The efficacy of probiotics and/or n-3 long-chain polyunsaturated fatty acids intervention on maternal prenatal and postnatal depressive and anxiety symptoms among overweight and obese women.

BACKGROUND: Maternal depression and anxiety may endanger well-being of both mother and child. We investigated the efficacy of probiotics and/or fish oil (FO) in modifying pre- and postnatal depressive and anxiety symptoms. Symptom trajectories were identified and the influence of lifestyle factors on symptoms was evaluated. METHODS: Overweight women (n = 439) were randomized to intervention groups (probiotics+FO, probiotics+placebo, FO+placebo, placebo+placebo) from early pregnancy until six months postpartum, and assessed for depressive and anxiety symptoms with Edinburgh Postnatal Depression Scale (EPDS) and Anxiety subscale of Symptoms Checklist (SCL-90) at early and late pregnancy and three, six and 12 months postpartum. Latent growth mixture modeling was used to model the symptom courses. Dietary quality and physical activity were assessed with validated indices. RESULTS: Symptom scores were generally low. Statistically significant intervention effect was seen during pregnancy (p = 0.017): EPDS scores increased (by 1.11 points) in the FO+probiotics group and decreased (by 0.85 points) in the FO+placebo group. At 12 months postpartum, FO+placebo group had lower EPDS scores compared to probiotics+placebo group (p = 0.039). No differences in SCL scores were seen in response to the intervention. Irrespective of the intervention, three depressive and two anxiety symptoms trajectories were identified. Dietary quality correlated negatively with depressive symptoms in early pregnancy and six months postpartum and with anxiety symptoms in early pregnancy. Perinatal events including mother-reported colic were related to symptoms. LIMITATIONS: Secondary outcomes of the primary trial. CONCLUSIONS: Intervention had a modest impact on depressive symptoms. Diet and obstetric events were associated with depressive and anxiety symptoms.

The impact of probiotics and n-3 long-chain polyunsaturated fatty acids on intestinal permeability in pregnancy: a randomised clinical trial.

A disruption in intestinal barrier integrity may predispose individuals to metabolic aberrations, particularly during the vulnerable period of pregnancy. We investigated whether intestinal permeability, as measured by serum zonulin concentration, changes over the duration of pregnancy and whether this change is reflected in lipopolysaccharide (LPS) activity. Second, we tested in a randomised double-blind placebo controlled clinical trial the impact of consuming dietary probiotics and/or long chain polyunsaturated fatty acid (LC-PUFA) supplements in lowering serum zonulin concentration and LPS activity. The probiotic supplement was a combination of two bacteria, Bifidobacterium animalis ssp. lactis 420 and Lactobacillus rhamnosus HN001. This study included 200 overweight pregnant women participating in an on-going study; participants were randomised to consume either (1) probiotics, (2) LC-PUFA, (3) probiotics and LC-PUFA, or (4) placebo for each supplement. Blood samples were obtained at early, the baseline, and late pregnancy (mean 14 and 35 weeks of gestation, respectively). Serum zonulin concentration increased from early (mean (standard deviation): 62.7 (12.9) ng/ml) to late pregnancy by 5.3 (95%CI 3.7-6.9) ng/ml, and LPS activity increased from (0.16 (0.04) EU/ml) by 0.04 (95%CI 0.03-0.05) EU/ml. No differences among the intervention groups were detected in the change from early to late pregnancy in serum zonulin concentration (P=0.8) or LPS activity (P=0.2). The change in serum zonulin concentration during the pregnancy was associated with the weeks of follow up (r=0.25, P<0.001). Serum LPS activity was correlated with higher maternal weight gain (r=0.19, P=0.008). As a conclusion, intestinal permeability increased with the progression of pregnancy in overweight and obese women and was reflected in LPS activity. No efficacy of supplementation with probiotics and/or LC-PUFA was demonstrated in pregnancy-induced changes in serum zonulin concentration or LPS activity.

Evaluation of serum zonulin for use as an early predictor for gestational diabetes.

Diet has an important role in regulating intestinal permeability and subsequently the risk for metabolic disorders. In this observational study, we examined whether serum intestinal permeability marker zonulin, could be used as a predictor for gestational diabetes mellitus (GDM). Serum zonulin concentration was measured in early pregnancy in overweight or obese pregnant women (n=88) at risk for developing GDM. Serum zonulin was associated with higher odds of GDM (adjusted OR for 1 ng ml-1 increase in zonulin: 1.08, 95% CI: 1.02-1.15; P=0.009), diagnosed by a 2-h 75-g oral glucose tolerance test at late pregnancy. The optimal cutoff value was 43.3 ng ml-1, with sensitivity of 88% (95% CI: 71-100%) and specificity of 47% (95% CI: 33-58%). The area under the ROC-curve was 0.67 (95% CI: 0.54-0.81). Our results show an association between increased early-pregnancy serum zonulin concentration and GDM, suggesting zonulin as a possible predictor for GDM.

Opportunities for probiotics and polyunsaturated fatty acids to improve metabolic health of overweight pregnant women.

Overweight during pregnancy predisposes both the mother and foetus to health complications. Maternal complications include gestational diabetes, obstetric problems and type 2 diabetes later in life. Complications for the offspring are not only restricted to the foetal period or birth, such as prematurity and foetal macrosomia, but may also have long-term metabolic health implications through the mechanism of early nutrition programming. One of the key metabolic components characterising overweight in the non-pregnant state is low-grade inflammation manifested by elevated levels of circulatory pro-inflammatory cytokines. In pregnancy, in addition to adipose tissue and placenta, inflammatory response may originate from the gut. The extent to which overweight induces metabolic maladaptation during pregnancy and further compromises maternal and child health is currently poorly understood. In this review, we evaluate recent scientific literature and describe the suggested links between overweight, gut and low-grade inflammation associated metabolic disorders. We focus on overweight pregnant women and gestational diabetes, and discuss how specific dietary factors, probiotics and long-chain polyunsaturated fatty acids (fish oil), might confer health benefits in combatting against metabolic risk factors.

Plant stanol content remains stable during storage of cholesterol-lowering functional foods.

Plant stanols reduce the absorption of both dietary and biliary cholesterol. The aim of this study was to examine the stability of plant stanols in the form of plant stanol esters in spreads and biscuits stored under typical storage conditions. The plant stanol content of two commercial margarine-type spreads, containing 35% and 60% absorbable fat, was 6.5 and 6.4 g/100 g after production and remained unaltered when stored at 6 °C for a shelf life of 18 and 22 weeks, respectively. Comparable results were obtained for plant stanol ester ingredient stored under the same conditions and for plant stanol ester-containing biscuits stored at room temperature for up to 74 weeks. Furthermore, the peroxide value and free fatty acids showed that the quality of the food products remained good. The present study demonstrated that plant stanol esters as an ingredient and when added in food products, are stable whilst stored under the appropriate conditions.

The hTAS2R38 genotype is associated with sugar and candy consumption in preschool boys.

BACKGROUND: The hTAS2R38 taste receptor genotype is related to bitter taste perception and thus may affect food preferences. The present study aimed to evaluate the relationship between the hTAS2R38 genotype and the food consumption and nutrient intakes of Finnish children aged 2-6 years. METHODS: Dietary intake was assessed with 7-day food records, and DNA samples were collected by cheek swabs for genotyping. Food intake data between the three most common genotypes were compared (n = 345). RESULTS: The proportion of the AVI/AVI genotype was 36.7%; PAV/AVI was 42.4%; and PAV/PAV was 14.9%. Boys with the PAV/PAV genotype consumed a mean (SD) weight of sugar and candy of 27 (13) g day(-1), which was significantly more compared to the other two genotypes [AVI/AVI 19 (12) g day(-1) and PAV/AVI 18 (12) g day(-1); both P < 0.01]. These boys also consumed significantly more meat (g day(-1)) compared to AVI/AVI boys (P < 0.05). PAV/PAV girls tended to consume more grains (g MJ(-1)) compared to AVI/AVI girls (P = 0.07). Vegetable and fruit consumption and nutrient intake did not differ significantly between genotypes. Based on principal component analysis carried out with total food consumption data, PAV/PAV boys were different from both AVI/AVI and PAV/AVI boys. CONCLUSIONS: The hTAS2R38 genotype may have distinct associations with food consumption in boys and girls.

Juvenile idiopathic arthritis patients with low inflammatory activity have increased adiposity.

OBJECTIVES: The aim of this study was to assess the effect of juvenile idiopathic arthritis (JIA), its subtypes and disease activity on anthropometric measurements, body composition, and nutritional parameters. METHOD: A cross-sectional cohort of 40 JIA patients, aged 3-10 years, was compared with 40 healthy children matched for age and gender. Concentrations of nutritional and inflammatory biomarkers in the blood, anthropometric measures, and clinical status were recorded and the parents filled in a 7-day food diary and completed the Childhood Health Assessment Questionnaire (CHAQ). RESULTS: The JIA patients had low disease activity: 60% had inactive disease, the median CHAQ score was 0.125, and the median erythrocyte sedimentation rate (ESR) was 6 mm/h. Significantly higher values for central and peripheral adiposity were found in JIA patients compared with in healthy controls [waist circumference mean (SD) 55.9 (4.9) vs. 53.4 (3.7) cm, p < 0.0001, and biceps skinfold thickness 6.2 (2.3) vs. 5.3 (1.7) cm, p = 0.035, respectively], and obesity/overweight was more common (30% vs. 12.5%, p = 0.056, respectively) despite no differences in weight-for-height. The intake of energy (kcal/day) was significantly higher in the JIA patients (p = 0.036). The nutritional biomarkers were comparable in both groups. The JIA subtype and disease activity did not affect body composition, energy intake, or the nutritional biomarkers. CONCLUSIONS: Even JIA patients with low disease activity have a higher central and peripheral adiposity and a higher energy intake than their healthy peers. Neither disease subtype nor disease activity had any association with changes in body composition.

Proportions and concentrations of serum n-3 fatty acids can be increased by dietary counseling during pregnancy.

BACKGROUND/OBJECTIVES: The mother is an important mediator to the infant of polyunsaturated fatty acids (PUFA), the essential constituents of membranes particularly in the brain and retina. We here aimed in a prospective study initiated in early pregnancy to establish whether serum fatty acid (FA) compositions and concentrations in the mother can be modified by dietary means emphasizing counseling on a recommended diet. SUBJECTS/METHODS: Ninety women in the first trimester of pregnancy were randomized into intervention (n=45) or control (n=45) groups. The intervention comprised individual dietary counseling advocating choice of foods that will increase the intake of unsaturated and reduce that of saturated FA. To support this, appropriate products, including spreads, were provided for consumption at home. Dietary intakes were measured from food records and serum phospholipids, cholesteryl esters and triacylglycerols FA were analyzed by gas chromatography. RESULTS: Dietary counseling resulted in lower intake of saturated and higher intake of unsaturated FA compared with the controls. These changes were reflected in higher proportions of serum phospholipid PUFA (mean difference between groups 0.61% (95% confidence interval, CI 0.05-1.17), P=0.03), docosahexaenoic acid (0.5% (0.15-0.85), P=0.01), sum of n-3 FA (0.61% (0.07-1.15), P=0.03) and lower ratio of n-6/n-3 FA (-0.42% (-0.81-0.03), P=0.03) in the intervention group at the third trimester of pregnancy but not at 1 month postpartum. Similar changes were seen in the FA of cholesteryl esters and triacylglycerols. CONCLUSION: Maternal serum n-3 FA status during pregnancy can be improved by dietary means emphasizing the importance of dietary advice.

Impact of intrauterine and post-natal nutritional determinants on blood pressure at 4 years of age.

BACKGROUND: To prospectively study how the early nutritional environment can programme blood pressure in a well-nourished population of children. METHODS: By means of multivariate modelling, we assessed whether gestational and post-natal dietary intakes and growth influence childhood blood pressure programming in a cohort of 109 healthy mother-child pairs. They had been followed from early pregnancy until the children reached 4 years of age. Dietary intakes were evaluated using 3-day food diaries. Blood pressure levels in the children were measured using an automated oscillometric DINAMAP ProCare 100 (Criticon, Tampa, FL, USA) at the age of 4 years. RESULTS: In the final multivariate model, the predictor variables of childhood systolic blood pressure were maternal dietary carbohydrate and fat intake during pregnancy, as well as childhood weight and dietary fat intake at 4 years of age. Systolic blood pressure levels in the children were found to be positively associated with the maternal carbohydrate intake (P = 0.003), whereas blood pressure levels were lowest in children exposed to the middle tertile of maternal dietary fat intake during pregnancy (P = 0.003) and whose own dietary fat intake was in the middle tertile at the age of 4 years (P = 0.013). The model also showed that heavier children have a higher systolic blood pressure (P < 0.001). None of the maternal clinical characteristics fulfilled the criterion to be included in the model. The only determinant underlying childhood diastolic blood pressure was childhood weight at 4 years of age (r = 0.289, P = 0.026). CONCLUSIONS: Interventions focusing on cardiovascular health in young women during pregnancy and their children should be considered to reduce cardiovascular diseases risk factors in these children.

Diet and blood lipids in 1-4 year-old children.

BACKGROUND AND AIM: Early nutrition may programme blood lipid levels and thereby later cardiovascular health of children. The objective here was to evaluate the effects of maternal dietary counselling during pregnancy and breastfeeding on dietary intakes and blood lipid values in 1-4 year-old children. Further, the nutritional determinants of children's lipid profiles were assessed. METHODS AND RESULTS: Mothers were randomised into dietary counselling or control groups at the first trimester of pregnancy. Their children were followed up clinically at 1, 2 and 4 years of age, by three-day food records and analyses of total cholesterol, HDL cholesterol and apolipoproteins A-I and B as well as lipoprotein (a). In general, the mean intake of saturated fatty acids as a proportion of total energy intake (E%) was higher than the recommended, while the mean intake of polyunsaturated fatty acids was low in children's diet. Over the first years, girls had higher concentration of non-HDL cholesterol than boys; 2.64 mmol/l (95% CI 2.54-2.74) vs. 2.49 (2.38-2.60); p = 0.038. Maternal dietary counselling was not reflected in the children's lipid values. Children's monounsaturated fatty acid intake (E%) correlated with apoA-I (p = 0.048) and, furthermore, there was a negative correlation between polyunsaturated fatty acid intake (E%) and apoB (p = 0.046). CONCLUSION: Children's dietary fatty acid intake, but not maternal dietary counselling was shown to be related to blood apolipoproteins in children.

Costs of allergic diseases from birth to two years in Finland.

OBJECTIVES: Costing studies are needed to identify the resources used for treatment and inform payers of the costs incurred. The objectives were to determine the costs of diagnosing and treating atopic dermatitis, food allergy and asthma, and to compare the share of costs to society and to the family during the first two years of life. STUDY DESIGN: The data were obtained from an ongoing mother-infant nutrition study. The sample comprised 60 infants who developed allergic disease by the age of 24 months and 56 healthy infants with no allergic disease. METHODS: The costs included diagnosis and treatment of the allergy, disability allowances, travel expenses and time spent by parents. RESULTS: The median costs per infant were €275 (range 94-1306) for atopic dermatitis, €1408 (163-5408) for asthma, €3182 (628-11195) for food allergy, and €10 (0-619) for the healthy infants due to the suspicion of allergic disease. The highest costs in atopic dermatitis were caused by primary care visits, topical treatments, travel costs and parents' time, and those for food allergy by hospital out-patient care, infant formulae for cow's milk allergy, disability allowances and travel costs. The families paid 43% of the costs arising from atopic dermatitis, 13.6% of those from food allergy and 16.5% of those from asthma. CONCLUSIONS: Cow's milk allergy emerged as the most expensive allergic disease, especially for the society, and concurrent asthma in particular further increased the costs.

Influences on infant feeding decisions of first-time mothers in five European countries.

BACKGROUND/OBJECTIVES: Infant feeding decisions made by new parents have significant health implications. The study aimed to investigate: influences on infant feeding decisions; characteristics of mothers reporting reliance on alternative information sources; associations between reliance on different sources and intentions to exclusively breastfeed and introduce complementary foods later; and subsequent breastfeeding and weaning behaviours. SUBJECTS/METHODS: First-time mothers in five European countries (England, Finland, Germany, Hungary, Spain) completed questionnaires about the importance of 17 influences on infant feeding choices at birth and 8 months later, during 2007-2008. Use of individual sources and reliance on four categories (family and friends, health professionals, written materials, audio-visual media) were compared between countries. Associations between information sources used and mother characteristics, feeding intentions and behaviours were investigated using appropriate statistical tests. RESULTS: In all, 2071 first-time mothers provided baseline data; 78% at 8 months. Variation exists between countries in the influence of different sources on feeding decisions of first-time mothers. Across all countries, the most important influences at both time points were books, partner and antenatal midwife. Mothers in higher income quintiles and remaining at school beyond age 16 years reported greater reliance on written sources (P<0.0005). Mothers relying most on written sources reported longer exclusive breastfeeding (P=0.002), and a tendency to introduce foods other than milk later (P=0.079) than mothers relying most on personal or professional contacts. CONCLUSION: Further research is required about which dissemination strategies are most effective at improving infant feeding behaviours in varied cultural settings, and for different socio-economic groups.

In vitro fungistatic effects of natural coniferous resin from Norway spruce (Picea abies).

Resins (rosin, pitch) are natural products of the coniferous trees and are antimicrobial against a wide range of microbes. The antifungal effectiveness of resin, purified from Norway spruce (Picea abies), was studied against human pathogenic fungi and yeasts with the agar plate diffusion tests and electron microscopy (EM). The fungistatic effect of these resin mixtures (resin salves) was tested against a set of Candida yeasts, dermatophytes, and opportunistic fungi. Transmission and scanning EM was done from samples of fungi (Trichophyton mentagrophytes). In agar diffusion tests, the resin was strongly antifungal against all dermatophytes tested, e.g., against all fungi of the genus Trichophyton, but it was not antifungal against the Candida yeasts or against the opportunistic fungi tested. According to EM, resin caused damages in the cell hyphae and cell wall structures. We conclude that, in the agar plate diffusion test, coniferous resins are strongly fungistatic against the dermatophytic fungi only.

Quality of life in infants with atopic dermatitis and healthy infants: a follow-up from birth to 24 months.

AIM: To evaluate quality of life (QOL) in infants with atopic dermatitis (AD) by comparison with healthy infants to find treatment modalities contributing most to QOL in these patients. METHODS: The population (N=134) was recruited in the context of an on-going prospective mother-infant study. QOL was measured using the Infant Dermatitis Quality of Life Index for the infants with AD and a modification of this for the healthy infants. RESULTS: The index scores of infants with AD were 4.15 (SD 2.96), 3.89 (SD 3.62) and 3.23 (SD 2.71) at 6, 12 and 24 months, respectively, the QOL being significantly poorer at 6 (p<0.001) and 12 (p=0.01) months compared to healthy infants. The principal impairments were itching, scratching and sleep disturbances at 6 and 12 months and treatment difficulties at 6 months. Problems with getting to sleep were reported at all stages irrespective of AD. CONCLUSIONS: Simple treatment regimens targeting itching in particular are likely to contribute most to the QOL of infants with AD; however, sleeping problems may remain as an age-related phenomenon. Early detection of symptoms and effective parent guidance contributed to the well-being of the child.

Impact of maternal diet during pregnancy and breastfeeding on infant metabolic programming: a prospective randomized controlled study.

OBJECTIVES: To evaluate the impact of maternal diet and intensive dietary counselling during pregnancy and breastfeeding on the infant's metabolic status. SUBJECTS/METHODS: At the first trimester of pregnancy, 256 women were randomized into a control/placebo group and two dietary counselling groups (diet/probiotics and diet/placebo). The counselling, with double-blind randomization to probiotics (Lactobacillus rhamnosus GG and Bifidobacterium lactis) or placebo, targeted excessive saturated fat and low fibre consumption. Maternal diet was evaluated repeatedly during pregnancy and postpartum by means of 3 days' food diaries. Metabolic markers, serum 32-33 split and intact proinsulin, leptin/adiponectin ratio, skinfold thickness and waist circumference were measured of 194 healthy infants at the age of 6 months, and the high levels were taken to mirror adverse metabolic status. RESULTS: The proportion of infants with a high 32-33 split proinsulin was significantly lower in dietary counselling with probiotics (n = 6/62, 9.7%) or placebo (n = 7/69, 10.1%) compared with the control/placebo group (n = 17/63, 27.0%). The high split proinsulin was associated with larger skinfold thickness, waist circumference and higher leptin/adiponectin ratio in the infants (P < 0.05). With respect to maternal diet during pregnancy, the highest and lowest tertiles of fat intake increased the infant's risk of high split proinsulin, whereas those of butter associated correspondingly with the infant's waist circumference. Further, breastfed infants showed a reduced risk of high split proinsulin and leptin/adiponectin ratio compared with formula-fed infants. CONCLUSIONS: Modification of maternal diet during pregnancy and breastfeeding may benefit infant metabolic health. High split proinsulin reflects adverse metabolic status in infancy, which can be improved by early dietary counselling.

The impact of perinatal probiotic intervention on the development of overweight and obesity: follow-up study from birth to 10 years.

BACKGROUND: The achievements in combating the increasing trend of overweight and obesity have thus far been inadequate. The recently discovered instrumental role of the gut microbiota in host metabolism may offer a novel target in the prevention and management of obesity. OBJECTIVE: To evaluate the impact of perinatal probiotic intervention on childhood growth patterns and the development of overweight during a 10-year follow-up. PATIENTS AND METHODS: Altogether 159 women were randomized and double-blinded to receive probiotics (1 × 10(10) colony-forming units of Lactobacillus rhamnosus GG, ATCC 53103) or placebo 4 weeks before expected delivery; the intervention extending for 6 months postnatally. Anthropometric measurements of the children were taken at the ages of 3, 6, 12 and 24 months and at 4, 7 and 10 years in 113 (72%) children. RESULTS: The excessive weight gain was detected to be two-parted; the initial phase of excessive weight gain initiating during fetal period and continuing until 24-48 months of age and a second phase of excessive weight gain starting after the age of 24-48 months. The perinatal probiotic intervention appeared to moderate the initial phase of excessive weight gain, especially among children who later became overweight, but not the second phase of excessive weight gain, the impact being most pronounced at the age of 4 years (P=0.063, analysis of variance for repeated measures). The effect of intervention was also shown as a tendency to reduce the birth-weight-adjusted mean body mass index at the age of 4 years (P=0.080, analysis of covariance). CONCLUSIONS: Early gut microbiota modulation with probiotics may modify the growth pattern of the child by restraining excessive weight gain during the first years of life. This novel observation calls for further epidemiological and clinical trials, with precise data on early growth patterns and on confounding factors influencing weight development.

Maternal vitamin D status determines bone variables in the newborn.

CONTEXT: Vitamin D regulates 3% of the human genome, including effects on bone health throughout life. Maternal vitamin D status may program neonatal skeletal development. The objective here was to determine the association of mothers' vitamin D status with bone variables of their newborns. SUBJECTS AND METHODS: In a birth hospital, pregnant women (n = 125) participated in a cross-sectional study with a longitudinal follow-up of the pregnancy. The mean (sd) values for age, body mass index before pregnancy, pregnancy weight gain, and total vitamin D intake in mothers were 31 (4) yr, 23.5 (3.7) kg/m(2), 13.1 (4.3) kg, and 14.3 (5.8) microg, respectively. All newborns were full-term, 99% were appropriate for gestational age, and 53% were boys. Blood samples were collected from mothers during the first trimester and 2 d postpartum and from umbilical cords at birth for analysis of serum 25-hydroxyvitamin D (S-25-OHD), PTH, and bone remodeling markers. Bone variables were measured by pQCT at the 20% site of the newborn tibia on an average of 10 (11) d postpartum. Bone contour was analyzed with a single threshold of 180 mg/mm(3) for the detection of total bone mineral density (BMD), bone mineral content (BMC), and cross-sectional area (CSA). RESULTS: Mean S-25-OHD was 41.0 (13.6), 45.1 (11.9), and 50.7 (14.9) nmol/liter during the first trimester, postpartum, and in the umbilical cord, respectively. The median value of the individual means for first trimester and the 2-d postpartum S-25-OHD was 42.6 nmol/liter, which was used as cutoff to define two equal-sized groups. Groups are called below median and above median in the text. Newborns below median were heavier (P = 0.05), and 60% were boys. Tibia bone mineral content was 0.047 (95% confidence interval, 0.011-0.082) g/cm higher (P = 0.01), and cross-sectional area was 12.3 (95% confidence interval, 2.0-22.6) mm(2) larger (P = 0.02), but no difference in bone mineral density was observed, above median compared with below median group. These results were adjusted for newborn Z-score birth weight, maternal height, and newborn age at the measurement. A positive, significant correlation was observed between remodeling markers in mothers at different time points and above median group in the cord. CONCLUSIONS: Although the mean total intake of vitamin D among mothers met current Nordic recommendations, 71% of women and 15% of newborns were vitamin D deficient during the pregnancy. Our results suggest that maternal vitamin D status affects bone mineral accrual during the intrauterine period and influences bone size. More efforts should be made to revise current nutrition recommendations for pregnant women that may have permanent effects on the well-being of children.

Early nutritional environment: focus on health effects of microbiota and probiotics.

Balanced maternal nutrition during pregnancy ensures both the growth and development of the foetus and the well-being of the mother. Recent evidence supports the programming theory, which envisages long-lasting effects on later risk of chronic life-style-related diseases by early nutrition. The increasing problem of overweight, affecting almost half of the female population in Western societies, sets off adverse programming effects in the offspring manifested in subsequent health effects. To combat this problem, new tools involving life-style modifications are being actively sought to increment the traditional approaches. Immunonutrition, the ability of nutrients to influence the activities of cells in the immune system, may be one answer in combating low-grade systemic inflammation, the key underlying determinant in the obesity epidemic. Further, microbial compounds possess immunomodulatory properties which may be utilised to improve immune responses in clinically meaningful ways. Aberrant microbiota compositions have been detected during critical periods when early programming occurs, including pregnancy and infancy. Such alterations may regulate the health of the infant and the risk of subsequent disease, as demonstrated by the divergence in gut microbiota composition between healthy and overweight individuals. It may thus be hypothesised that the composition of the gut microbiota could be used as a target for intervention. Probiotics interact with the mucosal immune system via the same pathways as commensal bacteria to influence both innate and adaptive immune responses. In consequence, interventions with immunomodulatory diets, including certain nutrients and probiotics, may be critical in coordinating the adaptive function necessary for the formation of tolerance and thus in the prevention of undesirable metabolic consequences.

Dietary and clinical impacts of nausea and vomiting during pregnancy.

BACKGROUND: Nutrition during pregnancy is important for the health of both mother and infant. Nausea and vomiting in pregnancy (NVP) may alter food intake but the dietary and clinical consequences of NVP are poorly understood. The present study aimed to identify the differences in dietary intakes and clinical characteristics of women with NVP compared with those without. METHODS: Women with (n = 134) or without (n = 53) NVP were studied in each trimester of pregnancy. The babies were studied at birth, and at 1 and 6 months. The presence of nausea and vomiting was established by interviews using standard questions. Daily intakes of foods and nutrients were assessed from 3-day food diaries. Weight gain during pregnancy and weights and lengths of the infants at birth and at 1 and 6 months of age were recorded. RESULTS: In the first trimester, intake of meat products and thus protein in women with NVP was lower both quantitatively (P = 0.007) and as a proportion of energy (16.4E% [interquartile range (IQR) 14.9-18.4]) compared to non-NVP [18.3E% (IQR 16.3-19.8), P = 0.003]. The proportional intakes of carbohydrates were higher in NVP subjects [50.1E% (IQR 46.7-53.6)] than in non-NVP [46.8E% (IQR 43.6-51.9), P = 0.008]. Dietary and total intakes of vitamin B(12), total intake of magnesium and dietary intake of zinc were lower in women with NVP. Changes in diet remained throughout pregnancy. Women with NVP had shorter pregnancies [39.9 (95% CI 39.6-40.1)] compared with those without [40.4 (95% CI 40.1-40.8) weeks, P = 0.018], but neither pregnancy weight gain nor infants' weight and length differed. CONCLUSIONS: Nausea and vomiting in pregnancy modified dietary intake and has potential clinical impacts as suggested by the altered pregnancy duration. In view of the programming effect of early nutrition, these alterations may carry long-term health consequences.

Foods with a high fat quality are essential for healthy diets.

Fat is generally a highly valued element of the diet to provide energy, palatability to dry foods or to serve as a cooking medium. However, some foods rich in fat have a low fat quality with respect to nutrition, i.e., a relative high content of saturated (SFA) as compared to unsaturated fatty acids, whereas others have a more desirable fat quality, i.e., a relative high content of unsaturated fatty acids as compared to SFA. High-fat dairy products and fatty meats are examples of foods with low fat quality, whereas vegetable oils (tropical oils such as palm and coconut oil excluded) are products with a generally high fat quality. The aim of this paper is to explore the nutritional impact of products made of vegetable oils, e.g. margarines and dressings, and how they can be designed to contribute to good health. Since their first industrial production, the food industry has endeavored to improve products like margarines, including their nutritional characteristics. With evolving nutrition science, margarines and cooking products, and to a lesser extent dressings, have been adapted to contain less trans fatty acids (TFA), less SFA and more essential (polyunsaturated, PUFA) fatty acids. This has been possible by using careful fat and oil selection and modification processes. By blending vegetable oils rich in the essential PUFAs alpha-linolenic acid (vegetable omega-3) or linoleic acid (omega-6), margarines and dressings with both essential fatty acids present in significant quantities can be realized. In addition, full hydrogenation and fat rearrangement have enabled the production of cost-effective margarines virtually devoid of TFA and low in SFA. Dietary surveys indicate that vegetable oils, soft margarines and dressings are indeed often important sources of essential fatty acids in people's diets, whilst providing negligible amounts of TFA and contributing modestly to SFA intakes. Based on empirical and epidemiological data, the public health benefit of switching from products with a low fat quality to products with a high fat quality can be predicted. For example, switching from butter or palm oil to a soft margarine shows a substantial improvement in the nutritional quality of the diet. These simple, practical dietary adaptations can be expected to contribute to the healthy growth and development of children and to reduce the burden of cardiovascular disease.