Higher Waist Circumference Is Related to Lower Plasma Polyunsaturated Fatty Acids in Healthy Participants: Metabolic Implications

Objective: We evaluated whether the relationship between waist circumference (WC) and cardiometabolic risk is related to usual diet and plasma fatty acid composition.

Methods: This cross-sectional study included 226 health professionals from 20 to 59?years old. Anthropometric features, oxidative stress, inflammatory markers, and plasma fatty acid profile were assessed. Dietary intake was evaluated with a semi-quantitative food frequency questionnaire, the quality of dietary habits by Healthy Eating Index, and insulin resistance by homeostasis model assessment–insulin resistance and triglyceride-glucose index.

Results: Higher WC was associated with lower concentrations of high-density lipoprotein cholesterol (p?=?0.000) and adiponectin (p?=?0.000) and higher uric acid levels (p?=?0.011). Plasma polyunsaturated fatty acid (PUFA) levels were negatively associated with weight (p?=?0.046), systolic blood pressure (p?=?0.035), fasting glucose (p?=?0.000), triglyceride-glucose index (p?=?0.023), and IL-1β (p?=?0.037). Individuals with elevated WC consumed more calories (p?=?0.002), niacin (p?=?0.002), and pyridoxine (p?=?0.017), but less calcium (p?=?0.001), phosphorus (p?=?0.016), and vitamin B2 (p?=?0.011). In addition, individuals with higher WC denoted lower PUFA concentrations (p?=?0.036).

Conclusion: The results suggest that participants with higher WC have lower plasma PUFA concentrations and higher levels of saturated fatty acids. This could be related to metabolic and inflammatory changes that could trigger increased risk of metabolic syndrome and cardiovascular disease.     

Association between Vitamin D Receptor Polymorphism and Serum Vitamin D Levels in Children with Low-Energy Fractures

Objective: Fractures of bones, especially forearm fractures, are very common in children and their number is increasing. This study was designed to determine the impact of vitamin D serum levels and vitamin D receptor (VDR) polymorphisms on the occurrence of low-energy fractures in children.

Methods: The study group consisted of 100 children with clinically relevant bone fractures and a control group consisted of 127 children without fractures. Total vitamin D [25(OH)D3 plus 25(OH)D2] serum concentrations were evaluated in every patient. Genotypes for 4 restriction fragment length polymorphisms of the vitamin D receptor gene (FokI, ApaI, TaqI, and BsmI) were determined by standard polymerase chain reaction–restriction fragment length polymorphism (PCR-RFLP) techniques.

Results: Differences in concentrations of vitamin D were observed between the group with bone fractures (median = 12 ng/ml) and the control group (median = 16 ng/ml; p = 0.000044).

Higher levels of vitamin D reduced the risk of fracture by 1.06 times (p = 0.0005). No impact of particular VDR polymorphism on the occurrence of low-energy fractures in children was detected. However, there were significant differences in the prevalence of FokI polymorphism genotypes between the fracture and control groups (p = 0.05). Furthermore, the recessive “aa” genotype of ApaI polymorphism and the dominant “TT” genotype of TaqI polymorphism were associated with higher levels of vitamin D (p = 0.005 and p = 0.036, respectively).

Conclusions: Vitamin D deficiency is an independent risk factor for fractures in children. ApaI polymorphism recessive “aa” and TaqI polymorphism dominant “TT” genotypes are associated with higher levels of vitamin D in serum.     

Vitamin D Deficiency in Pregnant Ukrainian Women: Effects of Alcohol Consumption on Vitamin D Status

Objective: Heavy alcohol consumption can alter vitamin D status; however, the relationships between alcohol consumption and vitamin D concentrations in pregnant women have not been well studied. The aim of this study was to investigate the vitamin D status in a population of alcohol-exposed (N = 180) and low/unexposed control (N = 179) Ukrainian pregnant women.

Methods: Women who attended prenatal care facilities in 2 regions of Ukraine (Rivne and Khmelnytsky) for a routine prenatal visit were screened for the study. At the time of enrollment (20.4 ± 7.0 weeks of gestation), blood samples and alcohol consumption data (during a typical week around conception and the most recent 2 weeks) were collected. Vitamin D status was assessed by 25-hydroxyvitamin D [25(OH)D] concentrations.

Results: A high prevalence of suboptimal vitamin D status in pregnant Ukrainian women was observed. Overall, 50.1% and 33.4% of the women were classified as vitamin D deficient [25(OH)D < 20 ng/mL] or insufficient [25(OH)D ≥ 20 ng/mL and ≤30 ng/mL], respectively, based on 2011 Endocrine Society guidelines. Alcohol-exposed women had significantly lower 25(OH)D concentrations than low/unexposed women in Spring (p = 0.006) and Winter (p = 0.022). When vitamin D concentrations were grouped into sunny season (Summer + Fall) compared to not sunny season (Winter + Spring), there was a significant ethanol by season interaction (p = 0.0028), with alcohol-drinking women having lower circulating vitamin D compared to low/unexposed women in seasons of low sun availability.

Conclusions: These data suggest that when vitamin D concentrations are generally low (e.g., during seasons of low sun availability), alcohol consumption during pregnancy has a negative impact on vitamin D status.     

Association of Serum Vitamin D Concentration With Clinical Symptoms and Quality of Life in Patients With Irritable Bowel Syndrome

Objective: A high prevalence of vitamin D deficiency (VDD) in gastrointestinal (GI) disorders and the role of vitamin D in the function of the gut have been shown previously. Therefore, we aimed to evaluated the VDD and the possible association of the GI symptoms severity and quality of life (QoL) score with the serum levels of vitamin D in irritable bowel syndrome (IBS).

Methods: A total of 90 patients with IBS based on Rome III criteria enrolled in the study from the tertiary referral university hospital. In addition, 90 sex- and age-matched healthy controls (HCs) were recruited. To measure the serum levels of 25(OH)D₃, blood samples were taken from all the participants. Severity of clinical symptoms, IBS quality of life (IBS-QoL), and IBS symptom severity score (IBSSS) were assessed.

Results: In 66.7% of IBS patients, serum 25(OH)D₃ concentrations were <20?ng/mL. The mean serum 25(OH)D₃ of IBS patients was statistically (p?<?0.05) lower vs. HCs. When different subtypes were analyzed, the serum 25(OH)D₃ concentrations in diarrhea-predominant IBS were statistically (p?<?0.05) lower as compared to HCs. Furthermore, the lower serum concentrations of 25(OH)D₃ were associated (p?<?0.05) with higher severity of abdominal pain and distention, flatulence, overall GI symptoms, and IBSSS. However, a direct significant association was seen between IBS-QoL and serum 25(OH)D₃.

Conclusion: Results of this study showed a high prevalence of VDD in patients with IBS. In addition, VDD was associated with a higher severity of clinical symptoms and lower QoL in IBS.     

Effects of dog-assisted intervention on quality of life in nursing home residents with dementia

Background: People with dementia often have a poor quality of life. Therefore, methods that can improve their life situation must be identified. One promising method is dog-assisted intervention.

Aim: This study aimed to investigate the effects of dog-assisted intervention on quality of life in nursing home residents with dementia.

Materials and methods: A one-group, pretest post-test study design was used. Quality of life was measured using the QUALID in 59 nursing home residents prior to and after a dog-assisted intervention. Non-parametric tests were used to analyze the data, and effect sizes were calculated.

Results: The participants’ total scores improved significantly between baseline and post-test 1 (p?=?<?0.001) and worsened significantly at post-test 2 (p?=?0.025). The largest effect size was found for the item ‘Verbalization suggests discomfort’ (p?=?0.001).

Conclusion: The results indicate that dog-assisted interventions can have positive effects on quality of life in nursing home residents with moderate to severe dementia.

Significance: The results contribute to a growing knowledge base about non-pharmacological methods that can be used in dementia care. Occupational therapists should consider dog-assisted interventions when planning activities that can reduce the illness burden and improve the quality of life for people with dementia.     

Vitamin D supplementation for diffuse musculoskeletal pain: Results of a before-and-after study

Background: Several studies have shown that vitamin D supplementation could be useful for treating diffuse musculoskeletal (DMS) pain in adults.

Objectives: The aim of this study was to evaluate the effects of correcting a vitamin D deficiency (≤ 50 nmol/l) on DMS pain and quality of life in adults.

Methods: A pragmatic prospective study was conducted in a general practice setting in the Rhone-Alps area between 1 February and 30 April 2009. Patients between the ages of 18 and 50 years old who consulted their general practitioner (GP) for DMS pain or chronic unexplained asthenia and had a deficient serum 25 (OH) D level with no signs of any other disease were enrolled in this study. The patients received high doses of vitamin D supplements (400 000 to 600 000 units). Mean pain evaluation scores were evaluated before and after vitamin D supplementation using mixed models and accounting for repeated measures.

Results: Before vitamin D supplementation, the adult study cohort (n = 49) had an adjusted mean serum 25 (OH) D level of 23.7 nmol/l, a mean pain evaluation score of 5.07 and a mean quality of life score of 3.55. After vitamin D supplementation, the adjusted mean serum 25 (OH) D level increased to 118.8 nmol/l (P < 0.001), the mean quality of life score increased to 2.8 nmol/l (P < 0.001) and the mean pain evaluation score decreased to 2.8 (P < 0.001).

Conclusion: In this small before-and-after study, vitamin D supplementation decreased pain scores in adult patients with diffuse musculoskeletal pain and vitamin D deficiency. These results must be confirmed by further studies.     

Fruit and Vegetable Consumption and Their Association With the Indicators of Iron and Inflammation Status Among Adolescent Girls

Background: The objective of this study was to identify an association among dietary components, iron, and inflammatory status among adolescent girls.

Method: Dietary information for 85 adolescent girls was collected through food frequency questionnaires. Biomarkers of iron and inflammatory status were analyzed.

Results: We found that 28.2% of adolescent girls had anemia and 65.9% girls were iron-deficient. Girls who did not consume guava had 3.8-fold (95% confidence interval =1.1–9.4; p?=?0.020) increased the risk of having low serum iron levels. Girls who consumed amaranth had significantly (p?=?0.024) higher serum hepcidin levels (n?=?44; 129.7?±?81.40?pg/mL vs n?=?41; 94.6?±?55.8?pg/mL) as well as ferritin levels (n?=?44; 19.7?±?16.4?µg/L vs n?=?41; 14.0?±?10.2?µg/L). Overall consumption of fruits and green leafy vegetables among girls significantly affects their iron status.

Conclusions: Regular consumption of vitamin C–rich fruits and green leafy vegetable intake are imperative for improvement of iron status among adolescent girls.     

Open defecation explains differences in nutritional status between Bengali and tribal children in the Chittagong Hill Tracts of Bangladesh

Objective: We describe differences in linear growth as measured by height-for-age z-score (HAZ) between children from Bengali and tribal populations in the Chittagong Hill Tracts of Bangladesh and examine factors associated with HAZ in both groups.

Design: We used nutritional surveillance data collected in Bangladesh from 2003 to 2006 to analyze HAZ among 12,006 children aged 6–23 months and conducted multivariate linear regression and Blinder-Oaxaca decomposition to quantify the relative contribution of independent variables to differences in HAZ between Bengali and tribal children.

Results: Mean HAZ was stable for Bengali children (?1.88 in 2003 to ?1.90 in 2006) but improved for tribal children (?1.87 in 2003 to ?1.68 in 2006). The difference between groups was significant across the study period (p?=?0.008). Among Bengali children, HAZ was positively associated with father’s schooling (β?=?0.221; 95% CI: 0.079–0.363). Among tribal children, HAZ was positively associated with consumption of animal source foods (β?=?0.073; 95% CI: 0.051–0.096) and goat ownership (β?=?0.240; 95% CI: 0.025–0.454). Results of a likelihood ratio test indicated that distance to a health center was inversely associated with HAZ among tribal children (p?<?0.001). Blinder-Oaxaca decomposition demonstrated a difference in pooled coefficients between groups (p?=?0.004), explained primarily by differences in coefficients for paternal education (p?=?0.001) and village-level prevalence of open defecation (p?=?0.004).

Conclusions: Different responses among Bengali and tribal children to village-level open defecation are an explanatory factor for the difference in HAZ between Bengali and tribal populations. Open defecation may also act a proxy for unmeasured factors such as household environmental conditions and food hygiene.

Abbreviations: Chittagong Hill Tracts (CHT); height-for-age z-scores (HAZ); Nutrition Surveillance Project (NSP); World Health Organization (WHO)     

Effects of Protein Versus Carbohydrate Supplementation on Markers of Immune Response in Master Triathletes: A Randomized Controlled Trial

Objective: This study examines the long-term effects of ingesting hydrolyzed beef protein versus carbohydrate on indirect markers of immunity during 10 weeks of endurance training in master-aged triathletes (n?=?16, age 35–60?years).

Methods: Participants were randomly assigned to either a hydrolyzed beef protein (PRO, n?=?8) or nonprotein isoenergetic carbohydrate (CHO, n?=?8) condition, which consisted of ingesting 20?g of each supplement, mixed with water, once a day immediately post workout, or before breakfast on nontraining days. Salivary human neutrophil peptides (HNP1–3) were measured before and after performing an incremental endurance test to volitional exhaustion at both pre and post intervention. Additionally, baseline levels of platelets, neutrophils, eosinophil basophils, monocytes, and lymphocytes were determined at pre and post intervention.

Results: No significant changes in baseline concentration and secretion rate of salivary HNP1–3 were observed for either treatment. The CHO group showed a nonsignificant decrease in resting HNP1–3 concentrations following the intervention (p?=?0.052, effect size d?=?0.53). Protein supplementation demonstrated a significant reduction in lymphocyte counts pre to post intervention (mean [SD]: 2.30 [0.57] vs. 1.93 [0.45] 10³/mm³, p?=?0.046, d?=?0.77), along with a moderate but not statistically significant increase (d?=?0.75, p?=?0.051) of the neutrophil-to-lymphocyte ratio.

Conclusions: In master-aged triathletes, postworkout ingestion of only protein, with no carbohydrate, may not be as effective as carbohydrate alone to attenuate negative long-term changes of some salivary and cellular immunological markers. Future studies should consider the co-ingestion of both macronutrients.     

Effects of Yeast (1,3)-(1,6)-Beta-Glucan on Severity of Upper Respiratory Tract Infections: A Double-Blind,Randomized, Placebo-Controlled Study in Healthy Subjects

Objectives: Each year, adults suffer about two to four upper respiratory tract infections (URTIs), mostly in winter. The aim of the study was to evaluate the effects of brewers’ yeast (1,3)-(1,6)-beta-glucan on incidence and severity of upper respiratory tract infections (URTIs).

Methods: Generally healthy men and women (n?=?299) reporting at least three URTIs during the previous year were randomized to receive either a placebo or 900?mg of yeast beta-glucan daily for 16?weeks during winter. In cases of acute URTI, the severity of URTI symptoms was assessed via the WURSS-21 questionnaire and the Jackson scale, and a clinical confirmation was implemented by the investigator.

Results: Overall, 70 subjects under placebo and 71 subjects under yeast beta-glucan experienced at least one clinically confirmed URTI episode. The global severity using WURSS-21 had been quite similar between the study groups (p?=?0.5267), whereas during the first days of URTIs the severity was less pronounced in the yeast beta-glucan group. On the episode level, the severity of physical symptoms was significantly lower for all investigated time intervals up to 7?days under yeast beta-glucan (WURSS (Q2-11) (days 1–2: p?=?0.0465, days 1–3: p?=?0.0323, days 1–4: p?=?0.0248, days 1–7: p?=?0.0278), also confirmed for the Jackson scale). The reduction of severity was accompanied by a significant increase in the joy subscore of the Perceived Stress Questionnaire (PSQ20) (p?=?0.0148). In addition, there was a reduction of systolic (p?=?0.0458) and diastolic (p?=?0.1439) blood pressure.

Conclusion: Subjects supplementing with yeast beta-glucan benefit by a reduced severity of physical URTI symptoms during the first week of an episode, even though the incidence and global severity of common colds could not be altered in comparison to placebo. Furthermore, accompanying benefits in terms of blood pressure and mood were identified. Altogether, yeast beta-glucan supports the immune function.     

Association Between Magnesium Status,Dietary Magnesium Intake,and Metabolic Control in Patients with Type 2 Diabetes Mellitus

Background: Hypomagnesemia could worsen glycemic control by impairing insulin release and promoting insulin resistance. On the contrary, type 2 diabetes mellitus (T2DM) may induce and/or exacerbate low serum magnesium levels, and this could, in turn, worsen glycemic control of diabetes.

Objective: The aim of this study was to investigate the relationship between serum magnesium level, dietary magnesium intake, and metabolic control parameters in patients with T2DM.

Methods: The study included 119 patients with T2DM (26 male, 93 female; mean age 54.7?±?8.4 years). Serum magnesium level was measured by spectrophotometric method. Magnesium intake was assessed by food frequency questionnaire. Anthropometric measurements were taken. The General Linear Model procedure was applied to determine the relationship of serum magnesium with quantitative variables.

Results: Of the 119 patients, 23.5% of the patients had inadequate magnesium intake (lower than 67% of the recommended daily allowance), and 18.5% had hypomagnesemia. In patients with hypomagnesemia (< 0.75?mmol/l), serum levels of fasting plasma glucose (FPG), postprandial plasma glucose (PPG), and serum glycosylated hemoglobin (HbA1c) were higher compared to patients with normomagnesemia. FPG levels were significantly higher in patients with hypomagnesemia in Model 1 (179.0?±?64.9 vs. 148.7?±?52.0?mg/dl, p?=?0.009) but the significance disappeared in other models. PPG levels were significantly higher in patients with hypomagnesemia in all models (287.9?±?108.4 vs. 226.8?±?89.4?mg/dl, p?=?0.006 for Model 1, p?=?0.027 for Model 2, p?=?0.016 for Model 3). Serum HbA1c levels were significantly higher in patients with hypomagnesemia, and this significance proceeded (8.0?±?1.9% vs. 6.5?±?1.2%, p?=?0.000 for all models). Body fat mass was significantly higher in patients with hypomagnesemia as compared to patients with normomagnesemia in model 3 (35.4?±?9.4?kg, 34.6?±?10.2?kg; p?=?0.034). Dietary magnesium intake was not significantly associated with either metabolic parameters or anthropometric measurements.

Conclusion: Hypomagnesemia in T2DM is directly associated with poor metabolic control. Clinical assessment should, therefore, focus on augmentation of magnesium status and adequate magnesium intake in patients with T2DM.     

Role of Vitamin D and Its Receptors in the Pathophysiology of Chronic Rhinosinusitis

Objectives: Chronic rhinosinusitis (CRS) is a disease that represents a challenging therapeutic problem. Vitamin D and its receptors (VDR) are involved in the regulation of the immune system and may play role in CRS. Objectives of this study were to assess the relationships between the total concentration of vitamin D (25VD3) in sera, vitamin D receptor (VDR) expression, 1α-hydroxylase expression, and clinical data, including age, gender, Sino-Nasal Outcome Test (SNOT-22), computerized tomography (CT) scan, allergy status, and vitamin D supplementation in CRS patients with (CRSwNP) and without nasal polyps (CRSsNP), and in a control group.

Methods: The studied group comprised 52 patients with CRS without nasal polyps (sNP), 55 with CRS with nasal polyps (wNP), and 59 in the control group. The endpoints were determined by appropriate methods. We conducted immunohistochemical staining of gathered tissue from the ostiomeatal complex for determination of VDR and 1α-hydroxylase. Analytical results were compared with clinical data as already noted.

Results: A decrease in VDR nuclear staining occurred in CRS patients as compared to controls. Insignificant differences were observed in 1α-hydroxylase, expression in all studied groups, while VDR and cytochrome CYP27B1 protein expression (1α-hydroxylase) correlated with clinical data.

Conclusions: The data provide evidence that indicates that vitamin D and its receptor and enzymes may play a role in CRS.     

Vitamin D Status in Hospitalized Chronically Ill Patients

Objectives: Vitamin D deficiency is rarely considered or treated in critically ill patients. Deficiency of 25-hydroxy vitamin D [25(OH)D] prior to hospital admission might be a significant predictor of short- and long-term all cause patient mortality in a critically ill patient. The aim of this work is to investigate the prevalence of vitamin D deficiency in hospitalized patients and its relation to the length of stay and outcome of hospitalization.

Methods: Prospective cohort study performed on 80 patients admitted with acute deterioration of their chronic illness. Four groups of diseases were included, namely, chronic liver diseases (CLD), chronic obstructive pulmonary diseases (COPD), cerebrovascular stroke (CVS), and heart failure (HF). The patients were followed up until their discharge, or transfer, or death. Patients were sampled for their vitamin D level on admission and were divided according to their vitamin D status into sufficient, insufficient, and deficient. Statistical methods and analysis of the present study were conducted using the SPSS V17 program.

Results: Vitamin D level had a significant inverse correlation with length of hospital stay (r = –0.648) (p < 0.001). In vitamin D-deficient and -insufficient groups, there was a significant difference between survivors and nonsurvivors as regards vitamin D levels and an inverse correlation between vitamin D level and outcome of hospital admission.

Conclusions: Vitamin D deficiency and insufficiency are significantly associated with a longer hospital stay and a poor outcome of hospital admission in comparison to control.     

Maternal breastfeeding and autism spectrum disorder in children: A systematic review and meta-analysis

Objectives: Autism spectrum disorder (ASD) refers to a group of conditions variably affecting communicative and social interactive abilities presenting alongside behaviors with various restricted and repetitive patterns. In addition to genetic factors that influence the onset of the symptoms, there is growing interest in the potential involvement of non-genetic environmental factors. Some aspects of breastfeeding practices, including rates, timing, or optimality, have been put forward as environmental risk factors for autism. However, previous studies showed a controversial relationship between ASD and breastfeeding.

Methods: A meta-analysis on the association between maternal breastfeeding and ASD in children was conducted. We also explored potential moderating factors which might influence this association. Articles reporting the association between breastfeeding and a diagnosis of ASD were included.

Results: Seven articles were included in the meta-analysis. Cumulatively, children with ASD (n?=?1463), either in the form of clinical diagnosis or self-report, were significantly less likely to have been breastfed than children without ASD (n?=?1180) (OR?=?0.61, 95% CI?=?0.45–0.83, P?=?0.002). Subgroup analyses revealed that results remained significant for children who were breastfed with additional supplementation.

Discussion: This meta-analysis provides evidence that breastfeeding (exclusively or including additional supplements) may protect against ASD. Prospective longitudinal research is required to disentangle the complex relationships and to explore potential pathophysiological mechanisms.     

Distinct Effects of Repeated-Sprint Training in Normobaric Hypoxia and β-Alanine Supplementation

Objective: The present study evaluated the effects of repeated-sprint training in normobaric hypoxia and β-alanine supplementation (BA) on aerobic and anaerobic performance in recreationally active men.

Methods: Participants were randomly assigned to one of the following groups: normoxia/β-alanine (NB, n?=?11), normoxia/placebo (NP, n?=?8), normobaric hypoxia/β-alanine (HB, n?=?10) and normobaric hypoxia/placebo (HP, n?=?9). All participants completed 8 training sessions over 4?weeks on a cycle ergometer either in normobaric hypoxia (oxygen fraction: FiO₂?=?14.2%) or normoxia (FiO₂?=?20.9%). Participants were instructed to consume a daily dosage of 6.4?g of BA or placebo. Changes in performance in a graded exercise test, repeated-sprint test (RST), and 3-minute all-out test (3MT) were examined before and after training and supplementation.

Results: No between-group differences were observed for training volume or supplementation compliance. Anthropometric and hematological measures remained unchanged before and after intervention in all groups. A main effect of training condition was shown for oxygen consumption and power output at respiratory compensation point, average power output during the last sprint of the RST, heart rate recovery following the RST, and total work during the 3MT. These measures in the normobaric hypoxia groups were significantly (p?<?0.05) higher than the normoxia groups, except for the heart rate recovery following the RST. A main effect of supplement was detected in anaerobic working capacity, with postintervention values in the BA groups being significantly (p?<?0.05) higher than the placebo groups.

Conclusions: Repeated-sprint training in hypoxia improved aerobic performance, exercise tolerance, cardiovascular recovery, and overall working capacity, while BA maintained the anaerobic working capacity. However, BA did not provide additional benefits with respect to attenuating fatigue or enhancing repeated-sprint performance.     

Vitamin D Status and Risk of Breast Cancer in Iranian Women: A Case–Control Study

Objective: Considering the rising incidence of breast cancer and high prevalence of vitamin D deficiency in Iran, this case–control study aimed to investigate the relationship between serum concentration and intake of vitamin D and risk of breast cancer.

Methods: A total of 135 incident breast cancer cases at the Cancer Research Center of Shahid Beheshti University of Medical Sciences were matched with 135 controls by age and menopausal status. A validated and reliable 168-item food frequency questionnaire was completed by participant interviews. To determine the vitamin D content of foods we used the U.S. Department of Agriculture (USDA) nutrient database. To analyze the food frequency questionnaires we used the data collected in the Iranian Household Food Pattern Study, conducted by the National Nutrition and Food Technology Research Institute and the Iranian Ministry of Agriculture. Five-milliliter blood samples were collected to measure serum 25-hydroxyvitamin D (25(OH)D) using an enzyme-linked immunosorbent assay method.

Results: Women in the fourth quartile of serum 25(OH)D level had 3 times lower risk of developing breast cancer compared to those in the first quartile. In the adjusted model the inverse relationship remained significant (odds ratio [OR] = 0.269; 95% confidence interval [CI], 0.122–0.593). In the stratified model by menopausal status the inverse association was only seen in premenopausal women (OR = 0.25; 95% CI, 0.094–0.687).

Dietary intake of vitamin D was inversely associated with risk of breast cancer (OR fourth quartile [Q4] vs first quartile [Q1] = 0.39; 95% CI, 0.196–0.784; p = 0.008). After adjusting for the confounding factors, this inverse association remained significant.

Conclusion: Results from this case–control study support the protective effect of higher serum concentration of 25(OH)D against breast cancer. Moreover, dietary but not total intake of vitamin D was associated with decreased risk of breast cancer.     

Serum and Erythrocyte Biomarkers of Nutrient Status Correlate with Short-Term Α-Carotene, Β-Carotene,Folate, and Vegetable Intakes Estimated by Food Frequency Questionnaire in Military Recruits

Objective: Food frequency questionnaires (FFQs) estimate habitual dietary intake and require evaluation in populations of interest in order to determine accuracy. Thus, the purpose of this study was to determine agreement between circulating biomarkers and FFQ estimated dietary intake in a military population consuming all meals in a dining facility over 12?weeks.

Methods: 2014 Block FFQs were administered and fasted blood samples were drawn to assess nutritional biomarkers at the end of a 12-week training period in male (n?=?141) and female (n?=?125) Marine recruits undergoing initial military training. FFQ estimates of alpha- and beta-carotene, folate, and fruit and vegetable intake and circulating concentrations of serum alpha- and beta-carotene and serum and erythrocyte folate were measured. Partial correlations were used in the full model, and weighted kappa coefficients were used to determine agreement between ranking quartiles of dietary intake estimates with corresponding biomarker status quartiles.

Results: Serum and dietary intake of alpha-carotene were positively associated in males (p?=?0.009) and females (p?<?0.001), as was serum and intake of beta-carotene (males, p?=?0.002; females, p?<?0.001). Alpha-carotene was positively associated with vegetable intake in males (p?=?0.02) and beta-carotene with vegetable intake in females (p?=?0.003). Serum folate in males (p?=?0.002) and erythrocyte folate in females (p?=?0.02) were associated with dietary folate intake. In females, the relationships between biomarker and dietary estimates yielded significant kappa coefficients. In males, a significant kappa coefficient was observed for erythrocyte folate and dietary intake of folate only. The kappa coefficient for serum and estimated intake of beta-carotene was not significant in males.

Conclusion: Twelve-week habitual intake of alpha-and beta-carotene and folate were correlated with circulating biomarkers in a military training population. The 2014 Block FFQ was able to accurately rank females into quartiles of nutrient status based on intake, while males were ranked less accurately than females.     

Ethnic differences in the cardiac responses to aerobic exercise

Background: Cardiovascular disease disproportionately affects North American Indigenous populations. Ethnic differences in cardiac responses to exercise are known, though Indigenous populations response is unknown. To evaluate cardiac responses to aerobic exercise among Canadian Indigenous and European adults.

Methods: Indigenous (N?=?12, 4 females, 1 male incomplete) and European (N?=?12, all completed) Canadian age and sex-matched adults 19–40 years and free of cardiovascular disease or diabetes completed a cycle ergometer maximal aerobic power test and 30?min at 60% maximal aerobic capacity on two separate days. Echocardiographic assessments preceded and immediately followed exercise.

Results: Responses to maximal exercise were similar among ethnicities including decreases in stroke volume index, cardiac output index and ejection fraction, and increases in arterial-ventricular coupling. However, following submaximal exercise, only Indigenous adults demonstrated reductions in end systolic volume, end diastolic volume (154.8?±?40.6?mL to 136.5?±?33.0?mL, p?=?0.01, vs. 149.4?±?22.4?mL to 147.1?±?27.0?mL; p?=?0.81), stroke volume index (44.9?±?8.7?mL?m^?2 to 38.0?±?6.5?mL?m^?2, p?=?0.002, vs. 46.4?±?7.1?mL?m^?2 to 44.0?±?6.5?mL?m^?2; p?=?0.28) and arterial compliance.

Conclusion: Indigenous and European adults demonstrated similar cardiac responses to maximal exercise, though only Indigenous adults demonstrated cardiac responses to submaximal exercise.     

An exploratory decision tree analysis to predict physical activity compliance rates in breast cancer survivors

Background: The study of physical activity in cancer survivors has been limited to one cause, one effect relationships. In this exploratory study, we used recursive partitioning to examine multiple correlates that influence physical activity compliance rates in cancer survivors.

Methods: African American breast cancer survivors (N?=?267, Mean age?=?54 years) participated in an online survey that examined correlates of physical activity. Recursive partitioning (RP) was used to examine complex and nonlinear associations between sociodemographic, medical, cancer-related, theoretical, and quality of life indicators.

Results: Recursive partitioning revealed five distinct groups. Compliance with physical activity guidelines was highest (82% met guidelines) among survivors who reported higher mean action planning scores (P?<?0.001) and lower mean barriers to physical activity (P?=?0.035). Compliance with physical activity guidelines was lowest (9% met guidelines) among survivors who reported lower mean action and coping (P?=?0.002) planning scores. Similarly, lower mean action planning scores and poor advanced lower functioning (P?=?0.034), even in the context of higher coping planning scores, resulted in low physical activity compliance rates (13% met guidelines). Subsequent analyses revealed that body mass index (P?=?0.019) and number of comorbidities (P?=?0.003) were lowest in those with the highest compliance rates.

Conclusion: Our findings support the notion that multiple factors determine physical activity compliance rates in African American breast cancer survivors. Interventions that encourage action and coping planning and reduce barriers in the context of addressing function limitations may increase physical activity compliance rates.