Nutritional status of pregnant and lactating women in Japan: a comparison with non-pregnant/non-lactating controls in the National Nutrition Survey

The influence of the co-exposure to polycyclic aromatic hydrocarbons and toxic metals on DNA damage in brazilian lactating women and their infants: A cross-sectional study using machine learning approaches

Polycyclic aromatic hydrocarbons (PAHs) and toxic metals are widely spread pollutants of public health concern. The co-contamination of these chemicals in the environment is frequent, but relatively little is known about their combined toxicities. In this context, this study aimed to evaluate the influence of the co-exposure to PAHs and toxic metals on DNA damage in Brazilian lactating women and their infants using machine learning approaches. Data were collected from an observational, cross-sectional study with 96 lactating women and 96 infants living in two cities. The exposure to these pollutants was estimated by determining urinary levels of seven mono-hydroxylated PAH metabolites and the free form of three toxic metals. 8-Hydroxydeoxyguanosine (8-OHdG) levels in the urine were used as the oxidative stress biomarker and set as the outcome. Individual sociodemographic factors were also collected using questionnaires. Sixteen machine learning algorithms were trained using 10-fold cross-validation to investigate the associations of urinary OH-PAHs and metals with 8-OHdG levels. This approach was also compared with models attained by multiple linear regression. The results showed that the urinary concentration of OH-PAHs was highly correlated between the mothers and their infants. Multiple linear regression did not show a statistically significant association between the contaminants and urinary 8OHdG levels. Machine learning models indicated that all investigated variables did not present predictive performance on 8-OHdG concentrations. In conclusion, PAHs and toxic metals were not associated with 8-OHdG levels in Brazilian lactating women and their infants. These novelty and originality results were achieved even after applying sophisticated statistical models to capture non-linear relationships. However, these findings should be interpreted cautiously because the exposure to the studied contaminants was considerably low, which may not reflect other populations at risk.

Maternal Dietary Diversity and Birth Weight in Offspring: Evidence from a Chinese Population-Based Study

Studies on the association between maternal dietary diversity and birth weight in offspring are limited, and the impact of such an adjustable factor on birth weight requires investigation to promote neonatal health. This study used data from a larger-scale population-based survey conducted in northwest China to evaluate the association of maternal dietary diversity with neonatal birth weight with a generalized estimating equation model. The results found that maternal dietary diversity was positively associated with neonate birth weight. Furthermore, a higher minimum dietary diversity for women (MDD-W) score during pregnancy was related to a lower risk of low birth weight (LBW) in offspring. The mothers with the highest MDD-W score had a 38% (OR = 0.62, 95% CI: 0.43-0.89) lower risk of LBW than those with the lowest score. Similarly, the mothers with the highest animal-based food dietary diversity score (DDS) had 39% (OR = 0.61, 95% CI: 0.38-0.98) lower risk of LBW in offspring compared with those with the lowest animal-based food DDS. Moreover, the ratio of animal-based food DDS to non-animal-based food DDS could play an important role in predicting neonate birth weight. In conclusion, increasing maternal dietary diversity would improve birth weight in offspring, especially by increasing the intake of animal-based foods among the Chinese population.

Trends in Food Group Intake According to Body Size among Young Japanese Women: The 2001-2019 National Health and Nutrition Survey

Unlike in many industrialised countries, the high proportion of young women who are underweight in Japan has been a long-term problem. We evaluated trends in food group intake according to body size among young Japanese women using data from the National Health and Nutrition Survey 2001-2019. Overall, 13,771 Japanese women aged 20-39 years were included. A 1-day household-based dietary record was used to estimate food intake. Foods were classified into 34 groups based on the Standard Tables of Food Composition in Japan. The trend of food group intake was analysed using the Joinpoint Regression Program. The proportion of young women who were underweight was consistently around 20%, while obesity among young women increased between 2001 (10%) and 2019 (13%). A decreased trend in fish and shellfish and seaweed intake and an increased trend in meat and soft drink intake were observed among young women. Decreased trends in the intake of fruit and dairy products were observed in young women who were not obese. An increased trend in the intake of confectionaries was observed in young women who were obese. This study suggests that the types of unhealthy eating habits may differ according to body size among young Japanese women.

Low Periconceptional Dietary Intakes among Japanese Women: The Japan Environment and Children's Study (JECS)

Pregnancy is usually associated with dietary imbalances. We aim to assess the changes in Japanese women's diet and nutritional adequacy before and during pregnancy. In the Japan Environment and Children's Study (JECS), we recruited a large cohort of pregnant women (>100,000) from 15 Japanese communities. We assessed their diet before and during pregnancy by a food frequency questionnaire. The before and during pregnancy intakes of energy, macronutrients, and micronutrients were lower than the recommended level for Japanese women by 1% to 49%. The dietary intakes of pregnant women were lower than their intakes before pregnancy, except for milk, dairy products, and calcium. The daily during pregnancy intake of energy, carbohydrate, fat, protein, folic acid, and iron decreased by 85 kcal, 11.6 g, 2.3 g, 2.8 g, 20 μg, and 0.5 mg than the before pregnancy intake. Pregnant women's declined food and nutrients intakes were moderately correlated to their dietary intakes before pregnancy; the correlation coefficient ranged between 0.47 and 0.67. The inter-individual variability was greater than the intra-individual variability of the dietary intakes. Almost half of the pregnant women remained in the same intake quartile for all nutrients and food groups as before pregnancy. Yet, approximately 10% of pregnant women changed their pregnancy intake by ≥50% (≥2 quartiles up or down) compared to before pregnancy. In conclusion, the study identified low periconceptional dietary intakes among Japanese pregnant women. The low dietary intake of essential nutrients, such as folate, requires revising the Japanese national periconceptional dietary and supplementation guidelines.

Association of daily nutrient intake with breakfast and snack consumption among young Japanese adults aged 20-39 years: data from the 2012 National Health and Nutrition Survey

Eating frequency has been associated with nutrient intake and diet quality. The aim of this study was to examine the association between daily nutrient and food group intake and consumption of breakfast and/or snacks among young Japanese adults, as secondary analysis of the 2012 National Health and Nutrition Survey in Japan involved 1420 men and 1659 women aged 20-39 years. Dietary intake data were collected using a one-day semi-weighed household dietary record. Participants were classified into four groups based their breakfast and snack consumption, defined as the consumption of any food or beverage that contained energy based on participant-defined eating occasions; both breakfast and snack consumption (B+S+), breakfast consumption without snacking (B+S-), breakfast skipping and snack consumption (B-S+) and breakfast skipping without snacking (B-S-). The proportion of breakfast skippers among men and women was 11·8 % and 6·6 %, whereas that of snack consumers among men and women was 55·3 % and 68·2 %, respectively. Energy, Mg potassium (in both sexes), vitamin B2, Ca, (only men) and folate and dietary fibre (only women) intakes were higher among breakfast and snack consumers than in the B+S- group. The nutrient intake level of the B+S- group was similar to that of the B-S+ group, whereas the B-S- group had lower energy (both sexes), Cu, dietary fibre and potassium (only women) intakes than the B+S- group. Snack consumption could supplement nutrients that may not be adequately consumed by three meals among young Japanese adults.

Individual and community-level determinants of underweight among lactating mothers in Ethiopia: A multilevel analysis

Background

Determining the nutritional status of lactating women is important because underweight lactating mothers will have low energy levels and reduced cognitive abilities, which will affect the inadequate care of their young children. Thus, malnutrition is passed down from generation to generation, perpetuating the vicious cycle. There is scarce national data on determinants of underweight among lactating mothers in Ethiopia. Hence, this study aimed to identify individual and community-level determinants of underweight among lactating mothers in Ethiopia.

Methods

Data from the Ethiopian Demographic and Health Survey (EDHS) from 2016 were used. A total of 3848 lactating mothers were included in this study, and a multilevel, multivariable logistic regression model was fitted to identify determinants of underweight among lactating mothers.

Results

The odds of being underweight among rural lactating mothers were 65% higher (AOR = 1.65, 95% CI = 1.13, 2.41) than lactating mothers in the urban area. The odds of being underweight among lactating mothers who have toilet facilities were 33% lower (AOR = 0.67, 95%CI = 0.54, 0.83) compared with those do not have toilet facilities. Those mothers in the age group of 25–34 years and greater than 35 years had (AOR = 0.61,95%CI = 0.48, 0.79), and (AOR = 0.66, 95%CI = 0.47, 0.95) times lower chance of being underweight compared with those who had 15–24 years of age, respectively. The likelihood of being underweight among lactating mothers in high community poverty (AOR = 1.40, 95%CI = 1.08, 1.82) was higher than the lower community poverty level.

Conclusion

Underweight among lactating mothers was significantly associated with individual-level (age and toilet facilities) variables and community-level (residence and community poverty). Therefore, focusing on these identified factors could improve underweight among lactating mothers in Ethiopia.

Trends in dietary salt sources in Japanese adults: data from the 2007-2019 National Health and Nutrition Survey

Identifying trends in dietary salt sources is essential for effectively reducing salt/Na intake. This study aimed to examine the trends in dietary salt sources among Japanese adults using the 2007-2019 National Health and Nutrition Survey data collected from 95 581 adults aged ≥ 20 years. Dietary intake was estimated using the 1-d household-based dietary record. Foods reported as potential sources of salt intake in Japan and other countries were categorised into twenty-one groups. Salt intake for each food group was adjusted using the density method based on the energy intake. Trends in dietary salt intake based on food sources by sex and age groups (20-39 years, 40-59 years and ≥ 60 years) were analysed using the Joinpoint Regression Program. Salt intake for each age group in both men and women decreased from 2007 (5·3 g/1000 kcal-6·4 g/1000 kcal) to 2019 (4·9 g/1000 kcal-5·6 g/1000 kcal). The major dietary source of salt continued to be seasonings such as soya sauce and soyabean paste (approximately 70 %). Salt intake from seasonings decreased over time in adults aged ≥ 40 years but did not change in those aged 20-39 years. Additionally, a decreasing salt intake from unprocessed fish and shellfish and an increasing salt intake from unprocessed meat were observed across all age categories for both sexes. This study demonstrated that a strategy targeting different age groups may be needed to reduce salt consumption from seasonings among the Japanese population. Further studies on salt content in seasonings and continued monitoring of trends in dietary salt sources are required.

Association of Lifestyle Changes Due to the COVID-19 Pandemic with Nutrient Intake and Physical Activity Levels during Pregnancy in Japan

The coronavirus disease 2019 (COVID-19) pandemic has introduced changes in our lifestyles, such as refraining from unnecessary outings. This study aimed to clarify the association of lifestyle changes due to the COVID-19 pandemic with nutrient intake and physical activity levels during pregnancy in Japan. A cross-sectional study involving 168 healthy pregnant Japanese women was conducted in 2020. Nutrient intake and physical activity levels were assessed using validated self-administered questionnaires. Participants who reported experiencing changes in both dietary habits and physical activity due to the COVID-19 pandemic were classified as the lifestyle-affected group. Analysis of covariance was used. Among primiparas, intake of the following nutrients was significantly higher in the lifestyle-affected group (n = 14) than in the unaffected group (n = 77): protein, potassium, calcium, magnesium, and vitamin B₆. Among multiparas, the intake of dietary fiber and β-carotene were significantly lower in the lifestyle-affected group (n = 13) than in the unaffected group (n = 64). No significant differences in physical activity levels were observed in accordance with the lifestyle changes. These findings suggest that lifestyle changes due to the COVID-19 pandemic have positive effects on nutrient intake during pregnancy in primiparas, whereas in multiparas, these changes have negative effects.

Effects of Individual Dietary Intervention on Nutrient Intake in Postpartum Japanese Women: A Randomized Controlled Trial

No dietary intervention that focuses on the diet quality of postpartum women has been developed in Japan, although most postpartum women experience an insufficient intake of vitamins and minerals. We aimed to examine whether dietary intervention, based on the health belief model, at both 1 and 3 months postpartum affects nutrient intake and food group consumption at 6 months postpartum. A randomized controlled trial was conducted at a university hospital in Tokyo between 2015 and 2016. Healthy women at 1 month postpartum were randomly allocated to either an intervention group (n = 100) or a control group (n = 94). Dietary intervention included dietary assessment, individual feedback, and dietary guidance. The dietary intakes between the two groups were compared using the Mann-Whitney U test. At 6 months postpartum, the energy-adjusted intakes of protein, total dietary fiber, potassium, magnesium, phosphorus, zinc, vitamin B₆, and β-carotene were significantly higher in the intervention group than in the control group. The changes in energy-adjusted intakes of total dietary fiber and iron from 1 month postpartum to 6 months postpartum were significantly different between the two groups. Dietary intervention based on the health belief model improved nutrition at 6 months postpartum, although the impact was limited.

Association of Free Sugars Intake with Cardiometabolic Risk Factors among Japanese Adults: The 2016 National Health and Nutrition Survey, Japan

The relationship between free sugars intake and cardiometabolic risk factors is unclear in Japanese adults. This cross-sectional study aimed to investigate this association using data from the 2016 National Health and Nutrition Survey, Japan. The percentage of energy intake from free sugars was estimated based on the 1-day weighed dietary record data of Japanese men (n = 4071) and women (n = 5794) aged ≥ 20 years. Associations between free sugars intake and cardiometabolic risk factors, including body mass index (BMI), waist circumference (WC), systolic and diastolic blood pressures, glycated haemoglobin (HbA1c) level and levels of serum total, low-density lipoprotein (LDL), and high-density lipoprotein (HDL) cholesterol, were investigated using linear regression and Dunnett’s test, with the lowest category of quartiles as a reference. After adjustment for potential confounding factors, free sugars intake was inversely associated with blood pressures (men only) and HDL-cholesterol level (both sexes) and positively associated with total-cholesterol level (women only) and LDL-cholesterol level (both sexes), whereas no association was observed for BMI, WC, and HbA1c level. This study identified both positive and inverse associations of free sugars intake with cardiometabolic risk factors in Japanese adults.

5,10-Methylenetetrahydrofolate reductase (MTHFR) C677T/A1298C polymorphisms in patients with nonsyndromic cleft lip and palate

Cleft lip with or without cleft palate (CL/P) is considered a multifactorial genetic disorder. Folic acid metabolism has been suggested to underlie the development of CL/P. The gene for the enzyme 5,10-methylentetrahydrofolate reductase (MTHFR) contributes to folic acid metabolism, and polymorphisms of this gene at C677T (rs1801133) and A1298C (rs1801131) are reported to alter its enzyme activity and are suggested to be involved in CL/P development. We investigated C677T and A1298C polymorphisms of the MTHFR gene in Japanese patients with nonsyndromic CL/P and cleft palate only (CPO). We examined 240 patients with CL/P, 103 fathers and 153 mothers of the patients, and 68 healthy controls. Restriction fragment length polymorphisms (RFLPs) of C677T and A1298C of MTHFR were analyzed. We determined the frequencies of the polymorphisms in the patients and controls and performed a transmission equilibrium test and haplotype analysis of both MTHFR C677T and A1298C. There were no significant differences in the frequencies of MTHFR C677T and A1298C polymorphisms between the patients and controls. We did not observe transmission equilibrium or linkage equilibrium among the cases. In this experimental condition, we did not detect an association of MTHFR C677T and/or A1298C polymorphisms with the development of CL/P in this Japanese cohort.

Maternal total energy, macronutrient and vitamin intakes during pregnancy associated with the offspring's birth size in the Japan Environment and Children's Study

Maternal diet during pregnancy can influence fetal growth; however, the available evidence is controversial. We aimed to assess whether maternal diet of Japanese women in mid-pregnancy can affect their offspring's birth size via collection of questionnaire and medical record data. The studied sample was a large cohort of paired mothers and their singleton offspring (n 78 793) from fifteen areas all over Japan who participated in the Japan Environment and Children's Study. The mid-pregnancy intakes of total energy, macronutrients and vitamins were lower than the recommended intakes for pregnant Japanese women. Maternal total energy intake was positively associated with the offspring's birth weight; there was a 10-g mean difference in the offspring's birth weight of mothers in the lowest (3026 g) v. highest (3036 g) quartiles of energy intake. Carbohydrate intake was positively associated with the offspring's birth length (mean difference of 0·7 cm) and inversely associated with the ponderal index (mean difference of 0·8 g/cm3). Offspring of mothers in the highest v. lowest quartiles of total dietary fibre intake were on average 9 g heavier and had 0·3 cm longer birth length and 0·2 cm longer head circumference. The highest in reference to lowest intake quartile of vitamin C was associated with 13 g and 0·7 cm mean differences in the offspring's birth weight and length, respectively. Several other associations were evident for maternal intakes of vitamins and the offspring's birth size. In conclusion, maternal dietary intakes of energy, dietary fibre, carbohydrate and vitamins during pregnancy were associated with the offspring's birth size.

The Association between Milk and Dairy Products Consumption and Nutrient Intake Adequacy among Japanese Adults: Analysis of the 2016 National Health and Nutrition Survey

Consumption of dairy products in the usual diet may be important for improving the overall quality of dietary intake. This study aimed to assess the difference in nutrient intake adequacy according to the intake of dairy products based on a 1-day weighed dietary record of Japanese adults from the 2016 National Health and Nutrition Survey. Nutritional adequacy was determined based on the Dietary Reference Intakes for Japanese 2015, with 2 goals: Tentative dietary goals (DG) for preventing lifestyle-related diseases, and the estimated average requirement (EAR). According to the dairy products consumption, participants were categorized into three groups (milk, other dairy product, or non-dairy), and the total number of those not meeting DG and EAR was compared. Non-dairy consumers were less likely to meet both DG and EAR compared to dairy consumers. Dairy consumers were more likely to exceed the DG for saturated fat than non-dairy consumers. Japanese adult dairy consumers were more likely to have adequate nutritional intake than non-dairy consumers, especially for calcium. We also observed a higher saturated fat intake in dairy consumers, which might be due to a certain dietary pattern in this group. Further investigation is needed to determine dairy intake and its influence on dietary quality among the Japanese population.

Optimal protein intake during pregnancy for reducing the risk of fetal growth restriction: the Japan Environment and Children's Study

Clinical trials show that protein supplement increases infant size in malnourished populations; however, epidemiological studies in high-income countries have reported mixed results. Although these findings suggest a non-linear relationship between maternal macronutrient intake and fetal growth, this relationship has not been closely examined. We assessed the association between maternal protein intake and fetal growth among 91 637 Japanese women with singletons in a nation-wide cohort study using validated FFQ. The respondents answered the FFQ twice, once during early pregnancy (FFQ1; 16·3 (sd 6·0) weeks), and second during mid-pregnancy (FFQ2, 28·1 (sd 4·1) weeks). Daily energy intake and percentage energy from protein, fats and carbohydrates were 7477 (sd 2577) kJ and 13·5 (sd 2·0), 29·5 (sd 6·5) and 55·3 (sd 7·8) %, respectively, for FFQ1, and 7184 (sd 2506) kJ and 13·6 (sd 2·1), 29·8 (sd 6·6) and 55·3 (sd 7·9) %, respectively, for FFQ2. The average birth weight was 3028 (sd 406) g, and 6350 infants (6·9 %) were small for gestational age (SGA). In both phases of the survey, birth weight was highest and the risk of SGA was lowest when the percentage energy from protein was 12 %, regardless of whether isoenergetic replacement was with fat or carbohydrates. Furthermore, when protein density in the maternal diet was held constant, birth weight was highest when 25 % of energy intake came from fat and 61 % came from carbohydrates during early pregnancy. We found maternal protein intake to have an inverse U-curve relationship with fetal growth. Our results strongly suggest that the effect of protein on birth weight is non-linear, and that a balanced diet fulfilling the minimum requirement for all macronutrients was ideal for avoiding fetal growth restriction.

Factors associated with underweight among lactating women in Womberma woreda, Northwest Ethiopia; a cross-sectional study

Background

Ensuring nutritional status of women is important because the malignant effects of malnutrition are procreated to the next generation through women and their off-springs. Malnutrition causes 3.5 million death of women and children each year and almost 11% of the disease burden in the world. Therefore, this study was conducted to assess nutritional status and factors associated with underweight among lactating women in Womberma woreda, Northwest Ethiopia, 2016.

Methods

A Community-based cross-sectional study was carried out in Womberma woreda, Northwest Ethiopia. A total of 668 lactating women who have 6–24 months of child were included in the study. Study participants were selected using a multistage sampling technique. Data were collected using interview-administered questionnaire. Body mass index (BMI) was used to measure the nutritional status of lactating women. Women’s body weight and height were measured using the standard anthropometric measurement procedures. Data were entered using EpiData software and analysis was done using SPSS software. Descriptive, bivariate and multivariable logistics regression analysis were used to present the findings. Variables with a p-value less than 0.05 on multiple variable logistic regression were taken as significant variables.

Results

Lactating women with normal nutritional status (BMI = 18.5–24.99 kg/m²) were 498 (74.5%), and underweight women (BMI < 88.5 kg/m²) were 170(25.4%). Respondents with less than five family size (AOR: 0.46, 95% CI: 0.26, 0.81, p-value = 0.007), women whose age of first pregnancy was less than 18 years old (AOR: 3.72, 95% CI: 2.33, 6.49 at p-value = 0.0001), home delivery for the recent child birth (AOR: 2.36, 95% CI: 1.50, 3.72 at p-value = 0.0001), and the absence of nutritional education programs in the community (AOR: 5.5, 95% CI: 1.8, 16.79 at p-value = 0.003) were the significant variables with underweight of lactating women.

Conclusions

Nutritional status of lactating women in the study area was poor. One fourth of lactating women was underweight. Factors associated with underweight of lactating women include; respondents with less than five family size, women whose age of first pregnancy was less than 18 years old, home delivery for the recent childbirth, and the absence of nutritional education programs in the community. Early childbearing and short birth intervals between births should be discouraged. Programs which encourage institutional delivery and community-based nutritional education are important to improve women nutritional status.

Availability of two self-administered diet history questionnaires for pregnant Japanese women: A validation study using 24-hour urinary markers

BACKGROUND

Accurate and easy dietary assessment methods that can be used during pregnancy are required in both epidemiological studies and clinical settings. To verify the utility of dietary assessment questionnaires in pregnancy, we examined the validity and reliability of a self-administered diet history questionnaire (DHQ) and a brief-type self-administered diet history questionnaire (BDHQ) to measure energy, protein, sodium, and potassium intake among pregnant Japanese women.

METHODS

The research was conducted at a university hospital in Tokyo, Japan, between 2010 and 2011. The urinary urea nitrogen, sodium, and potassium levels were used as reference values in the validation study. For the reliability assessment, participants completed the questionnaires twice within a 4-week interval.

RESULTS

For the DHQ (n = 115), the correlation coefficients between survey-assessed energy-adjusted intake and urinary protein, sodium, and potassium levels were 0.359, 0.341, and 0.368, respectively; for the BDHQ (n = 112), corresponding values were 0.302, 0.314, and 0.401, respectively. The DHQ-measured unadjusted protein and potassium intake levels were significantly correlated with the corresponding urinary levels (r_s = 0.307 and r_s = 0.342, respectively). The intra-class correlation coefficients for energy, protein, sodium, and potassium between the time 1 and time 2 DHQ (n = 58) and between the time 1 and time 2 BDHQ (n = 54) ranged from 0.505 to 0.796.

CONCLUSIONS

Both the DHQ and the BDHQ were valid and reliable questionnaires for assessing the energy-adjusted intake of protein, sodium, and potassium during pregnancy. In addition, given the observed validity of unadjusted protein and potassium intake measures, the DHQ can be a useful tool to estimate energy intake of pregnant Japanese women.

Association between high-risk fertility behaviours and the likelihood of chronic undernutrition and anaemia among married Bangladeshi women of reproductive age

OBJECTIVE

To explore the association between high-risk fertility behaviours and the likelihood of chronic undernutrition, anaemia and the coexistence of anaemia and undernutrition among women of reproductive age.

DESIGN

The 2011 Bangladesh Demographic and Health Survey, conducted from 8 July to 27 December 2011.

SETTING

Selected urban and rural areas of Bangladesh.

SUBJECTS

A total of 2197 ever-married women living with at least one child younger than 5 years. Exposure was determined from maternal reports of high-risk fertility behaviours. We considered three parameters, maternal age at the time of delivery, birth order and birth interval, to define the high-risk fertility behaviours. Chronic undernutrition, anaemia and the coexistence of anaemia and undernutrition among women were the outcome variables.

RESULTS

A substantial percentage of women were exposed to have a high-risk fertility pattern (41·8 %); 33·0 % were at single high-risk and 8·8 % were at multiple high-risk. After adjusting for relevant covariates, high-risk fertility behaviours were associated with increased likelihood of chronic undernutrition (adjusted relative risk; 95 % CI: 1·22; 1·03, 1·44), anaemia (1·12; 1·00, 1·25) and the coexistence of anaemia and undernutrition (1·52; 1·17, 1·98). Furthermore, multiple high-risk fertility behaviours appeared to have more profound consequences on the outcome measured.

CONCLUSIONS

Maternal high-risk fertility behaviours are shockingly frequent practices among women in Bangladesh. High-risk fertility behaviours are important predictors of the increased likelihood of women's chronic undernutrition, anaemia and the coexistence of anaemia and undernutrition.

Secondary Data Analysis of National Surveys in Japan Toward Improving Population Health

Secondary data analysis of national health surveys of the general population is a standard methodology for health metrics and evaluation; it is used to monitor trends in population health over time and benchmark the performance of health systems. In Japan, the government has established electronic databases of individual records from national surveys of the population’s health. However, the number of publications based on these datasets is small considering the scale and coverage of the surveys. There appear to be two major obstacles to the secondary use of Japanese national health survey data: strict data access control under the Statistics Act and an inadequate interdisciplinary research environment for resolving methodological difficulties encountered when dealing with secondary data. The usefulness of secondary analysis of survey data is evident with examples from the author’s previous studies based on vital records and the National Health and Nutrition Surveys, which showed that (i) tobacco smoking and high blood pressure are the major risk factors for adult mortality from non-communicable diseases in Japan; (ii) the decrease in mean blood pressure in Japan from the late 1980s to the early 2000s was partly attributable to the increased use of antihypertensive medication and reduced dietary salt intake; and (iii) progress in treatment coverage and control of high blood pressure is slower in Japan than in the United States and Britain. National health surveys in Japan are an invaluable asset, and findings from secondary analyses of these surveys would provide important suggestions for improving health in people around the world.

Differentials in the prevalence of anemia among non-pregnant, ever-married women in Bangladesh: multilevel logistic regression analysis of data from the 2011 Bangladesh Demographic and Health Survey

Background

Anemia is one of the most common public health problems globally, and high prevalence has been reported among women of reproductive age, especially in developing countries. This study was conducted to evaluate differentials in the prevalence of anemia among non-pregnant, ever-married women of reproductive age in Bangladesh, and to examine associations with demographic, socioeconomic, and nutritional factors.

Methods

Data for this cross-sectional study were taken from the 2011 Bangladesh Demographic and Health Survey (BDHS). In a sub-sample of one-third of the households, all ever-married women of reproductive age (15 to 49 years) were selected for the biomarker component of the survey, including anemia. The sample size for our study was 5,293. Data were analyzed using multilevel logistic regression analysis.

Results

The prevalence of anemia among non-pregnant, ever-married women was 41.3 % (urban: 37.2 % and rural: 43.5 %). Among anemic women, 35.5 % had mild anemia, 5.6 % had moderate anemia, and 0.2 % had severe anemia. Women with no education were more likely to be anemic than those with secondary education (p < 0.01) or higher education (p < 0.01). Undernourished women (BMI < 18.5) were at greater risk of anemia (p < 0.01) compared with normal women, overweight women, and obese women. Anemia was less pronounced among non-pregnant women using contraception (p < 0.05), Muslim women (p < 0.01), and women living in rich households (p < 0.01).

Conclusions

The prevalence of anemia among non-pregnant, ever-married women in Bangladesh is high. Illiteracy, poverty, and undernutrition are contributing factors.

Effect of traditional food supplements on nutritional status of lactating mothers and growth of their infants

OBJECTIVES

During lactation, traditional food supplements (TFS) are commonly consumed in India to increase lactation performance and health of mothers. TFS are rich in fats, nuts, dry fruits, and sugars and indulging in such supplements for 3 to 6 mo postpartum may put the mother at risk for obesity. The aim of this study was to assess the nutrient quality of TFS and its effect on nutritional status of lactating mothers and infant's weight gain in first 6 mo after delivery.

METHODS

A random sample of 125 Indian urban lactating mothers (28.9 ± 3.2 y) was assessed within 6 mo postpartum for anthropometry, diet by 24-h recall on 3 random days, along with socioeconomic factors, lactation history, and infant's birth weight and current weight.

RESULTS

Among 18 different TFS, 50% TFS were rich in calcium, 33% rich in iron, 38% in zinc, and only 13% were good sources of vitamins. Mothers consuming TFS (n = 75) had significantly higher fat intakes than mothers consuming no TFS Supplements (NTS; n = 50). A higher weight gain was seen in TFS mothers (10.5%) than NTS mothers (8.8%) after adjusting for number of days after delivery, parity, mother's age, and breast-feeding practices (P < 0.05). Percent weight gain in infants of TFS mothers (120.7% ± 7.3%) was higher than in infants of NTS mothers (96.2% ± 7.8%; P = 0.024) after adjusting for infant's age and mother's breast-feeding practices.

CONCLUSION

TFS may be modified to increase its micronutrient quality and to reduce fat contents with the goal of reducing the risk for obesity in mothers, while still benefiting infant growth.

Does cardiorespiratory fitness modify the association between birth weight and insulin resistance in adult life?

Objective

Lower birth weight is associated with higher insulin resistance in later life. The aim of this study was to determine whether cardiorespiratory fitness modifies the association of birth weight with insulin resistance in adults.

Methods

The subjects were 379 Japanese individuals (137 males, 242 females) aged 20–64 years born after 1943. Insulin resistance was assessed using a homeostasis model assessment of insulin resistance (HOMA-IR), which is calculated from fasting blood glucose and insulin levels. Cardiorespiratory fitness (maximal oxygen uptake, VO₂max) was assessed by a maximal graded exercise test on a cycle ergometer. Birth weight was reported according to the Maternal and Child Health Handbook records or the subject’s or his/her mother’s memory.

Results

The multiple linear regression analysis revealed that birth weight was inversely associated with HOMA-IR (β = −0.141, p = 0.003), even after adjustment for gender, age, current body mass index, mean blood pressure, triglycerides, HDL cholesterol, and smoking status. Further adjustments for VO₂max made little difference in the relationship between birth weight and HOMA-IR (β = −0.148, p = 0.001), although VO₂max (β = −0.376, p<0.001) was a stronger predictor of HOMA-IR than birth weight.

Conclusions

The results showed that the association of lower birth weight with higher insulin resistance was little modified by cardiorespiratory fitness in adult life. However, cardiorespiratory fitness was found to be a stronger predictor of insulin resistance than was birth weight, suggesting that increasing cardiorespiratory fitness may have a much more important role in preventing insulin resistance than an individual’s low birth weight.

Assessment of maternal anemia in rural Western China between 2001 and 2005: a two-level logistic regression approach

BACKGROUND

There are multiple adverse effects of anemia on human function, particularly on women. However, few researches are conducted on women anemia in rural Western China. This study mainly aims to investigate the levels and associated factors of maternal anemia between 2001 and 2005 in this region.

METHODS

6172 and 5372 mothers with children under three years old were selected from 8 provinces in 2001 and from 9 provinces in 2005 respectively in Western China by means of a multi-stage probability proportion to size sampling method (PPS). The blood samples were tested and related socio-demographic information was obtained through questionnaires. A two-level logistic regression model was employed to identify the determinants and provincial variations of women anemia in 2001 and 2005.

RESULTS

The results indicated that the crude prevalence of women anemia in 2005 was higher than the rate in 2001(45.7% vs 33.6%). Based on the nationwide census data in 2000, the age-standardized prevalence of women anemia in the study were obtained as 38.0% in 2001 and 50.0% in 2005 respectively. Two-level logistic model analysis showed that compared to the average, women were more likely to be anemic in Guangxi and Qinghai in 2001 as well as in Chongqing and Qinghai in 2005; that women from Minority groups had higher odds of anemia in contrast with Han; that women with higher parity, longer breastfeeding duration and higher socioeconomic level had a lower rate of anemia, while age of women was positively associated with anemia. The positive correlation between women anemia and altitude was also observed.

CONCLUSIONS

The study demonstrated that the burden of maternal anemia in rural Western China increased considerably between 2001 and 2005. The Chinese government should conduct integrated interventions on anemia of mothers in this region.

Evaluation of dietary intake of lactating women in China and its potential impact on the health of mothers and infants

BACKGROUND

Optimal nutrition for lactating mothers is importance for mother and infants' health and well-being. We determined the nutrient intake and dietary changes during the first 3-month of lactation, and its potential effect on health and disease risk.

METHOD

Personal interviews were conducted to collect a 24 h diet recall questionnaire from 199 healthy lactating women in the postpartum days 2, 7, 30, 90 and healthy 58 non-pregnant women served as the controls.

RESULTS

We found in lactating women (1) the mean daily energy and carbohydrate intake was lower than that of the Chinese Recommended Nutrient Intake (RNI, 2600 Kcal, 357.5 ~ 422.5 g) by 11% ~ 17% and 33% ~ 49%, respectively; (2) the fat intake increased from 3% to 13%, which was 9 ~ 77% higher than the RNI (57 ~ 86.7 g); (3) the protein intake exceeded the RNI of 85 g by 32 ~ 53%; (4) the total calories consumed from carbohydrate (39%-44%), fat (34% ~ 42%) and protein (20%-23%) failed to meet Chinese RNI (5) the intake of vitamin C, B1, folate, zinc, dietary fiber, and calcium was 5% ~ 73% lower than the RNI while vitamin B2, B3, E, iron and selenium intake was 20% to 3 times higher than the RNI. Nutrient intake in the control group was lower for all nutrients than the recommended RNI.

CONCLUSION

Lactating women on a self-selected diet did not meet the Chinese RNI for many important micronutrients, which may influence the nutritional composition of breast milk and thus impact the potential health of mothers and infants. RNI should consider the regional dietary habits and culture. A single national RNI is not applicable for all of China. Nutritional education into the community is needed.

Nutrition awareness before and throughout different trimesters in pregnancy: a quantitative study among Dutch women

OBJECTIVE

To examine the nutrition awareness of women before and during pregnancy in order to provide a greater understanding of the life course perspective (LCP) in relation to nutrition behaviours and pregnancy.

METHOD

Data were collected in a cross-sectional study with the aid of a face-to-face interview, based on our conceptualization of nutrition awareness and the 'rules of thumb' designed by the Dutch Nutrition Centre. The sample consisted of five groups each of ~100 Dutch nulliparous women: women not trying to conceive a child, women trying to conceive a child and women in their first, second or third trimesters of pregnancy.

RESULTS

The measurement tool based on our conceptualization of nutrition awareness resulted in a Cronbach's alpha of 0.84. Pregnant women are significantly more aware of their nutrition than women who are not trying to conceive. The scores on nutrition awareness do not differ significantly between the three trimester groups of pregnant women. Women who are trying to conceive do not have a significantly higher nutrition awareness than women who are not trying to conceive.

CONCLUSIONS

Our conceptualization of nutrition awareness has shown to be fruitful in obtaining a better understanding of behavioural changes in health. The study provided indications in favour of the LCP; pregnancy could indeed be an event in a woman's life that causes increased nutrition awareness. This should be kept in mind when healthy nutrition promotion activities are being developed.

Validity and reproducibility of folate and vitamin B(12) intakes estimated from a self-administered diet history questionnaire in Japanese pregnant women

Background

No validated dietary questionnaire for assessing folate and vitamin B₁₂ intakes during pregnancy is available in Japan. We evaluated the validity and reproducibility of intakes of folate and vitamin B₁₂ estimated from a self-administered diet history questionnaire (DHQ) in Japanese pregnant women.

Methods

A sample of 167 healthy subjects with singleton pregnancies in the second trimester was recruited at a private obstetric hospital in metropolitan Tokyo from June to October 2008 (n = 76), and at a university hospital in Tokyo from June 2010 to June 2011 (n = 91). The dietary intakes of folate and vitamin B₁₂ were assessed using the DHQ. The serum concentrations of folate and vitamin B₁₂ were measured as reference values in the validation study. To assess the reproducibility of the results, 58 pregnant women completed the DHQ twice within 4-5 week interval.

Results

Significantly positive correlations were found between energy-adjusted intakes and serum concentrations of folate and vitamin B₁₂ (r = 0.286, p < 0.001 and r = 0.222, p = 0.004, respectively). After excluding the participants with nausea (n = 121), the correlation coefficient for vitamin B₁₂ increased to 0.313 (p = 0.001). When participants were classified into quintiles based on intakes and serum concentrations of folate and vitamin B₁₂ , approximately 60% were classified in the same or adjacent quintile. The intraclass correlation coefficients of the two-time DHQ were 0.725 for folate and 0.512 for vitamin B₁₂ .

Conclusion

The present study indicated that the DHQ had acceptable validity and reproducibility for assessing folate and vitamin B₁₂ intakes in Japanese pregnant women.

Type of milk feeding affects hematological parameters and serum lipid profile in Japanese infants

BACKGROUND

Type and volume of infant feeding determines infant growth, hematological parameters, and serum lipids.

METHODS

Study subjects consisted of 103 infants who were born vaginally at term, with birthweight >2200 g. Milk feeding amount, type, and anthropometry were measured at 1 and 6 months. Hematological tests and serum lipid profile were assessed at 1 and 6 months. Thirty-four infants were breast-fed and 36 were formula-fed at 6 months.

RESULTS

Breast-fed infants demonstrated similar growth patterns compared with partially breast-fed or formula-fed infants, despite the lower milk intake. Infants with higher breast milk intake at 6 months, however, tended to have lower hemoglobin levels. In contrast, higher formula intake at 6 months was related to lower serum total cholesterol.

CONCLUSIONS

Japanese breast-fed infants were more likely to be anemic at 6 months, while formula-fed infants were likely to have low serum lipid levels. Iron-fortified infant foods may be useful to prevent anemia in breast-fed infants. Fat quality of infant formulas should be improved to enhance lipid status of formula-fed infants.

Smoking during pregnancy increases risks of various obstetric complications: a case-cohort study of the Japan Perinatal Registry Network database

BACKGROUND

The adverse effects of maternal smoking on the health of pregnant women have been examined mostly on a disease-by-disease basis. The aims of this study were to evaluate simultaneously the effects of smoking during pregnancy on various obstetric complications, using data from a large medical database, and to investigate the expediency of using a case-cohort design for such an analysis.

METHODS

A case-cohort study was conducted within the Japan Perinatal Registry Network database. Perinatal information on infant deliveries was entered into the database at 125 medical centers in Japan. The base population of the study was 180 855 pregnant women registered in the database from 2001 through 2005. The outcome measures were the incidences of 11 different obstetric complications. Logistic regression models were used to estimate age-adjusted risk ratios (aRRs) and relative excess incidence proportions (REIs).

RESULTS

The overall prevalence of smoking during pregnancy was 5.8% in the base cohort, and the prevalence was higher among younger women. A comparison of the cases and control cohort showed that smokers during pregnancy had statistically significant higher risks for preterm rupture of the membrane (aRR: 1.67, 95% confidence interval [CI]: 1.43-1.96; REI: 40.2%, 95% CI: 29.9%-49.1%), chorioamnionitis (1.65, 1.36-2.00; 39.4%, 26.4%-50.0%), incompetent cervix (1.63, 1.35-1.96; 38.5%, 25.8%-49.1%), threatened premature delivery (1.38, 1.17-1.64; 27.7%, 14.5%-38.9%), placental abruption (1.37, 1.10-1.72; 27.1%, 8.8%-41.7%), and pregnancy-induced hypertension (1.20, 1.01-1.41; 16.4%, 1.2%-29.3%).

CONCLUSIONS

Maternal smoking was associated with a number of obstetric complications. This highlights the importance of smoking cessation during pregnancy. In addition, case-cohort analysis proved useful in estimating RRs for multiple outcomes in a large database.

Dietary behaviours during pregnancy: findings from first-time mothers in southwest Sydney, Australia

BACKGROUND

Limited prevalence data are available for nutrition related health behaviours during pregnancy. This study aimed to assess dietary behaviours during pregnancy among first-time mothers, and to investigate the relationships between these behaviours and demographic characteristics, so that appropriate dietary intervention strategies for pregnant women can be developed.

METHOD

An analysis of cross-sectional survey was conducted using data from 409 first-time mothers at 26-36 weeks of pregnancy, who participated in the Healthy Beginnings Trial conducted in southwestern Sydney, Australia. Dietary behaviours, including consumption of vegetables, fruit, water, milk, soft drinks, processed meat products, fast foods/take away and chips, were assessed using the New South Wales Health Survey questionnaire through face-to-face interviews. Factors associated with dietary behaviours were determined by logistic regression modeling. Log-binomial regression was used to calculate adjusted risk ratios (ARR).

RESULTS

Only 7% of mothers reported meeting the recommended vegetable consumption and 13% reported meeting the recommended fruit consumption. Mean and median intakes per day were 2.3 (SD 1.3) and 2 serves of vegetables, and 2.1 (SD 1.4) and 2 serves of fruit respectively. About one fifth of mothers (21%) reported drinking 2 cups (500 ml) or more of soft drink per day and 12% reported consuming more than 2 meals or snacks from fast-food or takeaway outlets per week. A small percentage of mothers (5%) had experienced food insecurity over the past 12 months. There were significant inverse associations between water and soft drink consumption (Spearman's rho -0.20, P < 0.001), and between fruit and fast food/takeaway consumption (Spearman's rho -0.16, P = 0.001). The dietary behaviours were associated with a variety of socio-demographic characteristics, but no single factor was associated with all the dietary behaviours.

CONCLUSIONS

There were low reported levels of vegetable and fruit consumption and high reported levels of soft drink and takeaway/fast food consumption among pregnant women. Dietary interventions to prevent adverse health consequences need to be tailored to meet the needs of pregnant women of low socio-economic status in order to improve their own healthy eating behaviors. Increasing water and fruit consumption could lead to reduced consumption of soft drink and takeaway/fast food among pregnant women.

TRIAL REGISTRATION

HBT is registered with the Australian Clinical Trial Registry (ACTRNO12607000168459).

Common immune-related risk factors and incident non-Hodgkin lymphoma: the multiethnic cohort

Severe immune dysfunction is an established risk factor of lymphoma, but the role of moderate alterations of immunity is not clear and prospective investigations are needed. We examined several immune-related disorders and medications in relation to non-Hodgkin lymphoma (NHL) in the Multiethnic Cohort. Over 215,000 subjects of African American, Caucasian, Japanese American, Latino and Native Hawaiian ancestry aged 45-75 years completed a questionnaire, including information on medical history, in 1993-1996. After exclusions, we performed Cox regression among 193,050 cohort members including 939 incident NHL cases while adjusting for sex, age, ethnicity, education, body mass index and alcohol intake. Self-reported diabetes was not associated with NHL overall, but was positively associated with risk among Japanese Americans [hazard ratio (HR) = 1.55; 95% confidence interval (CI): 1.10-2.17]. Participants with a history of blood transfusion were at increased risk with HR = 1.39 (95% CI: 1.06-1.84) in men and HR = 1.22 (95% CI: 0.94-1.58) in women, especially for the diffuse large B-cell lymphoma subtype. History of asthma or other allergies was associated with elevated risk only among Latinos (HR = 1.46; 95% CI: 1.07-2.00) who also showed a significant relation between current use of antihistamines and NHL (HR = 1.80; 95% CI: 1.09-2.97). Use of nonsteroidal anti-inflammatory drugs was not associated with NHL. Our findings from this large prospective study support a moderate risk for NHL related to blood transfusions, current long-term antihistamine use and diabetes, but the associations were limited to certain ethnic groups and require further replications.

Effects of multiparity and prolonged breast-feeding on maternal bone mineral density: a community-based cross-sectional study

Background

Studies conducted in Western countries have shown that bone loss associated with pregnancy and breast-feeding is recovered after weaning. However, it is not clear whether recovery takes place after repeated pregnancies followed by prolonged periods of breast-feeding; especially in developing countries where nutritional intake is comparatively low.

This study was designed to examine the effects of multiparity and prolonged breast-feeding on maternal bone mineral density (BMD) in a community-based sample of 210 Sri Lankan women, aged between 46 and 98 years.

Methods

BMD of the lumbar spine (L₂–L₄) and femoral neck were measured by dual-energy X-ray absorptiometry. Reproductive history was recorded by using a questionnaire. Women were, first, divided into groups according to parity (nulliparous, 1–2, 3–4, and 5 or more children), and BMDs in different groups were compared, initially unadjusted and then adjusted for age. Same subjects were subdivided, again, according to the total duration of breast-feeding (0, 1–48, 49–96, and 97 months or more) and similar analysis was carried out.

Results

Women who had 5 or more children and women who had breast-fed for 97 months or more were older than the other women (p < 0.01) but no differences in height, weight or BMI were observed among the groups. Age adjusted BMD at lumbar spine and femoral neck BMDs of women grouped according to parity were not significantly different. Neither was there any difference between lumbar spine or femoral neck BMD in groups based on duration of breast-feeding.

Conclusion

From this population-based study conducted in a developing country, we infer that history of multiparity or prolonged breast-feeding has no detrimental effects on maternal BMD in post-menopausal age.

Nutrition awareness and pregnancy: Implications for the life course perspective

OBJECTIVE

To explore the influence of a life event (pregnancy) on nutrition awareness and the motivations for nutrition behaviour.

STUDY DESIGN

In-depth, face-to-face interviews with five groups of 12 women: women wishing to conceive a child, women in the first, second, and third trimesters of their first pregnancy, and women in the first trimester of their second pregnancy. As is common in qualitative research, participants were selected on the basis of diversity together with maximum representativeness within normal populations with respect to socio-demographic characteristics.

RESULTS

With respect to nutrition awareness, three groups of women can be distinguished: (1) those who are 'going all the way'; these women try to live precisely by the book, (2) those who are 'taking the flexible way'; these women are more aware of their nutrition, but are more flexible in handling it, and (3) women who 'continue the same way'; these women have a no-nonsense mentality and do not experience essential shifts in their nutrition awareness. The extent and fluctuations in nutrition awareness throughout preconception and pregnancy are based on three types of motivations, the interest of (1) the child, (2) the mother, and (3) the social environment.

CONCLUSIONS

This study provides indications that preconception and pregnancy could indeed be a life event leading to increased general nutrition awareness that might influence women's future nutrition-related behaviours.

Milk folate secretion is not impaired during iron deficiency in humans

The purpose of this study was to examine whether maternal iron and/or folate status influences human milk folate secretion and is responsible for growth faltering of Otomi infants in Capulhuac, Mexico. Breast-feeding mothers (n = 71) were randomized at 22 +/- 13 d (baseline) postpartum to receive a daily multivitamin supplement containing folic acid (400 microg) with and without iron (18 mg). Mothers provided blood and milk samples at baseline, and at 82 +/- 15 and 138 +/- 18 d postpartum. Iron supplementation significantly improved hematocrit and transferrin receptor concentrations but had no influence on maternal folate status or milk folate or iron concentrations. Forty-three percent of mothers (29/68) had low blood folate concentrations at baseline, whereas only 6% (4/66) had low blood folate concentrations at approximately 138 d postpartum. Milk folate concentrations did not differ between Fe-deficient and Fe-sufficient women and provided adequate levels of dietary folate by approximately 82 d postpartum. While milk iron concentrations were unrelated to maternal iron status, they decreased during lactation, and, by approximately 138 d, they provided only 55% of the current recommendation. In conclusion, milk folate concentrations appear to be well preserved during maternal iron deficiency; hence, faltering growth among infants in Capulhuac, Mexico is unlikely the result of reduced milk folate concentration secondary to maternal Fe deficiency. However, milk Fe concentrations showed a temporal decline. Whether the disjuncture between recommended and actual Fe intakes among infants born with low Fe reserves and weaned to foods low in bioavailable Fe has functional consequences is worthy of further investigation.

Folate intakes and folate biomarker profiles of pregnant Japanese women in the first trimester

OBJECTIVE

To assess the status of dietary folate intake, serum and red blood cell (RBC) folate, and related nutritional biomarkers in healthy Japanese women in early pregnancy.

DESIGN

A cross-sectional, observational study.

SUBJECTS

Pregnant women in the first trimester, at 7-15 weeks gestation (n=70), who were not consuming any folate supplements or folate fortified foods.

METHODS

Three-day dietary records were obtained from each subject to assess dietary folate intake. Blood samples were collected for measurement of biomarkers. Biomarkers and nutrient intake were analyzed in two groups defined by their serum folate concentrations: the low folate group (serum folate < 9 ng/ml) and the high folate group (serum folate > or = 9 ng/ml).

RESULT

Mean serum and RBC folate concentrations in all subjects were 10.3 and 519 ng/ml, respectively. These levels were remarkably higher than the reported values from many other countries despite our subjects receiving no folic acids supplements. However, mean folate intake by our subjects from natural foods was 289 microg/day, which is thought to be low according to the Japanese dietary recommendation specified for pregnant women. The intake of spinach and fruits was significantly greater in the high folate group than in the low folate group.

CONCLUSION

Folate intake was thought to be adequate to maintain a desirable level of serum folate concentration in Japanese pregnant women in the first trimester, although the intake of folate from natural food was not high enough to meet the recommended daily intake.

Increasing trend of spina bifida and decreasing birth weight in relation to declining body-mass index of young women in Japan

We analyzed the existing data from various surveys on the prevalence of spina bifida, birth weight, and body-mass index (BMI), dietary intake, and smoking habits of Japanese young women. We found that the increasing trend of the prevalence of spina bifida paralleled with the decrease in birth weight, and the decrease in BMI and dietary energy intake and the increase in smoking rate among women of childbearing age. The decreased energy intake is likely due to their distorted self-body image. Based on these findings, we hypothesize that lowering BMI in young women led to increasing prevalence of spina bifida and smaller babies in Japan. This low dietary intake possibly leads to poor folate nutritional status, a risk factor for the development of spina bifida, and increased smoking potentially accelerates these undesirable outcomes. Our hypothesis can be tested using two simultaneous approaches. The first step is an extensive educational campaign for young women to stop smoking, have a realistic body image and eat a sufficient balanced diet. Government officials and health-care workers are encouraged to establish an agenda to educate young women with emphasis on the importance of adequate nutrition during the critical period of reproduction. Together with this campaign, the distribution of folic acid tablets for the prevention of spina bifida can be tried in women of childbearing age through local health centers, which have been well established in Japan.

Increase in low-birth-weight infants in Japan and associated risk factors, 1980-2000

AIM

To investigate possible factors related to the recent rise in prevalence of low-birth-weight (LBW) infants in Japan.

METHODS

A data set comprising 11,746 infants from the Children and Infant Growth Surveys (1980, 1990, and 2000) was analyzed.

RESULTS

The proportion of LBW infants was 4.2% in 1980, 6.1% in 1990, and 8.3% in 2000. The maternal smoking prevalence increased from 6.5% in 1990 to 10.9% in 2000. When multivariate logistic regression analysis was applied to estimate the risk for LBW from 1990 to 2000, the following were selected as independent factors: preterm delivery, early term delivery, female sex of the infant, maternal primiparity, multiple gestation, maternal short stature, older maternal age (>24 years), and maternal smoking. The population attributable fraction (PAF) of preterm plus early term delivery and multiple gestations to LBW was 85.1% in 1990, and 89.3% in 2000. The PAF of maternal smoking was 6.4% in 1990, and 7.4% in 2000.

CONCLUSIONS

The increase in preterm deliveries and multiple gestations were found to be the important factors with regard to the increase in LBW infants in Japan. The increased prevalence of maternal smoking was not substantially associated with the increase in LBW infants.

Folate deficiency does not alter the usefulness of the serum transferrin receptor concentration as an index for the detection of iron deficiency in mexican women during early lactation

The purpose of this study was to investigate the usefulness of soluble serum transferrin receptor (TfR) concentration, TfR index and log TfR:ferritin ratio (TfR outcomes) in detecting tissue Fe deficiency among breast-feeding Otomi women residing in Capulhuac, Mexico (2800 m above sea level) and to determine whether folate deficiency modifies the interpretation of these data. Lactating women (n = 68) provided blood samples at 22 +/- 13 d (mean +/- SD) postpartum. Using the 3-index Fe assessment model with and without Hb, 2 women (3%) had Fe-deficient erythropoiesis, 24 (36%) Fe deficiency anemia, and 19 (29%) indeterminate Fe status; 29 (43%) and 5 (7.5%) women had plasma and erythrocyte folate concentrations below normative cutoff values, respectively. Mean values for TfR outcomes were higher among women classified as Fe deficient than those who were Fe sufficient, but did not differ with low or normal blood folate concentrations. Similarly, TfR outcomes did not differ among women with normocytic or macrocytic erythrocytes. Receiver-operating characteristic (ROC) curves generated for TfR outcomes yielded areas under the curve from 0.62 to 0.68, indicating that each of these measures, on its own, is a poor predictor of tissue Fe deficiency in lactating women. In conclusion, low blood folate concentrations or the presence of macrocytosis in Otomi women from Capulhuac, Mexico (moderate altitude) did not influence the utility of TfR outcomes for the detection of Fe deficiency during early lactation. Further, on their own, TfR, TfR index, and TfR:ferritin ratio were poor predictors of tissue Fe deficiency for any given individual.