Vitamin D Food Fortification and Biofortification Increases Serum 25-Hydroxyvitamin D Concentrations in Adults and Children: An Updated and Extended Systematic Review and Meta-Analysis of Randomized Controlled Trials.

BACKGROUND: Low vitamin D status is a global public health issue that vitamin D food fortification and biofortification may help to alleviate. OBJECTIVES: We investigated the effect of vitamin D food fortification and biofortification on circulating 25-hydroxyvitamin D (25(OH)D) concentrations. We expanded the scope of earlier reviews to include adults and children, to evaluate effects by vitamin D vitamer, and investigate linear and nonlinear dose-response relations. METHODS: We conducted a systematic review and meta-analysis. We searched CINAHL, MEDLINE, PubMed, Embase, the Cochrane Library, and gray and unpublished literature sites for randomized controlled trials, including people of all ages, with the criteria: absence of illness affecting vitamin D absorption, duration ≥4 wk, equivalent placebo food control, dose quantification, dose ≥5 µg/d, baseline and endpoint or absolute change in 25(OH)D concentrations reported, random allocation, and participant blinding. Quality was assessed using the Jadad Scale. RESULTS: Data from 34 publications (2398 adults: 1345 intervention, 1053 controls; 1532 children: 970 intervention, 562 controls) were included. Random-effects meta-analysis of all studies combined (mean dose 16.2 µg/d) indicated a pooled treatment effect of 21.2 nmol/L (95% CI: 16.2, 26.2), with a greater effect for studies using cholecalciferol than ergocalciferol. Heterogeneity was high (I2  > 75%). Metaregression analyses for all studies combined suggested positive effect differences for baseline circulating 25(OH)D concentrations <50 nmol/L, dose ≥10 µg/d and a negative effect difference when the intervention arm included a calcium dose ≥500 mg/d greater than the control arm. Dose-response rates were found to be nonlinear (Wald test for nonlinearity P < 0.001). For all studies combined, a threshold occurred at ∼26 nmol/L for a dose of ∼21 µg/d. CONCLUSIONS: These results support use of vitamin D food fortification to improve circulating 25(OH)D circulations in populations. This work was registered with PROSPERO as CRD42020145497.

Dietary Inflammatory Index and Epithelial Ovarian Cancer in Southern Chinese Women: A Case-Control Study.

The association between inflammatory properties of diet and ovarian cancer risk has been investigated in some Western populations. However, little evidence is available from Asian women whose ovarian cancer incidence rates are low and dietary and lifestyle patterns are very different from their Western counterparts. We aimed to examine whether more pro-inflammatory diets, as indicated by higher dietary inflammatory index (DII®) scores, are associated with increased odds of epithelial ovarian cancer in southern China. A case-control study was conducted during 2006-2008 in Guangzhou, Guangdong Province. Energy-adjusted DII (E-DII) scores were calculated based on dietary intake assessed by a validated food frequency questionnaire administered to 500 incident epithelial ovarian cancer patients and 500 hospital-based controls. Logistic regression models were used to assess the relationship between E-DII scores and odds of ovarian cancer. Positive associations were observed between higher E-DII scores and ovarian cancer odds, using both continuous DII scores (odds ratio (OR) 1.87; 95% confidence interval (CI) 1.65, 2.13) and by DII tertiles (ORtertile3vs1 7.04, 95% CI: 4.70, 10.54, p for trend < 0.001). Likewise, a more pro-inflammatory diet was associated with a higher chance of serous and mucinous ovarian tumors. Our results suggest that a pro-inflammatory diet was associated with increased odds of developing epithelial ovarian cancer in southern Chinese women. The findings add to epidemiological evidence for the role of dietary inflammatory potential in ovarian cancer development.

Physical activity and sedentary behaviour during pregnancy are associated with gestational weight gain in Vietnamese women.

BACKGROUND AND OBJECTIVES: Gestational weight gain is known to impact maternal and child health outcomes. Energy intake and energy expenditure are major components of clinical nutrition in relation to weight gain during pregnancy. The study was to determine the association of physical activity and sitting time during pregnancy with gestational weight gain in Vietnamese women. METHODS AND STUDY DESIGN: A multicentre prospective cohort study was conducted in Vietnam from 2015 to 2017. A total of 1873 women with a singleton pregnancy were included. Physical activity and sitting exposures during pregnancy were determined using an interviewer-administered validated questionnaire. Multiple regression analysis was performed to assess physical activity and sitting time in relation to gestational weight gain, adjusting for the confounding effects of maternal characteristics and total energy intake during pregnancy. RESULTS: The mean weight gain was 12.9 (Standard deviation 4.1) kg throughout pregnancy. Pregnant women with prolonged sitting time gained an average of 0.6 kg more weight (p=0.016 for highest versus lowest tertiles). Conversely, women who were physically active, in terms of having higher tertiles of total physical activity, moderate-to-vigorous-intensity, household/ caregiving activities, and occupational physical activity, experienced significantly less gestational weight gain (p<0.05 for highest versus lowest tertiles). CONCLUSIONS: Inverse associations were found between gestational weight gain and physical activity (i.e. intensities and several domains), whereas gestational weight gain tended to increase with longer sitting time. Therefore, being physically active and less sedentary is important to regulate weight gain during pregnancy.

Gestational diabetes incidence and delivery outcomes in Western China: A prospective cohort study.

BACKGROUND: Few studies have examined the age-standardized incidence of gestational diabetes mellitus (GDM) for comparison between populations. Information on delivery outcomes is also lacking for Chinese women with GDM. Therefore, the present study aimed to determine age-standardized GDM incidence and assess its association with maternal and neonatal outcomes. METHODS: A total of 1901 pregnant women were recruited in Chengdu, Sichuan Province. GDM was diagnosed between 24 and 28 weeks' gestation using oral glucose tolerance tests. Age-standardized incidence rates of GDM were calculated using the direct method. Delivery outcomes were extracted from medical records and compared between the GDM and non-GDM groups. RESULTS: The age-standardized GDM incidence was 18.3% (95% CI 15.6-21.1) and increased with maternal age and prepregnancy body mass index (BMI). Women with GDM experienced longer length of stay in hospital, shorter gestation at delivery, and a higher risk of cesarean delivery. Their newborns were more likely to be macrosomic or small for gestational age, and to require neonatal intensive care. CONCLUSIONS: The incidence of GDM was high in Western China, especially among older and overweight women. Moreover, women with GDM had higher rates of adverse delivery outcomes. The findings lend further support for the screening, prevention, and management of GDM in Chinese women.

Malaria and the 'last' parasite: how can technology help?

Malaria, together with HIV/AIDS, tuberculosis and hepatitis are the four most deadly infectious diseases globally. Progress in eliminating malaria has saved millions of lives, but also creates new challenges in detecting the 'last parasite'. Effective and accurate detection of malaria infections, both in symptomatic and asymptomatic individuals are needed. In this review, the current progress in developing new diagnostic tools to fight malaria is presented. An ideal rapid test for malaria elimination is envisioned with examples to demonstrate how innovative technologies can assist the global defeat against this disease. Diagnostic gaps where technology can bring an impact to the elimination campaign for malaria are identified. Finally, how a combination of microfluidic-based technologies and smartphone-based read-outs could potentially represent the next generation of rapid diagnostic tests is discussed.

Dietary patterns during pregnancy and risk of gestational diabetes: a prospective cohort study in Western China.

BACKGROUND: Previous research has demonstrated the association between maternal dietary patterns and gestational diabetes (GDM), but evidence in Asian populations remains limited and inconsistent. This study investigated the association between dietary patterns during early pregnancy and the risk of GDM among pregnant women in Western China. METHODS: A prospective cohort study was conducted among 1337 pregnant women in Western China. Dietary intakes were assessed at 15-20 weeks of gestation using a validated food frequency questionnaire. GDM was diagnosed by oral glucose tolerance tests at 24-28 weeks of gestation. Exploratory factor analysis was performed to derive dietary patterns, and logistic regression models were used to examine the association between dietary patterns and GDM. RESULTS: A total of 199 women (14.9%) developed GDM. Three dietary patterns were identified, namely, a plant-based pattern, a meat-based pattern and a high protein-low starch pattern. Notwithstanding a lack of association between dietary patterns and GDM risk in the whole cohort, there was a significant reduction in GDM risk among overweight women (BMI ≥24 kg/m2); the odds ratio being 0.29 (95% confidence interval 0.09 to 0.94) when comparing the highest versus the lowest score of the high protein-low starch pattern. CONCLUSIONS: There was no significant association between early pregnancy dietary patterns and GDM risk later in pregnancy for women in Western China, but high protein-low starch diet was associated with lower risk for GDM among women who were overweight at pre-pregnancy.

Habitual consumption of coffee and green tea in relation to serum adipokines: a cross-sectional study.

PURPOSE: Coffee and green tea consumption may be associated with circulating adipokines, but data are inconsistent, scarce or lacking. We examined the association of coffee and green tea consumption with serum adiponectin, leptin, visfatin, resistin and plasminogen activator inhibitor-1 (PAI-1) among a Japanese working population. METHODS: The authors analyzed data (n = 509) from a cross-sectional survey among Japanese workers aged 20-68 years. Serum adipokines were measured using a Luminex suspension bead-based multiplexed array. Coffee and green tea consumption was assessed using a validated diet history questionnaire, and caffeine consumption from these beverages was estimated. Multiple regression analysis was performed with adjustment for potential confounding variables. RESULTS: Coffee consumption was significantly, inversely associated with leptin and PAI-1 (P for trend = 0.007 and 0.02, respectively); compared with subjects consuming <1 cup per day, those consuming ≥4 cups per day had 13 and 10 % lower means of leptin and PAI-1, respectively. Similar associations were observed for caffeine consumption (P for trend = 0.02 for both leptin and PAI-1). Additionally, we noted a significant positive association between coffee consumption and adiponectin in men (P for trend = 0.046), but not in women (P for trend = 0.43, P for interaction = 0.11). Moreover, there was a positive association between coffee consumption and resistin in current male smokers (P for trend = 0.01), but not in male non-smokers (P for trend = 0.35, P for interaction = 0.11). Green tea consumption was not associated with any adipokine. CONCLUSIONS: Higher consumption of coffee and caffeine but not green tea was associated with lower serum levels of leptin and PAI-1 in Japanese adults.

Flushing response modifies the association of alcohol consumption with markers of glucose metabolism in Japanese men and women.

BACKGROUND: Influences of alcohol use on glucose metabolism may depend on alcohol flushing response. We investigated the effect of alcohol flushing response on the associations between alcohol consumption and markers of glucose metabolism in Japanese men and women. METHODS: The subjects were 979 employees (885 men and 94 women), aged 18 to 69 years, of a manufacturing company in Japan. Flushing response and alcohol consumption were determined using a self-administered questionnaire. Homeostasis model assessment-insulin resistance (HOMA-IR) and homeostasis model assessment for ß-cell function (HOMA-ß) were computed using fasting plasma glucose and insulin. For each group of flushers and nonflushers, multiple regression analysis was used to estimate means of fasting plasma glucose, hemoglobin A1c (HbA1c), and HOMAs for each category of alcohol consumption, with adjustments for potential confounders. RESULTS: In flushers, alcohol consumption was associated with HbA1c levels in a U-shaped manner, with the lowest HbA1c levels being observed at an alcohol consumption level of 23.0 to <34.5 g ethanol/d (p for quadratic trend = 0.002). In nonflushers, alcohol consumption was linearly and inversely associated with HbA1c levels (p for linear trend = 0.001). Decreases in HbA1c were more evident among flushers compared with nonflushers at moderate alcohol consumption levels (p for interaction = 0.049). An increase of fasting glucose associated with highest alcohol consumption was observed in both flushers and nonflushers. A statistically significant decrease in HOMA-IR with increasing alcohol consumption was observed in flushers (p for trend = 0.007), whereas HOMA-IR levels slightly decreased at higher alcohol consumption in nonflushers. HOMA-ß similarly decreased with increasing alcohol consumption in both flushers and nonflushers (both p for trend < 0.001). CONCLUSIONS: The results suggest that the alcohol flushing response may improve glucose metabolism and insulin resistance at moderate alcohol use levels in apparently healthy Japanese adults.

Comparison of body mass index, waist circumference, and waist-to-height ratio for predicting the clustering of cardiometabolic risk factors by age in Japanese workers--Japan Epidemiology Collaboration on Occupational Health study.

BACKGROUND: Waist-to-height ratio (WHtR) has been suggested as a better screening tool than body mass index (BMI) and waist circumference (WC) for assessing cardiometabolic risk. However, most previous studies did not consider age. METHODS AND RESULTS: Participants were 45,618 men and 8,092 women aged 15-84 years who received periodic health checkups in 9 companies in Japan. Clustering of cardiometabolic risk factors was defined by the existence of 2 or more of high blood pressure, hyperglycemia, and dyslipidemia. In both men and women, unadjusted area under the curve (AUC) of the receiver-operating characteristic curve for WHtR in detecting the clustering of cardiometabolic risk factors was significantly higher than that for either BMI or WC; the AUCs for WHtR, BMI, and WC, respectively, were 0.734, 0.705, and 0.717 in men and 0.782, 0.762, and 0.755 in women. After adjustment for age, however, such differences were not observed; the corresponding values were 0.702, 0.701, and 0.696 in men. In women, the age-adjusted AUC for BMI was slightly higher than for other indices (WHtR, 0.721; BMI, 0.726; WC, 0.707). CONCLUSIONS: The screening performance of WHtR for detecting the clustering cardiometabolic risk factors was not superior to that of BMI.

Meat consumption and colorectal cancer risk: an evaluation based on a systematic review of epidemiologic evidence among the Japanese population.

OBJECTIVE: The association between meat consumption and colorectal cancer remains inconsistent among Asians. The present study systematically evaluated and meta-analyzed epidemiologic studies on the association between consumption of total and specific meats and colorectal cancer risk among Japanese. METHODS: Original data were obtained from MEDLINE searched using PubMed or from searches of the Ichushi database, complemented with manual searches. The associations were evaluated based on the strength of evidence, the magnitude of association and biologic plausibility. A meta-analysis was performed according to total meat, red and processed meat as well as poultry and site-specific cancers. RESULTS: Six cohort studies and 13 case-control studies were identified. In cohort studies, most investigations found no association between total meat consumption and colon/rectal cancer, and several studies showed a weak-to-moderate positive association of red meat and processed meat consumption with colon/rectal cancer. The majority of case-control studies showed no association between total meat consumption and colon and rectal cancer; however, several ones reported a weak-to-strong positive association of red and processed consumption with colon and rectal cancer. In meta-analysis, the summary relative risks (95% confidence interval) for the highest versus lowest categories of red meat consumption were 1.16 (1.001-1.34) and 1.21 (1.03-1.43) for colorectal and colon cancer, respectively, and those for processed meat consumption were 1.17 (1.02-1.35) and 1.23 (1.03-1.47) for colorectal and colon cancer, respectively. Poultry consumption was associated with lower risk of rectal cancer; summary relative risk (95% confidence interval) was 0.80 (0.67-0.96). CONCLUSIONS: High consumption of red meat and processed meat possibly increases risk of colorectal cancer or colon cancer among the Japanese population.

Association of serum leptin and ghrelin with depressive symptoms in a Japanese working population: a cross-sectional study.

BACKGROUND: Leptin and ghrelin have been implicated in the pathogenesis of major depression. However, evidence is lacking among apparently healthy people. This study examined the relationship of these appetite hormones to depressive symptoms in a Japanese working population. METHODS: A cross-sectional study was conducted in 2009 among 497 Japanese employees (287 men and 210 women) aged 20-68 years. Fasting serum leptin and ghrelin levels were measured using a Luminex suspension bead-based multiplexed array. Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression (CES-D) scale. Logistic regression analysis was performed to estimate odds ratio (OR) and 95% confidence interval (CI) for depressive symptoms with adjustment for potential confounders. RESULTS: The prevalence of depressive symptoms (CES-D ≥16) was 26.5% and 33.3% among men and women, respectively. Women in the middle and highest tertiles of leptin levels showed lower odds for depressive symptoms compared with those in the lowest level, although the trend association was not statistically significant (Ptrend = 0.14). Higher ghrelin levels were associated with increased odds for depressive symptoms in women (Ptrend = 0.02). The multivariable adjusted OR (95% CI) of having depressive symptoms for the lowest through highest tertiles of ghrelin levels were 1.00 (reference), 1.71 (0.76 - 3.86), and 2.69 (1.16 - 6.28), respectively. Neither leptin nor ghrelin was associated with depressive symptoms in men. CONCLUSIONS: Results suggest that lower leptin and higher ghrelin levels may be related to higher prevalence of depressive status among Japanese women.

Green tea and coffee consumption is inversely associated with depressive symptoms in a Japanese working population.

OBJECTIVE: To examine the association between the consumption of green tea, coffee and caffeine and depressive symptoms. DESIGN: Cross-sectional study. Consumption of green tea and coffee was ascertained with a validated dietary questionnaire and the amount of caffeine intake was estimated from these beverages. Depressive symptoms were measured using the Center for Epidemiologic Studies Depression Scale. Multiple logistic regression analysis was performed to compute odds ratios and 95% confidence intervals for depressive symptoms with adjustments for potential confounders. SETTING: Two workplaces in north-eastern Kyushu, Japan, in 2009. SUBJECTS: A total of 537 men and women aged 20-68 years. RESULTS: Higher green tea consumption was associated with a lower prevalence of depressive symptoms. Compared with participants consuming ≤1 cup/d, those consuming ≥4 cups green tea/d had a 51% significantly lower prevalence odds of having depressive symptoms after adjustment for potential confounders, with significant trend association (P for trend = 0·01). Further adjustment for serum folate slightly attenuated the association. Coffee consumption was also inversely associated with depressive symptoms (≥2 cups/d v. <1 cup/d: OR = 0·61; 95% CI 0·38, 0·98). Multiple-adjusted odds for depressive symptoms comparing the highest with the lowest quartile of caffeine consumption was OR = 0·57 (95% CI 0·30, 1·05; P for trend = 0·02). CONCLUSIONS: Results suggest that higher consumption of green tea, coffee and caffeine may confer protection against depression.

Fish consumption and colorectal cancer risk: an evaluation based on a systematic review of epidemiologic evidence among the Japanese population.

OBJECTIVE: The association between fish consumption and colorectal cancer risk remains inconclusive. The present study systematically reviewed and meta-analyzed epidemiologic data on the association between fish consumption and colorectal cancer risk among Japanese. METHODS: Original data were obtained from MEDLINE searched using PubMed or from searches of the Ichushi database, complemented with manual searches. The associations were evaluated based on the strength of evidence, the magnitude of association and biologic plausibility. Meta-analysis was conducted according to the study design. RESULTS: Five cohort studies and 12 case-control studies were identified. Fish consumption was not significantly associated with colorectal, colon or rectal cancer risks. One cohort study showed a weak positive association with colorectal cancer, and another showed a weak inverse association with colon cancer in men and a moderate and weak inverse association with colon and rectal cancers in women. As regards case-control studies, four studies reported a weak inverse association, whereas one showed a weak positive association with colon cancer. Regarding rectal cancer, four case-control studies showed a weak inverse association, but two reported a weak-to-moderate positive association. The pooled relative risk/odds ratio (95% confidence interval) of colorectal cancer for the highest versus lowest category of fish consumption was 1.03 (0.89-1.18) and 0.84 (0.75-0.94) for cohort and case-control studies, respectively. CONCLUSIONS: There was insufficient evidence to support an association between fish consumption and the risk of colorectal cancer among Japanese.

Vitamin D status in healthy populations worldwide: a systematic review protocol.

OBJECTIVE: The objective of this systematic review is to report on circulating concentrations of 25-hydroxyvitamin D (25[OH]D) and the prevalence of 25(OH)D concentrations below commonly used cut points for vitamin D deficiency, insufficiency, and sufficiency in healthy populations worldwide. INTRODUCTION: Vitamin D sufficiency is important for optimal bone health and has been identified as being protective against a range of adverse health outcomes. Poor vitamin D status is considered a global public health concern. This review will provide up-to-date data on 25(OH)D concentrations in healthy populations worldwide. INCLUSION CRITERIA: This review will consider data from publications that include measurements of circulating 25(OH)D concentrations in healthy people of all ages across all global geographical regions. METHODS: MEDLINE, Embase, Scopus, Web of Science, and Global Index Medicus will be searched for relevant studies published from March 1, 2011. Two reviewers will independently screen titles and abstracts using Research Screener, review relevant full-text articles for quality and eligibility, and extract data. Studies will, where possible, be pooled with statistical meta-analysis, while heterogeneity will be statistically tested. If relevant data are available, subgroup and sensitivity analyses will be conducted to investigate latitude, sex, age, season of blood collection, supplement use, 25(OH)D assay used (and whether it's certified to Reference Measurement Procedures developed under the Vitamin D Standardization Program), as well as study quality. REVIEW REGISTRATION: PROSPERO CRD42021242466.

Designing and developing a mobile app (BeBo) in a randomized controlled trial study to promote breastfeeding among Vietnamese mothers.

BACKGROUND: Breastfeeding should begin as soon as possible after birth and continue exclusively to 6 months of age. In Vietnam, as in many other countries, breastfeeding is decreasing because of modern lifestyles and the promotion of infant formula. It is important to provide mothers, family members, and the community with the knowledge and strategies to improve breastfeeding rates. Smartphones are almost ubiquitous in Vietnam and of the potential to provide information about breastfeeding. This study aimed to document the process of designing and developing a mobile app to increase breastfeeding rates in Vietnamese women. METHODS: We used a four-step mixed methods approach with a literature review, formative research (22 in-depth interviews and 49 self-administered online questionnaires), and testing of prototype apps (3 focus groups discussion and external experts). Formative research and focus group discussion involved 99 participants. Finally, the revisions of the app were tested. All of the formative research was undertaken in Hanoi in 2019-2020. Target behaviors followed by key determinants, to improve breastfeeding self-efficacy were studied and this information was then applied in developing the messages and library content. Barriers and facilitators to breastfeeding were identified from literature reviews and qualitative research. The messages were targeted at not only mothers but also included fathers, mothers-in-law, or families. RESULTS: Mothers were mostly concerned about the initiation of breastfeeding, preventing and reducing difficulties encountered during breastfeeding, and nutrition for breastfeeding mothers. Mental health and well-being in the postnatal period are also concerns. Three key features to be included in the app were identified from the formative research: (1) notifications; (2) an information library; and (3) a searching function. The research found that the app should be installed during pregnancy rather than after delivery (81% vs 17%, respectively). Notifications that convey breastfeeding messages should be sent 2-3 times per week. CONCLUSION: The development of the app followed a best practice approach, including the involvement of stakeholders and grounding in behavior change theory. The next step is to evaluate the effectiveness of the BeBo mobile app in a well-conducted randomized controlled trial. TRIAL REGISTRATION: ACTRN12619000531112.

Physical activity and colorectal cancer risk: an evaluation based on a systematic review of epidemiologic evidence among the Japanese population.

OBJECTIVE: Higher levels of physical activity have been consistently associated with a decreased risk of colon cancer, but not rectal cancer, in Western populations. The present study systematically evaluated epidemiologic evidence on the association between physical activity and colorectal cancer risk among the Japanese population. METHODS: Original data were obtained from MEDLINE searched using PubMed or from searches of the Ichushi database, complemented by manual searches. The associations were evaluated based on the strength of evidence, the magnitude of association and biologic plausibility. RESULTS: Two cohort studies and six case-control studies were identified. A weak to strong protective association between physical activity and colon cancer risk was observed in both cohort studies, showing a graded relationship, and among the majority of case-control studies, with some showing a dose-response relationship. The association observed in cohort studies was more consistent and stronger in men than in women and for proximal colon cancer than for distal colon cancer. A protective association with rectal cancer was found only in case-control studies, but the evidence was less consistent and weaker than that observed for colon cancer. CONCLUSIONS: Physical activity probably decreases the risk of colorectal cancer among the Japanese population. More specifically, the evidence for the colon is probable, whereas that for the rectum is insufficient.

Intention to Exclusively Breastfeed Is Associated with Lower Rates of Cesarean Section for Nonmedical Reasons in a Cohort of Mothers in Vietnam.

BACKGROUND: Breastfeeding brings benefits to both mothers and children in the short term and long term. Unnecessary cesarean sections can bring risks to both parties. This study was undertaken to examine the relationship between exclusive breastfeeding intention and cesarean delivery. METHODS: We analyzed data collected from 554 single mothers who delivered in Dong Anh General District Hospital or Hanoi Obstetrics and Gynecology Hospital, Vietnam, in 2020-2021. The relationship between exclusive breastfeeding intention and cesarean delivery for nonmedical reasons was adjusted for maternal education, maternal age, parity, history of fetal loss, having at least eight antenatal contacts, hospital of delivery, child sex, and birth weight. RESULTS: Antenatally, 34.8% (184/529) of mothers intended to breastfeed exclusively until 6 months and 30.8% (84/274) underwent cesarean section for a nonmedical reason. After adjusting for other factors, mothers who intended to breastfeed exclusively until 6 months were less likely to undergo cesarean delivery for nonmedical reasons (OR = 0.55, 95% CI: 0.31-0.96, p = 0.034). CONCLUSIONS: This study adds to the growing evidence related to unnecessary cesarean sections and routine over-medicalization of normal birth in the urban areas of Vietnam. The association between breastfeeding intentions and a lower rate of cesarean section suggests that education on breastfeeding could be a useful intervention for reducing the rate of cesarean sections and improving maternal and child health.

Determination of bioactive compounds, antioxidant and anticancer activities of Tuckeroo (Cupaniopsis anacardioides) fruits.

This study aimed to determine the phytochemical, antioxidant, and anticancer activities of the crude extract and its fractions of Cupaniopsis anacardioides. The results showed that total phenolic content (TPC), their secondary metabolites (flavonoids-TFC; proanthocyanidins-TPro), and antioxidant activity were significantly different between the crude extract and its fractions. The butanol fraction (F3) had the highest levels of TPC, TFC, and TPro, followed by the crude extract, aqueous fraction (F4), dichloromethyl fraction (F2), and hexane fraction (F1). High-Pressure Liquid Chromatography (HPLC) analysis revealed 14 major bioactive compounds were identified in the C. anacardioides extract. Further analysis showed F3 fraction contained the highest levels of the major bioactive compounds, while F1 fraction had the lowest. A similar pattern was observed for antioxidant activities. The crude extract, F3 and F4 fractions were further tested for cytotoxicity against 10 cancer cell lines, including HT29 (colon); U87, SJG2 (glioblastoma); MCF-7 (Breast); A2780 (ovarian); H460 (lung); A431 (skin); Du145 (prostate); BE2-C (neuroblastoma); MIA PaCa-2 (pancreas); and one non-tumour-derived normal breast cell line (MCF10A). Except for Du145 (prostate), the crude extract, F3 and F4 fractions inhibited the cancer cell lines at 100 µg/mL, with F3 possessing greater activity against these cancer cell lines. Future studies are recommended to isolate and identify the major bioactive compounds of the F3 fraction, and further tested their impact against cancer cell lines. This could identify the potential of anticancer agents from C. anacardioides.

Effect of a Mobile Application on Breastfeeding Rates Among Mothers Who Have Cesarean Deliveries: A Randomized Controlled Trial.

Aim: Cesarean section often translates to negative impacts on breastfeeding rates. This study aims to evaluate the effect of a mobile application on breastfeeding outcomes among mothers who had cesarean sections using a randomized controlled trial in Vietnam in 2020-2022. Methods: A triple-blinded randomized trial of a mobile application was conducted. The mobile application was tailored to a Vietnamese cultural context with two separate versions, one for the intervention and one for the control. The intervention group version auto-generated three messages per week and linked with the information in the application's library content to improve breastfeeding practices. In contrast, the control group's version of the application sent messages on related general maternal and child health care. Pregnant mothers were recruited during their antenatal visits and randomly assigned to one of the two groups. Outcomes of interest included early initiation of breastfeeding and exclusive breastfeeding rates. Results: A total of 293 in the intervention group and 275 mothers in the control who had undergone cesarean sections were included in the analyses. Significant increases were observed in the intervention group for early initiated breastfeeding within 2 hours (adjusted odds ratio [aOR] = 1.50, 95% confidence interval [CI]: 1.01-2.24) and exclusive breastfeeding during hospital stay (aOR = 1.60, 95% CI: 1.03-2.48). Conclusion: Our results support the use of a theory-based and designed mobile phone application as a part of a promising intervention to improve breastfeeding outcomes among mothers who have cesarean sections.