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Zhang BB, Zhao GA, Yang M, Lin F, Zhang HX, Zhao YL, Li M, Pan RY, Song JQ, Zhang K, Zhang GH, Zhang JJ. Birth month associates with risk of coronary artery disease and its complications: A propensity score matched analysis. Med Clin (Barc) 2019; 153:454-459. [DOI: 10.1016/j.medcli.2019.02.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 02/11/2019] [Accepted: 02/14/2019] [Indexed: 01/17/2023]
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Beentjes CHL, Taylor-King JP, Bayani A, Davis CN, Dunster JL, Jabbari S, Mirams GR, Jenkinson C, Kilby MD, Hewison M, Tamblyn JA. Defining vitamin D status using multi-metabolite mathematical modelling: A pregnancy perspective. J Steroid Biochem Mol Biol 2019; 190:152-160. [PMID: 30926429 PMCID: PMC7614536 DOI: 10.1016/j.jsbmb.2019.03.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 02/11/2019] [Accepted: 03/25/2019] [Indexed: 11/21/2022]
Abstract
Vitamin D deficiency is linked to adverse pregnancy outcomes such as pre-eclampsia (PET) but remains defined by serum measurement of 25-hydroxyvitamin D3 (25(OH)D3) alone. To identify broader changes in vitamin D metabolism during normal and PET pregnancies we developed a relatively simple but fully parametrised mathematical model of the vitamin D metabolic pathway. The data used for parametrisation were serum vitamin D metabolites analysed for a cross-sectional group of women (n = 88); including normal pregnant women at 1 st (NP1, n = 25) and 3rd trimester (NP3, n = 21) and pregnant women with PET (n = 22), as well as non-pregnant female controls (n = 20). To account for the effects various metabolites have upon each other, data were analysed using an ordinary differential equation model of the vitamin D reaction network. Information obtained from the model was then also applied to serum vitamin D metabolome data (n = 50) obtained from a 2nd trimester pregnancy cohort, of which 25 prospectively developed PET. Statistical analysis of the data alone showed no significant difference between NP3 and PET for serum 25(OH)D3 and 24,25(OH)2D3 concentrations. Conversely, a statistical analysis informed by the reaction network model revealed that a better indicator of PET is the ratios of vitamin D metabolites in late pregnancy. Assessing the potential predicative value, no significant difference between NP3 and PET cases at 15 weeks gestation was found. Mathematical modelling offers a novel strategy for defining the impact of vitamin D metabolism on human health. This is particularly relevant within the context of pregnancy, where major changes in vitamin D metabolism occur across gestation, and dysregulated metabolism is evidenced in women with established PET.
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Affiliation(s)
- C H L Beentjes
- Mathematical Institute, University of Oxford, Oxford, UK
| | - J P Taylor-King
- Department of Chemical Engineering and Biotechnology, University of Cambridge, Cambridge, CB3 OAS, UK; Institute of Molecular Systems Biology, Department of Biology, ETHZ, CH-8093, Zurich, Switzerland
| | - A Bayani
- Department of Physics and Mathematics, School of Science and Technology, Nottingham Trent University, Nottingham, UK
| | - C N Davis
- MathSys CDT, Mathematics Institute, University of Warwick, Coventry, UK
| | - J L Dunster
- Institute for Cardiovascular and Metabolic Research, University of Reading, UK
| | - S Jabbari
- School of Mathematics and Institute of Microbiology and Infection, University of Birmingham, Birmingham, UK
| | - G R Mirams
- Centre for Mathematical Medicine & Biology, Mathematical Sciences, University of Nottingham, UK
| | - C Jenkinson
- Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - M D Kilby
- Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK; Centre for Women's & Newborn Health, Birmingham Health Partners, Birmingham Women's & Children's Foundation Hospital, Edgbaston, Birmingham, UK; Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, UK; Fetal Medicine Centre, Birmingham Women's & Children's Foundation Trust, Edgbaston, Birmingham, UK
| | - M Hewison
- Centre for Women's & Newborn Health, Birmingham Health Partners, Birmingham Women's & Children's Foundation Hospital, Edgbaston, Birmingham, UK; Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, UK
| | - J A Tamblyn
- Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK; Centre for Women's & Newborn Health, Birmingham Health Partners, Birmingham Women's & Children's Foundation Hospital, Edgbaston, Birmingham, UK; Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, UK.
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Koletzko B, Godfrey KM, Poston L, Szajewska H, van Goudoever JB, de Waard M, Brands B, Grivell RM, Deussen AR, Dodd JM, Patro-Golab B, Zalewski BM. Nutrition During Pregnancy, Lactation and Early Childhood and its Implications for Maternal and Long-Term Child Health: The Early Nutrition Project Recommendations. ANNALS OF NUTRITION & METABOLISM 2019; 74:93-106. [PMID: 30673669 PMCID: PMC6397768 DOI: 10.1159/000496471] [Citation(s) in RCA: 172] [Impact Index Per Article: 34.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Accepted: 12/28/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND A considerable body of evidence accumulated especially during the last decade, demonstrating that early nutrition and lifestyle have long-term effects on later health and disease ("developmental or metabolic programming"). METHODS Researchers involved in the European Union funded international EarlyNutrition research project consolidated the scientific evidence base and existing recommendations to formulate consensus recommendations on nutrition and lifestyle before and during pregnancy, during infancy and early childhood that take long-term health impact into account. Systematic reviews were performed on published dietary guidelines, standards and recommendations, with special attention to long-term health consequences. In addition, systematic reviews of published systematic reviews on nutritional interventions or exposures in pregnancy and in infants and young children aged up to 3 years that describe effects on subsequent overweight, obesity and body composition were performed. Experts developed consensus recommendations incorporating the wide-ranging expertise from additional 33 stakeholders. FINDINGS Most current recommendations for pregnant women, particularly obese women, and for young children do not take long-term health consequences of early nutrition into account, although the available evidence for relevant consequences of lifestyle, diet and growth patterns in early life on later health and disease risk is strong. INTERPRETATION We present updated recommendations for optimized nutrition before and during pregnancy, during lactation, infancy and toddlerhood, with special reference to later health outcomes. These recommendations are developed for affluent populations, such as women and children in Europe, and should contribute to the primary prevention of obesity and associated non-communicable diseases.
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Affiliation(s)
- Berthold Koletzko
- LMU, Ludwig-Maximilians-University of Munich, Dr. von Hauner Children's Hospital, Medical Centre of LMU Munich, München, Germany,
| | - K M Godfrey
- MRC Lifecourse Epidemiology Unit and NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Lucilla Poston
- Division of Women's Health, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
| | - Hania Szajewska
- Medical University of Warsaw, Department of Paediatrics, Warsaw, Poland
| | | | - Marita de Waard
- Department of Pediatrics, VU University Medical Center, Amsterdam, The Netherlands
| | - Brigitte Brands
- LMU, Ludwig-Maximilians-University of Munich, Dr. von Hauner Children's Hospital, Medical Centre of LMU Munich, München, Germany
| | - Rosalie M Grivell
- Discipline of Obstetrics and Gynaecology, The Robinson Research Institute, The University of Adelaide, Adelaide, South Australia, Australia
| | - Andrea R Deussen
- Discipline of Obstetrics and Gynaecology, The Robinson Research Institute, The University of Adelaide, Adelaide, South Australia, Australia
| | - Jodie M Dodd
- Discipline of Obstetrics and Gynaecology, The Robinson Research Institute, The University of Adelaide, Adelaide, South Australia, Australia
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Koletzko B, Cremer M, Flothkötter M, Graf C, Hauner H, Hellmers C, Kersting M, Krawinkel M, Przyrembel H, Röbl-Mathieu M, Schiffner U, Vetter K, Weißenborn A, Wöckel A. Diet and Lifestyle Before and During Pregnancy - Practical Recommendations of the Germany-wide Healthy Start - Young Family Network. Geburtshilfe Frauenheilkd 2018; 78:1262-1282. [PMID: 30655650 PMCID: PMC6294644 DOI: 10.1055/a-0713-1058] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 08/22/2018] [Accepted: 08/22/2018] [Indexed: 12/11/2022] Open
Abstract
Diet and exercise before and during pregnancy affect the course of the pregnancy, the child's development and the short- and long-term health of mother and child. The Healthy Start - Young Family Network has updated the recommendations on nutrition in pregnancy that first appeared in 2012 and supplemented them with recommendations on a preconception lifestyle. The recommendations address body weight before conception, weight gain in pregnancy, energy and nutritional requirements and diet (including a vegetarian/vegan diet), the supplements folic acid/folate, iodine, iron and docosahexaenoic acid (DHA), protection against food-borne illnesses, physical activity before and during pregnancy, alcohol, smoking, caffeinated drinks, oral and dental hygiene and the use of medicinal products. Preparation for breast-feeding is recommended already during pregnancy. Vaccination recommendations for women planning a pregnancy are also included. These practical recommendations of the Germany-wide Healthy Start - Young Family Network are intended to assist all professional groups that counsel women and couples wishing to have children and during pregnancy with uniform, scientifically-based and practical information.
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Affiliation(s)
- Berthold Koletzko
- Kinderklinik und Kinderpoliklinik, Dr. von Haunersches Kinderspital, LMU – Ludwig-Maximilians-Universität, München, Germany
- Deutsche Gesellschaft für Kinder- und Jugendheilkunde e. V. (DGKJ), Berlin, Germany
- Mitglied im wissenschaftlichen Beirat des Netzwerks Gesund ins Leben, Bonn, Germany
| | - Monika Cremer
- Netzwerk Gesund ins Leben/Bundeszentrum für Ernährung (BZfE) in der Bundesanstalt für Landwirtschaft und Ernährung (BLE), Bonn, Germany
| | - Maria Flothkötter
- Netzwerk Gesund ins Leben/Bundeszentrum für Ernährung (BZfE) in der Bundesanstalt für Landwirtschaft und Ernährung (BLE), Bonn, Germany
| | - Christine Graf
- Mitglied im wissenschaftlichen Beirat des Netzwerks Gesund ins Leben, Bonn, Germany
- Deutsche Sporthochschule Köln, Köln, Germany
| | - Hans Hauner
- Lehrstuhl für Ernährungsmedizin, Klinikum rechts der Isar der Technischen Universität München, München, Germany
| | - Claudia Hellmers
- Mitglied im wissenschaftlichen Beirat des Netzwerks Gesund ins Leben, Bonn, Germany
- Hochschule Osnabrück, Osnabrück, Germany
- Deutsche Gesellschaft für Hebammenwissenschaft e. V. (DGHWi), Münster, Germany
| | - Mathilde Kersting
- Mitglied im wissenschaftlichen Beirat des Netzwerks Gesund ins Leben, Bonn, Germany
- Forschungsdepartment Kinderernährung, Klinik für Kinder- und Jugendmedizin, Universitätsklinikum der Ruhr-Universität Bochum, Bochum, Germany
| | - Michael Krawinkel
- Mitglied im wissenschaftlichen Beirat des Netzwerks Gesund ins Leben, Bonn, Germany
- Institut für Ernährungswissenschaft, Justus-Liebig-Universität Gießen, Gießen, Germany
- Deutsche Gesellschaft für Ernährung e. V. (DGE), Bonn, Germany
| | - Hildegard Przyrembel
- Mitglied im wissenschaftlichen Beirat des Netzwerks Gesund ins Leben, Bonn, Germany
| | - Marianne Röbl-Mathieu
- Mitglied der Ständigen Impfkommission am Robert Koch-Institut (STIKO), Berlin, Germany
| | - Ulrich Schiffner
- Poliklinik für Zahnerhaltung und Präventive Zahnheilkunde, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
- Deutsche Gesellschaft für Kinderzahnheilkunde e. V. (DGKiZ), Würzburg, Germany
| | - Klaus Vetter
- Mitglied im wissenschaftlichen Beirat des Netzwerks Gesund ins Leben, Bonn, Germany
- Nationale Stillkommission, Bundesinstitut für Risikobewertung (BfR), Berlin, Germany
| | - Anke Weißenborn
- Mitglied im wissenschaftlichen Beirat des Netzwerks Gesund ins Leben, Bonn, Germany
- Bundesinstitut für Risikobewertung (BfR), Berlin, Germany
| | - Achim Wöckel
- Mitglied im wissenschaftlichen Beirat des Netzwerks Gesund ins Leben, Bonn, Germany
- Frauenklinik und Poliklinik Universitätsklinikum Würzburg, Würzburg, Germany
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Heyden EL, Wimalawansa SJ. Vitamin D: Effects on human reproduction, pregnancy, and fetal well-being. J Steroid Biochem Mol Biol 2018; 180:41-50. [PMID: 29262380 DOI: 10.1016/j.jsbmb.2017.12.011] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Revised: 12/09/2017] [Accepted: 12/14/2017] [Indexed: 11/27/2022]
Abstract
Pregnancy places exceptional demands on vitamin D and calcium availability; thus, their deficiencies during pregnancy threaten the woman and her fetus. Globally, vitamin D and other micronutrient deficiencies are common during pregnancy, especially in developing countries where pregnant women have less access to nutritional supplements. Vitamin D deficiency has been reported to be as high as 40% among pregnant women. As a pregnancy progresses, the requirements for vitamin D increase and thus, can worsen preexisting hypovitaminosis D. Consequently, hypovitaminosis D is increasingly associated with a higher incidence of fetal miscarriage, preeclampsia, gestational diabetes, bacterial vaginosis, and impaired fetal and childhood growth and development. This review explores the recent advances in the understanding of vitamin D and the pivotal role it plays in human reproduction, with an emphasis on pregnancy and its outcomes. Given the seriousness of the issue, there is a pressing need for clinicians to become aware of the risks associated with not identifying and correcting vitamin D deficiency. Identifying and correcting vitamin D deficiency, including safe exposure to sunlight, is particularly relevant for those who seek assistance with fertility issues or prenatal counseling, and those in the beginning of their pregnancy. The data point to a significant protective effects of vitamin D during pregnancy when the 25(OH)D serum level exceeds 30 ng/mL before pregnancy and during the first trimester and, sufficient levels are maintained throughout the pregnancy.
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Affiliation(s)
- E L Heyden
- Clinical Nursing, Providence Sacred Heart Medical Center, Spokane, WA, USA.
| | - S J Wimalawansa
- Endocrinology & Nutrition, Cardio Metabolic Institute, 661 Darmody Avenue, North Brunswick, NJ, USA.
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Accortt EE, Mirocha J, Dunkel Schetter C, Hobel CJ. Adverse Perinatal Outcomes and Postpartum Multi-Systemic Dysregulation: Adding Vitamin D Deficiency to the Allostatic Load Index. Matern Child Health J 2018; 21:398-406. [PMID: 28120286 DOI: 10.1007/s10995-016-2226-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Background Allostatic load (AL) is an index of multi-system physiological "wear-and-tear," operationalizing emergent chronic disease risk and predicting morbidity and mortality. AL has been proposed as an organizing framework for studying pregnancy outcomes and additional AL biomarkers for the study of maternal health would be valuable. Objectives To test whether adverse perinatal outcomes are associated with postpartum AL and if including vitamin D deficiency (serum 25(OH)D < 20 ng/ml) as an additional marker of postpartum AL increases the association. Methods The Community Child Health Network is a community-based participatory research network that enrolled women at birth and followed them for 2 years measuring ten biomarkers (body mass index, waist: hip ratio, pulse, systolic and diastolic blood pressures, cortisol slope, c-reactive protein, hgbA1c, HDL, and total cholesterol) at 6 and 12 months postpartum. A composite of four adverse perinatal outcomes (low birth weight, preterm birth, preeclampsia, and gestational diabetes) was collected from medical charts in a sample of 164 women from one site and serum 25(OH)D status was measured 24-39 weeks postpartum in this cohort. Results Twenty-nine percent experienced one or more of the four adverse perinatal outcomes. Serum 25(OH)D was significantly inversely correlated with the AL index (Spearman's r = -0.247, p = 0.002). Logistic regression results adjusting for maternal age and race showed that adverse outcome was significantly associated with higher postpartum AL (OR 1.53 for a 1-unit increase in AL, 95% CI 1.24-1.89). Adding 25(OH)D deficiency as an 11th component to the AL index improved the model fit (Delta (-2LogL) = 3.955, p = 0.047), and improved the Akaike information criterion (180.32 vs. 184.27). Conclusion Women with adverse perinatal outcomes have higher postpartum AL and adding vitamin D deficiency to the AL index strengthens this association.
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Affiliation(s)
- Eynav Elgavish Accortt
- Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, 8635 West 3rd Street, 280 West Tower, Los Angeles, CA, 90048, USA.
| | - James Mirocha
- Cedars-Sinai Biostatistics Core, Research Institute, Clinical & Translational Science Institute (CTSI), Clinical &Translational Research Center (CTRC), Burns and Allen Research Institute, Samuel Oschin Comprehensive Cancer Center, Los Angeles, CA, USA
| | - Christine Dunkel Schetter
- Department of Psychology, University of California, 1285a Franz Hall, Los Angeles, CA, 90095-1563, USA
| | - Calvin J Hobel
- Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, 8631 West 3rd Street, 1001 East Tower, Los Angeles, CA, 90048, USA.
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7
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Liu NQ, Larner DP, Yao Q, Chun RF, Ouyang Y, Zhou R, Tamblyn JA, Wagner CL, Hewison M. Vitamin D-deficiency and sex-specific dysregulation of placental inflammation. J Steroid Biochem Mol Biol 2018; 177:223-230. [PMID: 28676458 DOI: 10.1016/j.jsbmb.2017.06.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 06/14/2017] [Accepted: 06/18/2017] [Indexed: 12/21/2022]
Abstract
To investigate an immunomodulatory role for vitamin D in pregnancy we used mice raised on vitamin D-sufficient (SUFF), or -deficient (DEF) diets. At embryonic day 14, pregnant mice received intraperitoneal injection of lipopolysaccharide (LPS) or vehicle for 24h, with age-matched non-pregnant mice as controls. In non-pregnant mice, 6 serum analytes (IL-1β, IL-18, MDC/CCL22, MIP-1α/CCL3, EGF, IgA) were lower in DEF mice. In pregnant DEF mice only GH was higher. In non-pregnant mice LPS induced 28 analytes, with 5 (IL-18, IP-10/CXCL10, MCP-1/CCL2, MIP-1β/CCL4, MIP-3β/CCL19) being highest in DEF mice. In pregnant SUFF mice 16 serum analytes increased with LPS, and 6 of these (IP-10/CXCL10, MCP-1/CCL2, SAP, TIMP-1, VCAM-1, vWF) were higher and 1 (GCP-2/CXCL6) lower in DEF mice. Parallel analysis of placental mRNAs showed elevated mRNA for Il-6, Ccl2 and Cxcl10 in placentae from male and female fetuses in LPS-DEF mice. However, LPS-induced expression of Ifnγ, Tnfα, and Cxcl6 was only observed in female placentae from DEF mice. LPS-DEF mice also showed smaller litter sizes relative to control SUFF mice. Numbers of female fetuses per dam were significantly lower for DEF mice with or without LPS challenge. LPS had no effect on numbers of male fetuses from DEF mothers, but significantly decreased male fetuses from SUFF mothers. These data indicate that vitamin D is an important component of anti-inflammatory immune responses during pregnancy, with the placenta and fetal sex playing pivotal roles in this process.
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Affiliation(s)
- Nancy Q Liu
- Dept of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, 90095, USA
| | - Dean P Larner
- Institute of Metabolism and Systems Research, The University of Birmingham, Birmingham B15 2TT, UK; Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham B15 2TH, UK
| | - Qingqiang Yao
- Dept of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, 90095, USA
| | - Rene F Chun
- Dept of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, 90095, USA
| | - Yuxin Ouyang
- Dept of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, 90095, USA
| | - Rui Zhou
- Dept of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, 90095, USA
| | - Jennifer A Tamblyn
- Institute of Metabolism and Systems Research, The University of Birmingham, Birmingham B15 2TT, UK; Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham B15 2TH, UK
| | - Carol L Wagner
- Division of Neonatology, Department of Pediatrics, Medical University of South Carolina, Charleston, SC 29425, USA
| | - Martin Hewison
- Dept of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, 90095, USA; Institute of Metabolism and Systems Research, The University of Birmingham, Birmingham B15 2TT, UK; Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham B15 2TH, UK.
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Zerofsky MS, Jacoby BN, Pedersen TL, Stephensen CB. Daily Cholecalciferol Supplementation during Pregnancy Alters Markers of Regulatory Immunity, Inflammation, and Clinical Outcomes in a Randomized Controlled Trial. J Nutr 2016; 146:2388-2397. [PMID: 27655755 DOI: 10.3945/jn.116.231480] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Accepted: 08/23/2016] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Vitamin D deficiency is widespread in pregnancy and has been associated with adverse health conditions in mothers and infants. Vitamin D supplementation in pregnancy may support the maintenance of pregnancy by its effects on innate and adaptive immunity. OBJECTIVE We assessed the effects of vitamin D supplementation during pregnancy on vitamin D status and markers of immune function associated with adverse pregnancy outcomes. METHODS We conducted a randomized, controlled, double-blind intervention of 2 doses of cholecalciferol (400 and 2000 IU/d) from <20 wk to delivery in 57 pregnant women. Vitamin D status, regulatory and inflammatory T cells, markers of innate immunity and systemic inflammation, and clinical outcomes including maternal blood pressure and birth weight were assessed at 26 and 36 wk of pregnancy. RESULTS Supplementation with 2000 IU/d vitamin D had a greater effect on the change in vitamin D status over pregnancy (P < 0.0001) and the final value at 36 wk (P < 0.0001) than 400 IU/d, increasing serum 25-hydroxyvitamin D from 81.1 nmol/L at baseline to 116 nmol/L at 36 wk and from 69.6 nmol/L at baseline to 85.6 nmol/L at 36 wk, respectively. The 2000-IU/d group had 36% more interleukin-10+ regulatory CD4+ T cells at 36 wk than did the 400-IU/d group (P < 0.007). The daily intake of 2000 compared with 400 IU/d tended to dampen the pregnancy-related increase in diastolic blood pressure by 1.3-fold (P = 0.06) and increase birth weight by 8.6% (P = 0.06), but these differences were not statistically significant. CONCLUSIONS Supplementation with 2000 IU/d is more effective at increasing vitamin D status in pregnant women than 400 IU/d and is associated with increased regulatory T cell immunity that may prevent adverse outcomes caused by excess inflammation. This trial was registered at clinicaltrials.gov as NCT01417351.
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Affiliation(s)
- Melissa S Zerofsky
- Graduate Group in Nutritional Biology and .,USDA Western Human Nutrition Research Center, Davis, CA
| | - Bryon N Jacoby
- Division of Maternal/Fetal Medicine, Davis Medical Center, University of California, Davis, Davis, CA; and
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Abstract
Pregnancy represents a challenge from a nutritional perspective, because micronutrient intake during the periconceptional period and in pregnancy affects fetal organ development and the mother's health. Inappropriate diet/nutrition in pregnancy can lead to numerous deficiencies including iron deficiency and may impair placental function and play a role in miscarriage, intrauterine growth restriction, preterm delivery, and preeclampsia. This article reviews the risks associated with nutrient deficiencies in pregnant women and presents an overview of recommendations for dietary supplementation in pregnancy, focusing on oral iron supplementation. Risk factor detection, including dietary patterns and comorbidities, is paramount in optimal pregnancy management. Dietary habits, which can lead to deficiencies (e.g., iron, folate, vitamin D, and calcium) and result in negative health consequences for the mother and fetus/newborn, need to be investigated. Prenatal care should be personalized, accounting for ethnicity, culture, education, information level about pregnancy, and dietary and physical habits. Clinicians should make a plan for appropriate supplementation and prophylaxis/treatment of nutritional and other needs, and consider adequate intake of calcium, iodine, vitamin D, folate, and iron. Among the available oral iron supplements, prolonged-released ferrous sulfate (ferrous sulfate-polymeric complex) presents the lowest incidence of overall and gastrointestinal adverse events, with positive implications for compliance.
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Affiliation(s)
- Nils Milman
- a Departments of Clinical Biochemistry and Obstetrics , Naestved Hospital, Naestved, University of Copenhagen , Naestved , Denmark
| | - Tomasz Paszkowski
- b 3rd Chair and Department of Gynecology, Medical University of Lublin , Lublin , Poland
| | - Irene Cetin
- c Department of Obstetrics and Gynecology , University of Milan, Hospital Luigi Sacco , Milan , Italy , and
| | - Camil Castelo-Branco
- d Clínic Institute of Gynecology, Obstetrics and Neonatology, Hospital Clínic-Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Faculty of Medicine-University of Barcelona , Barcelona , Spain
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Vitamin D fortification and seasonality of birth in type 1 diabetic cases: D-tect study. J Dev Orig Health Dis 2015; 7:114-9. [PMID: 26503327 DOI: 10.1017/s2040174415007849] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Fortification of margarine with vitamin D was mandatory in Denmark during 1961-1985. The aim of the study was to assess whether gestational and early infancy exposure to margarine fortification was associated with seasonality of birth in Danish type 1 diabetes (T1D) patients. The risks of T1D in Danes born during various exposure periods around margarine fortification termination in 1985 were analyzed. As expected, the T1D hazards in males unexposed to margarine fortification and born in spring were higher than in males born in autumn: relevant hazard ratios (95% confidence intervals) in various exposure groups ranged from 1.74 (1.112/2.708) to 37.43 (1.804/776.558). There were no indications of seasonality of birth in males exposed to fortification, nor in both exposed and unexposed females. The study suggests that early life exposure to low-dose vitamin D from fortified food eliminates seasonality of birth in T1D male patients. Further studies are required to investigate the identified gender differences.
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Nandal R, Chhabra R, Sharma D, Lallar M, Rathee U, Maheshwari P. Comparison of cord blood vitamin D levels in newborns of vitamin D supplemented and unsupplemented pregnant women: a prospective, comparative study. J Matern Fetal Neonatal Med 2015; 29:1812-6. [PMID: 26135779 DOI: 10.3109/14767058.2015.1064106] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To screen pregnant women for deficiency of 25-hydroxyvitamin D (25(OH)D) and supplement selected vitamin D deficient pregnant women with vitamin D and to compare 25(OH)D levels in cord blood between them. METHOD Sixty pregnant women were selected as cases (vitamin D levels <30 ng/ml) and 60 unscreened pregnant women were taken as controls. Cases were supplemented with available 60,000 IU vitamin D every two weeks for eight doses or till delivery, whichever was earlier. In both the cases and controls, cord blood was collected at the time of delivery and tested for 25(OH)D levels using Biomerieux miniVIDAS. RESULT Maximum (66.7%) pregnant women who received vitamin D supplementation had cord blood vitamin D level >30 ng/ml, while only 3.3% unsupplemented pregnant women had cord blood vitamin D level >30 ng/ml. The median cord blood vitamin D level was 36.5 ng/ml in vitamin D supplemented and 11.35 ng/ml in unsupplemented women. The mean birth weight and mean crown heel length were 3.1 ± 0.485 kg versus 2.8 ± 0.705 kg and 49.35 ± 1.36 cm versus 48.67 ± 2.12 cm, respectively. CONCLUSION Vitamin D supplemented women had sufficient levels of 25(OH)D in cord blood at birth in maximum cases and neonates had higher birth weights and increased crown heel length.
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Affiliation(s)
- Rajesh Nandal
- a Department of Pediatrics , Artemis Health Institute , Gurgaon , Haryana , India
| | - Rajiv Chhabra
- a Department of Pediatrics , Artemis Health Institute , Gurgaon , Haryana , India
| | - Deepak Sharma
- b Department of Neonatology , Fernandez Hospital , Hyderguda , Hyderabad , Andhra Pradesh , India
| | - Meenakshi Lallar
- c Department of Obstetrics and Gynecology , SHKM Medical College Mewat , Haryana , India , and
| | - Urvashi Rathee
- d Department of Obstetrics and Gynecology , Artemis Health Institute , Gurgaon , Haryana , India
| | - Prabhat Maheshwari
- a Department of Pediatrics , Artemis Health Institute , Gurgaon , Haryana , India
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12
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Jacobsen R, Hypponen E, Sørensen TIA, Vaag AA, Heitmann BL. Gestational and Early Infancy Exposure to Margarine Fortified with Vitamin D through a National Danish Programme and the Risk of Type 1 Diabetes: The D-Tect Study. PLoS One 2015; 10:e0128631. [PMID: 26030061 PMCID: PMC4452099 DOI: 10.1371/journal.pone.0128631] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2015] [Accepted: 04/30/2015] [Indexed: 12/02/2022] Open
Abstract
The objective of the study was to assess whether gestational and early infancy exposure to low dose vitamin D from a mandatory margarine fortification programme in Denmark influenced the risk of developing type 1 diabetes (T1D) before age of 15 years. The study population included all individuals born in Denmark from 1983 to 1988 and consisted of 331,623 individuals. The 1st of June 1985, which was the date of issue of the new ministerial order cancelling mandatory fortification of margarine with vitamin D in Denmark, served as a reference point separating the studied population into various exposure groups. We further modelled birth cohort effects in children developing T1D as a linear spline, and compared the slopes between the birth cohorts with various prenatal and infancy exposures to vitamin D fortification. In total, 886 (0.26%) individuals developed T1D before the age of 15 years. The beta coefficients (95% CI), or slopes, for linear birth cohort effect in log Hazard Ratio (HR) per one month of birth in individuals born during the periods of gestational exposure, wash-out, and non-exposure were: 0.010 (-0.002/0.021), -0.010 (-0.035/0.018), and 0.008 (- 0.017/0.032), respectively. The beta coefficients (95% CI) for individuals born during the periods of first postnatal year exposure, wash-out, and non-exposure were: 0.007 (-0.016/0.030), 0.006 (-0.004/0.016), and 0.007 (-0.002/0.016), respectively. In conclusion, we found no evidence to support that exposure to low dose vitamin D from the Danish mandatory margarine fortification regimen during gestational and first postnatal year of life changed the risk of developing T1D before the age of 15 years.
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Affiliation(s)
- Ramune Jacobsen
- Research Unit for Dietary Studies, The Parker Institute, Bispebjerg and Frederiksberg Hospitals, The Capital Region, Frederiksberg, Denmark
- Institute of Preventive Medicine, Bispebjerg and Frederiksberg Hospitals, The Capital Region, Frederiksberg, Denmark
- * E-mail:
| | - Elina Hypponen
- School of Population Health, University of South Australia, Adelaide, Australia
| | - Thorkild I. A. Sørensen
- Institute of Preventive Medicine, Bispebjerg and Frederiksberg Hospitals, The Capital Region, Frederiksberg, Denmark
- Novo Nordisk Foundation Center for Basic Metabolic Research, University of Copenhagen, Copenhagen, Denmark
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, United Kingdom
| | - Allan A. Vaag
- Department of Endocrinology, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Berit L. Heitmann
- Research Unit for Dietary Studies, The Parker Institute, Bispebjerg and Frederiksberg Hospitals, The Capital Region, Frederiksberg, Denmark
- Institute of Preventive Medicine, Bispebjerg and Frederiksberg Hospitals, The Capital Region, Frederiksberg, Denmark
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
- Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, University of Sydney, Sydney, Australia
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Tavakoli M, Salek-Moghaddam A, Jeddi-Tehrani M, Talebi S, Kazemi-Sefat GE, Vafaei S, Mohammadzadeh A, Sheikhhassani S, Zarnani AH. Comparable vitamin D3 metabolism in the endometrium of patients with recurrent spontaneous abortion and fertile controls. Mol Reprod Dev 2015; 82:356-64. [DOI: 10.1002/mrd.22486] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2015] [Accepted: 03/04/2015] [Indexed: 12/31/2022]
Affiliation(s)
- Maryam Tavakoli
- Reproductive Immunology Research Center; Avicenna Research Institute; ACECR; Tehran Iran
| | | | - Mahmood Jeddi-Tehrani
- Monoclonal Antibody Research Center; Avicenna Research Institute; ACECR; Tehran Iran
| | - Saeed Talebi
- Department of Medical Genetics; School of Medicine; Tehran University of Medical Sciences; Tehran Iran
| | | | - Sedigheh Vafaei
- Nanobiotechnology Research Center; Avicenna Research Institute; ACECR; Tehran Iran
| | - Afsaneh Mohammadzadeh
- Reproductive Immunology Research Center; Avicenna Research Institute; ACECR; Tehran Iran
| | - Shahrzad Sheikhhassani
- Obstetrics and Gynecology-Oncology Department; Vali-asr Hospital; Tehran University of Medical Sciences; Tehran Iran
| | - Amir-Hassan Zarnani
- Reproductive Immunology Research Center; Avicenna Research Institute; ACECR; Tehran Iran
- Immunology Research Center; Iran University of Medical Sciences; Tehran Iran
- Nanobiotechnology Research Center; Avicenna Research Institute; ACECR; Tehran Iran
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14
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Koletzko B, Bauer CP, Bung P, Cremer M, Flothkötter M, Hellmers C, Kersting M, Krawinkel M, Przyrembel H, Rasenack R, Schäfer T, Vetter K, Wahn U, Weissenborn A, Wöckel A. German national consensus recommendations on nutrition and lifestyle in pregnancy by the 'Healthy Start - Young Family Network'. ANNALS OF NUTRITION AND METABOLISM 2014; 63:311-22. [PMID: 24514069 DOI: 10.1159/000358398] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2013] [Accepted: 12/03/2013] [Indexed: 11/19/2022]
Abstract
Diet and physical activity before and during pregnancy affect short- and long-term health of mother and child. The energy needs at the end of pregnancy increase only by about 10% compared to nonpregnant women. An excessive energy intake is undesirable since maternal overweight and excessive weight gain can increase the risks for a high birth weight and later child overweight and diabetes. Maternal weight at the beginning of pregnancy is especially important for pregnancy outcome and child health. Women should strive to achieve normal weight already before pregnancy. Regular physical activity can contribute to a healthy weight and to the health of pregnant women. The need for certain nutrients increases more than energy requirements. Before and during pregnancy, foods with a high content of essential nutrients should be preferentially selected. Supplements should include folic acid and iodine, iron (in case of suboptimal iron stores), the ω-3 fatty acid docosahexaenoic acid (in case of infrequent consumption of ocean fish) and vitamin D (in case of decreased sun exposure and decreased endogenous vitamin D synthesis). Pregnant women should not smoke and not stay in rooms where others smoke or have smoked before (passive smoking). Alcohol consumption should be avoided, since alcohol can harm unborn children.
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Affiliation(s)
- B Koletzko
- Dr. von Hauner Children's Hospital, University of Munich Medical Center, Munich, Germany
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15
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Uriu-Adams JY, Obican SG, Keen CL. Vitamin D and maternal and child health: overview and implications for dietary requirements. ACTA ACUST UNITED AC 2014; 99:24-44. [PMID: 23723170 DOI: 10.1002/bdrc.21031] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2013] [Accepted: 03/13/2013] [Indexed: 02/06/2023]
Abstract
The essentiality of vitamin D for normal growth and development has been recognized for over 80 years, and vitamin D fortification programs have been in place in the United States for more than 70 years. Despite the above, vitamin D deficiency continues to be a common finding in certain population groups. Vitamin D deficiency has been suggested as a potential risk factor for the development of preeclampsia, and vitamin D deficiency during infancy and early childhood is associated with an increased risk for numerous skeletal disorders, as well as immunological and vascular abnormalities. Vitamin D deficiency can occur through multiple mechanisms including the consumption of diets low in this vitamin and inadequate exposure to environmental ultraviolet B rays. The potential value of vitamin D supplementation in high-risk pregnancies and during infancy and early childhood is discussed. Currently, there is vigorous debate concerning what constitutes appropriate vitamin D intakes during early development as exemplified by differing recommendations from the Institute of Medicine Dietary Reference Intake report and recent recommendations by the Endocrine Society. As is discussed, a major issue that needs to be resolved is what key biological endpoint should be used when making vitamin D recommendations for the pregnant woman and her offspring.
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Affiliation(s)
- Janet Y Uriu-Adams
- Department of Nutrition, University of California, Davis, Davis, California 95616, USA
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16
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Parildar H, Dogruk Unal A, Aksan Desteli G, Cigerli O, Guvener Demirag N. Frequency of Vitamin D deficiency in pregnant diabetics at Baskent University Hospital, Istanbul. Pak J Med Sci 2013; 29:15-20. [PMID: 24353500 PMCID: PMC3809191 DOI: 10.12669/pjms.291.2896] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2012] [Revised: 09/04/2012] [Accepted: 10/29/2012] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVE To find out the frequency of vitamin D deficiency and its relation with glucose parameters and the incidence of gestational diabetes (GDM). METHODOLOGY Gestational diabetes was diagnosed with 75 gram oral glucose tolerance test. Forty-four pregnant women diagnosed with GDM and 78 non-GDM pregnant women were enrolled as case and control group, respectively in this descriptive study. Vitamin D status was classified as deficiency at ≤20 ng/ml for serum 25(OH)D concentrations. RESULTS The mean ages were 33.4±5.2 (18-44) years and 29.7±4.1 (21-39) years, mean BMI was 30.6±5.9 kg/m² (19.5-46.1) and 25.9±4.4 kg/m2 (16.5-38) in case and control groups, respectively. The frequency of GDM was found 9.38%. The mean serum vitamin D levels in GDM group were significantly lower than in non-GDM subjects (p=0.07). A total of 56.8% of GDM patients were compared with 35.8% of control group which had Vitamin D deficiency and the difference was significant (p= 0.02). There was no significant association between vitamin D levels and fasting glucose, insulin and HbA1c. Vitamin D levels were inversely correlated with clothing style, parathyroid hormone levels, dental problems and muscle cramps. CONCLUSIONS The association of maternal Vitamin D status with the markers of glucose metabolism in pregnancy needs prospective studies.
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Affiliation(s)
- Hulya Parildar
- Hulya Parildar, MD, Department of Family Medicine, Baskent University, Istanbul Hospital, Mahir Iz caddesi No: 53 Altunizade/Uskudar,Istanbul, Turkey
| | - Asli Dogruk Unal
- Asli Dogruk Unal, MD, Department of Endocrinology and Metabolism, Baskent University, Istanbul Hospital, Oymaci Sokak No: 7 Altunizade/Uskudar, Istanbul, Turkey
| | - Guldeniz Aksan Desteli
- Guldeniz Aksan Desteli, MD, Department of Gynecology and Obstetrics, Baskent University, Istanbul Hospital, Oymaci Sokak No:7 Altunizade/Uskudar Istanbul, Turkey
| | - Ozlem Cigerli
- Ozlem Cigerli, MD, Department of Family Medicine, Baskent University, Istanbul Hospital, Mahir Iz caddesi No: 53 Altunizade/Uskudar,Istanbul, Turkey
| | - Nilgun Guvener Demirag
- Nilgun Guvener Demirag, MD, Department of Endocrinology and Metabolism, Baskent University, Istanbul Hospital, Oymaci Sokak No: 7 Altunizade/Uskudar, Istanbul, Turkey
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17
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Lehotay DC, Smith P, Krahn J, Etter M, Eichhorst J. Vitamin D levels and relative insufficiency in Saskatchewan. Clin Biochem 2013; 46:1489-92. [DOI: 10.1016/j.clinbiochem.2013.05.051] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Revised: 05/12/2013] [Accepted: 05/13/2013] [Indexed: 01/17/2023]
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Abstract
Vitamin D is a secosteroid hormone that resembles other nuclear steroid hormones such as thyroid, gluco-, and mineralocorticoids, as well as gonadal effector systems. Primarily understood as a master regulator of bone and calcium/phosphate physiology, it is now increasingly recognized as orchestrating numerous aspects of cell growth and differentiation in many tissues, including those of innate and acquired immunity. This review addresses recently discovered aspects that highlight vitamin D's potential for immune intervention and how the vitamin D pathway is utilized for anti-infective and antineoplastic immunity. This provides the rationale for novel therapeutic strategies in the context both of prevention and of therapy of immune dysregulation in type 1 diabetes.
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Affiliation(s)
- Klaus Badenhoop
- Division Endocrinology & Diabetology, Medical Department 1, Goethe-University Hospital Frankfurt am Main, Theodor-Stern-Kai 7, D-60590, Frankfurt am Main, Germany.
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Morse NL. Benefits of docosahexaenoic acid, folic acid, vitamin D and iodine on foetal and infant brain development and function following maternal supplementation during pregnancy and lactation. Nutrients 2012; 4:799-840. [PMID: 22852064 PMCID: PMC3407995 DOI: 10.3390/nu4070799] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2012] [Revised: 07/09/2012] [Accepted: 07/12/2012] [Indexed: 11/17/2022] Open
Abstract
UNLABELLED Scientific literature is increasingly reporting on dietary deficiencies in many populations of some nutrients critical for foetal and infant brain development and function. PURPOSE To highlight the potential benefits of maternal supplementation with docosahexaenoic acid (DHA) and other important complimentary nutrients, including vitamin D, folic acid and iodine during pregnancy and/or breast feeding for foetal and/or infant brain development and/or function. METHODS English language systematic reviews, meta-analyses, randomised controlled trials, cohort studies, cross-sectional and case-control studies were obtained through searches on MEDLINE and the Cochrane Register of Controlled Trials from January 2000 through to February 2012 and reference lists of retrieved articles. Reports were selected if they included benefits and harms of maternal supplementation of DHA, vitamin D, folic acid or iodine supplementation during pregnancy and/or lactation. RESULTS Maternal DHA intake during pregnancy and/or lactation can prolong high risk pregnancies, increase birth weight, head circumference and birth length, and can enhance visual acuity, hand and eye co-ordination, attention, problem solving and information processing. Vitamin D helps maintain pregnancy and promotes normal skeletal and brain development. Folic acid is necessary for normal foetal spine, brain and skull development. Iodine is essential for thyroid hormone production necessary for normal brain and nervous system development during gestation that impacts childhood function. CONCLUSION Maternal supplementation within recommended safe intakes in populations with dietary deficiencies may prevent many brain and central nervous system malfunctions and even enhance brain development and function in their offspring.
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Affiliation(s)
- Nancy L Morse
- Efamol Ltd., 14 Mole Business Park, Leatherhead KT22 7BA, UK.
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Hermoso M, Vollhardt C, Bergmann K, Koletzko B. Critical micronutrients in pregnancy, lactation, and infancy: considerations on vitamin D, folic acid, and iron, and priorities for future research. ANNALS OF NUTRITION AND METABOLISM 2011; 59:5-9. [PMID: 22123630 DOI: 10.1159/000332062] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The Early Nutrition Academy and the European Commission-funded EURRECA Network of Excellence jointly sponsored a scientific workshop on critical micronutrients in pregnancy, lactation, and infancy. Current knowledge and unresolved questions on the supply of vitamin D, folic acid, and iron for pregnant women, lactating women, and infants, and their health effects were discussed. The question was addressed of whether, and under which circumstances, supplementation with these micronutrients in addition to usual dietary intakes is advisable. The workshop participants concluded that public health strategies for improving supplementation with these micronutrients in pregnancy, lactation, and infancy are required. Further research priorities should focus on adequately powered human intervention trials to obtain a stronger evidence base for the amounts of vitamin D, folic acid, and iron that have optimal effects on health. The conclusions of the workshop should help to inform the scientific community as well as public health policy strategies.
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Affiliation(s)
- Maria Hermoso
- Division of Metabolic and Nutritional Medicine, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University of Munich Medical Centre, Munich, Germany
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