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Vlaardingerbroek H, Joustra SD, Oostdijk W, de Bruin C, Wit JM. Assessment of Nutritional Status in the Diagnostic Evaluation of the Child with Growth Failure. Horm Res Paediatr 2023; 97:11-21. [PMID: 37054683 DOI: 10.1159/000530644] [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: 02/13/2023] [Accepted: 03/23/2023] [Indexed: 04/15/2023] Open
Abstract
Current clinical guidelines provide information about the diagnostic workup of children with growth failure. This mini-review focuses on the nutritional assessment, which has received relatively little attention in such guidelines. The past medical history, in particular a low birth size and early feeding problems, can provide information that can increase the likelihood of nutritional deficits or several genetic causes. The current medical history should include a dietary history and can thereby reveal a poorly planned or severely restricted diet, which can be associated with nutritional deficiencies. Children on a vegan diet should receive various nutritional supplements, but insufficient compliance has been reported in one-third of cases. While proper use of nutritional supplements in children consuming a vegan diet appears to be associated with normal growth and development, insufficient intake of supplements may impede growth and bone formation. Physical examination and analysis of height and weight over time can help differentiating between endocrine causes, gastrointestinal disorders, psychosocial problems, or underlying genetic conditions that prevent adequate nutritional intake. Laboratory screening should be part of the workup in every child with short stature, and further laboratory tests can be indicated if warranted by the dietary history, especially in children on a poorly planned vegan diet.
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Affiliation(s)
- Hester Vlaardingerbroek
- Division of Paediatric Endocrinology, Department of Paediatrics, Willem-Alexander Children's Hospital, Leiden University Medical Centre, Leiden, The Netherlands
| | - Sjoerd D Joustra
- Division of Paediatric Endocrinology, Department of Paediatrics, Willem-Alexander Children's Hospital, Leiden University Medical Centre, Leiden, The Netherlands
| | - Wilma Oostdijk
- Division of Paediatric Endocrinology, Department of Paediatrics, Willem-Alexander Children's Hospital, Leiden University Medical Centre, Leiden, The Netherlands
| | - Christiaan de Bruin
- Division of Paediatric Endocrinology, Department of Paediatrics, Willem-Alexander Children's Hospital, Leiden University Medical Centre, Leiden, The Netherlands
| | - Jan M Wit
- Division of Paediatric Endocrinology, Department of Paediatrics, Willem-Alexander Children's Hospital, Leiden University Medical Centre, Leiden, The Netherlands
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2
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Timms K, Holder B, Day A, Mclaughlin J, Forbes KA, Westwood M. Watermelon-Derived Extracellular Vesicles Influence Human Ex Vivo Placental Cell Behavior by Altering Intestinal Secretions. Mol Nutr Food Res 2022; 66:e2200013. [PMID: 35938208 PMCID: PMC9787345 DOI: 10.1002/mnfr.202200013] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 06/20/2022] [Indexed: 12/30/2022]
Abstract
SCOPE During pregnancy, mother-to-fetus transfer of nutrients is mediated by the placenta; sub-optimal placental development and/or function results in fetal growth restriction (FGR), and the attendant risk of stillbirth, neurodevelopmental delay, and non-communicable diseases in adulthood. A maternal diet high in fruit and vegetables lowers the risk of FGR but the association cannot be explained fully by known macro- and micronutrients. METHODS AND RESULTS This study investigates if dietary-derived extracellular vesicles (EVs) can regulate placental function. The study characterizes the microRNA and protein cargo of EVs isolated from watermelon, show they are actively internalized by human intestinal epithelial cells in vitro, use mass spectrometry to demonstrate that they alter the intestinal secretome and bioinformatic analyses to predict the likely affected pathways in cells/tissues distal to gut. Application of the watermelon EV-modified intestinal secretome to human placental trophoblast cells and ex vivo tissue explants affects the trophoblast proteome and key aspects of trophoblast behavior, including migration and syncytialization. CONCLUSION Dietary-derived plant EVs can modify intestinal communication with distal tissues, including the placenta. Harnessing the beneficial properties of dietary-derived plant EVs and/or exploiting their potential as natural delivery agents may provide new ways to improve placental function and reduce rates of FGR.
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Affiliation(s)
- Kate Timms
- Maternal and Fetal Health Research CentreSchool of Medical SciencesUniversity of ManchesterManchesterM13 9WLUK,Manchester University NHS Foundation TrustManchester Academic Health Sciences CentreManchesterM13 9WLUK
| | - Beth Holder
- Department of MetabolismDigestion and ReproductionInstitute of Reproductive and Developmental BiologyImperial College LondonLondonUK
| | - Anil Day
- Division of Molecular and Cellular FunctionSchool of Biological SciencesUniversity of ManchesterManchesterM13 9PTUK
| | - John Mclaughlin
- Division of DiabetesEndocrinology and GastroenterologyUniversity of ManchesterManchesterM13 9PTUK,Department of GastroenterologySalford Royal NHS Foundation TrustSalfordM6 8HDUK
| | - Karen A. Forbes
- Discovery and Translational Science DepartmentLeeds Institute of Cardiovascular and Metabolic MedicineFaculty of Medicine and HealthUniversity of LeedsLeedsLS2 9JTUK
| | - Melissa Westwood
- Maternal and Fetal Health Research CentreSchool of Medical SciencesUniversity of ManchesterManchesterM13 9WLUK,Manchester University NHS Foundation TrustManchester Academic Health Sciences CentreManchesterM13 9WLUK
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Iglesia Altaba I, Larqué E, Mesa MD, Blanco-Carnero JE, Gomez-Llorente C, Rodríguez-Martínez G, Moreno LA. Early Nutrition and Later Excess Adiposity during Childhood: A Narrative Review. Horm Res Paediatr 2022; 95:112-119. [PMID: 34758469 DOI: 10.1159/000520811] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 11/09/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Studies on childhood obesity mainly focus on the genetic component and on the lifestyle that may be associated with the development of obesity. However, the study of perinatal factors in their programming effect toward future obesity in children or adults is somewhat more recent, and there are still mechanisms to be disentangled. SUMMARY In this narrative review, a comprehensive route based on the influence of some early factors in life in the contribution to later obesity development is presented. Maternal pre-pregnancy BMI and gestational weight gain have been pointed out as independent determinants of infant later adiposity. Lifestyle interventions could have an impact on pregnant mothers through epigenetic mechanisms capable of redirecting the genetic expression of their children toward a future healthy weight and body composition and dietary-related microbiome modifications in mothers and newborns might also be related. After birth, infant feeding during the first months of life is directly associated with its body composition and nutritional status. From this point of view, all the expert committees in the world are committed to promote exclusive breastfeeding up to 6 months of age and to continue at least until the first year of life together with complementary feeding based on healthy dietary patterns such as Mediterranean Diet. KEY MESSAGES To develop future effective programs to tackle early obesity, it is necessary not only by controlling lifestyle behaviors like infant feeding but also understanding the role of other mechanisms like the effect of perinatal factors such as maternal diet during pregnancy, epigenetics, or microbiome.
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Affiliation(s)
- Iris Iglesia Altaba
- Aragon Health Research Institute, University of Zaragoza, Zaragoza, Spain.,Maternal-Infant and Developmental Health Network (SAMID), RETICS Carlos III Health Institute (ISCIII), Madrid, Spain.,Growth, Exercise, Nutrition and Development (GENUD), Faculty of Health Sciences, University of Zaragoza, and Instituto Agroalimentario de Aragón (IA2), Zaragoza, Spain
| | - Elvira Larqué
- Maternal-Infant and Developmental Health Network (SAMID), RETICS Carlos III Health Institute (ISCIII), Madrid, Spain.,Department of Physiology, Murcia University, Murcia, Spain
| | - María Dolores Mesa
- Maternal-Infant and Developmental Health Network (SAMID), RETICS Carlos III Health Institute (ISCIII), Madrid, Spain.,Department of Biochemistry and Molecular Biology II, School of Pharmacy. Institute of Nutrition and Food Technology "José Mataix", Biomedical Research Center, University of Granada, Granada, Spain.,ibs.GRANADA, Biosanitary Research Institute, Granada, Spain
| | | | - Carolina Gomez-Llorente
- Department of Biochemistry and Molecular Biology II, School of Pharmacy. Institute of Nutrition and Food Technology "José Mataix", Biomedical Research Center, University of Granada, Granada, Spain.,ibs.GRANADA, Biosanitary Research Institute, Granada, Spain.,Center for Biomedical Research on Physiopathology of Obesity and Nutrition (CIBERObn), Instituto de Salud Carlos III, Madrid, Spain
| | - Gerardo Rodríguez-Martínez
- Aragon Health Research Institute, University of Zaragoza, Zaragoza, Spain.,Maternal-Infant and Developmental Health Network (SAMID), RETICS Carlos III Health Institute (ISCIII), Madrid, Spain.,Growth, Exercise, Nutrition and Development (GENUD), Faculty of Health Sciences, University of Zaragoza, and Instituto Agroalimentario de Aragón (IA2), Zaragoza, Spain.,Department of Pediatrics, Faculty of Medicine, University of Zaragoza, Zaragoza, Spain
| | - Luis A Moreno
- Aragon Health Research Institute, University of Zaragoza, Zaragoza, Spain.,Growth, Exercise, Nutrition and Development (GENUD), Faculty of Health Sciences, University of Zaragoza, and Instituto Agroalimentario de Aragón (IA2), Zaragoza, Spain.,Center for Biomedical Research on Physiopathology of Obesity and Nutrition (CIBERObn), Instituto de Salud Carlos III, Madrid, Spain
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Maternal Dietary Quality and Dietary Inflammation Associations with Offspring Growth, Placental Development, and DNA Methylation. Nutrients 2021; 13:nu13093130. [PMID: 34579008 PMCID: PMC8468062 DOI: 10.3390/nu13093130] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 08/31/2021] [Accepted: 09/04/2021] [Indexed: 12/14/2022] Open
Abstract
The ‘Developmental Origins of Health and Diseases’ hypothesis posits that prenatal maternal diet influences offspring growth and later life health outcomes. Dietary assessment has focused on selected nutrients. However, this approach does not consider the complex interactions between foods and nutrients. To provide a more comprehensive approach to public health, dietary indices have been developed to assess dietary quality, dietary inflammation and risk factors for non-communicable diseases. Thus far, their use in the context of placental development is limited and associations with offspring outcomes have been inconsistent. Although epidemiological studies have focused on the role of maternal diet on foetal programming, the underlying mechanisms are still poorly understood. Some evidence suggests these associations may be driven by placental and epigenetic changes. In this narrative review, we examine the current literature regarding relationships between key validated diet quality scores (Dietary Inflammatory Index [DII], Mediterranean diet [MD], Healthy Eating Index [HEI], Alternative Healthy Eating Index [AHEI], Dietary Approaches to Stop Hypertension [DASH], Glycaemic Index [GI] and Glycaemic Load [GL]) in pregnancy and birth and long-term offspring outcomes. We summarise findings, discuss potential underlying placental and epigenetic mechanisms, in particular DNA methylation, and highlight the need for further research and public health strategies that incorporate diet quality and epigenetics.
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Miranda C, Souza RCVE, Santos LCD. Influence of ultra-processed foods consumption during pregnancy on baby's anthropometric measurements, from birth to the first year of life: a systematic review. REVISTA BRASILEIRA DE SAÚDE MATERNO INFANTIL 2021. [DOI: 10.1590/1806-93042021000100002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Abstract Objectives: to perform a systematic review of studies that investigated the influence of ultra-processed foods (UPF) consumption during pregnancy on child’s anthropometric parameters up to one year of life. Methods: cohort and cross-sectional studies were researched in BVS, Cinahl, Cochrane, Embase, Pubmed, Scopus and Web of Science databases until March 2020, and the main descriptors were: “Pregnant Women”, “Ultra-processed foods”, “Birth Weight”, “Smallfor Gestational Age”, “Infant”, “Newborn”. Results: seventeen articles were considered eligible and evaluated the associations between the exposures: ultra-processed dietary patterns; soft drinks, sugar-sweetened beverages, artificially sweetened beverages; fast food, junk food, sweets, snacks and the outcomes: birth weight and its classifications; length and head circumference at birth; birth weight adjustments according to gestational age; weight/age, length/age, body mass index/age and weight/length indices. The results showed: 36 non-significant associations between the exposures and the outcomes; 13 direct associations (outcomes versus ultraprocessed dietary patterns, soft drinks, artificially sweetened beverages, sweets, junk food) and 5 inverse associations (outcomes versus ultra-processed dietary patterns, soft drinks). Conclusions: most of the evaluated literature did not demonstrate the influence of UPF consumption during pregnancy on the newborn’s anthropometric measurements up to one year of life and denoted a smaller number of direct and inverse associations between the exposures and the outcomes.
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Gonzalez-Nahm S, Hoyo C, Østbye T, Neelon B, Allen C, Benjamin-Neelon SE. Associations of maternal diet with infant adiposity at birth, 6 months and 12 months. BMJ Open 2019; 9:e030186. [PMID: 31494614 PMCID: PMC6731802 DOI: 10.1136/bmjopen-2019-030186] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Revised: 08/13/2019] [Accepted: 08/16/2019] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVES To assess associations between maternal prenatal diet quality and infant adiposity. DESIGN The design was a prospective birth cohort. SETTING We used data from the Nurture study, a cohort of women and their infants residing in the southeastern USA. PARTICIPANTS AND EXPOSURE ASSESSMENT Between 2013 and 2015, we enrolled 860 women between 20 and 36 weeks' gestation. After reconsenting at delivery and excluding women with implausible calorie intakes, we measured dietary intake using the Block food frequency questionnaire, and assessed diet quality using a modified Alternate Healthy Eating Index 2010 (AHEI-2010), which assessed intake of 10 food categories, including fruits, vegetables, whole grains, nuts/legumes, fats, meats, beverages and sodium (excluding alcohol). OUTCOMES We assessed birth weight for gestational age z-score, small and large for gestational age, low birth weight and macrosomia. Outcomes at 6 and 12 months were weight-for-length z-score, sum of subscapular and triceps skinfold thickness (SS+TR) and subscapular-to-triceps skinfold ratio (SS:TR). RESULTS Among mothers, 70.2% were black and 20.9% were white; less than half (45.2%) reported having a high school diploma or less. Among infants, 8.7% were low birth weight and 8.6% were small for gestational age. Unadjusted estimates showed that a higher AHEI-2010 score, was associated with a higher birth weight for gestational z-score (β=0.01; 95% CI 0.002 to 0.02; p=0.02) and a greater likelihood of macrosomia (OR=1.04; 95% CI 1.004 to 1.09; p=0.03). After adjustment, maternal diet quality was not associated with infant adiposity at birth, 6 or 12 months. CONCLUSIONS Although poor maternal diet quality during pregnancy was not associated with infant adiposity in our study, maternal diet during pregnancy may still be an important and modifiable factor of public health importance.
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Affiliation(s)
- Sarah Gonzalez-Nahm
- Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Cathrine Hoyo
- Biological Sciences, North Carolina State University, Raleigh, North Carolina, USA
| | - Truls Østbye
- Community and Family Medicine, Duke University Medical Center, Durham, North Carolina, USA
| | - Brian Neelon
- Public Health Sciences, Division of Biostatistics, The Medical University of South Carolina, Charleston, South Carolina, USA
| | - Carter Allen
- Public Health Sciences, Division of Biostatistics, The Medical University of South Carolina, Charleston, South Carolina, USA
| | - Sara E Benjamin-Neelon
- Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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7
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Chia AR, Chen LW, Lai JS, Wong CH, Neelakantan N, van Dam RM, Chong MFF. Maternal Dietary Patterns and Birth Outcomes: A Systematic Review and Meta-Analysis. Adv Nutr 2019; 10:685-695. [PMID: 31041446 PMCID: PMC6628847 DOI: 10.1093/advances/nmy123] [Citation(s) in RCA: 127] [Impact Index Per Article: 25.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 09/25/2018] [Accepted: 12/03/2018] [Indexed: 01/03/2023] Open
Abstract
Findings on the relations of maternal dietary patterns during pregnancy and risk of preterm birth and offspring birth size remain inconclusive. We aimed to systematically review and quantify these associations. We searched MEDLINE, Embase, CENTRAL, and CINAHL up to December 2017. Three authors independently conducted a literature search, study selection, data extraction, and quality assessment. Summary effect sizes were calculated with random effects models and studies were summarized narratively if results could not be pooled. We included 36 studies and pooled results from 25 observational studies (167,507 participants). Two common dietary patterns-"healthy" and "unhealthy"-were identified. Healthy dietary patterns-characterized by high intakes of vegetables, fruits, wholegrains, low-fat dairy, and lean protein foods-were associated with lower risk of preterm birth (OR for top compared with bottom tertile: 0.79; 95% CI: 0.68, 0.91; I2 = 32%) and a weak trend towards a lower risk of small-for-gestational-age (OR: 0.86; 95% CI: 0.73, 1.01; I2 = 34%). Only statistically data-driven healthy dietary patterns, and not dietary index-based patterns, were associated with higher birth weight (mean difference: 67 g; 95% CI: 37, 96 g; I2 = 75%). Unhealthy dietary patterns-characterized by high intakes of refined grains, processed meat, and foods high in saturated fat or sugar-were associated with lower birth weight (mean difference: -40 g; 95% CI: -61, -20 g; I2 = 0%) and a trend towards a higher risk of preterm birth (OR: 1.17; 95% CI: 0.99, 1.39; I2 = 76%). Data from observational studies indicate that greater adherence to healthy dietary patterns during pregnancy is significantly related to lower risk of preterm birth. No consistent associations with birth weight and small- or large-for-gestational-age were observed.
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Affiliation(s)
| | - Ling-Wei Chen
- Departments of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Jun Shi Lai
- Singapore Institute for Clinical Sciences, Agency for Science, Technology, and Research, Singapore
| | - Chun Hong Wong
- Singapore Institute for Clinical Sciences, Agency for Science, Technology, and Research, Singapore
- Food Science and Technology Program, Department of Chemistry
| | - Nithya Neelakantan
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Rob Martinus van Dam
- Departments of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Mary Foong-Fong Chong
- Singapore Institute for Clinical Sciences, Agency for Science, Technology, and Research, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
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8
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Martínez‐Galiano JM, Amezcua‐Prieto C, Cano‐Ibañez N, Salcedo‐Bellido I, Bueno‐Cavanillas A, Delgado‐Rodriguez M. Maternal iron intake during pregnancy and the risk of small for gestational age. MATERNAL & CHILD NUTRITION 2019; 15:e12814. [PMID: 30903732 PMCID: PMC7199034 DOI: 10.1111/mcn.12814] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 01/31/2019] [Accepted: 03/15/2019] [Indexed: 12/01/2022]
Abstract
Studies of iron and its association with the risk of small for gestational age (SGA) show inconsistent results. Consuming iron supplements during pregnancy is controversial because of possible risks. This study assessed the association between iron intake and the risk of having an SGA newborn and whether iron intake is associated with gestational diabetes. A case-control study of 518 pairs of Spanish women who were pregnant and attending five hospitals was conducted. Groups were matched 1:1 for age (±2 years) and hospital. Cases were women with an SGA newborn at delivery. Controls were women with normal-sized newborns at delivery. Data were gathered on demographic characteristics, socio-economic status, adverse habits (like smoking), and diet. A 137-item food frequency questionnaire was completed. Iron intakes were categorized in quintiles (Q1-Q5). Crude odds ratios (ORs) and adjusted ORs (aORs) with 95% confidence intervals (CIs) were estimated by conditional logistic regression. No significant relationship was found between dietary iron intake and SGA. A protective association was found for women receiving iron supplementation >40 mg/day and SGA versus women not taking supplements (aOR = 0.64, 95% CI [0.42, 0.99]). This association was identified in mothers both with (aOR = 0.57, 95% CI [0.40, 0.81]) and without (aOR = 0.64, 95% CI [0.64, 0.97]) anaemia. In women in the control group without anaemia, iron supplementation >40 mg/day was positively associated with gestational diabetes (aOR = 6.32, 95% CI [1.97, 20.23]). Iron supplementation in pregnancy may prevent SGA independently of existing anaemia but may also increase the risk of gestational diabetes.
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Affiliation(s)
- Juan Miguel Martínez‐Galiano
- Department of Health SciencesUniversity of JaénJaénSpain
- CIBER de Epidemiología y Salud Pública, CIBERESPMadridSpain
| | - Carmen Amezcua‐Prieto
- CIBER de Epidemiología y Salud Pública, CIBERESPMadridSpain
- Department of Preventive Medicine and Public HealthUniversity of GranadaGranadaSpain
- Biosanitary Research Institute Granada, IBSGranadaSpain
| | - Naomi Cano‐Ibañez
- CIBER de Epidemiología y Salud Pública, CIBERESPMadridSpain
- Department of Preventive Medicine and Public HealthUniversity of GranadaGranadaSpain
- Biosanitary Research Institute Granada, IBSGranadaSpain
| | - Inmaculada Salcedo‐Bellido
- CIBER de Epidemiología y Salud Pública, CIBERESPMadridSpain
- Department of Preventive Medicine and Public HealthUniversity of GranadaGranadaSpain
- Biosanitary Research Institute Granada, IBSGranadaSpain
| | - Aurora Bueno‐Cavanillas
- CIBER de Epidemiología y Salud Pública, CIBERESPMadridSpain
- Department of Preventive Medicine and Public HealthUniversity of GranadaGranadaSpain
- Biosanitary Research Institute Granada, IBSGranadaSpain
| | - Miguel Delgado‐Rodriguez
- Department of Health SciencesUniversity of JaénJaénSpain
- CIBER de Epidemiología y Salud Pública, CIBERESPMadridSpain
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Effect of Adherence to Mediterranean Diet during Pregnancy on Children's Health: A Systematic Review. Nutrients 2019; 11:nu11050997. [PMID: 31052443 PMCID: PMC6566280 DOI: 10.3390/nu11050997] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Revised: 04/26/2019] [Accepted: 04/27/2019] [Indexed: 12/17/2022] Open
Abstract
The traditional Mediterranean diet has been shown to be a healthy eating pattern that protects against the development of many diseases in adults and children. Pregnancy is a critical period of plasticity during which foetal development may be significantly influenced by different environmental factors, including maternal nutrition. In this context, several studies have examined the potential benefits of adherence to a Mediterranean diet during pregnancy on birth outcomes, considering the Mediterranean diet as a whole rather than focusing on the effect of its individual components. In this review, we systematically summarized and discussed results of studies investigating the protective role of Mediterranean diet against foetal growth, prematurity, neural tube defects and other congenital pathologies, asthma and allergy, body weight and metabolic markers. Although current data are insufficient and randomized control trials are needed, growing evidence suggests the beneficial effect of the Mediterranean diet during pregnancy on children's health. In this sense, strategies aiming to promote adherence to this dietary pattern might be of considerable importance to public health.
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10
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The Effects of Vegetarian and Vegan Diet during Pregnancy on the Health of Mothers and Offspring. Nutrients 2019; 11:nu11030557. [PMID: 30845641 PMCID: PMC6470702 DOI: 10.3390/nu11030557] [Citation(s) in RCA: 116] [Impact Index Per Article: 23.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 02/19/2019] [Accepted: 03/01/2019] [Indexed: 11/17/2022] Open
Abstract
Vegetarian and vegan diets have increased worldwide in the last decades, according to the knowledge that they might prevent coronary heart disease, cancer, and type 2 diabetes. Althought plant-based diets are at risk of nutritional deficiencies such as proteins, iron, vitamin D, calcium, iodine, omega-3, and vitamin B12, the available evidence shows that well planned vegetarian and vegan diets may be considered safe during pregnancy and lactation, but they require a strong awareness for a balanced intake of key nutrients. A review of the scientific literature in this field was performed, focusing specifically on observational studies in humans, in order to investigate protective effects elicited by maternal diets enriched in plant-derived foods and possible unfavorable outcomes related to micronutrients deficiencies and their impact on fetal development. A design of pregestational nutrition intervention is required in order to avoid maternal undernutrition and consequent impaired fetal growth.
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Tan C, Zhao Y, Wang S. Is a vegetarian diet safe to follow during pregnancy? A systematic review and meta-analysis of observational studies. Crit Rev Food Sci Nutr 2019; 59:2586-2596. [PMID: 29621406 DOI: 10.1080/10408398.2018.1461062] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background: Whether a vegetarian diet is appropriate for pregnancy remains unclear. Objective: This study aimed to determine the association between vegetarian diet during pregnancy and various maternal-fetal outcomes. Method: PubMed-Medline, EMBASE, and Cochrane Library databases were searched for relevant articles published by August 30, 2017. Quantitative data were analyzed by a random-effects model with pooled odds ratios or weighted mean difference (WMD) and 95% confidence interval as aggregate estimations. Results: A total of 19 observational studies were identified for each of meta-analysis and narrative review. The overall estimated relation between vegetarian pregnancy and low birth weight (LBW) was marginally significant (1.27 (0.98, 1.65), P = 0.07, I2=0%). Asian (India/Nepal) vegetarian mothers exhibited increased risks to deliver a baby with LBW (1.33 (1.01, 1.76), P = 0.04, I2=0%). However, the WMD of neonatal birth weight in five studies suggested no difference between vegetarians and omnivores. Given the high heterogeneity of the included studies, lack of high-quality evidence, and limited studies included for each category, we failed to reach conclusive results regarding the risks of hypospadias, intrauterine growth retardation, maternal anemia, and gestational diabetes mellitus. Conclusion: Asian vegetarian mothers presented increased risks to deliver babies with LBW than those of omnivores. Large-scale prospective studies focusing on pre- and/or early gestational nutrition will help clarify the correlation between vegetarian diet and various pregnancy outcomes.
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Affiliation(s)
- Chang Tan
- Department of Nutrition and Food Hygiene, School of Health Sciences , Wuhan University , Wuhan , China
| | - Yudi Zhao
- Department of Computer Science, Volgenau School of Engineering , George Mason University , Fairfax , Virginia , USA
| | - Suqing Wang
- Department of Nutrition and Food Hygiene, School of Health Sciences , Wuhan University , Wuhan , China.,Hubei Provincial Key Laboratory for Applied Toxicology, Hubei Provincial Academy for Preventive Medicine , Wuhan , 430060 , China
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12
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Effect of Adherence to a Mediterranean Diet and Olive Oil Intake during Pregnancy on Risk of Small for Gestational Age Infants. Nutrients 2018; 10:nu10091234. [PMID: 30189597 PMCID: PMC6164545 DOI: 10.3390/nu10091234] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 08/28/2018] [Accepted: 08/28/2018] [Indexed: 12/25/2022] Open
Abstract
To quantify the effect of a Mediterranean dietary pattern, as well as the consumption of olive oil (OO), on the risk of having a small for gestational age infants (SGA), a matched case-control study was conducted in Spain. Dietary intake during pregnancy was assessed using a validated food frequency questionnaire. Three indices were used to evaluate the adherence to Mediterranean diet (MD) (Predimed, Trichopoulou and Panagiotakos). Crude odds ratios (cOR) and adjusted odds ratios (aOR) and their 95% confidence intervals (CI) were estimated using conditional logistic regression models. Results were stratified by severity of SGA: moderate (percentiles 6–10), and severe (percentiles ≤5). For moderate, four or more points in the Predimed´s index was associated with a 41% reduction of having SGA compared with women with a score ≤3, aOR = 0.59 (95% CI 0.38–0.98); for severe, the reduction in risk was not statistically significant. Similar results were found when the other MD indexes were used. An intake of OO above 5 g/day was associated with a lower risk of SGA (aOR = 0.53, 95% CI 0.34–0.85); statistical significance was observed for moderate SGA (aOR = 0.53, 95% CI 0.30–0.96), but not for severe SGA (aOR = 0.51, 95% CI 0.24–1.07), although the magnitude of ORs were quite similar. Adherence to a MD and OO intake is associated with a reduced risk of SGA.
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Alcohol consumption during pregnancy and risk of small-for-gestational-age newborn. Women Birth 2018; 32:284-288. [PMID: 30119966 DOI: 10.1016/j.wombi.2018.07.024] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 07/24/2018] [Accepted: 07/30/2018] [Indexed: 01/18/2023]
Abstract
BACKGROUND Contradictory results have been published on the association of alcohol consumption during pregnancy with perinatal outcomes, including the risk of small for gestational age newborn. AIM To determine whether alcohol consumption during pregnancy is associated with the risk of small for gestational age newborn. METHOD A case-control study with 518 pairs of pregnant Spanish women in five hospitals was conducted; cases were women with small for gestational age newborn and age-matched (±2years) controls were women with non-small for gestational age newborn. Data were gathered on demographic characteristics, socioeconomic status, toxic habits, and diet. Alcohol intake was recorded with a self-administered 137 food frequency questionnaire and with a personal interview, Alcohol intake was categorized -. Agreement in alcohol intake results between direct interview and frequency food questionnaire was evaluated with the Kappa index. Crude and adjusted odds ratios and their 95% confidence intervals were estimated by conditional logistic regression. FINDINGS Poor agreement was observed between food frequency questionnaire and personal interview results for both cases (κ=0.23) and controls (κ=0.14). A food frequency questionnaire-recorded intake of less than 4g/day was associated with a significantly lower odds ratios for small for gestational age newborn (odds ratios=0.62, 95% confidence intervals, 0.43-0.88), whereas an interview-recorded intake of <4g/day was not related to small for gestational age newborn (odds ratios=0.86, 95% confidence intervals, 0.49-1.54). CONCLUSIONS A very moderate alcohol intake during pregnancy may have a negative association with the risk of having a small for gestational age newborn.
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Peraita-Costa I, Llopis-González A, Perales-Marín A, Sanz F, Llopis-Morales A, Morales-Suárez-Varela M. A Retrospective Cross-Sectional Population-Based Study on Prenatal Levels of Adherence to the Mediterranean Diet: Maternal Profile and Effects on the Newborn. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:E1530. [PMID: 30029539 PMCID: PMC6069129 DOI: 10.3390/ijerph15071530] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/24/2018] [Revised: 07/16/2018] [Accepted: 07/17/2018] [Indexed: 12/20/2022]
Abstract
The Mediterranean diet (MD) is a dietary pattern with important benefits. The objectives of this study were to assess the adherence to the MD among pregnant women in Valencia (Spain) and characterize the pregnant women according to their level of adherence. Finally, we aimed to examine the role of MD adherence during pregnancy in the anthropometric development of the newborn. The study included 492 pregnant women who were followed at La Fe Hospital in 2017. The self-administered "Kidmed" questionnaire for data collection on dietary information evaluation was used and a clinical history review of mothers and newborns was performed. Two groups of mothers were identified: those with low adherence (LA) and optimal adherence (OA). The study revealed that 40.2% of the women showed LA to the MD. The newborns born to these women presented a higher risk of being small for gestational age (SGA) {adjusted odds ratio (aOR) = 1.68; 95% confidence interval (CI) 1.02⁻5.46} when adjusting for parental body mass index (BMI) and multiple gestation, but not when adjusting for all significant possible confounders (aOR = 2.32; 95% CI 0.69⁻7.78). The association between MD and SGA was not significantly affected by the use of iron and folic acid supplements (aOR = 2.65; 95% CI 0.66⁻10.65). The profile of the pregnant woman with LA is that of a young smoker, with a low level of education and a low daily intake of dairy products. These results suggest that LA to the MD is not associated with a higher risk of giving birth to a SGA newborn.
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Affiliation(s)
- Isabel Peraita-Costa
- Unit of Public Health and Environmental Care, Department of Preventive Medicine, University of Valencia, Avinguda Vicente Andrés Estellés s/n, Burjassot, 46100 Valencia, Spain.
- CIBER in Epidemiology and Public Health (CIBERESP), Av. Monforte de Lemos, 3⁻5, Pabellón 11, Planta 0, 28029 Madrid, Spain.
| | - Agustín Llopis-González
- Unit of Public Health and Environmental Care, Department of Preventive Medicine, University of Valencia, Avinguda Vicente Andrés Estellés s/n, Burjassot, 46100 Valencia, Spain.
- CIBER in Epidemiology and Public Health (CIBERESP), Av. Monforte de Lemos, 3⁻5, Pabellón 11, Planta 0, 28029 Madrid, Spain.
| | - Alfredo Perales-Marín
- Department of Obstetrics, La Fe University Hospital, Avinguda de Fernando Abril Martorell, 106, 46026 València, Spain.
| | - Ferran Sanz
- Department of Obstetrics, La Fe University Hospital, Avinguda de Fernando Abril Martorell, 106, 46026 València, Spain.
| | - Agustín Llopis-Morales
- Unit of Public Health and Environmental Care, Department of Preventive Medicine, University of Valencia, Avinguda Vicente Andrés Estellés s/n, Burjassot, 46100 Valencia, Spain.
| | - María Morales-Suárez-Varela
- Unit of Public Health and Environmental Care, Department of Preventive Medicine, University of Valencia, Avinguda Vicente Andrés Estellés s/n, Burjassot, 46100 Valencia, Spain.
- CIBER in Epidemiology and Public Health (CIBERESP), Av. Monforte de Lemos, 3⁻5, Pabellón 11, Planta 0, 28029 Madrid, Spain.
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