Metabolic syndrome and time to pregnancy: a retrospective study of nulliparous women

OBJECTIVE

To determine: (1) the association between metabolic syndrome (MetS), time to pregnancy (TTP), and infertility; (2) associations between individual and an increasing number of MetS components, TTP, and infertility; and (3) whether these relationships differ by body mass index (BMI < 30 kg/m² versus BMI ≥ 30 kg/m² ).

DESIGN

Retrospective cohort study.

SETTING

Multiple centres (in Australia, Ireland, New Zealand, and the UK).

POPULATION

Five thousand five hundred and nineteen low-risk nulliparous pregnant women.

METHODS

Data on retrospectively reported TTP (number of months to conceive) and a blood sample to assess metabolic health were collected between 14 and 16 weeks of gestation. MetS was defined according to the International Diabetes Federation criteria. Accelerated failure time models with log-normal distribution were conducted to estimate time ratios (TRs) and 95% CIs. Differences in MetS on infertility (TTP > 12 months) were compared using a generalised linear model (Poisson distribution) with robust variance estimates (relative risks, RRs; 95% CIs). All analyses (entire cohort and split by BMI) were controlled for a range of maternal and paternal confounding factors.

MAIN OUTCOME MEASURES

Time to pregnancy and infertility.

RESULTS

Of the 5519 women included, 12.4% (n = 684) had MetS. Compared with women without MetS, women with MetS had a longer TTP (adjusted TR 1.30; 95% CI 1.15-1.46), which was similar in women who were obese and in women who were not obese. Marginal estimates for median TTP in women with MetS versus without MetS was 3.1 months (3.0-3.3 months) versus 4.1 months (3.6-4.5 months), respectively. Women with MetS were at a 62% greater risk for infertility and were at a greater risk for infertility whether they were obese (adjusted RR 1.62; 95% CI 1.15-2.29) or not (adjusted RR 1.73; 95% CI 1.33-2.23). Reduced high-density lipoprotein cholesterol (HDL-C) and raised triglycerides (TGs) were the main individual components associated with risk for infertility.

CONCLUSION

Metabolic syndrome is associated with longer TTP and infertility, independent of obesity. Additional studies, before pregnancy, are required to support our findings and to determine the applicability of which combinations of metabolic abnormalities pose the greatest risk to delayed fertility, or whether individual components are amenable to modification.

TWEETABLE ABSTRACT

Metabolic syndrome is associated with longer time to pregnancy and infertility, independent of obesity.

The Impact of Dietary Factors on Indices of Chronic Disease in Older People: A Systematic Review

OBJECTIVES

There has been little evaluation of the evidence relating dietary factors to functional capacity in older adults. The aims were to i) conduct a systematic review of studies assessing dietary factors in relation to six key functional indicators which impact on quality of life in adults ≥65 yrs: non-fatal cardiovascular events, cognition, mental health, falls and fractures, physical health (muscle mass, strength) and frailty; and ii) assess if there was sufficient evidence to devise food-based dietary recommendations.

DESIGN

Systematic review.

PARTICIPANTS

Cross-sectional and prospective cohort studies were included together with intervention studies that evaluated food/drink interventions (excluding supplements). Evidence base statements were determined according to the GRADE (Grades of Recommendation, Assessment, Development and Evaluation) levels of evidence criteria (Grades (A-excellent; B-good; C-satisfactory; D-poor).

RESULTS

There was good evidence that the Mediterranean type diet (MD) reduced the risk of non-fatal cardiovascular events (Grade B) and reduced cognitive decline (Grade B). There was some evidence indicating that a MD decreases the likelihood of frailty (Grade C), consistent but weaker evidence that ≥3 servings/d of vegetables is associated with reduced cognitive decline (Grade D), a modest increase in protein may be associated with improved cognition (Grade C) and decreased frailty (Grade C), and that protein plus resistance exercise training in frail elderly may enhance physical strength (Grade C).

CONCLUSION

It is recommended that older adults adopt the characteristics of a Mediterranean type diet such as including olive oil and eating ≥3 servings/d of vegetables to reduce their risk of chronic disease, impaired cognition and frailty. Consumption of dietary protein above the current dietary requirements would be recommended to reduce risk of frailty and impaired cognition. A modest increase in dietary protein when combined with resistance exercise would be recommended to help maintain muscle mass and strength and to enhance functional capacity.

Maternal creatine in pregnancy: a retrospective cohort study

OBJECTIVE

To estimate creatine concentrations in maternal plasma and urine, and establish relationships with maternal characteristics, diet and fetal growth.

DESIGN

Retrospective cohort study.

SETTING

Lyell McEwin Hospital, Adelaide, Australia.

POPULATION

A biobank of plasma and urine samples collected at 13, 18, 30 and 36 weeks' gestation from 287 pregnant women from a prospective cohort of asthmatic and non-asthmatic women.

METHODS

Creatine was measured by enzymatic analysis. Change in creatine over pregnancy was assessed using the Friedman test. Linear mixed models regression was used to determine associations between maternal factors and diet with creatine across pregnancy and between creatine with indices of fetal growth at birth.

MAIN OUTCOME MEASURES

Maternal creatine concentrations, associations between maternal factors and creatine and between creatine and fetal growth parameters.

RESULTS

Maternal smoking, body mass index, asthma and socio-economic status were positively and parity negatively associated with maternal plasma and/or urine creatine. Maternal urine creatine concentration was positively associated with birthweight centile and birth length. After adjustment, each μmol/l increase in maternal urinary creatine was associated with a 1.23 (95% CI 0.44-2.02) unit increase in birthweight centile and a 0.11-cm (95% CI 0.03-0.2) increase in birth length.

CONCLUSIONS

Maternal factors and fetal growth measures are associated with maternal plasma and urine creatine concentrations.

TWEETABLE ABSTRACT

Maternal creatine is altered by pregnancy; fetal growth measures are associated with maternal creatine concentrations.

Nutrient intake and plate waste from an Australian residential care facility

OBJECTIVE

To determine the plate waste, energy and selected-nutrient intake, from elderly residents living in a high-level care (HLC) and low-level care (LLC) facility.

DESIGN

Three, single, whole day assessments of plate waste, energy, and selected nutrients, using a visual rating plate waste scale.

SETTING

Long-term residential care establishment.

SUBJECTS

One hundred and sixty-nine (93 HLC and 76 LLC) individual daily intakes.

MAIN FINDINGS

The mean energy wasted throughout the whole day was 17%. The energy wasted from main meals (16%) was significantly less than the energy wasted at mid-meals (22%, P=0.049). The lowest mean energy wastage occurred at breakfast (8%) compared to lunch (22%) and dinner (25%, P<0.001). The mean (s.d.) daily energy served and consumed was 8.1 (2.0) and 6.6 (2.2) MJ, respectively. There was no difference in energy served or consumed between HLC and LLC residents. On the observation day, 60% of residents consumed less than their estimated energy requirement. The mean calcium intake was 796 (346) mg, and the median (inter-quartile range) vitamin D intake was 1.78 (2.05) microg.

CONCLUSION

On 1 day, more than half the residents surveyed were at risk of consuming an inadequate energy intake, which over-time, may result in body weight loss. Although wastage was not excessive and energy served was adequate, the amount of food eaten was insufficient to meet energy and calcium requirements for a significant number of residents and it is not possible to consume sufficient vitamin D through food sources.

Radiochemotherapy for anal carcinoma - effectivity and late toxicity

BACKGROUND

Radiochemotherapy of anal carcinoma is an organ-sparing approach with a high curative potential. The purpose was to evaluate the effectivity and late toxicity for patients treated with radiochemotherapy in our department.

PATIENTS AND METHODS

During 1990-2000, 27 patients with anal carcinoma were treated at the Universitätsklinikum Mannheim. The median follow-up time was 23 months (max. 68 months). Before treatment, 23 patients were colostomy-free. Patients were treated according to 3 different protocols (Cummings n = 8, EORTC n = 5, RTOG n = 14). Acute toxicity was scored according to the RTOG/EORTC scale, and late toxicity according to the LENT/SOMA scale.

RESULTS

25 patients completed the therapy. One patient died due to leukopenic sepsis, and 1 patient interrupted therapy. 4 patients had a tumor relapse (2 patients immunosuppressed, 1 T4 tumor and 1 recurrence at the field-margin), one underwent abdomino- perineal resection. This resulted in a disease-free survival of about 80% and colostomy-free survival of 90% at 5 years. Total doses < 50 Gy and immunosuppression resulted in higher recurrence rates. Most patients suffered from acute toxicity grades 2 (n = 7) and 3 (n = 19) and late toxicity grades 1 (n = 7) and 2 (n = 4).

CONCLUSIONS

Radiochemotherapy for anal carcinoma is an effective therapy with acceptable toxicity. Immunosuppressed patients have a higher risk for tumor recurrences and should be monitored more closely.