1
|
Xu L, Sheng XJ, Gu LP, Yang ZM, Feng ZT, Gu DF, Gao L. Influence of perinatal factors on full-term low-birth-weight infants and construction of a predictive model. World J Clin Cases 2024; 12:5901-5907. [PMID: 39286375 PMCID: PMC11287508 DOI: 10.12998/wjcc.v12.i26.5901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Revised: 07/09/2024] [Accepted: 07/12/2024] [Indexed: 07/19/2024] Open
Abstract
BACKGROUND Being too light at birth can increase the risk of various diseases during infancy. AIM To explore the effect of perinatal factors on term low-birth-weight (LBW) infants and build a predictive model. This model aims to guide the clinical management of pregnant women's healthcare during pregnancy and support the healthy growth of newborns. METHODS A retrospective analysis was conducted on data from 1794 single full-term pregnant women who gave birth. Newborns were grouped based on birth weight: Those with birth weight < 2.5 kg were classified as the low-weight group, and those with birth weight between 2.5 kg and 4 kg were included in the normal group. Multiple logistic regression analysis was used to identify the factors influencing the occurrence of full-term LBW. A risk prediction model was established based on the analysis results. The effectiveness of the model was analyzed using the Hosmer-Leme show test and receiver operating characteristic (ROC) curve to verify the accuracy of the predictions. RESULTS Among the 1794 pregnant women, there were 62 cases of neonatal weight < 2.5 kg, resulting in an LBW incidence rate of 3.46%. The factors influencing full-term LBW included low maternal education level [odds ratio (OR) = 1.416], fewer prenatal examinations (OR = 2.907), insufficient weight gain during pregnancy (OR = 3.695), irregular calcium supplementation during pregnancy (OR = 1.756), and pregnancy hypertension syndrome (OR = 2.192). The prediction model equation was obtained as follows: Logit (P) = 0.348 × maternal education level + 1.067 × number of prenatal examinations + 1.307 × insufficient weight gain during pregnancy + 0.563 × irregular calcium supplementation during pregnancy + 0.785 × pregnancy hypertension syndrome - 29.164. The area under the ROC curve for this model was 0.853, with a sensitivity of 0.852 and a specificity of 0.821. The Hosmer-Leme show test yielded χ 2 = 2.185, P = 0.449, indicating a good fit. The overall accuracy of the clinical validation model was 81.67%. CONCLUSION The occurrence of full-term LBW is related to maternal education, the number of prenatal examinations, weight gain during pregnancy, calcium supplementation during pregnancy, and pregnancy-induced hypertension. The constructed predictive model can effectively predict the risk of full-term LBW.
Collapse
Affiliation(s)
- Liang Xu
- Department of Neonatology, Suzhou Ninth People's Hospital, Suzhou 215200, Jiangsu Province, China
| | - Xue-Juan Sheng
- Department of Obstetrics, Suzhou Ninth People's Hospital, Suzhou 215200, Jiangsu Province, China
| | - Lian-Ping Gu
- Department of Obstetrics, Suzhou Ninth People's Hospital, Suzhou 215200, Jiangsu Province, China
| | - Zu-Ming Yang
- Department of Neonatology, Suzhou Municipal Hospital, Suzhou 215008, Jiangsu Province, China
| | - Zong-Tai Feng
- Department of Neonatology, Suzhou Municipal Hospital, Suzhou 215008, Jiangsu Province, China
| | - Dan-Feng Gu
- Department of Neonatology, Suzhou Municipal Hospital, Suzhou 215008, Jiangsu Province, China
| | - Li Gao
- Department of Neonatology, Suzhou Ninth People's Hospital, Suzhou 215200, Jiangsu Province, China
| |
Collapse
|
2
|
Matamoros N, Puchulu MB, Colman Lerner JE, Maury-Sintjago E, López JL, Sosio V, Belizán JM, Porta A, Cormick G. Feasibility of increasing calcium content of drinking tap water following quality regulations to improve calcium intake at population level. Gates Open Res 2024; 8:5. [PMID: 39319308 PMCID: PMC11421485 DOI: 10.12688/gatesopenres.15184.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/28/2024] [Indexed: 09/26/2024] Open
Abstract
Background Calcium intake is below recommendations in several parts of the world. Improving calcium intake has benefits not only for bone health but also helps to prevent pregnancy hypertension disorders. Calcium concentration of tap water is usually low The aim of the present study was to determine the maximum amount of calcium that can be added to tap water while complying with drinking water Argentine regulations. Methods Tap water samples were collected from the Province of Buenos Aires (Argentina). Physicochemical properties and saturation index were measured. Different incremental concentrations of calcium chloride were added to the experimental aliquots. Results Baseline water had a mean calcium concentration of 22.00 ± 2.54 mg/L, water hardness of 89.9 ± 6.4 mg/L CaCO 3, and a saturation index of -1.50 ± 0.11. After the addition of 0.4554 ± 0.0071 g of salt, water hard-ness reached 355.0 ± 7.1 mg/L CaCO 3, a calcium concentration of 140.50 ± 2.12 mg/L, and a saturation index -0.53 ± 0.02. Conclusions This study shows that at laboratory level it is feasible to increase calcium concentration of drinking water by adding calcium chloride while complying with national standards. Calcium concentration of drinking tap water could be evaluated and minimum calcium concentration of tap water regulated so as to improve calcium intake in populations with low calcium intake.
Collapse
Affiliation(s)
- Natalia Matamoros
- Instituto de Desarrollo e Investigaciones Pediátricas "Prof. Dr. Fernando E. Viteri" Hospital de Niños Sor María Ludovica (IDIP), Instituto de Desarrollo e Investigaciones Pediátricas "Prof. Dr. Fernando E. Viteri" Hospital de Niños Sor María Ludovica (IDIP), Ministerio de Salud/Comisión de Investigaciones Científicas de La Provincia de Buenos Aires, La Plata, Buenos Aires Province, 1900, Argentina
- Universidad Nacional Arturo Jauretche (UNAJ), Florencio Varela, Buenos Aires, Argentina
| | - María Bernardita Puchulu
- Facultad de Medicina, Departamento de Ciencias Fisiológicas, Universidad de Buenos Aires, Buenos Aires, 1121, Argentina
- Universidad Nacional de La Matanza, San Justo, Provincia de Buenos Aires, Argentina
| | - Jorge E Colman Lerner
- Universidad Nacional Arturo Jauretche (UNAJ), Florencio Varela, Buenos Aires, Argentina
- Centro de Investigación y Desarrollo en Ciencias Aplicadas "Dr. Jorge J. Ronco" (CINDECA), CONICET, La Plata, 1900, Argentina
- Facultad de Ciencias Exactas, Universidad Nacional de La Plata (UNLP), La Plata, Argentina
| | - Eduard Maury-Sintjago
- Department of Nutrition and Public Health, Universidad del Bío-Bío, Chillan, 3800708, Chile
- Centro de Investigaciones en Epidemiología y Salud Pública (CIESP), CONICET, Ciudad de Buenos Aires, Argentina
| | - Jorge L López
- Universidad Nacional Arturo Jauretche (UNAJ), Florencio Varela, Buenos Aires, Argentina
- Facultad de Ciencias Exactas, Universidad Nacional de La Plata (UNLP), La Plata, Argentina
| | - Verónica Sosio
- Departamento de Hidráulica, Facultad de Ingeniería, Universidad Nacional de La Plata (UNLP), La Plata, 1900, Argentina
| | - José M Belizán
- Centro de Investigaciones en Epidemiología y Salud Pública (CIESP), CONICET, Ciudad de Buenos Aires, Argentina
- Instituto de Efectividad Clinica y Sanitaria, Buenos Aires, Argentina
| | - Andrés Porta
- Facultad de Ciencias Exactas, Universidad Nacional de La Plata (UNLP), La Plata, Argentina
- Centro de Investigaciones del Medio Ambiente (CIM), CONICET, La Plata, 1900, Argentina
| | - Gabriela Cormick
- Universidad Nacional de La Matanza, San Justo, Provincia de Buenos Aires, Argentina
- Centro de Investigaciones en Epidemiología y Salud Pública (CIESP), CONICET, Ciudad de Buenos Aires, Argentina
- Instituto de Efectividad Clinica y Sanitaria, Buenos Aires, Argentina
| |
Collapse
|
3
|
Pannu PK, Scherini AJJ, Silva DT, Whalan S. The ORIGINS Project: A Cross-Sectional Analysis of the Nutrition Profile of Pregnant Women in a Longitudinal Birth Cohort. Nutrients 2024; 16:2571. [PMID: 39125450 PMCID: PMC11314159 DOI: 10.3390/nu16152571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2024] [Revised: 07/30/2024] [Accepted: 07/30/2024] [Indexed: 08/12/2024] Open
Abstract
Pregnancy is an opportunistic time for dietary intake to influence future disease susceptibility in offspring later in life. The ORIGINS Project was established to identify the factors that contribute to 'a healthy start to life' through a focus supporting childhood health and preventing disease (including non-communicable diseases). We aim to describe the dietary intakes of pregnant women in this cohort and to compare these to the Nutrient Reference Values (NRVs) and Australian Recommended Food Score (ARFS). The usual food and nutrient intakes of women were collected using the Australian Eating Survey (AES), a semi-quantitative food frequency questionnaire (FFQ). A total of 374 women completed the AES FFQ at both 20 weeks and 36 weeks of gestation between December 2016 and January 2023. Macronutrient, micronutrient, and food group intake were explored using descriptive statistics. Overall, it was found that the energy contribution from carbohydrates was low, while that from fat and saturated fat was high; participants were not meeting the recommendations for several key micronutrients (calcium, iron, iodine, and folate); and they had low diet quality scores for all food groups. These findings suggest that despite the ongoing promotion of healthy eating during pregnancy, further exploration into why dietary guidelines during pregnancy are not being adhered to is warranted.
Collapse
Affiliation(s)
- Poonam K. Pannu
- Telethon Kids Institute, Nedlands 6009, Australia; (A.J.J.S.); (D.T.S.); (S.W.)
| | | | - Desiree T. Silva
- Telethon Kids Institute, Nedlands 6009, Australia; (A.J.J.S.); (D.T.S.); (S.W.)
- Faculty of Science, Medical School, University of Western Australia, Crawley 6009, Australia
- Joondalup Health Campus, Joondalup 6027, Australia
| | - Sarah Whalan
- Telethon Kids Institute, Nedlands 6009, Australia; (A.J.J.S.); (D.T.S.); (S.W.)
| |
Collapse
|
4
|
Ti G, He Y, Xiao Y, Yan J, Ding R, Cheng P, Wu W, Ye D, Wang J, Li L. Global prevalence of diet low in calcium and the disease burden: results from the Global Burden of Disease Study 2019. Nutr Diabetes 2024; 14:59. [PMID: 39097595 PMCID: PMC11297965 DOI: 10.1038/s41387-024-00321-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 07/15/2024] [Accepted: 07/24/2024] [Indexed: 08/05/2024] Open
Abstract
BACKGROUND Due to the essential role of calcium in vital biological functions, diet low in calcium (DLC) is associated with various diseases. However, there is a lack of study about the current prevalence and health burden due to DLC using reliable data sources. METHODS We used data from the Global Burden of Disease study 2019 (GBD 2019) to estimate the prevalence and health burden of DLC in 204 countries from 1990 to 2019, by age, sex, and sociodemographic index (SDI). The estimates were produced in DisMod-MR 2.1, a Bayesian meta-regression tool. Summary exposure value (SEV) was used to show the prevalence of DLC, while diseases adjusted life year (DALY) was used to represent the disease burden. The disease burden was estimated for DLC-induced colorectal cancer. Spearman Rank Order correlation was used for correlation analysis, and estimated annual percentage (EAPC) was used to reflect the temporal trends. RESULTS From 1990 to 2019, the global prevalence of DLC decreased (EAPC of SEV, -0.47; 95% CI, -0.5 to -0.43), but have increased in Oceania region and in many countries, such as United Arab Emirates, New Zealand, Japan, and France. The global DALYs associated with low in calcium were estimated to be 3.14 million (95% uncertainty interval (UI), 2.25-4.26 million) in 2019, with an age standardized rate of 38.2 (95% UI, 27.2-51.8) per 100,000. Unlike the prevalence, the global age standardized DALY rates has remained unchanged (EAPC, -0.03; 95% CI, -0.12 to 0.07), but has increased in over 80 of the 204 countries, located mainly in Asia, Africa, and South America. In all years and regions, the age standardized SEV and DALY rates were higher in male people than that in female people. The prevalence (rho = -0.823; P < 0.001) and disease burden (rho = -0.433; P < 0.001) associated with diet in low calcium were strongly correlated to SDI. The prevalence decreased with age, but the DALY rates increased with age and peaked at about 90 years. The prevalence of DLC has decreased worldwide and in most countries, but the disease burden of DLC induced colorectal cancer has increased in over 40% of countries worldwide. CONCLUSION Countries with low sociodemographic level and male people are more likely to experience the risk of DLC and related disease burden. Related measures in improve dietary calcium intake are in need to address diet in low calcium related health problems.
Collapse
Affiliation(s)
- Gang Ti
- Department of Medical Record, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, 030032, Shanxi, China
| | - Yuan He
- Department of Hepatobiliary Surgery, Baogang Hospital of Inner Mongolia, Baotou, 014010, China
| | - Youde Xiao
- Department of Oncology, Taikang Tongji (Wuhan) Hospital, Sixin North Road No.322, Hanyang District, Wuhan, 430050, China
| | - Jiyuan Yan
- Department of Orthopaedics, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, Sichuan, China
| | - Rong Ding
- Department of Geriatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Pengfei Cheng
- Department of General Surgery, Shanxi Bethune Hospital, Shanxi Academy of Medical Science, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, 030032, Shanxi, China
| | - Wei Wu
- Department of Orthopaedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Dawei Ye
- Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
| | - Jinxi Wang
- Department of General Surgery, Shanxi Bethune Hospital, Shanxi Academy of Medical Science, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, 030032, Shanxi, China.
| | - Lili Li
- Department of Radiotherapy, Shanxi Province Cancer Hospital/Shanxi Hospital Affiliated to Cancer Hospital, Chinese Academy of Medical Sciences/Cancer Hospital Affiliated to Shanxi Medical University, Taiyuan, 030012, China.
| |
Collapse
|
5
|
Prentice A, Jarjou LM, Goldberg GR, Schoenbuchner SM, Moore SE, Ward KA, Cole TJ. Effects of maternal calcium supplementation on offspring blood pressure and growth in childhood and adolescence in a population with a low-calcium intake: follow-up study of a randomized controlled trial. Am J Clin Nutr 2024; 119:1443-1454. [PMID: 38839195 PMCID: PMC11196864 DOI: 10.1016/j.ajcnut.2024.02.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 02/13/2024] [Accepted: 02/18/2024] [Indexed: 06/07/2024] Open
Abstract
BACKGROUND The World Health Organization recommends calcium supplementation (1500-2000 mg/d) during pregnancy for women with a low-calcium intake. OBJECTIVES The purpose of this study was to investigate whether pregnancy calcium supplementation affects offspring blood pressure and growth in The Gambia where calcium intakes are low (300-400 mg/d). METHODS Follow-up of offspring born during a randomized controlled trial of pregnancy calcium supplementation (ISRCTN96502494, 1996-2000) in which mothers were randomly assigned to 1500 mg Ca/d (Ca) or placebo (P) from 20 wk pregnancy to delivery. Offspring were enrolled at age 3 y in studies where blood pressure and anthropometry were measured under standardized conditions at approximately 2-yearly intervals. Mean blood pressure and growth curves were fitted for females and males separately, using the longitudinal SuperImposition by Translation and Rotation (SITAR) mixed effects model. This generates 3 individual-specific random effects: size, timing, and intensity, reflecting differences in size, age at peak velocity, and peak velocity through puberty relative to the mean curve, respectively. RESULTS Five hundred twenty-three singleton infants were born during the trial (maternal group assignment: Ca/P = 259/264). Four hundred ninety-one were enrolled as children (females: F-Ca/F-P = 122/129 and males: M-Ca/M-P = 119/121) and measured regularly from 3.0 y to mean age 18.4 y; 90% were measured on ≥8 occasions. SITAR revealed differences in the systolic blood pressure and height curves between pregnancy supplement groups in females, but not in males. F-Ca had lower systolic blood pressure than F-P at all ages (size = -2.1 ± SE 0.8 mmHg; P = 0.005) and lower peak height velocity (intensity = -2.9 ± SE 1.1%, P = 0.009). No significant pregnancy supplement effects were seen for other measures. CONCLUSIONS This study showed, in female offspring, that pregnancy calcium supplementation may lower systolic blood pressure and slow linear growth in childhood and adolescence, adding to evidence of offspring sexual dimorphism in responses to maternal supplementation. Further research is warranted on the long-term and intergenerational effects of antenatal supplementations. This trial was registered at ISRCTN Registry as ISRCTN96502494.
Collapse
Affiliation(s)
- Ann Prentice
- MRC Unit The Gambia at London School of Hygiene and Tropical Medicine, Serrekunda, The Gambia; MRC Nutrition and Bone Health Research Group, Cambridge, United Kingdom; MRC Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom.
| | - Landing Ma Jarjou
- MRC Unit The Gambia at London School of Hygiene and Tropical Medicine, Serrekunda, The Gambia
| | - Gail R Goldberg
- MRC Nutrition and Bone Health Research Group, Cambridge, United Kingdom
| | - Simon M Schoenbuchner
- MRC Nutrition and Bone Health Research Group, Cambridge, United Kingdom; Centre for Trials Research, Cardiff University, Cardiff, United Kingdom
| | - Sophie E Moore
- MRC Unit The Gambia at London School of Hygiene and Tropical Medicine, Serrekunda, The Gambia; Department of Women and Children's Health, Kings College London, London, United Kingdom
| | - Kate A Ward
- MRC Unit The Gambia at London School of Hygiene and Tropical Medicine, Serrekunda, The Gambia; MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, United Kingdom
| | - Tim J Cole
- Department of Population, Policy and Practice Research and Teaching, University College London Great Ormond Street Institute of Child Health, London, United Kingdom
| |
Collapse
|
6
|
Cormick G, Ciapponi A, Harbron J, Perez SM, Vazquez P, Rivo J, Metzendorf MI, Althabe F, Belizán JM. Calcium supplementation for people with overweight or obesity. Cochrane Database Syst Rev 2024; 5:CD012268. [PMID: 38721870 PMCID: PMC11079972 DOI: 10.1002/14651858.cd012268.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/12/2024]
Abstract
BACKGROUND Obesity is a major health problem worldwide as it can lead to high blood pressure, heart disease, stroke, diabetes, and insulin resistance. The prevalence of overweight and obesity is increasing worldwide across different age groups. There is evidence of an inverse relationship between calcium intake and body weight. The clinical relevance of a small reduction in body weight has been questioned. However, at a population level, a small effect could mitigate the observed global trends. OBJECTIVES To assess the effects of calcium supplementation on weight loss in individuals living with overweight or obesity. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, LILACS (Latin American and Caribbean Health Science Information database), and two clinical trials registries. The date of the last search of all databases (except Embase) was 10 May 2023. No language restrictions were applied. SELECTION CRITERIA We included randomised controlled trials evaluating the effect of calcium in participants with overweight or obesity of any age or gender. We excluded studies in participants with absorption problems. We included studies of any dose with a minimum duration of two months. We included the following comparisons: calcium supplementation versus placebo, calcium-fortified food or beverage versus placebo, or calcium-fortified food or beverage versus non-calcium-fortified food or beverage. We excluded studies that evaluated the effect of calcium and vitamin D or mixed minerals compared to placebo. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. Our primary outcomes were body weight, health-related quality of life, and adverse events. Our secondary outcomes were anthropometric measures other than body weight, all-cause mortality, and morbidity. MAIN RESULTS We found 18 studies that evaluated the effect of calcium compared to placebo or control, with a total of 1873 randomised participants (950 participants in the calcium supplementation groups and 923 in the control groups). All included studies gave oral calcium supplementation as the intervention. We did not find any studies evaluating calcium-fortified foods. We excluded 38 studies, identified four ongoing studies, and listed one study as 'awaiting classification'. Sixteen studies compared calcium supplementation to placebo; two studies compared different doses of calcium supplementation. Doses ranged from very low (0.162 g of calcium/day) to high (1.5 g of calcium/day). Most studies were performed in the USA and Iran, lasted less than six months, and included only women. Low-certainty evidence suggests that calcium supplementation compared to placebo or control may result in little to no difference in body weight (mean difference (MD) -0.15 kg, 95% confidence interval (CI) -0.55 to 0.24; P = 0.45, I2 = 46%; 17 studies, 1317 participants; low-certainty evidence). We downgraded the certainty of the evidence by two levels for risk of bias and heterogeneity. None of the included studies reported health-related quality of life, all-cause mortality, or morbidity/complications as outcomes. Only five studies assessed or reported adverse events. Low-certainty evidence suggests a low frequency of adverse events, with no clear difference between intervention and control groups. Moderate-certainty evidence shows that calcium supplementation compared to placebo or control probably results in a small reduction in body mass index (BMI) (MD -0.18 kg/m2,95% CI -0.22 to -0.13; P < 0.001, I2 = 0%; 9 studies, 731 participants) and waist circumference (MD -0.51 cm, 95% CI -0.72 to -0.29; P < 0.001, I2 = 0%; 6 studies, 273 participants). Low-certainty evidence suggests that calcium supplementation compared to placebo or control may result in a small reduction in body fat mass (MD -0.34 kg, 95% CI -0.73 to 0.05; P < 0.001, I2 = 97%; 12 studies, 812 participants). AUTHORS' CONCLUSIONS Calcium supplementation for eight weeks to 24 months may result in little to no difference in body weight in people with overweight or obesity. The current evidence is of low certainty, due to concerns regarding risk of bias and statistical heterogeneity. We found that the degree of heterogeneity might be partly explained by calcium dosage, the presence or absence of a co-intervention, and whether an intention-to-treat analysis was pursued. While our analyses suggest that calcium supplementation may result in a small reduction in BMI, waist circumference, and fat mass, this evidence is of low to moderate certainty. Future studies could investigate the effect of calcium supplementation on lean body mass to explore if there is a change in body composition.
Collapse
Affiliation(s)
- Gabriela Cormick
- Instituto de Efectividad Clínica y Sanitaria (IECS-CONICET), Buenos Aires, Argentina
| | - Agustín Ciapponi
- Argentine Cochrane Centre, Institute for Clinical Effectiveness and Health Policy (IECS-CONICET), Buenos Aires, Argentina
| | - Janetta Harbron
- Research Centre for Health through Physical Activity, Lifestyle & Sport, Division of Physiological Sciences, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | | | - Paula Vazquez
- Instituto de Efectividad Clínica y Sanitaria (IECS-CONICET), Buenos Aires, Argentina
| | - Julie Rivo
- Instituto de Efectividad Clínica y Sanitaria (IECS-CONICET), Buenos Aires, Argentina
| | - Maria-Inti Metzendorf
- Institute of General Practice, Medical Faculty of the Heinrich-Heine University, Düsseldorf, Germany
| | - Fernando Althabe
- Instituto de Efectividad Clínica y Sanitaria (IECS-CONICET), Buenos Aires, Argentina
| | - José M Belizán
- Instituto de Efectividad Clínica y Sanitaria (IECS-CONICET), Buenos Aires, Argentina
| |
Collapse
|
7
|
Ladak Z, Grewal N, Kim MO, Small S, Leber A, Hemani M, Sun Q, Hamza DM, Laur C, Ivers NM, Falenchuk O, Volpe R. Equity in prenatal healthcare services globally: an umbrella review. BMC Pregnancy Childbirth 2024; 24:191. [PMID: 38468220 PMCID: PMC10926563 DOI: 10.1186/s12884-024-06388-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 03/04/2024] [Indexed: 03/13/2024] Open
Abstract
BACKGROUND Timely, appropriate, and equitable access to quality healthcare during pregnancy is proven to contribute to better health outcomes of birthing individuals and infants following birth. Equity is conceptualized as the absence of differences in healthcare access and quality among population groups. Healthcare policies are guides for front-line practices, and despite merits of contemporary policies striving to foster equitable healthcare, inequities persist. The purpose of this umbrella review is to identify prenatal healthcare practices, summarize how equities/inequities are reported in relation to patient experiences or health outcomes when accessing or using services, and collate equity reporting characteristics. METHODS For this umbrella review, six electronic databases were searched (Medline, EMBASE, APA PsychInfo, CINAHL, International Bibliography of the Social Sciences, and Cochrane Library). Included studies were extracted for publication and study characteristics, equity reporting, primary outcomes (prenatal care influenced by equity/inequity) and secondary outcomes (infant health influenced by equity/inequity during pregnancy). Data was analyzed deductively using the PROGRESS-Plus equity framework and by summative content analysis for equity reporting characteristics. The included articles were assessed for quality using the Risk of Bias Assessment Tool for Systematic Reviews. RESULTS The search identified 8065 articles and 236 underwent full-text screening. Of the 236, 68 systematic reviews were included with first authors representing 20 different countries. The population focus of included studies ranged across prenatal only (n = 14), perinatal (n = 25), maternal (n = 2), maternal and child (n = 19), and a general population (n = 8). Barriers to equity in prenatal care included travel and financial burden, culturally insensitive practices that deterred care engagement and continuity, and discriminatory behaviour that reduced care access and satisfaction. Facilitators to achieve equity included innovations such as community health workers, home visitation programs, conditional cash transfer programs, virtual care, and cross-cultural training, to enhance patient experiences and increase their access to, and use of health services. There was overlap across PROGRESS-Plus factors. CONCLUSIONS This umbrella review collated inequities present in prenatal healthcare services, globally. Further, this synthesis contributes to future solution and action-oriented research and practice by assembling evidence-informed opportunities, innovations, and approaches that may foster equitable prenatal health services to all members of diverse communities.
Collapse
Affiliation(s)
- Zeenat Ladak
- University of Toronto, Toronto, Canada.
- Women's College Hospital Institute for Health System Solutions & Virtual Care, Toronto, Canada.
| | | | | | | | | | | | - Qiuyu Sun
- University of Alberta, Edmonton, Canada
| | | | - Celia Laur
- University of Toronto, Toronto, Canada
- Women's College Hospital Institute for Health System Solutions & Virtual Care, Toronto, Canada
| | - Noah M Ivers
- University of Toronto, Toronto, Canada
- Women's College Hospital Institute for Health System Solutions & Virtual Care, Toronto, Canada
- Women's College Hospital, Toronto, Canada
| | | | | |
Collapse
|
8
|
Zhao C, Zhang Z, Matsubae K. Adequacy and Distribution Equity of Nutrition Supplies across China. Nutrients 2024; 16:426. [PMID: 38337710 PMCID: PMC10857370 DOI: 10.3390/nu16030426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 01/19/2024] [Accepted: 01/28/2024] [Indexed: 02/12/2024] Open
Abstract
Procuring food enriched with diverse nutrients is pivotal for maintaining a robust immune system. However, the food system is now unprecedentedly globalized and faces challenges arising from climate change, pandemics, and political unrest. This study aims to illuminate the gap in exploring the adequacy and distribution equity of nutrition supplies in response to potential trade fluctuations and restrictions on agrifood within China's local agriculture endowments. Also, it seeks to identify the role of trade in contributing to these indices. Accordingly, we analyzed the distribution of nutrients in agrifood categories from production to consumption and assessed the adequacy and distribution equity of corresponding available nutrition supply from the local food provision system in terms of meeting residents' nutritional requirements, across China, and compared with those in the practical market. The local self-supply system showed that 12 out of 31 provinces have difficulty achieving an iron supply with 11% to 108% deficiencies. Except for iron, 52% (folate)-90% (vitamin B12) of agricultural output was available for diet provisioning nationwide. While food trade emerges as a crucial factor in enhancing secure and equitable nutrition supply, risks associated with micronutrient deficiencies necessitate careful consideration in current global circumstances. Our analysis explored a regional pool of nutrient information in supplements to the conventional food profile in China and could implicate better knowledge toward healthier food supplies and tailored improvements for achieving a resilient nutrition supply.
Collapse
Affiliation(s)
- Chuan Zhao
- Graduate School of Environmental Studies, Tohoku University, Sendai 980-8577, Japan; (C.Z.); (K.M.)
| | - Zhengyang Zhang
- Graduate School of Environmental Studies, Tohoku University, Sendai 980-8577, Japan; (C.Z.); (K.M.)
- Research Institute for Humanity and Nature, Kyoto 603-8047, Japan
| | - Kazuyo Matsubae
- Graduate School of Environmental Studies, Tohoku University, Sendai 980-8577, Japan; (C.Z.); (K.M.)
- Research Institute for Humanity and Nature, Kyoto 603-8047, Japan
| |
Collapse
|
9
|
Dwarkanath P, Muhihi A, Sudfeld CR, Wylie BJ, Wang M, Perumal N, Thomas T, Kinyogoli SM, Bakari M, Fernandez R, Raj JM, Swai NO, Buggi N, Shobha R, Sando MM, Duggan CP, Masanja HM, Kurpad AV, Pembe AB, Fawzi WW. Two Randomized Trials of Low-Dose Calcium Supplementation in Pregnancy. N Engl J Med 2024; 390:143-153. [PMID: 38197817 PMCID: PMC10921922 DOI: 10.1056/nejmoa2307212] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Abstract
BACKGROUND The World Health Organization recommends 1500 to 2000 mg of calcium daily as supplementation, divided into three doses, for pregnant persons in populations with low dietary calcium intake in order to reduce the risk of preeclampsia. The complexity of the dosing scheme, however, has led to implementation barriers. METHODS We conducted two independent randomized trials of calcium supplementation, in India and Tanzania, to assess the noninferiority of a 500-mg daily dose to a 1500-mg daily dose of calcium supplementation. In each trial, the two primary outcomes were preeclampsia and preterm birth, and the noninferiority margins for the relative risks were 1.54 and 1.16, respectively. RESULTS A total of 11,000 nulliparous pregnant women were included in each trial. The cumulative incidence of preeclampsia was 3.0% in the 500-mg group and 3.6% in the 1500-mg group in the India trial (relative risk, 0.84; 95% confidence interval [CI], 0.68 to 1.03) and 3.0% and 2.7%, respectively, in the Tanzania trial (relative risk, 1.10; 95% CI, 0.88 to 1.36) - findings consistent with the noninferiority of the lower dose in both trials. The percentage of live births that were preterm was 11.4% in the 500-mg group and 12.8% in the 1500-mg group in the India trial (relative risk, 0.89; 95% CI, 0.80 to 0.98), which was within the noninferiority margin of 1.16; in the Tanzania trial, the respective percentages were 10.4% and 9.7% (relative risk, 1.07; 95% CI, 0.95 to 1.21), which exceeded the noninferiority margin. CONCLUSIONS In these two trials, low-dose calcium supplementation was noninferior to high-dose calcium supplementation with respect to the risk of preeclampsia. It was noninferior with respect to the risk of preterm live birth in the trial in India but not in the trial in Tanzania. (Funded by the Bill and Melinda Gates Foundation and others; ClinicalTrials.gov number, NCT03350516; Clinical Trials Registry-India number, CTRI/2018/02/012119; and Tanzania Medicines and Medical Devices Authority Trials Registry number, TFDA0018/CTR/0010/5).
Collapse
Affiliation(s)
- Pratibha Dwarkanath
- From St. John's Research Institute (P.D., R.F.), St. John's Medical College (T.T., J.M.R., A.V.K.), and Bruhat Bengaluru Mahanagara Palike (N.B., R.S.) - all in Bangalore, India; the Africa Academy for Public Health (A.M., S.M.K., M.M.S.), Muhimbili University of Health and Allied Sciences (M.B., A.B.P.), Dar es Salaam Regional Medical Office of Health (N.O.S.), and Ifakara Health Institute (H.M.M.) - all in Dar es Salaam, Tanzania; the Harvard T.H. Chan School of Public Health (C.R.S., M.W., N.P., C.P.D., W.W.F.), Harvard Medical School (M.W., C.P.D.), and Boston Children's Hospital (C.P.D.) - all in Boston; Columbia University Medical Center, New York (B.J.W.); and the University of South Carolina, Columbia (N.P.)
| | - Alfa Muhihi
- From St. John's Research Institute (P.D., R.F.), St. John's Medical College (T.T., J.M.R., A.V.K.), and Bruhat Bengaluru Mahanagara Palike (N.B., R.S.) - all in Bangalore, India; the Africa Academy for Public Health (A.M., S.M.K., M.M.S.), Muhimbili University of Health and Allied Sciences (M.B., A.B.P.), Dar es Salaam Regional Medical Office of Health (N.O.S.), and Ifakara Health Institute (H.M.M.) - all in Dar es Salaam, Tanzania; the Harvard T.H. Chan School of Public Health (C.R.S., M.W., N.P., C.P.D., W.W.F.), Harvard Medical School (M.W., C.P.D.), and Boston Children's Hospital (C.P.D.) - all in Boston; Columbia University Medical Center, New York (B.J.W.); and the University of South Carolina, Columbia (N.P.)
| | - Christopher R Sudfeld
- From St. John's Research Institute (P.D., R.F.), St. John's Medical College (T.T., J.M.R., A.V.K.), and Bruhat Bengaluru Mahanagara Palike (N.B., R.S.) - all in Bangalore, India; the Africa Academy for Public Health (A.M., S.M.K., M.M.S.), Muhimbili University of Health and Allied Sciences (M.B., A.B.P.), Dar es Salaam Regional Medical Office of Health (N.O.S.), and Ifakara Health Institute (H.M.M.) - all in Dar es Salaam, Tanzania; the Harvard T.H. Chan School of Public Health (C.R.S., M.W., N.P., C.P.D., W.W.F.), Harvard Medical School (M.W., C.P.D.), and Boston Children's Hospital (C.P.D.) - all in Boston; Columbia University Medical Center, New York (B.J.W.); and the University of South Carolina, Columbia (N.P.)
| | - Blair J Wylie
- From St. John's Research Institute (P.D., R.F.), St. John's Medical College (T.T., J.M.R., A.V.K.), and Bruhat Bengaluru Mahanagara Palike (N.B., R.S.) - all in Bangalore, India; the Africa Academy for Public Health (A.M., S.M.K., M.M.S.), Muhimbili University of Health and Allied Sciences (M.B., A.B.P.), Dar es Salaam Regional Medical Office of Health (N.O.S.), and Ifakara Health Institute (H.M.M.) - all in Dar es Salaam, Tanzania; the Harvard T.H. Chan School of Public Health (C.R.S., M.W., N.P., C.P.D., W.W.F.), Harvard Medical School (M.W., C.P.D.), and Boston Children's Hospital (C.P.D.) - all in Boston; Columbia University Medical Center, New York (B.J.W.); and the University of South Carolina, Columbia (N.P.)
| | - Molin Wang
- From St. John's Research Institute (P.D., R.F.), St. John's Medical College (T.T., J.M.R., A.V.K.), and Bruhat Bengaluru Mahanagara Palike (N.B., R.S.) - all in Bangalore, India; the Africa Academy for Public Health (A.M., S.M.K., M.M.S.), Muhimbili University of Health and Allied Sciences (M.B., A.B.P.), Dar es Salaam Regional Medical Office of Health (N.O.S.), and Ifakara Health Institute (H.M.M.) - all in Dar es Salaam, Tanzania; the Harvard T.H. Chan School of Public Health (C.R.S., M.W., N.P., C.P.D., W.W.F.), Harvard Medical School (M.W., C.P.D.), and Boston Children's Hospital (C.P.D.) - all in Boston; Columbia University Medical Center, New York (B.J.W.); and the University of South Carolina, Columbia (N.P.)
| | - Nandita Perumal
- From St. John's Research Institute (P.D., R.F.), St. John's Medical College (T.T., J.M.R., A.V.K.), and Bruhat Bengaluru Mahanagara Palike (N.B., R.S.) - all in Bangalore, India; the Africa Academy for Public Health (A.M., S.M.K., M.M.S.), Muhimbili University of Health and Allied Sciences (M.B., A.B.P.), Dar es Salaam Regional Medical Office of Health (N.O.S.), and Ifakara Health Institute (H.M.M.) - all in Dar es Salaam, Tanzania; the Harvard T.H. Chan School of Public Health (C.R.S., M.W., N.P., C.P.D., W.W.F.), Harvard Medical School (M.W., C.P.D.), and Boston Children's Hospital (C.P.D.) - all in Boston; Columbia University Medical Center, New York (B.J.W.); and the University of South Carolina, Columbia (N.P.)
| | - Tinku Thomas
- From St. John's Research Institute (P.D., R.F.), St. John's Medical College (T.T., J.M.R., A.V.K.), and Bruhat Bengaluru Mahanagara Palike (N.B., R.S.) - all in Bangalore, India; the Africa Academy for Public Health (A.M., S.M.K., M.M.S.), Muhimbili University of Health and Allied Sciences (M.B., A.B.P.), Dar es Salaam Regional Medical Office of Health (N.O.S.), and Ifakara Health Institute (H.M.M.) - all in Dar es Salaam, Tanzania; the Harvard T.H. Chan School of Public Health (C.R.S., M.W., N.P., C.P.D., W.W.F.), Harvard Medical School (M.W., C.P.D.), and Boston Children's Hospital (C.P.D.) - all in Boston; Columbia University Medical Center, New York (B.J.W.); and the University of South Carolina, Columbia (N.P.)
| | - Shabani M Kinyogoli
- From St. John's Research Institute (P.D., R.F.), St. John's Medical College (T.T., J.M.R., A.V.K.), and Bruhat Bengaluru Mahanagara Palike (N.B., R.S.) - all in Bangalore, India; the Africa Academy for Public Health (A.M., S.M.K., M.M.S.), Muhimbili University of Health and Allied Sciences (M.B., A.B.P.), Dar es Salaam Regional Medical Office of Health (N.O.S.), and Ifakara Health Institute (H.M.M.) - all in Dar es Salaam, Tanzania; the Harvard T.H. Chan School of Public Health (C.R.S., M.W., N.P., C.P.D., W.W.F.), Harvard Medical School (M.W., C.P.D.), and Boston Children's Hospital (C.P.D.) - all in Boston; Columbia University Medical Center, New York (B.J.W.); and the University of South Carolina, Columbia (N.P.)
| | - Mohamed Bakari
- From St. John's Research Institute (P.D., R.F.), St. John's Medical College (T.T., J.M.R., A.V.K.), and Bruhat Bengaluru Mahanagara Palike (N.B., R.S.) - all in Bangalore, India; the Africa Academy for Public Health (A.M., S.M.K., M.M.S.), Muhimbili University of Health and Allied Sciences (M.B., A.B.P.), Dar es Salaam Regional Medical Office of Health (N.O.S.), and Ifakara Health Institute (H.M.M.) - all in Dar es Salaam, Tanzania; the Harvard T.H. Chan School of Public Health (C.R.S., M.W., N.P., C.P.D., W.W.F.), Harvard Medical School (M.W., C.P.D.), and Boston Children's Hospital (C.P.D.) - all in Boston; Columbia University Medical Center, New York (B.J.W.); and the University of South Carolina, Columbia (N.P.)
| | - Ryan Fernandez
- From St. John's Research Institute (P.D., R.F.), St. John's Medical College (T.T., J.M.R., A.V.K.), and Bruhat Bengaluru Mahanagara Palike (N.B., R.S.) - all in Bangalore, India; the Africa Academy for Public Health (A.M., S.M.K., M.M.S.), Muhimbili University of Health and Allied Sciences (M.B., A.B.P.), Dar es Salaam Regional Medical Office of Health (N.O.S.), and Ifakara Health Institute (H.M.M.) - all in Dar es Salaam, Tanzania; the Harvard T.H. Chan School of Public Health (C.R.S., M.W., N.P., C.P.D., W.W.F.), Harvard Medical School (M.W., C.P.D.), and Boston Children's Hospital (C.P.D.) - all in Boston; Columbia University Medical Center, New York (B.J.W.); and the University of South Carolina, Columbia (N.P.)
| | - John-Michael Raj
- From St. John's Research Institute (P.D., R.F.), St. John's Medical College (T.T., J.M.R., A.V.K.), and Bruhat Bengaluru Mahanagara Palike (N.B., R.S.) - all in Bangalore, India; the Africa Academy for Public Health (A.M., S.M.K., M.M.S.), Muhimbili University of Health and Allied Sciences (M.B., A.B.P.), Dar es Salaam Regional Medical Office of Health (N.O.S.), and Ifakara Health Institute (H.M.M.) - all in Dar es Salaam, Tanzania; the Harvard T.H. Chan School of Public Health (C.R.S., M.W., N.P., C.P.D., W.W.F.), Harvard Medical School (M.W., C.P.D.), and Boston Children's Hospital (C.P.D.) - all in Boston; Columbia University Medical Center, New York (B.J.W.); and the University of South Carolina, Columbia (N.P.)
| | - Ndeniria O Swai
- From St. John's Research Institute (P.D., R.F.), St. John's Medical College (T.T., J.M.R., A.V.K.), and Bruhat Bengaluru Mahanagara Palike (N.B., R.S.) - all in Bangalore, India; the Africa Academy for Public Health (A.M., S.M.K., M.M.S.), Muhimbili University of Health and Allied Sciences (M.B., A.B.P.), Dar es Salaam Regional Medical Office of Health (N.O.S.), and Ifakara Health Institute (H.M.M.) - all in Dar es Salaam, Tanzania; the Harvard T.H. Chan School of Public Health (C.R.S., M.W., N.P., C.P.D., W.W.F.), Harvard Medical School (M.W., C.P.D.), and Boston Children's Hospital (C.P.D.) - all in Boston; Columbia University Medical Center, New York (B.J.W.); and the University of South Carolina, Columbia (N.P.)
| | - Nirmala Buggi
- From St. John's Research Institute (P.D., R.F.), St. John's Medical College (T.T., J.M.R., A.V.K.), and Bruhat Bengaluru Mahanagara Palike (N.B., R.S.) - all in Bangalore, India; the Africa Academy for Public Health (A.M., S.M.K., M.M.S.), Muhimbili University of Health and Allied Sciences (M.B., A.B.P.), Dar es Salaam Regional Medical Office of Health (N.O.S.), and Ifakara Health Institute (H.M.M.) - all in Dar es Salaam, Tanzania; the Harvard T.H. Chan School of Public Health (C.R.S., M.W., N.P., C.P.D., W.W.F.), Harvard Medical School (M.W., C.P.D.), and Boston Children's Hospital (C.P.D.) - all in Boston; Columbia University Medical Center, New York (B.J.W.); and the University of South Carolina, Columbia (N.P.)
| | - Rani Shobha
- From St. John's Research Institute (P.D., R.F.), St. John's Medical College (T.T., J.M.R., A.V.K.), and Bruhat Bengaluru Mahanagara Palike (N.B., R.S.) - all in Bangalore, India; the Africa Academy for Public Health (A.M., S.M.K., M.M.S.), Muhimbili University of Health and Allied Sciences (M.B., A.B.P.), Dar es Salaam Regional Medical Office of Health (N.O.S.), and Ifakara Health Institute (H.M.M.) - all in Dar es Salaam, Tanzania; the Harvard T.H. Chan School of Public Health (C.R.S., M.W., N.P., C.P.D., W.W.F.), Harvard Medical School (M.W., C.P.D.), and Boston Children's Hospital (C.P.D.) - all in Boston; Columbia University Medical Center, New York (B.J.W.); and the University of South Carolina, Columbia (N.P.)
| | - Mary M Sando
- From St. John's Research Institute (P.D., R.F.), St. John's Medical College (T.T., J.M.R., A.V.K.), and Bruhat Bengaluru Mahanagara Palike (N.B., R.S.) - all in Bangalore, India; the Africa Academy for Public Health (A.M., S.M.K., M.M.S.), Muhimbili University of Health and Allied Sciences (M.B., A.B.P.), Dar es Salaam Regional Medical Office of Health (N.O.S.), and Ifakara Health Institute (H.M.M.) - all in Dar es Salaam, Tanzania; the Harvard T.H. Chan School of Public Health (C.R.S., M.W., N.P., C.P.D., W.W.F.), Harvard Medical School (M.W., C.P.D.), and Boston Children's Hospital (C.P.D.) - all in Boston; Columbia University Medical Center, New York (B.J.W.); and the University of South Carolina, Columbia (N.P.)
| | - Christopher P Duggan
- From St. John's Research Institute (P.D., R.F.), St. John's Medical College (T.T., J.M.R., A.V.K.), and Bruhat Bengaluru Mahanagara Palike (N.B., R.S.) - all in Bangalore, India; the Africa Academy for Public Health (A.M., S.M.K., M.M.S.), Muhimbili University of Health and Allied Sciences (M.B., A.B.P.), Dar es Salaam Regional Medical Office of Health (N.O.S.), and Ifakara Health Institute (H.M.M.) - all in Dar es Salaam, Tanzania; the Harvard T.H. Chan School of Public Health (C.R.S., M.W., N.P., C.P.D., W.W.F.), Harvard Medical School (M.W., C.P.D.), and Boston Children's Hospital (C.P.D.) - all in Boston; Columbia University Medical Center, New York (B.J.W.); and the University of South Carolina, Columbia (N.P.)
| | - Honorati M Masanja
- From St. John's Research Institute (P.D., R.F.), St. John's Medical College (T.T., J.M.R., A.V.K.), and Bruhat Bengaluru Mahanagara Palike (N.B., R.S.) - all in Bangalore, India; the Africa Academy for Public Health (A.M., S.M.K., M.M.S.), Muhimbili University of Health and Allied Sciences (M.B., A.B.P.), Dar es Salaam Regional Medical Office of Health (N.O.S.), and Ifakara Health Institute (H.M.M.) - all in Dar es Salaam, Tanzania; the Harvard T.H. Chan School of Public Health (C.R.S., M.W., N.P., C.P.D., W.W.F.), Harvard Medical School (M.W., C.P.D.), and Boston Children's Hospital (C.P.D.) - all in Boston; Columbia University Medical Center, New York (B.J.W.); and the University of South Carolina, Columbia (N.P.)
| | - Anura V Kurpad
- From St. John's Research Institute (P.D., R.F.), St. John's Medical College (T.T., J.M.R., A.V.K.), and Bruhat Bengaluru Mahanagara Palike (N.B., R.S.) - all in Bangalore, India; the Africa Academy for Public Health (A.M., S.M.K., M.M.S.), Muhimbili University of Health and Allied Sciences (M.B., A.B.P.), Dar es Salaam Regional Medical Office of Health (N.O.S.), and Ifakara Health Institute (H.M.M.) - all in Dar es Salaam, Tanzania; the Harvard T.H. Chan School of Public Health (C.R.S., M.W., N.P., C.P.D., W.W.F.), Harvard Medical School (M.W., C.P.D.), and Boston Children's Hospital (C.P.D.) - all in Boston; Columbia University Medical Center, New York (B.J.W.); and the University of South Carolina, Columbia (N.P.)
| | - Andrea B Pembe
- From St. John's Research Institute (P.D., R.F.), St. John's Medical College (T.T., J.M.R., A.V.K.), and Bruhat Bengaluru Mahanagara Palike (N.B., R.S.) - all in Bangalore, India; the Africa Academy for Public Health (A.M., S.M.K., M.M.S.), Muhimbili University of Health and Allied Sciences (M.B., A.B.P.), Dar es Salaam Regional Medical Office of Health (N.O.S.), and Ifakara Health Institute (H.M.M.) - all in Dar es Salaam, Tanzania; the Harvard T.H. Chan School of Public Health (C.R.S., M.W., N.P., C.P.D., W.W.F.), Harvard Medical School (M.W., C.P.D.), and Boston Children's Hospital (C.P.D.) - all in Boston; Columbia University Medical Center, New York (B.J.W.); and the University of South Carolina, Columbia (N.P.)
| | - Wafaie W Fawzi
- From St. John's Research Institute (P.D., R.F.), St. John's Medical College (T.T., J.M.R., A.V.K.), and Bruhat Bengaluru Mahanagara Palike (N.B., R.S.) - all in Bangalore, India; the Africa Academy for Public Health (A.M., S.M.K., M.M.S.), Muhimbili University of Health and Allied Sciences (M.B., A.B.P.), Dar es Salaam Regional Medical Office of Health (N.O.S.), and Ifakara Health Institute (H.M.M.) - all in Dar es Salaam, Tanzania; the Harvard T.H. Chan School of Public Health (C.R.S., M.W., N.P., C.P.D., W.W.F.), Harvard Medical School (M.W., C.P.D.), and Boston Children's Hospital (C.P.D.) - all in Boston; Columbia University Medical Center, New York (B.J.W.); and the University of South Carolina, Columbia (N.P.)
| |
Collapse
|
10
|
Sheikh J, Allotey J, Kew T, Khalil H, Galadanci H, Hofmeyr GJ, Abalos E, Vogel JP, Lavin T, Souza JP, Kaur I, Ram U, Betran AP, Bohren MA, Oladapo OT, Thangaratinam S. Vulnerabilities and reparative strategies during pregnancy, childbirth, and the postpartum period: moving from rhetoric to action. EClinicalMedicine 2024; 67:102264. [PMID: 38314056 PMCID: PMC10837549 DOI: 10.1016/j.eclinm.2023.102264] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 09/18/2023] [Accepted: 09/25/2023] [Indexed: 02/06/2024] Open
Abstract
Maternal outcomes throughout pregnancy, childbirth, and the postnatal period are influenced by interlinked and interdependent vulnerabilities. A comprehensive understanding of how various threats and barriers affect maternal and perinatal health is critical to plan, evaluate and improve maternal health programmes. This paper builds on the introductory paper of the Series on the determinants of maternal health by assessing vulnerabilities during pregnancy, childbirth, and the postnatal period. We synthesise and present the concept of vulnerability in pregnancy and childbirth, and map vulnerability attributes and their dynamic influence on maternal outcomes in early and late pregnancy and during childbirth and the postnatal period, with a particular focus on low-income and middle-income countries (LMICs). We summarise existing literature and present the evidence on the effects of various reparative strategies to improve pregnancy and childbirth outcomes. Lastly, we discuss the implications of the identified vulnerability attributes and reparative strategies for the efforts of policymakers, healthcare professionals, and researchers working towards improving outcomes for women and birthing people in LMICs.
Collapse
Affiliation(s)
- Jameela Sheikh
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - John Allotey
- WHO Collaborating Centre for Global Women’s Health, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, United Kingdom
- National Institute of Health and Care Research (NIHR) Birmingham Biomedical Research Centre, Birmingham, United Kingdom
| | - Tania Kew
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Halimah Khalil
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Hadiza Galadanci
- Africa Center of Excellence for Population Health and Policy, College of Health Sciences, Bayero University, Kano, Nigeria
| | - G Justus Hofmeyr
- Department of Obstetrics and Gynaecology, University of Botswana, Gaborone, Botswana
- University of the Witwatersrand and Walter Sisulu University, East London, South Africa
| | - Edgardo Abalos
- Centro de Estudios de Estado y Sociedad (CEDES), Buenos Aires, Argentina
| | - Joshua P. Vogel
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia
| | - Tina Lavin
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - João Paulo Souza
- Department of Social Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
- BIREME, Evidence and Intelligence for Action in Health Department, Pan America Health Organization/World Health Organization, São Paulo, Brazil
| | - Inderjeet Kaur
- Fernandez Hospital Educational & Research Foundation, Hyderabad, India
| | - Uma Ram
- Seethapathy Clinic & Hospital, Chennai, India
| | - Ana Pilar Betran
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Meghan A. Bohren
- Gender and Women’s Health Unit, Nossal Institute for Global Health, School of Population and Global Health, The University of Melbourne, Victoria, Australia
| | - Olufemi T. Oladapo
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Shakila Thangaratinam
- WHO Collaborating Centre for Global Women’s Health, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, United Kingdom
- National Institute of Health and Care Research (NIHR) Birmingham Biomedical Research Centre, Birmingham, United Kingdom
- Birmingham Women’s Hospital, Birmingham Women’s and Children’s NHS Foundation Trust, Birmingham, United Kingdom
| |
Collapse
|
11
|
Diaz-Thomas A, Iyer P. Global Health Disparities in Childhood Rickets. Endocrinol Metab Clin North Am 2023; 52:643-657. [PMID: 37865479 DOI: 10.1016/j.ecl.2023.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2023]
Abstract
Nutritional rickets is a global health problem reflecting both historical and contemporary health disparities arising from racial, ethnic, environmental, and geopolitical circumstances. It primarily affects marginalized populations and can contribute to long-term morbidity. Deficits in bone health in childhood may also contribute to osteomalacia/osteoporosis. Solutions require a global public health approach.
Collapse
Affiliation(s)
- Alicia Diaz-Thomas
- Department of Pediatrics, Division of Pediatric Endocrinology, The University of Tennessee Health Science Center, 910 Madison Avenue, Suite 1010, Memphis, TN 38163, USA.
| | - Pallavi Iyer
- Department of Pediatrics, Division of Endocrinology and Diabetes, Medical College of Wisconsin, Children's Corporate Center, Suite 520, 9000 West Wisconsin Avenue, Milwaukee, WI 53226, USA
| |
Collapse
|
12
|
Tay W, Quek R, Lim J, Kaur B, Ponnalagu S, Henry CJ. Plant-based alternative proteins-are they nutritionally more advantageous? Eur J Clin Nutr 2023; 77:1051-1060. [PMID: 37580584 DOI: 10.1038/s41430-023-01328-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 08/03/2023] [Accepted: 08/04/2023] [Indexed: 08/16/2023]
Abstract
BACKGROUND The transition towards sustainable nutrition as well as the exploration of alternative sources of protein have been at the forefront of thinking in the 21st century. However, further research is required to ascertain if a diet composed of alternative plant-based proteins has similar nutritional advantages to a plant-based diet. This study aims to model the replacement of a diet consisting of animal-based proteins with plant-based alternatives (PBA), in a group of Asians. METHODS A 4-day food record was collected from 50 individuals residing in Singapore and nutrient profiles were generated for each individual. Food records were analysed, and meat, dairy, and seafood ingredients were substituted gram-for-gram with their PBA. The original and replaced nutrient profiles were compared against each other and the differences in macro and micronutrients were analysed. RESULTS A significant increase in carbohydrates, dietary fibre, as well as in micronutrients such as sodium and calcium was observed. Conversely, there was a significant decreased intake in overall energy, protein and fat (p < 0.005). CONCLUSIONS The significant nutritional impact of substituting animal-based proteins for PBA may present benefits for bone health and individuals on a caloric restriction diet. However, higher sodium levels may be undesirable for individuals with cardiovascular conditions and hypertension, and the low bioavailability of iron in plant-based sources may present issues for iron deficient populations. Bearing some of these key findings in mind, researchers and manufacturers need to consider these when developing alternative protein products to meet consumer demands for palatable and nutritious plant-based products.
Collapse
Affiliation(s)
- Wesley Tay
- Clinical Nutrition Research Centre (CNRC), Singapore Institute of Food and Biotechnology Innovation (SIFBI), Agency for Science, Technology and Research (A*STAR), #07-02, 14 Medical Drive, Singapore, 117599, Singapore
| | - Rina Quek
- Clinical Nutrition Research Centre (CNRC), Singapore Institute of Food and Biotechnology Innovation (SIFBI), Agency for Science, Technology and Research (A*STAR), #07-02, 14 Medical Drive, Singapore, 117599, Singapore
| | - Joseph Lim
- Clinical Nutrition Research Centre (CNRC), Singapore Institute of Food and Biotechnology Innovation (SIFBI), Agency for Science, Technology and Research (A*STAR), #07-02, 14 Medical Drive, Singapore, 117599, Singapore
| | - Bhupinder Kaur
- Clinical Nutrition Research Centre (CNRC), Singapore Institute of Food and Biotechnology Innovation (SIFBI), Agency for Science, Technology and Research (A*STAR), #07-02, 14 Medical Drive, Singapore, 117599, Singapore
| | - Shalini Ponnalagu
- Clinical Nutrition Research Centre (CNRC), Singapore Institute of Food and Biotechnology Innovation (SIFBI), Agency for Science, Technology and Research (A*STAR), #07-02, 14 Medical Drive, Singapore, 117599, Singapore
| | - Christiani Jeyakumar Henry
- Clinical Nutrition Research Centre (CNRC), Singapore Institute of Food and Biotechnology Innovation (SIFBI), Agency for Science, Technology and Research (A*STAR), #07-02, 14 Medical Drive, Singapore, 117599, Singapore.
- Department of Biochemistry, National University of Singapore, 8 Medical Drive, Singapore, 117596, Singapore.
| |
Collapse
|
13
|
Ajong AB, Kenfack B, Ali IM, Yakum MN, Ukaogo PO, Mangala FN, Aljerf L, Telefo PB. Calcium supplementation in pregnancy: An analysis of potential determinants in an under-resourced setting. PLoS One 2023; 18:e0292303. [PMID: 37796953 PMCID: PMC10553325 DOI: 10.1371/journal.pone.0292303] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 09/18/2023] [Indexed: 10/07/2023] Open
Abstract
INTRODUCTION Despite the evidence that calcium supplementation in pregnancy improves maternofoetal outcomes, many women still do not take calcium supplements during pregnancy in Cameroon. This study identifies factors that influence calcium supplementation during pregnancy in a low resource setting. METHODS We conducted a cross-sectional hospital-based study (from November 2020 to September 2021) targeting 1074 healthy women in late pregnancy at the maternities of four major health facilities in the Nkongsamba Health District, Cameroon. Data were collected using an interview-administered semi-structured questionnaire and analysed using Epi Info version 7.2.4.0, and the statistical threshold for significance set at p-value = 0.05. RESULTS The mean age of the participants was 28.20±6.08 years, with a range of 15-47 years. The proportion of women who reported taking any calcium supplements in pregnancy was 72.62 [69.85-75.22]%. Only 12% of calcium-supplemented women took calcium supplements throughout pregnancy, while a majority (50%) took calcium supplements just for 4-5 months. Women believe that taking calcium supplements is more for foetal growth and development (37.12%) and prevention of cramps (38.86%), than for the prevention of hypertensive diseases in pregnancy (2.84%). About all pregnant women (97.65%) took iron and folic acid supplements during pregnancy, and 99.24% took these supplements at least once every two days. Upon control for multiple confounders, the onset of antenatal care before 4 months of pregnancy (AOR = 2.64 [1.84-3.78], p-value = 0.000), having had more than 3 antenatal care visits (AOR = 6.01 [3.84-9.34], p-value = 0.000) and support/reminder from a partner on the necessity to take supplements in pregnancy (AOR = 2.00 [1.34-2.99], p-value = 0.001) were significantly associated with higher odds of taking any calcium supplements in pregnancy. CONCLUSION Calcium supplementation practices in pregnancy remain poor in this population and far from WHO recommendations. Early initiation of antenatal care, a high number of antenatal visits and reminders or support from the partner on supplement intake significantly increase the odds of taking any calcium supplements in pregnancy. In line with WHO recommendations, women of childbearing age should be sensitised to initiate antenatal care earlier and attain as many visits as possible. Male involvement in prenatal care might also boost the likelihood of these women taking calcium supplements.
Collapse
Affiliation(s)
- Atem Bethel Ajong
- Department of Mother and Child care, Kekem District Hospital, Kekem, West Region, Cameroon
- Department of Biochemistry, University of Dschang, Dschang, West Region, Cameroon
| | - Bruno Kenfack
- Department of Obstetrics / Gynaecology and Maternal Health, Faculty of Medicine and Pharmaceutical Sciences, University of Dschang, Dschang, West Region, Cameroon
| | - Innocent Mbulli Ali
- Department of Biochemistry, University of Dschang, Dschang, West Region, Cameroon
| | - Martin Ndinakie Yakum
- Department of Epidemiology and Biostatistics, School of Medical and Health Sciences, Kesmonds International University, Bamenda, Cameroon
| | | | - Fulbert Nkwele Mangala
- Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
- Maternity unit, Nkongsamba Regional Hospital, Nkongsamba, Littoral Region, Cameroon
| | - Loai Aljerf
- Faculty of Dentistry, Damascus University, Damascus, Syria
| | - Phelix Bruno Telefo
- Department of Biochemistry, University of Dschang, Dschang, West Region, Cameroon
| |
Collapse
|
14
|
Liu Y, Wang X, Fu W, Cao Y, Dou W, Duan D, Zhao X, Ma S, Lyu Q. The association between dietary mineral intake and the risk of preeclampsia in Chinese pregnant women: a matched case-control study. Sci Rep 2023; 13:16103. [PMID: 37752229 PMCID: PMC10522594 DOI: 10.1038/s41598-023-43481-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 09/25/2023] [Indexed: 09/28/2023] Open
Abstract
Previous studies on the relationship between dietary minerals and preeclampsia (PE) have given inconsistent results. The aim of this study was to further clarify the relationship between dietary minerals intake and PE in Chinese pregnant women. In this study, 440 pairs of hospital-based preeclamptic and healthy women were matched 1:1. Dietary intake was obtained through a 78-item semi-quantitative food frequency questionnaire. Multivariate conditional logistic regression was used to estimate the odds ratios (ORs) and 95% confidence intervals (CIs). Restricted cubic splines were plotted to evaluate the dose-response relationship between dietary minerals intake and PE. This study found significant inverse associations for dietary intake of calcium, magnesium, phosphorus, iron, copper, manganese and zinc and the risk of PE in both univariate and multivariate models (all P- trend < 0.05). After adjusting for possible confounders, compared with the lowest quartile, the odds ratio of the highest quartile was 0.74 (95% CI 0.56-0.98) for calcium, 0.63 (95% CI 0.42-0.93) for magnesium, 0.45 (95% CI 0.31-0.65) for phosphorus, 0.44 (95% CI 0.30-0.65) for iron, 0.72 (95% CI 0.53-0.97) for copper, 0.66 (95% CI 0.48-0.91) for manganese and 0.38 (95% CI 0.25-0.57) for zinc. In addition, a reverse J-shaped relationship between dietary minerals intake and PE risk was observed (P-overall association < 0.05). In Chinese pregnant women, a higher intake of dietary minerals, including calcium, magnesium, phosphorus, copper, iron, manganese, and zinc was associated with a lower odds of PE.
Collapse
Affiliation(s)
- Yanhua Liu
- Department of Nutrition, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, China
| | - Xinyi Wang
- Department of Nutrition and Food Hygiene, College of Public Health, Zhengzhou University, Zhengzhou, 450000, Henan, China
- Department of Clinical Nutrition, The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, China
| | - Wenjun Fu
- Department of Obstetrics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, China
| | - Yuan Cao
- The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, China
| | - Weifeng Dou
- Department of Nutrition and Food Hygiene, College of Public Health, Zhengzhou University, Zhengzhou, 450000, Henan, China
- Zhengzhou Shuqing Medical College, Zhengzhou, 450064, Henan, China
| | - Dandan Duan
- Department of Clinical Nutrition, Luoyang New Area People's Hospital, Luoyang, 471023, Henan, China
| | - Xianlan Zhao
- Department of Obstetrics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, China
| | - Shunping Ma
- Department of Nutrition, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, China
| | - Quanjun Lyu
- Department of Nutrition, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, China.
- Department of Nutrition and Food Hygiene, College of Public Health, Zhengzhou University, Zhengzhou, 450000, Henan, China.
| |
Collapse
|
15
|
Ahmed A, Saleem MA, Saeed F, Afzaal M, Imran A, Akram S, Hussain M, Khan A, Al Jbawi E. A comprehensive review on the impact of calcium and vitamin D insufficiency and allied metabolic disorders in females. Food Sci Nutr 2023; 11:5004-5027. [PMID: 37701195 PMCID: PMC10494632 DOI: 10.1002/fsn3.3519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 06/01/2023] [Accepted: 06/01/2023] [Indexed: 09/14/2023] Open
Abstract
Calcium is imperative in maintaining a quality life, particularly during later ages. Its deficiency results in a wide range of metabolic disorders such as dental changes, cataracts, alterations in brain function, and osteoporosis. These deficiencies are more pronounced in females due to increased calcium turnover throughout their life cycle, especially during pregnancy and lactation. Vitamin D perform a central role in the metabolism of calcium. Recent scientific interventions have linked calcium with an array of metabolic disorders in females including hypertension, obesity, premenstrual dysphoric disorder, polycystic ovary syndrome (PCOS), multiple sclerosis, and breast cancer. This review encompasses these female metabolic disorders with special reference to calcium and vitamin D deficiency. This review article aims to present and elaborate on available data regarding the worldwide occurrence of insufficient calcium consumption in females and allied health risks, to provide a basis for formulating strategies and population-level scientific studies to adequately boost calcium intake and position where required.
Collapse
Affiliation(s)
- Aftab Ahmed
- Department of Nutritional SciencesGovernment College University FaisalabadFaisalabadPakistan
| | - Muhammad Awais Saleem
- Department of Nutritional SciencesGovernment College University FaisalabadFaisalabadPakistan
- Department of Human Nutrition and DieteticsMirpur University of Science and TechnologyMirpurPakistan
| | - Farhan Saeed
- Department of Food SciencesGovernment College University FaisalabadFaisalabadPakistan
| | - Muhammad Afzaal
- Department of Food SciencesGovernment College University FaisalabadFaisalabadPakistan
| | - Ali Imran
- Department of Food SciencesGovernment College University FaisalabadFaisalabadPakistan
| | - Sidra Akram
- Department of Nutritional SciencesGovernment College University FaisalabadFaisalabadPakistan
| | - Muzzamal Hussain
- Department of Food SciencesGovernment College University FaisalabadFaisalabadPakistan
| | - Aqsa Khan
- Department of Nutritional SciencesGovernment College University FaisalabadFaisalabadPakistan
| | | |
Collapse
|
16
|
Knight F, Ferguson EL, Rana ZH, Belizan J, Gomes F, Bourassa MW, Dickin KL, Weaver CM, Cormick G. Including calcium-fortified water or flour in modeled diets based on local foods could improve calcium intake for women, adolescent girls, and young children in Bangladesh, Uganda, and Guatemala. Ann N Y Acad Sci 2023; 1526:84-98. [PMID: 37391187 DOI: 10.1111/nyas.15032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/02/2023]
Abstract
Adequate calcium intake is essential for health, especially for infants, children, adolescents, and women, yet is difficult to achieve with local foods in many low- and middle-income countries. Previous analysis found it was not always possible to identify food-based recommendations (FBRs) that reached the calcium population recommended intake (PRI) for these groups in Bangladesh, Guatemala, and Uganda. We have modeled the potential contribution of calcium-fortified drinking water or wheat flour to FBR sets, to fill the remaining intake gaps. Optimized diets containing fortified products, with calcium-rich local foods, achieved the calcium PRI for all target groups. Combining fortified water or flour with FBRs met dietary intake targets for adolescent girls in all geographies and allowed a reduction from 3-4 to the more feasible 1-2 FBRs. Water with a calcium concentration of 100 mg/L with FBRs was sufficient to meet calcium targets in Uganda, but higher concentrations (400-500 mg/L) were mostly required in Guatemala and Bangladesh. Combining calcium-fortified wheat flour at 400 mg/100 g of flour and the FBR for small fish resulted in diets meeting the calcium PRI in Bangladesh. Calcium-fortified water or flour could improve calcium intake for vulnerable populations, especially when combined with FBRs based on locally available foods.
Collapse
Affiliation(s)
- Frances Knight
- London School of Hygiene and Tropical Medicine, London, UK
- Nutrition Division, United Nations World Food Programme, Rome, Italy
| | | | - Ziaul H Rana
- The New York Academy of Sciences, New York, New York, USA
| | - José Belizan
- Centro de Investigaciones en Epidemiología y Salud Pública (CIESP-IECS). CONICET, Ciudad de Buenos Aires, Argentina
- Department of Mother and Child Health Research, Institute for Clinical Effectiveness and Health Policy (IECS-CONICET), Ciudad de Buenos Aires, Argentina
| | - Filomena Gomes
- The New York Academy of Sciences, New York, New York, USA
- NOVA Medical School, Universidade NOVA de Lisboa, Lisboa, Portugal
| | | | - Katherine L Dickin
- Department of Public and Ecosystem Health, Cornell University, Ithaca, New York, USA
| | | | - Gabriela Cormick
- Centro de Investigaciones en Epidemiología y Salud Pública (CIESP-IECS). CONICET, Ciudad de Buenos Aires, Argentina
- Department of Mother and Child Health Research, Institute for Clinical Effectiveness and Health Policy (IECS-CONICET), Ciudad de Buenos Aires, Argentina
- Departamento de Salud, Universidad Nacional de La Matanza (UNLAM), San Justo, Argentina
| |
Collapse
|
17
|
Knight F, Rana ZH, Cormick G, Belizan J, Gomes F, Bourassa MW, Dickin KL, Weaver CM, Ferguson EL. Could local foods achieve recommended calcium intakes for nutritionally vulnerable populations in Uganda, Guatemala, and Bangladesh? Ann N Y Acad Sci 2023; 1525:173-183. [PMID: 37230491 DOI: 10.1111/nyas.15008] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Globally, dietary intake of calcium is often insufficient, and it is unclear if adequacy could be achieved by promoting calcium-rich local foods. This study used linear programming and household consumption data from Uganda, Bangladesh, and Guatemala to assess whether local foods could meet calcium population reference intakes (Ca PRIs). The most promising food-based approaches to promote dietary calcium adequacy were identified for 12- to 23-month-old breastfed children, 4- to 6-year-old children, 10- to 14-year-old girls, and nonpregnant and nonbreastfeeding (NPNB) women of reproductive age living in two regions of each country. Calcium-optimized diets achieved 75-253% of the Ca PRI, depending on the population, and were <100% for 4- to 6-year-olds in one region of each country and 10- to 14-year-old girls in Sylhet, Bangladesh. The best food sources of calcium were green leafy vegetables and milk, across geographic locations, and species of small fish, nixtamalized (lime-treated) maize products, sesame seeds, and bean varieties, where consumed. Food-based recommendations (FBRs) achieving the minimum calcium threshold were identified for 12- to 23-month-olds and NPNB women across geographic locations, and for 4- to 6-year-olds and 10-to 14-year-old girls in Uganda. However, for 4- to 6-year-olds and 10- to 14-year-old girls in Bangladesh and Guatemala, calcium-adequate FBRs could not be identified, indicating a need for alternative calcium sources or increased access to and consumption of local calcium-rich foods.
Collapse
Affiliation(s)
- Frances Knight
- London School of Hygiene and Tropical Medicine, London, UK
- Nutrition Division, United Nations World Food Programme, Rome, Italy
| | - Ziaul H Rana
- The New York Academy of Sciences, New York, New York, USA
| | - Gabriela Cormick
- Centro de Investigaciones Epidemiológicas y Salud Pública (CIESP-IECS). CONICET, Ciudad de Buenos Aires, Argentina
- Department of Mother and Child Health Research, Institute for Clinical Effectiveness and Health Policy (IECS-CONICET), Ciudad de Buenos Aires, Argentina
- Departamento de Salud, Universidad Nacional de La Matanza (UNLAM), San Justo, Argentina
| | - José Belizan
- Centro de Investigaciones Epidemiológicas y Salud Pública (CIESP-IECS). CONICET, Ciudad de Buenos Aires, Argentina
- Department of Mother and Child Health Research, Institute for Clinical Effectiveness and Health Policy (IECS-CONICET), Ciudad de Buenos Aires, Argentina
| | - Filomena Gomes
- The New York Academy of Sciences, New York, New York, USA
- NOVA Medical School, Universidade NOVA de Lisboa, Lisboa, Portugal
| | | | - Katherine L Dickin
- Department of Public and Ecosystem Health, Cornell University, Ithaca, New York, USA
| | | | | |
Collapse
|
18
|
Sabah Z, Al Zomia AS, Deajim M, Alshahrani A, Alamri AH, Alqahtani AM, Lahiq LA, Alwaqdi NA, Raj B. A Retrospective Cohort Study of the Association Between Calcium Serum Level and Hypertension in Older Adults. Cureus 2023; 15:e40492. [PMID: 37461765 PMCID: PMC10349918 DOI: 10.7759/cureus.40492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2023] [Indexed: 07/20/2023] Open
Abstract
INTRODUCTION One of the major global risk factors for cardiovascular morbidity and death is hypertension. Earlier research has been conducted on the connection between calcium consumption and blood pressure. OBJECTIVE This study aims to investigate the association between calcium serum levels and hypertension in older hypertensive adults. METHODS A retrospective cohort study of 121 of hypertension patients was conducted in Prince Faisal Bin Khalid Cardiac Center. The data of all patients were collected by records, including lab, pathology, and medical review, in order to determine the effects on patients, providers, and institutions. Statistical analyses were performed using SPSS Statistics version 26.0. A p-value of <0.05 was considered statistically significant. RESULTS The study included 121 adult hypertensive patients with a mean of age 60.29 ± 13.92. The majority of included patients were male (81%). More than one-third of patients were obese (39.7%), about one-third (33.9%) were overweight, and 26.4% of patients were in normal weight. The majority of patients had co-morbidities (68.3%); about one-half of them had diabetes mellitus (52.1%). The calcium level mean was 5.07 ± 1.26. The creatine kinase (CK) (initial day) mean ± SD was 813.22 ± 1146.37 became 221.4 ± 330.67 on the last day. The CK-myocardial band (CK-MB) (initial day) was 65.43 ± 118.9 and became 24.38 ± 23.26 on the last day. Additionally, the troponin (initial day) mean was 23.49 ± 104.26 and became 1.65 ± 2.66 on the last day. The most common discharge medications were anti-platelets (95%), beta-blockers (78.5%), statins (70.2%), and proton-pump inhibitors (PPI) (64.5%). The hospital stay days ranged from 1 to 20 days with a mean of 4.83 ± 3.38. The ICU stay days ranged from 1 to 15 days with a mean of 3.57 ± 2.72. Most of the patients (90.9%) improved. CONCLUSION There is no significant correlation between calcium levels in hypertensive patients and the demographic characteristics of patients, home or current medications, ECHO findings, or procedures done. However, there is a significant correlation between the calcium level and CK level among patients with hypertension. Further investigations are required to verify the relationship between CK and calcium levels in hypertensive patients.
Collapse
Affiliation(s)
- Zia Sabah
- Department of Cardiology, King Khalid University, Abha, SAU
| | | | - Mosab Deajim
- College of Medicine, King Khalid University, Abha, SAU
| | | | | | | | - Lama A Lahiq
- College of Medicine, King Khalid University, Abha, SAU
| | | | - Berin Raj
- Department of Public Health, Prince Faisal Bin Khalid Cardiac Center, Abha, SAU
- Department of Public Health, University of Sunderland, Sunderland, GBR
| |
Collapse
|
19
|
Bangi EF, Yousuf MH, Upadhyay S, Jain P, Jain R. Comprehensive Review of Hypertensive Disorders Related to Pregnancy. South Med J 2023; 116:482-489. [PMID: 37263611 DOI: 10.14423/smj.0000000000001571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Hypertensive disorder of pregnancy is a common complication during pregnancy that affects approximately 10% of pregnancies and is responsible for nearly 14% of maternal deaths worldwide. It affects the mother and the fetus simultaneously, sometimes putting the health of the mother and the fetus at odds with each other. It may present with only hypertension and proteinuria or with life-threatening complications in the mother such as eclampsia; stroke; acute pulmonary edema; acute renal failure; disseminated intravascular coagulation; placental abruption; hemolysis, elevated liver enzymes, and low platelet syndrome; pregnancy loss; and fetal growth restriction and prematurity resulting from the frequent need of delivering preterm in the fetus. In this review, we aimed to describe hypertensive disorders of pregnancy, mainly preeclampsia and chronic hypertension in pregnancy, by discussing the pathophysiology, the central role of abnormal placentation, the release of antiangiogenic factors in the circulation and immunological factors, the clinical outcome in the mother and the fetus, and the diagnostic criteria and principles of management of both the conditions. We also discuss possible screening methods and prevention of preeclampsia using low-dose aspirin and eclampsia prophylaxis.
Collapse
Affiliation(s)
- Eera Fatima Bangi
- From the Seth Gordhandas Sunderdas Medical College and King Edward Memorial Hospital, Mumbai, India
| | | | | | | | - Rohit Jain
- Department of Internal Medicine, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania
| |
Collapse
|
20
|
Rocha T, Allotey J, Palacios A, Vogel JP, Smits L, Carroli G, Mistry H, Young T, Qureshi ZP, Cormick G, Snell KIE, Abalos E, Pena-Rosas JP, Khan KS, Larbi KK, Thorson A, Singata-Madliki M, Hofmeyr GJ, Bohren M, Riley R, Betran AP, Thangaratinam S. Calcium supplementation to prevent pre-eclampsia: protocol for an individual participant data meta-analysis, network meta-analysis and health economic evaluation. BMJ Open 2023; 13:e065538. [PMID: 37169508 PMCID: PMC10186423 DOI: 10.1136/bmjopen-2022-065538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 04/11/2023] [Indexed: 05/13/2023] Open
Abstract
INTRODUCTION Low dietary calcium intake is a risk factor for pre-eclampsia, a major contributor to maternal and perinatal mortality and morbidity worldwide. Calcium supplementation can prevent pre-eclampsia in women with low dietary calcium. However, the optimal dose and timing of calcium supplementation are not known. We plan to undertake an individual participant data (IPD) meta-analysis of randomised trials to determine the effects of various calcium supplementation regimens in preventing pre-eclampsia and its complications and rank these by effectiveness. We also aim to evaluate the cost-effectiveness of calcium supplementation to prevent pre-eclampsia. METHODS AND ANALYSIS We will identify randomised trials on calcium supplementation before and during pregnancy by searching major electronic databases including Embase, CINAHL, MEDLINE, CENTRAL, PubMed, Scopus, AMED, LILACS, POPLINE, AIM, IMSEAR, ClinicalTrials.gov and the WHO International Clinical Trials Registry Platform, without language restrictions, from inception to February 2022. Primary researchers of the identified trials will be invited to join the International Calcium in Pregnancy Collaborative Network and share their IPD. We will check each study's IPD for consistency with the original authors before standardising and harmonising the data. We will perform a series of one-stage and two-stage IPD random-effect meta-analyses to obtain the summary intervention effects on pre-eclampsia with 95% CIs and summary treatment-covariate interactions (maternal risk status, dietary intake, timing of intervention, daily dose of calcium prescribed and total intake of calcium). Heterogeneity will be summarised using tau2, I2 and 95% prediction intervals for effect in a new study. Sensitivity analysis to explore robustness of statistical and clinical assumptions will be carried out. Minor study effects (potential publication bias) will be investigated using funnel plots. A decision analytical model for use in low-income and middle-income countries will assess the cost-effectiveness of calcium supplementation to prevent pre-eclampsia. ETHICS AND DISSEMINATION No ethical approvals are required. We will store the data in a secure repository in an anonymised format. The results will be published in peer-reviewed journals. PROSPERO REGISTRATION NUMBER CRD42021231276.
Collapse
Affiliation(s)
- Thaís Rocha
- WHO Collaborating Centre for Global Women's Health, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
| | - John Allotey
- WHO Collaborating Centre for Global Women's Health, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
| | - Alfredo Palacios
- Health Economics, Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Joshua Peter Vogel
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Victoria, Australia
| | - Luc Smits
- Department of Epidemiology, Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | | | - Hema Mistry
- Warwick Evidence, University of Warwick, Coventry, UK
| | - Taryn Young
- Centre for Evidence-Based Health Care, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- South African Cochrane Centre, South African Medical Research Council, Cape Town, South Africa
| | - Zahida P Qureshi
- Department of Obstetrics and Gynecology, University of Nairobi, Nairobi, Kenya
| | - Gabriela Cormick
- Department of Health Technology Assessment and Health Economics, Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Kym I E Snell
- Centre for Prognosis Research, School of Medicine, Keele University, Keele, UK
| | - Edgardo Abalos
- Centro Rosarino de Estudios Perinatales (CREP), Rosario, Argentina
| | | | - Khalid Saeed Khan
- Public Health, University of Granada Faculty of Medicine, Granada, Spain
| | | | - Anna Thorson
- Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Mandisa Singata-Madliki
- Effective Care Research Unit (ECRU), East London Hospital Complex, East London, South Africa
| | | | - Meghan Bohren
- Centre for Health Equity, University of Melbourne School of Population and Global Health, Carlton, Victoria, Australia
| | - Richard Riley
- Centre for Prognosis Research, School of Medicine, Keele University, Keele, UK
| | - Ana Pilar Betran
- Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Shakila Thangaratinam
- WHO Collaborating Centre for Global Women's Health, Institute of Metabolism and Systems Research, University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
- Birmingham Women's and Children's Hospitals NHS Foundation Trust, Birmingham, UK
| |
Collapse
|
21
|
Agustina R, Rianda D, Lasepa W, Birahmatika FS, Stajic V, Mufida R. Nutrient intakes of pregnant and lactating women in Indonesia and Malaysia: Systematic review and meta-analysis. Front Nutr 2023; 10:1030343. [PMID: 37063336 PMCID: PMC10098007 DOI: 10.3389/fnut.2023.1030343] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 01/02/2023] [Indexed: 04/03/2023] Open
Abstract
IntroductionOptimizing dietary intake during pregnancy and lactation is crucial to the growth and development of children and their lifelong health. We performed a systematic review and meta-analysis to describe the nutrient intakes of pregnant and lactating women in Indonesia and Malaysia, countries that are experiencing rapid nutrition transition in Southeast Asia.MethodsWe screened 2,258 studies published between January 1980 and March 2021. The nutrient intakes of pregnant and lactating women were quantitatively analyzed to calculate the percentage of adequacy using national recommended daily allowances or nutrient intakes (RDA/RNI) and estimated average requirements (EAR) for micronutrients. Standardized mean differences (SMD) between dietary intake and RDA/RNI were determined for selected nutrients.ResultsFifty-three studies were included and showed that energy and macronutrient intakes among pregnant and lactating women in both countries were below the RDA/RNI. In addition, most studies reported that women failed to meet the EAR for vitamin D (<70% EAR), vitamin E (<50% EAR), and water-soluble vitamins (<80% EAR) except for vitamin C and A among Malaysians. Moreover, calcium, potassium, and iron intakes of pregnant women were <60% EAR in Indonesia and <80% EAR in Malaysia. Phosphorus intake among pregnant women in both countries and sodium intake among Malaysian pregnant women exceeded 100% EAR. Indonesian lactating women had <60% EAR for calcium and potassium intakes, while Malaysian women had more than 100% EAR. For 21 studies reporting overall protein intakes, the standard mean difference (SMD) was −2.26 (95% CI; −2.98, −1.54) below the RDA/RNI for pregnant women and −0.67 SMD (95% CI −15.7, −11.5) for lactating women. When the four studies from Malaysia were analyzed separately, protein intakes of pregnant women were above the RNI. Moreover, low intakes of vitamin D, vitamin C, calcium, and iron, but sufficient intakes in vitamin A, zinc, and phosphorus were observed in pregnant women in both countries.ConclusionDietary intakes of energy, macronutrients, and micronutrients (vitamin D, vitamin E, water-soluble vitamins, calcium, and iron) of pregnant and lactating women in Indonesia and Malaysia were below the recommendations. Important heterogeneities were observed even between these two countries for specific essential nutrient intakes. Innovative research and targeted programs to address specific deficiencies should be prioritized.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021252204, identifier: CRD42021252204.
Collapse
Affiliation(s)
- Rina Agustina
- Department of Nutrition, Faculty of Medicine, Universitas Indonesia - Dr. Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
- *Correspondence: Rina Agustina ;
| | - Davrina Rianda
- Human Nutrition Research Center, Indonesian Medical Education, and Research Center (HNRC-IMERI), Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Wanda Lasepa
- Human Nutrition Research Center, Indonesian Medical Education, and Research Center (HNRC-IMERI), Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Fitya S. Birahmatika
- Human Nutrition Research Center, Indonesian Medical Education, and Research Center (HNRC-IMERI), Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Vladimir Stajic
- Blackmores Institute, Blackmores Limited, Sydney, NSW, Australia
| | - Rachmi Mufida
- Human Nutrition Research Center, Indonesian Medical Education, and Research Center (HNRC-IMERI), Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| |
Collapse
|
22
|
Willemse JP, Smits LJ, Braat MM, Meertens LJ, van Montfort P, van Dongen MC, Ellerbrock J, van Dooren IM, Duvekot EJ, Zwaan IM, Spaanderman ME, Scheepers HC. Counseling pregnant women on calcium: effects on calcium intake. J Perinat Med 2023; 51:346-355. [PMID: 35998889 PMCID: PMC10010736 DOI: 10.1515/jpm-2021-0376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 07/29/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To evaluate the effect of incorporating calcium advice into early pregnancy counseling on calcium intake during pregnancy in the Netherlands. METHODS A multicenter prospective before-after cohort study was conducted introducing risk-based care including calculating individual pre-eclampsia risk. Part of the intervention was to incorporate calcium advice into routine counseling. We calculated individual daily calcium intake and adequacy of calcium intake (≥1,000 mg/day) at 16, 24 and 34 weeks of pregnancy. We performed a multiple logistic regression adjusting for covariates to identify any differences in the risk of inadequate calcium intake between RC and CAC. RESULTS In regular care (RC, 2013-2015, n=2,477) 60% had inadequate calcium intake, compared to 49% during calcium advice care (CAC, 2017-2018, n=774) (aOR 0.75, 95% CI 0.64-0.88). Specific calcium supplements were used by 2% and 29% in RC and CAC, respectively (OR 25.1, 95% CI 17.8-36.0). Determinants of an inadequate calcium intake were lower age (aOR per additional year 0.96, 95% CI: 0.94-0.98), nulliparity (aOR 1.22, 95% CI: 1.03-1.45) and non-Caucasian origin (aOR 1.83, 95% CI 1.09-3.09). In CAC, risk of inadequate intake decreased with increasing predicted pre-eclampsia risk, which was a trend reversal compared to RC. CONCLUSIONS Incorporating calcium advice into early pregnancy counseling was shown to lead to a decrease in the risk of inadequate calcium intake during pregnancy, but still inadequate intake in half of the women suggesting the need for further study on improving implementation. Awareness of individual increased PE risk had positive effect on calcium intake.
Collapse
Affiliation(s)
- Jessica P.M.M. Willemse
- Department of Epidemiology, CAPHRI Care and Public Health Research Institute, Maastricht UniversityMaastricht, The Netherlands
| | - Luc J.M. Smits
- Department of Epidemiology, CAPHRI Care and Public Health Research Institute, Maastricht UniversityMaastricht, The Netherlands
| | | | - Linda J.E. Meertens
- Department of Epidemiology, CAPHRI Care and Public Health Research Institute, Maastricht UniversityMaastricht, The Netherlands
| | - Pim van Montfort
- Department of Epidemiology, CAPHRI Care and Public Health Research Institute, Maastricht UniversityMaastricht, The Netherlands
| | - Martien C. van Dongen
- Department of Epidemiology, CAPHRI Care and Public Health Research Institute, Maastricht UniversityMaastricht, The Netherlands
| | - Jonas Ellerbrock
- Department of Obstetrics & Gynaecology, Zuyderland Medical CentreHeerlen, The Netherlands
| | - Ivo M.A. van Dooren
- Department of Obstetrics and Gynaecology, Sint Jans Gasthuis WeertWeert, The Netherlands
| | - Ella. J. Duvekot
- Department of Obstetrics and Gynaecology, VieCuri Medical CentreVenlo, The Netherlands
| | - Iris M. Zwaan
- Department of Obstetrics and Gynaecology, Laurentius Medical CentreRoermond, The Netherlands
| | - Marc E.A. Spaanderman
- Department of Obstetrics and Gynaecology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Hubertina C.J. Scheepers
- Department of Obstetrics and Gynaecology, Maastricht University Medical Centre, Maastricht, The Netherlands
- Grow, school for oncology and developmental biology, Maastricht University, Maastricht, The Netherlands
| |
Collapse
|
23
|
Cormick G, Settecase E, Wu ML, Nichols PM, Devia M, Dziarski A, Matamoros N, Puchulu MB, Belizán JM, Gibbons L. Calculation of the contribution of water to calcium intake in low- and middle-income countries. Ann N Y Acad Sci 2023; 1522:149-157. [PMID: 36841929 DOI: 10.1111/nyas.14973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2023]
Abstract
Dietary calcium intake is low in many countries, particularly in low- and middle-income countries (LMICs). Water is often overlooked as a source of dietary calcium despite it being universally consumed and providing good calcium bioavailability. Our objective was to assess water distribution systems in LMICs and to develop a formula to simulate the contribution of different water sources to calcium availability. We calculated the contribution of drinking water considering different calcium concentration levels to estimate total calcium availability. We consider a country's households' access to drinking water sources and the distribution of the country's population by age and gender. Calcium availability could be increased by an average of 49 mg of calcium per person per day in the 62 countries assessed if calcium in drinking water was considered. In 22 (31%) of the countries studied, 80% of households are supplied by water sources that could increase calcium availability. Improving calcium concentration in water could be considered as a strategy in LMICs to slightly improve calcium availability.
Collapse
Affiliation(s)
- Gabriela Cormick
- Centro de Investigaciones Epidemiológicas y Salud Pública (CIESP-IECS), CONICET, Buenos Aires, Argentina.,Department of Mother and Child Health Research, Institute for Clinical Effectiveness and Health Policy (IECS-CONICET), Buenos Aires, Argentina.,Departamento de Salud, Universidad Nacional de La Matanza (UNLAM), San Justo, Argentina
| | - Eugenia Settecase
- Department of Mother and Child Health Research, Institute for Clinical Effectiveness and Health Policy (IECS-CONICET), Buenos Aires, Argentina
| | - Michaella L Wu
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Paulina M Nichols
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Mara Devia
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Alisha Dziarski
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Natalia Matamoros
- Instituto de Desarrollo E Investigaciones Pediátricas "Prof. Dr. Fernando E. Viteri" Hospital de Niños "Sor María Ludovica de La Plata (IDIP), Ministerio de Salud/Comisión de Investigaciones Científicas de La Provincia de Buenos Aires, La Plata, Argentina
| | - María B Puchulu
- Universidad de Buenos Aires, Facultad de Medicina, Departamento de Ciencias Fisiológicas, Ciudad Autónoma de Buenos Aires, Buenos Aires, Argentina
| | - José M Belizán
- Centro de Investigaciones Epidemiológicas y Salud Pública (CIESP-IECS), CONICET, Buenos Aires, Argentina.,Department of Mother and Child Health Research, Institute for Clinical Effectiveness and Health Policy (IECS-CONICET), Buenos Aires, Argentina
| | - Luz Gibbons
- Department of Mother and Child Health Research, Institute for Clinical Effectiveness and Health Policy (IECS-CONICET), Buenos Aires, Argentina
| |
Collapse
|
24
|
Cormick G, Hofmeyr GJ, Kinshella MLW, Dadelszen P, Belizán JM, Magee LA. Mandatory food fortification with folic acid. Lancet Glob Health 2022; 10:e1393. [DOI: 10.1016/s2214-109x(22)00383-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 08/23/2022] [Indexed: 10/14/2022]
|
25
|
Shlisky J, Mandlik R, Askari S, Abrams S, Belizan JM, Bourassa MW, Cormick G, Driller‐Colangelo A, Gomes F, Khadilkar A, Owino V, Pettifor JM, Rana ZH, Roth DE, Weaver C. Calcium deficiency worldwide: prevalence of inadequate intakes and associated health outcomes. Ann N Y Acad Sci 2022; 1512:10-28. [PMID: 35247225 PMCID: PMC9311836 DOI: 10.1111/nyas.14758] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 01/26/2022] [Indexed: 12/18/2022]
Abstract
Dietary calcium deficiency is considered to be widespread globally, with published estimates suggesting that approximately half of the world's population has inadequate access to dietary calcium. Calcium is essential for bone health, but inadequate intakes have also been linked to other health outcomes, including pregnancy complications, cancers, and cardiovascular disease. Populations in low- and middle-income countries (LMICs) are at greatest risk of low calcium intakes, although many individuals in high-income countries (HICs) also do not meet recommendations. Paradoxically, many LMICs with lower calcium intakes show lower rates of osteoporotic fracture as compared with HICs, though data are sparse. Calcium intake recommendations vary across agencies and may need to be customized based on other dietary factors, health-related behaviors, or the risk of calcium-related health outcomes. The lack of standard methods to assess the calcium status of an individual or population has challenged efforts to estimate the prevalence of calcium deficiency and the global burden of related adverse health consequences. This paper aims to consolidate available evidence related to the global prevalence of inadequate calcium intakes and associated health outcomes, with the goal of providing a foundation for developing policies and population-level interventions to safely improve calcium intake and status where necessary.
Collapse
Affiliation(s)
| | - Rubina Mandlik
- Hirabai Cowasji Jehangir Medical Research InstitutePuneIndia
| | - Sufia Askari
- Children's Investment Fund FoundationLondonUnited Kingdom
| | | | - Jose M. Belizan
- Centro de Investigaciones en Epidemiología y Salud Pública (CIESP)Instituto de Efectividad Clínica y Sanitaria (IECS‐CONICET)Buenos AiresArgentina
| | | | - Gabriela Cormick
- Centro de Investigaciones en Epidemiología y Salud Pública (CIESP)Instituto de Efectividad Clínica y Sanitaria (IECS‐CONICET)Buenos AiresArgentina
| | | | - Filomena Gomes
- The New York Academy of SciencesNew YorkNew York
- NOVA Medical SchoolUniversidade NOVA de LisboaLisboaPortugal
| | | | - Victor Owino
- Division of Human HealthInternational Atomic Energy AgencyViennaAustria
| | - John M. Pettifor
- Faculty of Health SciencesUniversity of WitwatersrandJohannesburgSouth Africa
| | | | - Daniel E. Roth
- The Hospital for Sick Children/University of TorontoTorontoOntarioCanada
| | | |
Collapse
|
26
|
Mohamed HJJ, Loy SL, Mitra AK, Kaur S, Teoh AN, Rahman SHA, Amarra MS. Maternal diet, nutritional status and infant birth weight in Malaysia: a scoping review. BMC Pregnancy Childbirth 2022; 22:294. [PMID: 35387600 PMCID: PMC8988411 DOI: 10.1186/s12884-022-04616-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 03/21/2022] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Women's diet and nutritional status during pregnancy are important in influencing birth outcomes. We conducted a systematic scoping review of the best available evidence regarding dietary intake of Malaysian pregnant women, and the associations of maternal diet, anthropometry, and nutrition-related co-morbidities with the infant's birth weight (IBW). The study objectives were to examine: (1) the adequacy of micronutrient intake among pregnant women; and (2) the association of maternal factors (anthropometry, diet, plasma glucose and blood pressure) during pregnancy with IBW. METHODS Eleven search engines such as Proquest, EbscoHost, Scopus, Cochrane Library, Science Direct, Wiley Online Library, PubMed, Google Scholar, MyJournal, BookSC and Inter Library Loan with Medical Library Group were extensively searched to identify the primary articles. Three reviewers independently screened the abstracts and full articles based on the inclusion and exclusion criteria. Extracted data included details about the population characteristics, study methods and key findings related to the review objectives. Seventeen studies published from 1972 to 2021 were included, following the PRISMA-ScR guideline. RESULTS Studies showed that maternal micronutrient intakes including calcium, iron, vitamin D, folic acid, and niacin fell short of the national recommendations. Increased maternal fruit intake was also associated with increased birth weight. Factors associated with fetal macrosomia included high pre-pregnancy body mass index (BMI), excess gestational weight gain (GWG) and high blood glucose levels. Low pre-pregnancy BMI, inadequate GWG, intake of confectioneries and condiments, and high blood pressure were associated with low birth weight. CONCLUSION This review identified several factors such as the mother's food habits, comorbidities, BMI and gestational weight gain as the determinants of low birth weight. This implies that emphasis should be given on maternal health and nutrition for the birth outcome.
Collapse
Affiliation(s)
- Hamid Jan Jan Mohamed
- Nutrition and Dietetics Programme, School of Health Sciences, Universiti Sains Malaysia, Health Campus, 16150, Kubang Kerian, Kelantan, Malaysia.
| | - See Ling Loy
- Department of Reproductive Medicine, KK Women's and Children's Hospital, Singapore, 229899, Singapore.,Duke-NUS Medical School, Singapore, 169857, Singapore
| | - Amal K Mitra
- Nutrition and Dietetics Programme, School of Health Sciences, Universiti Sains Malaysia, Health Campus, 16150, Kubang Kerian, Kelantan, Malaysia.,Department of Epidemiology and Biostatistics, School of Public Health, College of Health Sciences, Jackson State University, Jackson, MS, 39213, USA
| | - Satvinder Kaur
- Faculty of Applied Sciences, UCSI University, Wilayah Persekutuan Kuala Lumpur, 56000, Kuala Lumpur, Malaysia
| | - Ai Ni Teoh
- Faculty of Applied Sciences, UCSI University, Wilayah Persekutuan Kuala Lumpur, 56000, Kuala Lumpur, Malaysia
| | - Siti Hamizah Abd Rahman
- Nutrition and Dietetics Programme, School of Health Sciences, Universiti Sains Malaysia, Health Campus, 16150, Kubang Kerian, Kelantan, Malaysia
| | - Maria Sofia Amarra
- Department of Food Science and Nutrition, University of the Philippines Diliman, 1101, Quezon City, Philippines.,School of Nutrition, Philippine Women's University, Taft Avenue, Manila, 1004, Philippines
| |
Collapse
|
27
|
Gomes F, Ashorn P, Askari S, Belizan JM, Boy E, Cormick G, Dickin KL, Driller‐Colangelo AR, Fawzi W, Hofmeyr GJ, Humphrey J, Khadilkar A, Mandlik R, Neufeld LM, Palacios C, Roth DE, Shlisky J, Sudfeld CR, Weaver C, Bourassa MW. Calcium supplementation for the prevention of hypertensive disorders of pregnancy: current evidence and programmatic considerations. Ann N Y Acad Sci 2022; 1510:52-67. [PMID: 35000200 PMCID: PMC9306576 DOI: 10.1111/nyas.14733] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 10/27/2021] [Accepted: 11/14/2021] [Indexed: 12/13/2022]
Abstract
Most low- and middle-income countries present suboptimal intakes of calcium during pregnancy and high rates of mortality due to maternal hypertensive disorders. Calcium supplementation during pregnancy is known to reduce the risk of these disorders and associated complications, including preeclampsia, maternal morbidity, and preterm birth, and is, therefore, a recommended intervention for pregnant women in populations with low dietary calcium intake (e.g., where ≥25% of individuals in the population have intakes less than 800 mg calcium/day). However, this intervention is not widely implemented in part due to cost and logistical issues related to the large dose and burdensome dosing schedule (three to four 500-mg doses/day). WHO recommends 1.5-2 g/day but limited evidence suggests that less than 1 g/day may be sufficient and ongoing trials with low-dose calcium supplementation (500 mg/day) may point a path toward simplifying supplementation regimens. Calcium carbonate is likely to be the most cost-effective choice, and it is not necessary to counsel women to take calcium supplements separately from iron-containing supplements. In populations at highest risk for preeclampsia, a combination of calcium supplementation and food-based approaches, such as food fortification with calcium, may be required to improve calcium intakes before pregnancy and in early gestation.
Collapse
Affiliation(s)
- Filomena Gomes
- Nutrition Science ProgramNew York Academy of SciencesNew York CityNew York
- NOVA Medical SchoolUniversidade NOVA de LisboaLisboaPortugal
| | - Per Ashorn
- Faculty of Medicine and Health TechnologyTampere University and Tampere University HospitalTampereFinland
| | | | - Jose M. Belizan
- Institute for Clinical Effectiveness and Health Policy/CONICETBuenos AiresArgentina
| | - Erick Boy
- International Food Policy Research InstituteWashingtonDistrict of Columbia
| | - Gabriela Cormick
- Institute for Clinical Effectiveness and Health Policy/CONICETBuenos AiresArgentina
| | | | | | - Wafaie Fawzi
- Harvard T.H. Chan School of Public HealthBostonMassachusetts
| | - G. Justus Hofmeyr
- University of BotswanaGaboroneBotswana
- University of the Witwatersrand and Walter Sisulu UniversityMthathaSouth Africa
| | - Jean Humphrey
- Johns Hopkins Bloomberg School of Public HealthBaltimoreMaryland
| | | | - Rubina Mandlik
- Hirabai Cowasji Jehangir Medical Research InstitutePuneIndia
| | | | | | - Daniel E. Roth
- The Hospital for Sick Children and University of TorontoTorontoOntarioCanada
| | - Julie Shlisky
- Nutrition Science ProgramNew York Academy of SciencesNew York CityNew York
| | | | | | - Megan W. Bourassa
- Nutrition Science ProgramNew York Academy of SciencesNew York CityNew York
| |
Collapse
|
28
|
Palacios A, Rojas-Roque C, Balan D, Sosa Estani I, Belizán JM, Cormick G, Augustovski F. Fortification of staple foods with calcium: a novel costing tool to inform decision making. Ann N Y Acad Sci 2022; 1513:79-88. [PMID: 35357714 DOI: 10.1111/nyas.14775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 03/04/2022] [Indexed: 11/30/2022]
Abstract
Low calcium intake and its impact on maternal and child health are a major concern in low- and middle-income countries. Given the low calcium in diet, as well as the low adherence and acceptability of calcium pills in those settings, the discussion about policies to increase calcium intake has moved toward staple food fortification strategies. Nevertheless, there is scarce information on the economic feasibility of implementing these strategies. We aimed to design and propose a novel costing tool to estimate the cost of the flour fortification with calcium by carrying out a literature review about costing studies for staple food fortification programs and costing tools previously developed. A deliberative meeting with stakeholders was held to discuss and face-validate the conceptual framework proposed. We showed the costing tool application for the case of Costa Rica (a country with a population with low calcium intake), including the absolute cost of the staple food fortification production process, the incremental cost of fortification according to the public/private sector, and the incremental cost by target population. This open-source and publicly available costing tool can be useful to inform policymaking in countries considering the implementation of staple food fortification programs.
Collapse
Affiliation(s)
- Alfredo Palacios
- Health Technology Assessment and Health Economics Department, Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
| | - Carlos Rojas-Roque
- Health Technology Assessment and Health Economics Department, Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
| | - Dario Balan
- Health Technology Assessment and Health Economics Department, Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
| | - Isabela Sosa Estani
- Health Technology Assessment and Health Economics Department, Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
| | - José M Belizán
- Department of Mother and Child Health Research, Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina.,Center for Research in Epidemiology and Public Health (CIESP), National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina
| | - Gabriela Cormick
- Department of Mother and Child Health Research, Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina.,Center for Research in Epidemiology and Public Health (CIESP), National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina.,Departamento de Salud, Universidad Nacional de La Matanza, San Justo, Argentina
| | - Federico Augustovski
- Health Technology Assessment and Health Economics Department, Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina.,Center for Research in Epidemiology and Public Health (CIESP), National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina.,University of Buenos Aires School of Medicine, Buenos Aires, Argentina
| |
Collapse
|
29
|
Tihtonen K, Korhonen P, Isojärvi J, Ojala R, Ashorn U, Ashorn P, Tammela O. Calcium supplementation during pregnancy and maternal and offspring bone health: a systematic review and meta-analysis. Ann N Y Acad Sci 2022; 1509:23-36. [PMID: 34780069 PMCID: PMC9298950 DOI: 10.1111/nyas.14705] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 09/26/2021] [Indexed: 11/29/2022]
Abstract
Insufficient calcium intake during pregnancy may lead to maternal bone resorption and lower bone density of offspring. We evaluated the impact of supplementary calcium with or without vitamin D during pregnancy on maternal and offspring bone mineral density (BMD) and teeth firmness of the offspring. Randomized controlled trials (RCTs) were searched systematically in 11 databases. Two researchers independently screened the titles and abstracts of 3555 records and the full texts of 31 records to examine eligibility. The search yielded seven RCTs (11 reports, n = 1566). No advantage of calcium supplementation was found on maternal BMD after delivery or during breastfeeding, or on offspring BMD, even when dietary calcium intake was low. The results were neither modified by the dose of calcium nor concomitant vitamin D administration. A suspicion of some long-term harm of the intervention on maternal BMD and growth of female offspring was raised based on the data. One study suggested some benefit of high-dose calcium supplementation on offspring teeth firmness at 12 years old. A low number of the studies and abundant missing data reduced the quality of the findings. The impact of calcium supplementation on maternal and offspring bone health was deemed unknown because of inconclusive research results.
Collapse
Affiliation(s)
- Kati Tihtonen
- Department of Obstetrics and GynecologyTampere University HospitalTampereFinland
- Faculty of Medicine and Health Technology, Center for Child, Adolescent, and Maternal Health ResearchTampere UniversityTampereFinland
| | - Päivi Korhonen
- Faculty of Medicine and Health Technology, Center for Child, Adolescent, and Maternal Health ResearchTampere UniversityTampereFinland
- Department of PediatricsTampere University HospitalTampereFinland
| | | | - Riitta Ojala
- Faculty of Medicine and Health Technology, Center for Child, Adolescent, and Maternal Health ResearchTampere UniversityTampereFinland
- Department of PediatricsTampere University HospitalTampereFinland
| | - Ulla Ashorn
- Faculty of Medicine and Health Technology, Center for Child, Adolescent, and Maternal Health ResearchTampere UniversityTampereFinland
| | - Per Ashorn
- Faculty of Medicine and Health Technology, Center for Child, Adolescent, and Maternal Health ResearchTampere UniversityTampereFinland
- Department of PediatricsTampere University HospitalTampereFinland
| | - Outi Tammela
- Faculty of Medicine and Health Technology, Center for Child, Adolescent, and Maternal Health ResearchTampere UniversityTampereFinland
- Department of PediatricsTampere University HospitalTampereFinland
| |
Collapse
|
30
|
Cormick G, Gibbons L, Belizán JM. Impact of water fortification with calcium on calcium intake in different countries: a simulation study. Public Health Nutr 2022; 25:344-357. [PMID: 32744224 PMCID: PMC8883601 DOI: 10.1017/s1368980020002232] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 05/28/2020] [Accepted: 06/12/2020] [Indexed: 01/02/2023]
Abstract
OBJECTIVE To simulate the impact - effectiveness and safety - of water fortification with different concentrations of Ca using the Intake Modelling, Assessment and Planning Program. DESIGN This is a secondary analysis of national or sub-national dietary intake databases. SETTING AND PARTICIPANTS Uganda, Lao People's Democratic Republic (PDR), Bangladesh, Zambia, Argentina, USA and Italy. RESULTS We found that for dietary databases assessed from low- and middle-income countries (LMIC), the strategy of fortifying water with 500 mg of Ca/l would decrease the prevalence of low Ca intake in all age groups. We also found that this strategy would be safe as no group would present a percentage of individuals exceeding the upper limit in >2 %, except women aged 19-31 years in Lao PDR, where 6·6 % of women in this group would exceed the upper limit of Ca intake. The same strategy would lead to some groups exceeding the upper limit in USA and Italy. CONCLUSIONS We found that for most LMIC countries, water fortified with Ca could decrease the prevalence of Ca intake inadequacy without exceeding the upper levels of Ca intake.
Collapse
Affiliation(s)
- Gabriela Cormick
- Department of Mother and Child Health Research, Institute for Clinical Effectiveness and Health Policy (IECS-CONICET), Buenos Aires1414, Argentina
- Departamento de Salud, Universidad Nacional de La Matanza, San Justo1754, Argentina
| | - Luz Gibbons
- Department of Mother and Child Health Research, Institute for Clinical Effectiveness and Health Policy (IECS-CONICET), Buenos Aires1414, Argentina
| | - Jose M Belizán
- Department of Mother and Child Health Research, Institute for Clinical Effectiveness and Health Policy (IECS-CONICET), Buenos Aires1414, Argentina
| |
Collapse
|
31
|
Cormick G, Matamoros N, Romero IB, Perez SM, White C, Watson DZ, Belizán JM, Sosa M, Gugole Ottaviano MF, Elizagoyen E, Garitta L. Testing for sensory threshold in drinking water with added calcium: a first step towards developing a calcium fortified water. Gates Open Res 2022; 5:151. [PMID: 35071994 PMCID: PMC8753188 DOI: 10.12688/gatesopenres.13361.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2021] [Indexed: 11/20/2022] Open
Abstract
Background: Food fortification is an effective strategy that has been recommended for improving population calcium inadequate intakes. Increasing calcium concentration of water has been proposed as a possible strategy to improve calcium intake. The objective of this study was to determine the sensory threshold of different calcium salts added to drinking water using survival analysis. Methods: We performed the triangle test methodology for samples of water with added calcium using three different calcium salts: calcium chloride, calcium gluconate and calcium lactate. For each salt, a panel of 54 consumers tested seven batches of three water samples. Data were adjusted for chance and sensory threshold was estimated using the survival methodology and a discrimination of 50%. Results: The threshold value estimation for calcium gluconate was 587 ± 131 mg/L of water, corresponding to 25% discrimination, for calcium lactate was 676 ± 186 mg/L, corresponding to 50% discrimination, and for calcium chloride was 291 ± 73 mg/L, corresponding to 50% discrimination. Conclusions: These results show that water with calcium added in different salts and up to a concentration of 500 mg of calcium/L of water is feasible. The calcium salt allowing the highest calcium concentration with the lowest perceived changes in taste was calcium gluconate. Future studies need to explore stability and acceptability over longer periods of time.
Collapse
Affiliation(s)
- Gabriela Cormick
- Department of Mother and Child Health Research, Institute for Clinical Effectiveness and Health Policy (IECS-CONICET), Ciudad de Buenos Aires, 1414, Argentina
- Centro de Investigaciones en Epidemiología y Salud Pública (CIESP-IECS), Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Ciudad de Buenos Aires, 1414, Argentina
- Departamento de Ciencias de la Salud, Universidad Nacional de La Matanza (UNLaM), San Justo, 1754, Argentina
| | - Natalia Matamoros
- Instituto de Desarrollo E Investigaciones Pediátricas "Prof. Dr. Fernando E. Viteri" Hospital de Niños "Sor María Ludovica de La Plata (IDIP), Ministerio de Salud/Comisión de Investigaciones Científicas de La Provincia de Buenos Aires, La Plata, 1900, Argentina
| | - Iris B. Romero
- Departamento de Ciencias de la Salud, Universidad Nacional de La Matanza (UNLaM), San Justo, 1754, Argentina
| | - Surya M. Perez
- Departamento de Ciencias de la Salud, Universidad Nacional de La Matanza (UNLaM), San Justo, 1754, Argentina
| | - Cintia White
- Departamento de Ciencias de la Salud, Universidad Nacional de La Matanza (UNLaM), San Justo, 1754, Argentina
| | - Dana Z. Watson
- Departamento de Ciencias de la Salud, Universidad Nacional de La Matanza (UNLaM), San Justo, 1754, Argentina
| | - José M. Belizán
- Department of Mother and Child Health Research, Institute for Clinical Effectiveness and Health Policy (IECS-CONICET), Ciudad de Buenos Aires, 1414, Argentina
- Centro de Investigaciones en Epidemiología y Salud Pública (CIESP-IECS), Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Ciudad de Buenos Aires, 1414, Argentina
| | - Miriam Sosa
- Departamento de Evaluación Sensorial de Alimentos (DESA), Instituto Superior Experimental de Tecnología Alimentaria (ISETA), 9 de Julio, Buenos Aires, Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
| | - M. Fernanda Gugole Ottaviano
- Departamento de Evaluación Sensorial de Alimentos (DESA), Instituto Superior Experimental de Tecnología Alimentaria (ISETA), 9 de Julio, Buenos Aires, Argentina
- Comisión de Investigaciones Científicas de la provincia de Buenos Aires (CIC), Buenos Aires, Argentina
| | - Eliana Elizagoyen
- Departamento de Evaluación Sensorial de Alimentos (DESA), Instituto Superior Experimental de Tecnología Alimentaria (ISETA), 9 de Julio, Buenos Aires, Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
| | - Lorena Garitta
- Departamento de Evaluación Sensorial de Alimentos (DESA), Instituto Superior Experimental de Tecnología Alimentaria (ISETA), 9 de Julio, Buenos Aires, Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
| |
Collapse
|
32
|
Benini C, Esposito D, Adami G, Vantaggiato E, Gatti D, Rossini M, Fassio A. Calcium and vitamin D supplementation: when and why. Minerva Obstet Gynecol 2021; 73:704-713. [PMID: 34905876 DOI: 10.23736/s2724-606x.20.04682-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Osteoporosis is a common disease, with fragility fractures representing its dreaded complications. The role of calcium and vitamin D supplementation needs to be addressed in the context of a heavy health burden, with a massive impact on individuals, healthcare systems, and societies as a whole. Calcium and vitamin D are often discussed together as interventions for promoting bone health. Still, it is essential to remember that they are quite distinct entities that play different roles in mineral metabolism. Insufficient calcium intake and vitamin D deficiency are common and widespread. Furthermore, a strong association between vitamin D deficiency and extra-skeletal outcomes has emerged over the last decades. When dietary intake is insufficient, with little room for improvement, several supplementation strategies have proved to be effective and safe. Adequate calcium intake and vitamin D serum levels should be pursued efficiently in the general population, and deficiency should be considered unacceptable in subsets particularly at risk. The aim of this narrative review was to present an overview of calcium and vitamin D intake and their supplementation.
Collapse
Affiliation(s)
- Camilla Benini
- Unit of Rheumatology, University of Verona, Verona, Italy
| | | | - Giovanni Adami
- Unit of Rheumatology, University of Verona, Verona, Italy
| | | | - Davide Gatti
- Unit of Rheumatology, University of Verona, Verona, Italy
| | | | - Angelo Fassio
- Unit of Rheumatology, University of Verona, Verona, Italy -
| |
Collapse
|
33
|
[Synthesis of evidence and recommendations for the management of calcium supplementation before and during pregnancy for the prevention of preeclampsia and its complicationsSíntese de evidências e recomendações para o manejo da suplementação com cálcio antes e durante a gravidez para a prevenção da pré-eclâmpsia e de suas complicações]. Rev Panam Salud Publica 2021; 45:e134. [PMID: 34737771 PMCID: PMC8559666 DOI: 10.26633/rpsp.2021.134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 08/18/2021] [Indexed: 11/24/2022] Open
Abstract
Introducción. La preeclampsia es una de las principales causas de morbimortalidad maternofetal en el mundo. La suplementación con calcio ha demostrado prevenir este trastorno y, por lo tanto, es importante contar con guías que emitan recomendaciones respecto de su uso. Objetivos. Sintetizar las recomendaciones relacionadas con la preeclampsia desarrolladas por la Organización Mundial de la Salud (OMS) con el fin de mejorar la calidad del cuidado y desenlaces en salud de las mujeres en edad reproductiva y embarazadas, y abordar aspectos sobre su implementación. Métodos. Las guías elaboradas por la OMS siguen los métodos de elaboración de las guías GRADE (Grading of Recommendations Assessment Development and Evaluation) del Manual para la elaboración de directrices de la OMS. Se llevó a cabo una síntesis de las recomendaciones de dos guías de la OMS. Además, se realizó una búsqueda sistemática en PubMed, Lilacs, Health Systems Evidence, Epistemonikos y literatura gris de estudios desarrollados en la Región de las Américas con el fin de identificar barreras, facilitadores y estrategias de implementación, así como determinar indicadores. Resultados. Se formularon dos recomendaciones relacionadas con preeclampsia, eclampsia y sus complicaciones para aplicar antes y durante el embarazo. Se identificaron barreras, facilitadores para la implementación y se crearon indicadores de adherencia y resultado. Conclusiones. Las recomendaciones formuladas buscan proveer orientación sobre cómo prevenir la preeclampsia a través del consumo de calcio con consideraciones para su implementación en América Latina y el Caribe.
Collapse
|
34
|
Cormick G, Matamoros N, Romero IB, Perez SM, White C, Watson DZ, Belizán JM, Sosa M, Gugole Ottaviano MF, Elizagoyen E, Garitta L. Testing for sensory threshold in drinking water with added calcium: a first step towards developing a calcium fortified water. Gates Open Res 2021; 5:151. [DOI: 10.12688/gatesopenres.13361.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/06/2021] [Indexed: 11/20/2022] Open
Abstract
Background: Food fortification is an effective strategy that has been recommended for improving population calcium inadequate intakes. Increasing calcium concentration of water has been proposed as a possible strategy to improve calcium intake. The objective of this study was to determine the sensory threshold of different calcium salts added to drinking water using survival analysis. Methods: We performed the triangle test methodology for samples of water with added calcium using three different calcium salts: calcium chloride, calcium gluconate and calcium lactate. For each salt, a panel of 54 consumers tested seven batches of three water samples. Data were adjusted for chance and sensory threshold was estimated using the survival methodology and a discrimination of 50%. Results: The threshold value estimation for calcium gluconate was 587 ± 131 mg/L of water, corresponding to 25% discrimination, for calcium lactate was 676 ± 186 mg/L, corresponding to 50% discrimination, and for calcium chloride was 291 ± 73 mg/L, corresponding to 50% discrimination. Conclusions: These results show that water with calcium added in different salts and up to a concentration of 500 mg of calcium/L of water is feasible. The calcium salt allowing the highest calcium concentration with the lowest perceived changes in taste was calcium gluconate. Future studies need to explore stability and acceptability over longer periods of time.
Collapse
|
35
|
Kaneshapillai A, Hettiaratchi U, Prathapan S, Liyanage G. Parathyroid hormone in Sri Lankan pregnant women: Vitamin D and other determinants. PLoS One 2021; 16:e0258381. [PMID: 34624060 PMCID: PMC8500411 DOI: 10.1371/journal.pone.0258381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Accepted: 09/26/2021] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Determinants of parathyroid hormone level during pregnancy have been less frequently studied. We aimed to describe the serum parathyroid hormone (PTH) and its determinants in Sri Lankan pregnant women in a community setting. MATERIALS AND METHODS In this cross-sectional analysis, 390 pregnant mothers in their third trimester were enrolled from primary care centers of 15 health divisions in the Colombo District in Sri Lanka. Venous blood was analyzed for a total 25-hydroxyvitamin-D [25(OH)D], serum parathyroid hormone (PTH), serum calcium, and alkaline phosphatase. The bone quality was assessed in terms of speed of sound (SOS) using the quantitative ultrasound scan (QUS). Univariate and multivariate regression analysis was used to examine the determinants of PTH concentration in blood. RESULTS Median serum 25(OH)D was 17.5ng/mL. Most (61.6%) were vitamin D deficient (<20ng/mL). Median PTH was 23.7pg/mL. Only 0.8% had hyperparathyroidism (PTH >65pg/mL). The correlation between 25(OH)D and PTH was weak but significant (r = -0.197; p<0.001). SOS Z-score was below the cut-off (≤-2) in fifty-six women (14.7%), and SOS did not relate significantly to PTH. In regression analysis, serum 25(OH)D, serum calcium, body mass index, educational level, and weeks of pregnancy were significant independent variables when adjusted. The model explained 16% of the variation in the PTH level. CONCLUSIONS A high prevalence of vitamin D deficiency was observed among Sri Lankan pregnant women in the present study. Serum 25(OH)D, calcium, weeks of pregnancy, and educational level were determinants of serum PTH.
Collapse
Affiliation(s)
- Anusha Kaneshapillai
- Department of Biochemistry, Faculty of Medical Sciences, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
| | - Usha Hettiaratchi
- Department of Biochemistry, Faculty of Medical Sciences, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
| | - Shamini Prathapan
- Department of Community Medicine, Faculty of Medical Sciences, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
| | - Guwani Liyanage
- Department of Paediatrics, Faculty of Medical Sciences, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
| |
Collapse
|
36
|
Cormick G, Betrán AP, Harbron J, Seuc A, White C, Roberts JM, Belizán JM, Hofmeyr GJ. The Effect of Calcium Supplementation on Body Weight Before and During Pregnancy in Women Enrolled in the WHO Calcium and Preeclampsia Trial. Food Nutr Bull 2021; 41:332-342. [PMID: 33200626 DOI: 10.1177/0379572120944671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Obesity is a major and challenging public health problem. The aim of this substudy is to evaluate the effect of calcium supplementation on body weight in women recruited in the Calcium and Preeclampsia trial. METHODS Women were recruited before pregnancy and randomized to receive a calcium supplement containing 500 mg of elemental calcium or placebo until 20 weeks' gestation; all women received 1.5 g from 20 weeks until delivery. RESULTS A total of 630 women conceived during the study, 322 allocated to calcium and 308 to placebo. Among these, 230 allocated to calcium and 227 allocated to placebo had information on body weight at baseline and at 8 weeks' gestation. During the study period, women allocated to calcium had a mean weight increase of 1.1 (SD ±5.5) kg, whereas those allocated to placebo had a mean increase of 1.5 (SD ±6.1) kg, a mean difference of 0.4 kg (95% -0.4 (-1.4 to 0.6); P = .408). Women classified as obese at the start of the trial had a lower body weight gain at 8 weeks' gestation (1.0 kg; 95% CI: -3.2 to 1.2; P = .330) and at 32 weeks' gestation (2.1 kg; 95% CI: 5.6-1.3; P = .225) if they received calcium as compared to placebo. However, none of these differences were statistically significant. CONCLUSION The smaller increase in body weight found in women supplemented with 500 mg elemental calcium daily is quantitatively consistent with previous studies. However, in this study, the difference was not statistically significant.
Collapse
Affiliation(s)
- Gabriela Cormick
- Department of Mother and Child Health Research, 172472Institute for Clinical Effectiveness and Health Policy (IECS-CONICET), Buenos Aires, Argentina.,Department of Human Biology, Faculty of Health Sciences, 37716University of Cape Town, South Africa.,Departamento de Salud, 28224Universidad Nacional de La Matanza, San Justo, Argentina
| | - Ana Pilar Betrán
- HRP-UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Reproductive Health and Research, 3489World Health Organization, Geneva, Switzerland
| | - Janetta Harbron
- Department of Human Biology, Faculty of Health Sciences, 37716University of Cape Town, South Africa
| | - Armando Seuc
- 217256Instituto Nacional de Higiene, Epidemiología y Microbiología, La Habana, Cuba
| | - Cintia White
- Departamento de Salud, 28224Universidad Nacional de La Matanza, San Justo, Argentina
| | - James M Roberts
- Magee-Womens Research Institute, Department of Obstetrics and Gynecology, Epidemiology and Clinical and Translational Research 6614University of Pittsburgh, PA, USA
| | - Jose M Belizán
- Department of Mother and Child Health Research, 172472Institute for Clinical Effectiveness and Health Policy (IECS-CONICET), Buenos Aires, Argentina
| | - G Justus Hofmeyr
- Effective Care Research Unit, 37707Universities of the Witwatersrand, Walter Sisulu and Fort Hare, South Africa.,University of Botswana, Gaborone, Botswana
| |
Collapse
|
37
|
Belizán JM, Gibbons L, Cormick G. Maternal mortality reduction: a need to focus actions on the prevention of hypertensive disorders of pregnancy. Int J Equity Health 2021; 20:194. [PMID: 34454497 PMCID: PMC8403409 DOI: 10.1186/s12939-021-01535-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 08/12/2021] [Indexed: 12/28/2022] Open
Abstract
Maternal mortality (MM) reflects one of the most striking global health inequalities. Global figures of MM fell significantly from 1990 to 2017. The reduction was largely due to a 70% fall in haemorrhages, and a limited (18.2%) improvement in hypertensive disorders of pregnancy (HDP). If this trend continues, by 2021 HDP will be the main cause of global MM.MM reductions due to haemorrhage is reassuring, however MM due to HDP show a more complex situation as early detection of HDP requires regular contact of pregnant women with the health system. In order to reduce MM due to HDP, population wide preventive actions such as low dose aspirin and adequate calcium intake are required, especially in areas where women have little contact with the health systems.Calcium supplementation for women with low calcium intake has reduced the risk of pre-eclampsia, with further reductions starting daily supplementation with 500 mg of calcium preconceptionally, however adherence to supplementation is limited.To reduce global inequities in calcium intake and consequently in the HDP, food fortification seem to be an attractive strategy to achieve an increase of calcium intake.
Collapse
Affiliation(s)
- José M Belizán
- Centro de Investigaciones Epidemiológicas y Salud Pública (CIESP-IECS), CONICET, 1414, Ciudad de Buenos Aires, Argentina
- Department of Mother and Child Health Research, Institute for Clinical Effectiveness and Health Policy (IECS-CONICET), 1414, Ciudad de Buenos Aires, Argentina
| | - Luz Gibbons
- Department of Mother and Child Health Research, Institute for Clinical Effectiveness and Health Policy (IECS-CONICET), 1414, Ciudad de Buenos Aires, Argentina
| | - Gabriela Cormick
- Centro de Investigaciones Epidemiológicas y Salud Pública (CIESP-IECS), CONICET, 1414, Ciudad de Buenos Aires, Argentina.
- Department of Mother and Child Health Research, Institute for Clinical Effectiveness and Health Policy (IECS-CONICET), 1414, Ciudad de Buenos Aires, Argentina.
- Departamento de Salud, Universidad Nacional de La Matanza (UNLAM), 1903, San Justo, Argentina.
| |
Collapse
|
38
|
No effect of calcium and vitamin D intake on maternal blood pressure in a healthy pregnant population. Eur J Obstet Gynecol Reprod Biol 2021; 264:8-14. [PMID: 34271366 DOI: 10.1016/j.ejogrb.2021.07.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Revised: 06/27/2021] [Accepted: 07/04/2021] [Indexed: 11/23/2022]
Abstract
OBJECTIVES Clinical studies have reported an inverse relationship between calcium and vitamin D intake and hypertensive disorders of pregnancy (HDP). The aim of this study was to investigate if there was an association between calcium/vitamin D intake, and vitamin D (25OHD) status, and maternal blood pressure (BP), during pregnancy and at 5-year follow-up. STUDY DESIGN This was an observational study of 415 women who participated in the ROLO (Randomised cOntrolled trial of LOw glycaemic index diet for the prevention of recurrence of macrosomia) study. Maternal BP measurements were taken during each trimester and at 5-year follow-up. Calcium and vitamin D intake were determined at each trimester and 25OHD was measured in early and late pregnancy. RESULTS Over two-thirds of the cohort were vitamin D sufficient (25OHD > 30 nmol/L) and had adequate calcium intake (>750 mg/day). There was no correlation between calcium intake or vitamin D intake and maternal BP in trimester 1 to 3 or at 5-year follow-up. Vitamin D status at 13 weeks' gestation negatively correlated with mean arterial pressure in trimester 1 (r = -0.152, p = 0.044). There was no correlation however between 25OHD at 28 weeks' gestation and BP at 28 or 34 weeks' gestation or 25OHD and BP at 5-year follow-up. CONCLUSIONS In a healthy population of women with adequate calcium and vitamin D intake, no clinically significant correlation existed between calcium and vitamin D and maternal BP.
Collapse
|
39
|
Cormick G, Betran AP, Romero IB, García‐Casal MN, Perez SM, Gibbons L, Belizán JM. Impact of flour fortification with calcium on calcium intake: a simulation study in seven countries. Ann N Y Acad Sci 2021; 1493:59-74. [PMID: 33432622 PMCID: PMC9290501 DOI: 10.1111/nyas.14550] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 11/13/2020] [Accepted: 11/19/2020] [Indexed: 12/27/2022]
Abstract
Calcium intake is low in many countries, especially in low-income countries. Our objective was to perform a simulation exercise on the impact, effectiveness, and safety of a flour fortification strategy using the Intake Modelling, Assessment, and Planning Program. Modeling of calcium fortification scenarios was performed with available dietary intake databases from Argentina, Bangladesh, Italy, the Lao People's Democratic Republic (Lao PDR), Uganda, Zambia, and the United States. This theoretical exercise showed that simulating a fortification with 156 mg of calcium per 100 g of flour would decrease the prevalence of low calcium intake, and less than 2% of the individuals would exceed the recommended calcium upper limit (UL) in Argentina, Italy, Uganda, and Zambia. Bangladesh and the Lao PDR showed little impact, as flour intake is uncommon. By contrast, in the United States, this strategy would lead to some population groups exceeding the UL. This exercise should be replicated and adapted to each country, taking into account the updated prevalence of calcium inadequacy, flour consumption, and technical compatibility between calcium and the flour-type candidate for fortification. A fortification plan should consider the impact on all age groups to avoid the risk of exceeding the upper levels of calcium intake.
Collapse
Affiliation(s)
- Gabriela Cormick
- Department of Mother and Child Health ResearchInstitute for Clinical Effectiveness and Health Policy (IECS‐CONICET)Buenos AiresArgentina
- Departamento de SaludUniversidad Nacional de La Matanza (UNLAM)San JustoArgentina
| | - Ana Pilar Betran
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and ResearchWorld Health OrganizationGenevaSwitzerland
| | - Iris B. Romero
- Departamento de SaludUniversidad Nacional de La Matanza (UNLAM)San JustoArgentina
| | | | - Surya M. Perez
- Departamento de SaludUniversidad Nacional de La Matanza (UNLAM)San JustoArgentina
| | - Luz Gibbons
- Department of Mother and Child Health ResearchInstitute for Clinical Effectiveness and Health Policy (IECS‐CONICET)Buenos AiresArgentina
| | - José M. Belizán
- Department of Mother and Child Health ResearchInstitute for Clinical Effectiveness and Health Policy (IECS‐CONICET)Buenos AiresArgentina
| |
Collapse
|
40
|
Hofmeyr GJ, Seuc A, Betrán AP, Cormick G, Singata M, Fawcus S, Mose S, Frank K, Hall D, Belizán J, Roberts JM, Magee LA, von Dadelszen P. The effect of calcium supplementation on blood pressure in non-pregnant women with previous pre-eclampsia: A randomized placebo-controlled study. Pregnancy Hypertens 2021; 23:91-96. [PMID: 33302116 PMCID: PMC7910271 DOI: 10.1016/j.preghy.2020.11.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 11/27/2020] [Accepted: 11/27/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND Low dietary calcium is associated with the hypertensive disorders of pregnancy, and evidence suggests that the risks associated with pre-eclampsia are reduced by calcium supplementation. In the general (non-pregnant) population, low dietary calcium intake is associated with hypertension with inconsistent evidence that calcium supplementation may reduce blood pressure. Women with pre-eclampsia are also at risk of hypertension later in life. An exploratory sub-study among early participants enrolled in the WHO long-term calcium supplementation in women at high risk of pre-eclampsia (CAP) study reported a trend to more blood pressure reduction with calcium in non-pregnant women with previous severe as opposed to non-severe pre-eclampsia. The current study reports the effects of low-dose calcium supplementation in non-pregnant women in the complete trial cohort. METHODS The CAP Study was a multi-country randomized, double-blind placebo-controlled clinical trial to test the hypothesis that calcium deficiency may play a role in the genesis of pre-eclampsia in early pregnancy. From 2011 to 2016, non-pregnant women who had pre-eclampsia or eclampsia in their most recent pregnancy were randomized to receive either 500 mg/day elemental calcium or placebo. In this sub-study we compared the change in blood pressure from baseline to the 12-week visit between participants receiving calcium versus placebo for those not pregnant at the 12-week visit. RESULTS Of 1355 women randomized, 810 attended a 12-week visit without being pregnant, of whom 791 had blood pressure measurements available for both baseline and 12-week visits. There was a greater reduction in blood pressure in the calcium group compared with the placebo group for systolic pressure (difference 3.1 mmHg, 95% CI 0.8 to 5.4) and mean arterial pressure (MAP) (difference 2.0 mmHg, 95% CI 0.1 to 3.8). The difference in diastolic blood pressure reduction (1.4 mmHg, 95% CI -0.5 to 3.3) was not statistically significant (p = 0.140). For women with previous pre-eclampsia with severe features (n = 447), there was significantly greater reduction in blood pressure in the calcium than the placebo group (difference for systolic 4.0, 95% CI 0.7 to 7.3; diastolic 3.0, 95% CI 0.5 to 5.5 and mean arterial pressure 3.3, 95% CI 0.8 to 5.9 mmHg). For women with previous pre-eclampsia without severe features (n = 344), there were no significant differences between calcium and placebo groups. ANOVA analysis found no statistically significant interaction between previous pre-eclampsia severity and treatment, for systolic (p = 0.372), diastolic (p = 0.063) or mean blood pressure (p = 0.103). CONCLUSIONS Low-dose calcium supplementation significantly reduced systolic and mean arterial pressure in non-pregnant women with previous pre-eclampsia. We did not confirm a greater calcium effect in women with previous pre-eclampsia with severe versus non-severe features. The effect of low-dose calcium is of importance since even modest blood pressure reductions at a population level may have important benefits in terms of reduced major complications of hypertension. This study adds to the mounting evidence of health benefits which could be achieved for populations with low dietary calcium through strategies to increase calcium intake, particularly among women at high risk due to previous pre-eclampsia. CLINICAL TRIAL REGISTRATION The trial was registered with the Pan-African Clinical Trials Registry, registration number PACTR201105000267371 (https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=267).
Collapse
Affiliation(s)
- G Justus Hofmeyr
- Effective Care Research Unit, Eastern Cape Department of Health/Universities of the Witwatersrand, Walter Sisulu and Fort Hare, South Africa; University of Botswana, Gaborone, Botswana
| | - Armando Seuc
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Ana Pilar Betrán
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland.
| | - Gabriela Cormick
- Department of Mother and Child Health Research, Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
| | - Mandisa Singata
- Effective Care Research Unit, Eastern Cape Department of Health/Universities of the Witwatersrand, Walter Sisulu and Fort Hare, South Africa; University of Botswana, Gaborone, Botswana
| | - Sue Fawcus
- Department of Obstetrics and Gynaecology, University of Cape Town, Cape Town, South Africa
| | - Simpiwe Mose
- Department of Obstetrics and Gynaecology, Chris Hani Baragwanath Hospital, University of the Witwatersrand, Soweto, Johannesburg, South Africa
| | - Karlyn Frank
- Department of Obstetrics and Gynaecology, Chris Hani Baragwanath Hospital, University of the Witwatersrand, Soweto, Johannesburg, South Africa
| | - David Hall
- Department of Obstetrics and Gynaecology, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - José Belizán
- Department of Mother and Child Health Research, Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
| | - James M Roberts
- Magee-Womens Research Institute, Department of Obstetrics and Gynecology, Epidemiology and Clinical and Translational Research University of Pittsburgh, Pittsburgh, USA
| | - Laura A Magee
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK
| | - Peter von Dadelszen
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK
| |
Collapse
|
41
|
Rodrigues Amorim Adegboye A, Dias Santana D, Teixeira dos Santos PP, Guedes Cocate P, Benaim C, Trindade de Castro MB, Maia Schlüssel M, Kac G, Lilienthal Heitmann B. Exploratory Efficacy of Calcium-Vitamin D Milk Fortification and Periodontal Therapy on Maternal Oral Health and Metabolic and Inflammatory Profile. Nutrients 2021; 13:783. [PMID: 33673568 PMCID: PMC7997467 DOI: 10.3390/nu13030783] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Revised: 02/21/2021] [Accepted: 02/24/2021] [Indexed: 12/16/2022] Open
Abstract
In this 2 × 2 factorial, outcome-assessor blinded, feasibility randomised trial we explored the effect of a non-pharmaceutical multi-component intervention on periodontal health and metabolic and inflammatory profiles among pregnant women with periodontitis receiving prenatal care in a Brazilian public health centre. 69 pregnant women (gestational age ≤20 weeks, T0) were randomly allocated into four groups: (1) fortified sachet (vitamin D and calcium) and powdered milk plus periodontal therapy during pregnancy (early PT) (n = 17); (2) placebo sachet and powdered milk plus early PT (n = 15); (3) fortified sachet and powdered milk plus late PT (after delivery) (n = 19); (4) placebo sachet and powdered milk plus late PT (n = 18). Third trimester (T1) and 6-8 weeks postpartum (T2) exploratory outcomes included periodontal health (% sites with bleeding on probing (BOP)), glucose, insulin, C-Reactive Protein, serum calcium and vitamin D. The mean BOP was significantly reduced in the early PT groups, while BOP worsened in the late PT groups. No significant effect of fortification on BOP was observed. Changes in glucose levels and variation on birthweight did not differ among groups This feasibility trial provides preliminary evidence for estimating the minimum clinically important differences for selected maternal outcomes. A large-scale trial to evaluate the interventions' clinical benefits and cost-effectiveness is warranted.
Collapse
Affiliation(s)
- Amanda Rodrigues Amorim Adegboye
- Faculty of Health and Life Sciences, School of Nursing, Midwifery and Health, Coventry University, Priory Street, Coventry CV1 5FB, UK
| | - Danilo Dias Santana
- Nutritional Epidemiology Observatory, Department of Social and Applied Nutrition, Institute of Nutrition Josué de Castro, Federal University of Rio de Janeiro, Rio de Janeiro 21941-902, Brazil; (D.D.S.); (P.P.T.d.S.); (C.B.); (M.B.T.d.C.); (G.K.)
| | - Pedro Paulo Teixeira dos Santos
- Nutritional Epidemiology Observatory, Department of Social and Applied Nutrition, Institute of Nutrition Josué de Castro, Federal University of Rio de Janeiro, Rio de Janeiro 21941-902, Brazil; (D.D.S.); (P.P.T.d.S.); (C.B.); (M.B.T.d.C.); (G.K.)
| | - Paula Guedes Cocate
- Department of Bioscience and Physical Activity, School of Physical Education and Sports, Federal University of Rio de Janeiro, Rio de Janeiro 21941-599, Brazil;
| | - Camila Benaim
- Nutritional Epidemiology Observatory, Department of Social and Applied Nutrition, Institute of Nutrition Josué de Castro, Federal University of Rio de Janeiro, Rio de Janeiro 21941-902, Brazil; (D.D.S.); (P.P.T.d.S.); (C.B.); (M.B.T.d.C.); (G.K.)
| | - Maria Beatriz Trindade de Castro
- Nutritional Epidemiology Observatory, Department of Social and Applied Nutrition, Institute of Nutrition Josué de Castro, Federal University of Rio de Janeiro, Rio de Janeiro 21941-902, Brazil; (D.D.S.); (P.P.T.d.S.); (C.B.); (M.B.T.d.C.); (G.K.)
| | - Michael Maia Schlüssel
- The EQUATOR Network—UK Centre, Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Old Road, Oxford OX3 7LD, UK;
| | - Gilberto Kac
- Nutritional Epidemiology Observatory, Department of Social and Applied Nutrition, Institute of Nutrition Josué de Castro, Federal University of Rio de Janeiro, Rio de Janeiro 21941-902, Brazil; (D.D.S.); (P.P.T.d.S.); (C.B.); (M.B.T.d.C.); (G.K.)
| | - Berit Lilienthal Heitmann
- Research Unit for Dietary Studies at the Parker Institute, Bispebjerg and Frederiksberg Hospital, The Capital Region, 2000 Frederiksberg, Denmark;
- Section for General Practice, Institute of Public Health, Copenhagen University, 1014 Copenhagen, Denmark
| |
Collapse
|
42
|
Palacios C, Cormick G, Hofmeyr GJ, Garcia‐Casal MN, Peña‐Rosas JP, Betrán AP. Calcium-fortified foods in public health programs: considerations for implementation. Ann N Y Acad Sci 2021; 1485:3-21. [PMID: 32986887 PMCID: PMC7891425 DOI: 10.1111/nyas.14495] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 08/19/2020] [Accepted: 08/27/2020] [Indexed: 12/12/2022]
Abstract
Low calcium intake is common worldwide and can result in nutritional rickets in children and osteomalacia in adults. Calcium-fortified foods could improve calcium intake. However, there is limited calcium fortification experience, with technical and practical issues that may hamper its adoption. The objective of this landscape review is to summarize these issues to help policymakers guide the planning and design of calcium fortification as a public health strategy. One challenge is the low bioavailability of calcium salts (∼20-40%); thus, large amounts need to be added to food to have a meaningful impact. Solubility is important when fortifying liquids and acidic foods. Calcium salts could change the flavor, color, and appearance of the food and may account for 70-90% of the total fortification cost. Safety is key to avoid exceeding the recommended intake; so the amount of added calcium should be based on the target calcium intake and the gap between inadequate and adequate levels. Monitoring includes the quality of the fortified food and population calcium intake using dietary assessment methods. Calcium fortification should follow regulations, implemented in an intersectorial way, and be informed by the right to health and equity. This information may help guide and plan this public health strategy.
Collapse
Affiliation(s)
- Cristina Palacios
- Department of Dietetics and Nutrition, Stempel School of Public HealthFlorida International UniversityMiamiFlorida
| | - Gabriela Cormick
- Department of Mother and Child Health ResearchInstitute for Clinical Effectiveness and Health Policy (IECS‐CONICET)Buenos AiresArgentina
- Departamento de SaludUniversidad Nacional de La MatanzaSan JustoArgentina
| | - G. Justus Hofmeyr
- Universities of the Witwatersrand and Fort HareAliceSouth Africa
- University of BotswanaGaboroneBotswana
| | | | | | - Ana Pilar Betrán
- WHO – UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and ResearchWorld Health OrganizationGenevaSwitzerland
| |
Collapse
|
43
|
Cormick G, Betran AP, Romero IB, Cormick MS, Belizán JM, Bardach A, Ciapponi A. Effect of Calcium Fortified Foods on Health Outcomes: A Systematic Review and Meta-Analysis. Nutrients 2021; 13:316. [PMID: 33499250 PMCID: PMC7911363 DOI: 10.3390/nu13020316] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 01/02/2021] [Accepted: 01/05/2021] [Indexed: 12/14/2022] Open
Abstract
Calcium supplementation and fortification are strategies widely used to prevent adverse outcome in population with low-calcium intake which is highly frequent in low-income settings. We aimed to determine the effectiveness and cost-effectiveness of calcium fortified foods on calcium intake and related health, or economic outcomes. We performed a systematic review and meta-analysis involving participants of any age or gender, drawn from the general population. We searched PubMed, Agricola, EMBASE, CINAHL, Global Health, EconLit, the FAO website and Google until June 2019, without language restrictions. Pair of reviewers independently selected, extracted data and assessed the risk of bias of included studies using Covidence software. Disagreements were resolved by consensus. We performed meta-analyses using RevMan 5.4 and subgroup analyses by study design, age group, and fortification levels. We included 20 studies of which 15 were randomized controlled trials (RCTs), three were non-randomised studies and two were economic evaluations. Most RCTs had high risk of bias on randomization or blinding. Most represented groups were women and children from 1 to 72 months, most common intervention vehicles were milk and bakery products with a fortification levels between 96 and 1200 mg per 100 g of food. Calcium intake increased in the intervention groups between 460 mg (children) and 1200 mg (postmenopausal women). Most marked effects were seen in children. Compared to controls, height increased 0.83 cm (95% CI 0.00; 1.65), plasma parathyroid hormone decreased -1.51 pmol/L, (-2.37; -0.65), urine:calcium creatinine ratio decreased -0.05, (-0.07; -0.03), femoral neck and hip bone mineral density increased 0.02 g/cm2 (0.01; 0.04) and 0.03 g/cm2 (0.00; 0.06), respectively. The largest cost savings (43%) reported from calcium fortification programs came from prevented hip fractures in older women from Germany. Our study highlights that calcium fortification leads to a higher calcium intake, small benefits in children's height and bone health and also important evidence gaps for other outcomes and populations that could be solved with high quality experimental or quasi-experimental studies in relevant groups, especially as some evidence of calcium supplementation show controversial results on the bone health benefit on older adults.
Collapse
Affiliation(s)
- Gabriela Cormick
- Department of Mother and Child Health Research, Institute for Clinical Effectiveness and Health Policy (IECS-CONICET), Ciudad de Buenos Aires 1414, Argentina;
- Centro de Investigaciones Epidemiolóicas y Salud Púlica (CIESP-IECS), CONICET, Ciudad de Buenos Aires 1414, Argentina; (A.B.); (A.C.)
- Departament de Salud, Universidad Nacional de La Matanza (UNLAM), San Justo 1903, Argentina;
| | - Ana Pilar Betran
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, 1211 Geneva, Switzerland;
| | - Iris Beatriz Romero
- Departament de Salud, Universidad Nacional de La Matanza (UNLAM), San Justo 1903, Argentina;
| | - Maria Sol Cormick
- Departament de Diagnóstico por Imágenes, Fleni, Montañeses 2325, Ciudad de Buenos Aires C1428, Argentina;
| | - José M. Belizán
- Department of Mother and Child Health Research, Institute for Clinical Effectiveness and Health Policy (IECS-CONICET), Ciudad de Buenos Aires 1414, Argentina;
- Centro de Investigaciones Epidemiolóicas y Salud Púlica (CIESP-IECS), CONICET, Ciudad de Buenos Aires 1414, Argentina; (A.B.); (A.C.)
| | - Ariel Bardach
- Centro de Investigaciones Epidemiolóicas y Salud Púlica (CIESP-IECS), CONICET, Ciudad de Buenos Aires 1414, Argentina; (A.B.); (A.C.)
- Centro Cochrane Argentino-Instituto de Efectividad Clínica y Sanitaria (IECS-CONICET), Ciudad de Buenos Aires 1414, Argentina
| | - Agustín Ciapponi
- Centro de Investigaciones Epidemiolóicas y Salud Púlica (CIESP-IECS), CONICET, Ciudad de Buenos Aires 1414, Argentina; (A.B.); (A.C.)
- Centro Cochrane Argentino-Instituto de Efectividad Clínica y Sanitaria (IECS-CONICET), Ciudad de Buenos Aires 1414, Argentina
| |
Collapse
|
44
|
Panburana P, Komwilaisak R, Tongprasert F, Phadungkiatwattana P, Kor-Anantakul O, Lumbiganon P. Calcium Consumption During Pregnancy: A Multicenter Study in a Middle-Income Country in Southeast Asia. Int J Womens Health 2021; 13:31-38. [PMID: 33447091 PMCID: PMC7801190 DOI: 10.2147/ijwh.s285516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 12/28/2020] [Indexed: 11/23/2022] Open
Abstract
Objective To perform a cross-sectional observational study of calcium consumption among pregnant women from multicenter tertiary care hospitals in the middle-income country in Southeast Asia. Study Design A cross-sectional observational study. Setting The study was conducted in four geographical regions (northern, northeastern, southern, and central) of Thailand. Five participating hospitals consisted of one university hospital in each region and one additional tertiary care hospital in the central region. Materials and Methods A cross-sectional study was performed nationwide from 1st November 2017 to 31st January 2019. All singleton aged 19-40 years were included. Exclusion criteria were any conditions that influenced calcium-containing food consumption. Dietary intake self-records immediately after eating for two working days and one holiday were analyzed via INMUCAL-NV3.0 dietary program. Results The 1549 records were obtained. The mean age was 29 ± 5.7 years. Most participants were primigravida (48.6%). The average gestational age was 20.6 ± 8.8 weeks. Mean calcium consumption was 602.4 mg/day (95% CI; 589.2615.6 mg/day) mg/dL. Inadequate calcium consumption prevalence based on the Thai dietary reference intake (less than 800 mg/day) and US Institute of Medicine (less than 1000 mg/day) were 82.0% and 93.4%, respectively. Conclusion The mean calcium consumption among pregnant women in the middle-income country in Southeast Asia was 602.4 mg/day (95% CI 589.2-615.6 mg/day). Inadequate calcium consumption of Thai pregnant women prevalence was 82.0% and 93.4% according to Thai dietary reference intake in pregnancy and the US Institute of Medicine.
Collapse
Affiliation(s)
- Panyu Panburana
- Department of Obstetrics & Gynecology, Faculty of Medicine, Ramathibodi University Hospital, Mahidol University, Bangkok, Thailand
| | - Ratana Komwilaisak
- Department of Obstetrics & Gynecology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Fuanglada Tongprasert
- Department of Obstetrics & Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | | | - Ounjai Kor-Anantakul
- Department of Obstetrics & Gynecology, Faculty of Medicine, Songklanagarind Hospital, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Pisake Lumbiganon
- Department of Obstetrics & Gynecology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| |
Collapse
|
45
|
Palacios C, Hofmeyr GJ, Cormick G, Garcia‐Casal MN, Peña‐Rosas JP, Betrán AP. Current calcium fortification experiences: a review. Ann N Y Acad Sci 2021; 1484:55-73. [PMID: 32949062 PMCID: PMC8246751 DOI: 10.1111/nyas.14481] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 07/31/2020] [Accepted: 08/06/2020] [Indexed: 12/11/2022]
Abstract
Low dietary calcium is very common in many populations, contributing to nutritional rickets/osteomalacia in children/adults and increasing the risk of several health problems. Calcium is a nutrient of concern as the recommended nutrient requirements are difficult to meet in the absence of dairy products. The provision of culturally acceptable calcium-fortified foods may improve calcium intake when it is a feasible and cost-effective strategy in a particular setting. This landscape review was conducted in 2019 and describes current calcium fortification efforts and lessons learned from these experiences. Worldwide, the United Kingdom is the only country where calcium fortification of wheat flour is mandatory. It is estimated that this fortified staple ingredient contributes to 13-14% of calcium intake of the British population. Other items voluntary fortified with calcium include maize flour, rice, and water. Current calcium fortification programs may lack qualified personnel/training, clear guidelines on implementation, regulation, monitoring/evaluation, and functional indicators. Also, the cost of calcium premix is high and the target groups may be hard to reach. There is a lack of rigorous evaluation, particularly in settings with multiple micronutrient programs implemented simultaneously, with low quality of the evidence. Further research is needed to assess the impact of calcium fortification programs.
Collapse
Affiliation(s)
- Cristina Palacios
- Department of Dietetics and NutritionStempel School of Public HealthFlorida International UniversityMiamiFlorida
| | - G. Justus Hofmeyr
- Effective Care Research UnitEastern Cape Department of HealthUniversities of the Witwatersrand and Fort HareEast LondonSouth Africa
| | - Gabriela Cormick
- Department of Mother and Child Health ResearchInstitute for Clinical Effectiveness and Health Policy (IECS‐CONICET)Buenos AiresArgentina
- Departamento de SaludUniversidad Nacional de La MatanzaSan JustoArgentina
| | | | | | - Ana Pilar Betrán
- WHO–World Bank Special Programme of ResearchDevelopmentand Research Training in Human ReproductionDepartment of Reproductive Health and ResearchWorld Health OrganizationGenevaSwitzerland
| |
Collapse
|
46
|
Ajong AB, Kenfack B, Ali IM, Yakum MN, Aljerf L, Telefo PB. Hypocalcaemia and calcium intake in pregnancy: A research protocol for critical analysis of risk factors, maternofoetal outcomes and evaluation of diagnostic methods in a third-category health facility, Cameroon. PLoS One 2020; 15:e0241812. [PMID: 33152011 PMCID: PMC7644052 DOI: 10.1371/journal.pone.0241812] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Accepted: 10/20/2020] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Hypocalcaemia in pregnancy remains a major health issue, particularly in the developing world where daily calcium intakes are suboptimal. This electrolyte imbalance can lead to severe maternofoetal and childhood consequences. Calcium supplementation, amongst others, contributes significantly to meeting calcium demands in pregnancy. With ionised calcaemia as the gold standard for diagnosis, total calcaemia and albumin-corrected calcaemia in other pathological states have been found to overestimate the burden of hypocalcaemia. The main objectives of this study are to describe the blood calcium level (total, albumin corrected, and ionised calcaemia) and associated maternofoetal outcomes while identifying determinants of calcium supplementation and ionised hypocalcaemia. This study will also evaluate the sensitivity and specificity of albumin corrected calcaemia as a diagnostic tool for hypocalcaemia (ionised calcaemia as the gold standard) among pregnant women in the Nkongsamba Regional Hospital, Cameroon. METHODS Our study will target a total of 1067 term pregnant women who shall be included consecutively into the study as they arrive the maternity of the Nkongsamba Regional Hospital for their last antenatal care visit. Data shall be collected using a semi-structured interview-administered questionnaire and blood samples collected for total plasma calcium, albumin and serum ionized calcium assays. Additional data will be collected at birth (maternal and foetal variables; foetal outcomes evaluated as secondary outcomes). Total calcaemia and albuminemia shall be measured by atomic absorption spectrophotometry, while ionised calcaemia will be measured by ion-selective electrode potentiometry(using MSLEA15-H electrolyte analyzer) per standard BIOLABO and MSLEA15 protocols, respectively. Data will be analysed using the statistical softwares epi-Info version 7.2.2.16 and STATA version 16. EXPECTED RESEARCH OUTCOME This study will present a more precise estimate of the burden of hypocalcaemia in late pregnancy as well as identify and analyse the different factors associated with calcium supplementation and ionised hypocalcaemia among term pregnant women in a developing world setting. Maternofoetal outcomes associated with hypocalcaemia will be determined as well as the sensitivity and specificity of total and albumin-corrected calcaemia in diagnosing hypocalcaemia. Our findings will contribute significantly to designing or strengthening interventions to control this electrolyte imbalance.
Collapse
Affiliation(s)
- Atem Bethel Ajong
- Kekem District Hospital, Kekem, West Region, Cameroon
- Department of Biochemistry, University of Dschang, Dschang, West Region, Cameroon
| | - Bruno Kenfack
- Department of Obstetrics / Gynaecology and Maternal Health, Faculty of Medicine and Pharmaceutical Sciences, University of Dschang, Dschang, West Region, Cameroon
| | - Innocent Mbulli Ali
- Department of Biochemistry, University of Dschang, Dschang, West Region, Cameroon
| | | | - Loai Aljerf
- Faculty of Dentistry, Damascus University, Damascus, Syria
| | - Phelix Bruno Telefo
- Department of Biochemistry, University of Dschang, Dschang, West Region, Cameroon
| |
Collapse
|
47
|
Li P, Yan K, Chang X, Chen X, Wang R, Fan X, Tang T, Zhan D, Qi K. Sex-specific maternal calcium requirements for the prevention of nonalcoholic fatty liver disease by altering the intestinal microbiota and lipid metabolism in the high-fat-diet-fed offspring mice. Gut Microbes 2020; 11:1590-1607. [PMID: 32576050 PMCID: PMC7524148 DOI: 10.1080/19490976.2020.1768645] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
The significance of maternal appropriate calcium intakes for energy metabolism in the offspring has been recognized. Nonalcoholic fatty liver disease (NAFLD) is considered as the hepatic manifestation of metabolic syndrome. So in this study, we proposed that there were long-term effects of maternal calcium status on the progress of NAFLD by altering the intestinal microbiota and lipid metabolism with attention to potential sex differences among the mouse offspring. Thirty-four-week female C57BL/6 J mice were subjected to obtain low, normal and high calcium reproductive diets throughout the gestation and lactation. After weaning, both the male and female mouse offspring were fed with the high-fat diet for 16 weeks, with the normal diet as control. Biochemical indicators in the plasma and hepatic tissue were measured using ELISA or enzymatic methods. The expression of lipid metabolism, inflammatory and fibrosis related genes was determined by RT-PCR. The intestinal microbiota was analyzed by 16S rRNA high-throughput sequencing. Maternal normal and low calcium intake could, respectively, inhibit the progress of high-fat diet induced NAFLD in the male and female mouse offspring, which was characterized by the least lipid droplets, inflammatory infiltration and fibrosis, the lowest concentrations of free fatty acids and triglyceridethe lowest expression of genes involving in de novo lipogenesis and the highest expression of genes related to lipid oxidation and hydrolysis, inflammatory, and fibrosis. Pyrosequencing of 16S rRNA genes revealed that the male mouse offspring with maternal normal calcium intake and the female mouse offspring with maternal low calcium intake, after the high-fat diet feeding, had distinct intestinal microbiota, which was closer to thosein mice with the normal diet feeding. Analysis of the functional features for the different microbiota was compatible with the expression of genes associated with lipogenesis, lipid oxidation and hydrolysis. Thus, there is a sex-specific manner for maternal calcium requirement to inhibit the progress of offspring NAFLD, that might be less for the female offspring and more for the male offspring.
Collapse
Affiliation(s)
- Ping Li
- Laboratory of Nutrition and Development, Beijing Pediatric Research Institute, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
| | - Kesong Yan
- Animal Laboratory Center, Fourth Medical Center of PLA General Hospital, Beijing, China
| | - Xuelian Chang
- Laboratory of Nutrition and Development, Beijing Pediatric Research Institute, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
| | - Xiaoyu Chen
- Laboratory of Nutrition and Development, Beijing Pediatric Research Institute, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
| | - Rui Wang
- Laboratory of Nutrition and Development, Beijing Pediatric Research Institute, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
| | - Xiuqin Fan
- Laboratory of Nutrition and Development, Beijing Pediatric Research Institute, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
| | - Tiantian Tang
- Laboratory of Nutrition and Development, Beijing Pediatric Research Institute, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
| | - Dawei Zhan
- Animal Laboratory Center, Fourth Medical Center of PLA General Hospital, Beijing, China
| | - Kemin Qi
- Laboratory of Nutrition and Development, Beijing Pediatric Research Institute, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China,CONTACT Kemin Qi Laboratory of Nutrition and Development, Beijing Pediatric Research Institute, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, No.56 Nan-li-shi Road, Beijing100045, China
| |
Collapse
|
48
|
Rajwar E, Parsekar SS, Venkatesh BT, Sharma Z. Effect of vitamin A, calcium and vitamin D fortification and supplementation on nutritional status of women: an overview of systematic reviews. Syst Rev 2020; 9:248. [PMID: 33109248 PMCID: PMC7592561 DOI: 10.1186/s13643-020-01501-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Accepted: 10/08/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Micronutrient deficiency affects the health and development of vulnerable population such as children and pregnant women. Measures such as fortification of food and supplementation have been implemented to prevent or control deficiencies related to micronutrients. OBJECTIVE To assess the effect of vitamin A, vitamin D, and calcium fortification and supplementation on nutritional status of women in reproductive age group. To assess the toxicities and adverse events related to intervention. METHODOLOGY Systematic reviews including RCTs on women of reproductive age group provided with vitamin A, vitamin D, and calcium supplementation or fortified food were included, to report all malnutrition-related outcomes due to deficiency of the abovementioned micronutrients. The Cochrane Database of Systematic Reviews, EPPI Centre, Campbell Collaboration, PubMed, Web of Science, and Scopus were searched electronically for English language publications, until 31 March 2018. Hand searching of the articles was done from the Journal of Food Science and Technology. Two independent reviewers selected the systematic reviews, extracted data, and assessed for the quality. RESULTS A total of 16 systematic reviews were included in narrative synthesis. Supplementation of vitamin A was reported to result in increased maternal serum retinol concentrations and increased breast milk retinol concentration. It reduced the risk of anemia (Hb < 11 g/dL) and reduced maternal clinical infection. Vitamin D supplementation increased 25-hydroxy vitamin D levels. There was insufficient evidence for the effect on bone mineral density and serum calcium levels. Calcium supplementation did not have any significant effect on body weight, weight gain, and body mass index of the participants. CONCLUSION This overview of systematic reviews reiterates the nutritional importance of vitamin A, vitamin D, and calcium supplementation for the reproductive age women. However, there was no empirical evidence available for fortification of food with vitamin A, vitamin D, and calcium and nutritional benefits of the same for reproductive age women, therefore thrusting upon the need of conducting future quality research, i.e., clinical trials and systematic reviews for food fortification. SYSTEMATIC REVIEW REGISTRATION A priori protocol for this overview of systematic reviews was registered in PROSPERO with registration number CRD42018089403 .
Collapse
Affiliation(s)
- Eti Rajwar
- Public Health Evidence South Asia, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
| | - Shradha S Parsekar
- Public Health Evidence South Asia, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
| | - Bhumika Tumkur Venkatesh
- Public Health Evidence South Asia, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India.
| | - Zinnia Sharma
- Public Health Evidence South Asia, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
| |
Collapse
|
49
|
Cormick G, Lombarte M, Minckas N, Porta A, Rigalli A, Belizán JM, Matamoros N, Lupo M. Contribution of calcium in drinking water from a South American country to dietary calcium intake. BMC Res Notes 2020; 13:465. [PMID: 33008447 PMCID: PMC7532645 DOI: 10.1186/s13104-020-05308-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 09/25/2020] [Indexed: 11/10/2022] Open
Abstract
Objective To describe the calcium concentration of tap and bottled waters from Argentina and to estimate the contribution of drinking water to calcium recommendations. Results Calcium concentrations provided by water authorities ranged from 6 to 105 mg/L. The mean calcium level of samples analysed at the Laboratorio de Ingeniería Sanitaria, National University of La Plata was 15.8 (SD ± 13.2) mg/L and at the Bone Biology Laboratory of the National University of Rosario was 13.1 (± 10.0) mg/L. Calcium values of samples from supply systems and private wells was similar. Most bottled waters had calcium levels well below 50 mg/L. The intake of one litre of drinking water from Argentina could represent in average between 1.2 and 8.0% of the calcium daily values for an adult.
Collapse
Affiliation(s)
- Gabriela Cormick
- Department of Mother and Child Health Research, Institute for Clinical Effectiveness and Health Policy (IECS-CONICET), Emilio Ravignani 2024, Buenos Aires, Argentina. .,Departamento de Salud, Universidad Nacional de La Matanza (UNLAM), 1754, San Justo, Argentina.
| | - Mercedes Lombarte
- Bone Biology Laboratory, School of Medicine, Rosario National University, 2000, Rosario, Santa Fe, Argentina
| | - Nicole Minckas
- Department of Mother and Child Health Research, Institute for Clinical Effectiveness and Health Policy (IECS-CONICET), Emilio Ravignani 2024, Buenos Aires, Argentina
| | - Andrés Porta
- Centro de Investigaciones del Medio Ambiente CIM, UNLP-CONICET, Calle 47 esquina 115, La Plata, Argentina
| | - Alfredo Rigalli
- Bone Biology Laboratory, School of Medicine, Rosario National University, 2000, Rosario, Santa Fe, Argentina
| | - Jose M Belizán
- Department of Mother and Child Health Research, Institute for Clinical Effectiveness and Health Policy (IECS-CONICET), Emilio Ravignani 2024, Buenos Aires, Argentina
| | - Natalia Matamoros
- Instituto de Desarrollo E Investigaciones Pediátricas "Prof. Dr. Fernando E. Viteri" Hospital de Niños "Sor María Ludovica de La Plata (IDIP), Ministerio de Salud/Comisión de Investigaciones Científicas de La Provincia de Buenos Aires, La Plata, Argentina
| | - Maela Lupo
- Bone Biology Laboratory, School of Medicine, Rosario National University, 2000, Rosario, Santa Fe, Argentina
| |
Collapse
|
50
|
Klemm GC, Birhanu Z, Ortolano SE, Kebede Y, Martin SL, Mamo G, Dickin KL. Integrating Calcium Into Antenatal Iron-Folic Acid Supplementation in Ethiopia: Women's Experiences, Perceptions of Acceptability, and Strategies to Support Calcium Supplement Adherence. GLOBAL HEALTH: SCIENCE AND PRACTICE 2020; 8:413-430. [PMID: 33008855 PMCID: PMC7541115 DOI: 10.9745/ghsp-d-20-00008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 06/16/2020] [Indexed: 01/10/2023]
Abstract
Recommendations for antenatal calcium supplementation to prevent preeclampsia could substantially reduce maternal mortality, but adherence to multiple daily doses may constrain effectiveness. World Health Organization guidelines recommend 3 daily calcium supplements (1.5-2 g/d), taken separately from 1 iron-folic acid (IFA) supplement; however, limited data suggest lower calcium doses may also be effective. We conducted mixed-methods household trials to identify strategies for supporting adherence and integrating calcium into antenatal IFA supplementation programming in Ethiopia. Participants were randomly assigned to 3 regimens varying in dose and timing and were later given a choice of regimens. Semistructured interviews conducted over 6 weeks explored acceptability, barriers, and facilitators and offered opportunities to choose calcium pill type. Interviews were transcribed, translated, and analyzed thematically. Calcium adherence was measured using medication event monitoring. All participants (N=48) agreed to try supplementation. Adherence barriers included forgetting to take pills when busy or travelling and perceived side effects. Midday doses were the most challenging because of farming, market, and social events; women avoided taking supplements in public due to fear of being perceived as HIV positive. Social support from families, visual reminders, and anticipated benefits motivated adherence. More participants (75%) selected chewable versus conventional supplements due to organoleptic properties, but this preference declined over time. Adherence rates did not substantially differ across regimens with 2 (81.1%), 3 (83.4%), or 4 (77.1%) pill-taking events. Women indicated that the 2-event regimen was more acceptable than 3- and 4-event regimens, but this acceptability was not associated with higher adherence. Consequently, mean daily calcium consumption (811.3 mg) was lower than for 3-event (1,251.1 mg) and 4-event (1,156.4 mg) regimens. Integrating calcium into antenatal IFA supplementation is acceptable to Ethiopian women, with a 3-event regimen yielding the highest consumption rates. Despite women experiencing challenges with midday dosing and stigma, using simple home-based strategies and being counseled on the purpose of supplementation were more effective than reducing dosage for mitigating barriers and improving adherence.
Collapse
Affiliation(s)
- Gina C Klemm
- Program in International Nutrition, Division of Nutritional Sciences, Cornell University, Ithaca, NY, USA
| | - Zewdie Birhanu
- Faculty of Public Health, Department of Health, Behavior and Society, Jimma University, Jimma, Ethiopia
| | - Stephanie E Ortolano
- Program in International Nutrition, Division of Nutritional Sciences, Cornell University, Ithaca, NY, USA
| | - Yohannes Kebede
- Faculty of Public Health, Department of Health, Behavior and Society, Jimma University, Jimma, Ethiopia
| | - Stephanie L Martin
- Program in International Nutrition, Division of Nutritional Sciences, Cornell University, Ithaca, NY, USA
| | - Girma Mamo
- Ethiopia-Canada Cooperation Office, Nutrition International, Addis Ababa, Ethiopia
| | - Katherine L Dickin
- Program in International Nutrition, Division of Nutritional Sciences, Cornell University, Ithaca, NY, USA.
| |
Collapse
|