a beneficial composition with about 39% of elemental Ca, relevant amounts of Sr, and low levels of Al, Pb, Cd and Hg. It may be used as a Ca source in human nutrition.

Development of low-birthweight infants at 19 months of age correlates with early intake and status of long-chain polyunsaturated fatty acids.

We investigated the influence of early nutrition with and without long-chain polyunsaturated fatty acids (LCP) on later development of < or = 2500 g newborns receiving preterm formula without LCP (n=75), preterm formula with 18:3omega6 and LCPomega3 (at two doses; n=26) or their mother's own milk (n=27). All diets were given from birth to day 42. Erythrocytes (RBC) fatty-acid compositions were determined on day 42. Bayley's mental development (MDI) and psychomotor development (PDI) indices were assessed at 19 months. Multivariate regression analysis revealed that PDI was most strongly related to RBC 22:6omega3 in the cohort of 101 infants who received formula. The most consistent correlations were between development and early LCPomega3 intake, and between development and parameters of RBC LCPomega3 status day 42, in infants who received formula with 18:3omega6 and LCPomega3. Development of formula-fed low-birthweight infants seems positively influenced by early dietary LCPomega3.

Does supplementation of formula with evening primrose and fish oils augment long chain polyunsaturated fatty acid status of low birthweight infants to that of breast-fed counterparts?

We investigated whether formulae with evening primrose and fish oils raise long chain polyunsaturated fatty acids (LCPUFA) in plasma cholesterol esters (CE), erythrocytes (RBC) and platelets (PLT) to levels encountered in breast-fed infants. Low birthweight infants (< or =2500 g) received LCP1 formula (n = 16; 0.31% 18:3 omega6, 0.17% 20:5 omega3 and 0.20% 22:6 omega3) or LCP2 formula (n = 13; 0.32% 18:3 omega6, 0.34% 20:5 omega3 and 0.43% 22:6 omega3). Fatty acids were measured days 10+/-2, 20+/-3 and 42+/-3. The formulae raised CE, RBC and PLT 20:5 omega3 and 22:6 omega3 dose-dependently (P<0.01), to exceed levels of breast-fed babies (n = 18) day 42 (P<0.05). CE, RBC and PLT 20:3 omega6 was comparable with, and CE, RBC, PLT 20:4 omega6 were below, that of breast-fed infants (P<0.05). Dietary 20:5 omega3 and 22:6 omega3 related with CE, RBC and PLT 20:5 omega3 and 22:6 omega3 (n = 47; P< or =0.01). Dietary 20:5 omega3 and LCPUFA omega3 related inversely with CE, RBC and PLT 20:4 omega6 and LCPUFA omega6 (P< or =0.002). LCP1 and LCP2 fed infants had similar LCPUFA omega6 status day 42. Added 18:3 omega6 does not correct 20:4 omega6 to that of breast-fed infants, but improves 20:3 omega6 status. Fish oil dose-dependently raises 20:5 omega3 and 22:6 omega3, but decreases 20:4 omega6 and other LCPUFA omega6.

Short-term effects of a chicken egg shell powder enriched dairy-based products on bone mineral density in persons with osteoporosis or osteopenia.

Based on the high calcium content, chicken egg shells are an interesting source of calcium. We studied the short-term effects on bone mineral density (BMD) of the lumbar spine and hip in 9 women and one man (mean age +/- SD, 63.9 +/- 8.1 years) with osteoporosis or osteopenia. Also the effects on pain and general well-being were monitored. Ten women (62.5 +/- 5.0 years) from a population study on BMD served as a control group. During a study period of 4-8 months, the intervention group consumed twice daily a dairy-based supplement which resulted in a daily intake of, among others, 3.0 g of egg shell powder, 400 IU of vitamin D3 and 400 mg of magnesium. BMD of the lumbar spine (anteroposterior (AP) and lateral (LA) position) and hip were measured by dual-energy X-ray absorptiometry. After the intervention period, BMDs of the lumbar spine, total proximal femur and trochanter were significantly (p < 0.05) increased with (median) 4.4%: (range) 1.7 to 10.4% (lumbar spine AP), 5.7%: -1.3 to 15.9% (lumbar spine LA), 2.2%: -1.9 to 9.4% (total proximal femur), 1.8%: -1.8 to 9.0% (trochanter). Within a period of 4 months, an important reduction in pain was reported and as a consequence an improvement in general well-being. In the control group, BMDs of the lumbar spine AP and of the femoral neck significantly decreased over a period of 8 months with -0.7% (-1.3 to 0.2%) and -0.9% (-2.4 to -0.1%) respectively. Six women of the intervention group continued to use the supplement on their own free will and without any check on compliance, up to 24 months. They consumed the supplement only once daily except for the last three months when they were asked to take the double dosage again. After 24 months BMDs did not differ from baseline. This study shows that egg shell powder is a source of bioavailable calcium. Furthermore, this pilot study indicates that the chicken egg shell powder enriched dairy-based supplement increases BMD of subjects with a low bone mass in the short term and as a consequence delays bone demineralisation for a longer period. (Tab. 3, Fig. 1, Ref. 23.)

Long-chain polyunsaturated fatty acid content in Dutch preterm breast milk; differences in the concentrations of docosahexaenoic acid and arachidonic acid due to length of gestation.

Recognizing the important role of long-chain polyunsaturated fatty acids (LCP) particularly in preterm infant nutrition, we studied the fatty acid composition of breast milk from 65 mothers of very preterm ( < 31 weeks of gestation) and preterm ( > or = 31 and < 36 weeks of gestation) infants. Fatty acids were determined as fatty acid methyl esters by capillary gas chromatography. In accordance with other studies, the increase of capric acid, lauric acid and myristic acid during lactation is influenced by prematurity. Unsaturated fatty acids had the inclination to decrease. Our interest was mainly focused on docosahexaenoic acid (DHA) and arachidonic acid (AA). Accelerated brain growth during the last trimester of gestation requires an extra need for these LCPs. In our study, preterm milk after a gestation period of at least 32 weeks contained the highest amounts of DHA and AA. The Western maternal diet is considered to be low in omega 3 fatty acids, that is why the concentration of DHA in our preterm milk can be regarded as a low amount. As it is the milk of their mothers, and because the amounts are higher than normally found in Western full term breast milk, the contribution of DHA to preterm milk fat (0.34%) might be considered, for the time being, as a safe natural guideline for formulas for preterm infants.