Nutritional Status and Osteoporotic Fracture Rehabilitation Outcomes in Older Adults

Abstract

To determine the impact of nutritional status and risk factors for undernutrition based on the changes in functional outcomes and rehabilitation success, defined as the ability of older adults to return as close as possible to their original functional state. Retrospective cohort study among 107 rehabilitation patients, aged ≥65 y. Data included demographics, Functional Independence Measure (FIM), Short Nutritional Assessment Questionnaire (SNAQ), reported weight, Mini-Mental Status Examination (MMSE), and Cumulative Illness Rating-Scale for Geriatrics (CIRS-G). Rehabilitation success was determined by delta-FIM. Higher vs. lower functioning patients were younger, had shorter hospitalization, and lower CIRS-G score with higher mean MMSE. Delta-FIM was significantly higher in patients with low malnutrition risk (SNAQ): 14.2?±?10.5 vs. 6.9?±?13.9 in undernourished patients, those who did not lose weight 14.5?±?10.5 vs. 5.6?±?12.8 in patients who lost weight with normal dietary intake, normal albumin, and lower CIES-G. Patients who achieved functional independence, FIM_DC ≥90, ate normally and experienced less “appetite loss” [40.5% vs. 68.4%; P?=?0.048]. Weight loss was the strongest negative predictor of delta-FIM (B?=?–9.094; P?=?0.007). To conclude, nutritional status, mainly weight change, is an independent negative predictor for rehabilitation success.     

Nutritional assessment and follow-up of residents with and without dementia in nursing homes in the Limousin region of France: A health network initiative

Introduction

Limousin in France has the second oldest regional population in Europe, with people over 65-years-old who have Alzheimer??s disease accounting for more than 9%. In France as a whole, a large number of residents in nursing homes (NH) have dementia, leading to many nutritional problems. LINUT is a health network that assesses the nutritional status of elderly NH residents and provides support where necessary. Aims of the present study were to use this network to evaluate the nutritional status of NH residents with and without dementia and to review changes after 4 months of intervention.

Methods

A cross-sectional survey was conducted by a doctor and a dietician at baseline (T0) and 4 months (T4) among residents at the 26 NH in Limousin that agreed to take part. The evaluation criteria included presence of dementia, depression and autonomy, weight, height, body mass index, Mini Nutritional Assessement (MNA?), and a 3-day survey of food intake.

Results

The 346 residents assessed at T0 were aged 87.9±6.9 years, 83.4% were women, 66.8% had dementia, 53.3% were malnourished and 27.4% obese. Autonomy was not affected by obesity. Residents with dementia had a lower Activities of Daily Living score and a lower weight than non-demented individuals (2.2±1.2 vs. 2.7±1.7 p=0.03 and 60.1±16.3 vs. 64.7±20.0 kg p=0.03, respectively), were more often malnourished (56.1% vs. 46.4% p=0.004) and less often obese (22.0% vs. 39.1% p=0.004) but consumed more protein (62.6±17.8 vs. 58.2±16.9 g/d p=0.04, 1.1±0.4 vs. 1.0±0.4 g/kg/d p=0.005). Energy intake was at the lower limit of French recommendations (26.4±8.8 vs. >25.0 kcal/kg/d). Assessment of all residents at T4 showed improved MNA? (+0.4 points/month p=0.02), protein intake (+3.3 g/d p=0.0007), and energy intake (+41.4 kcal/d p=0.01 and 0.1 kcal/kg/d p=0.03). Variations in prevalences of malnutrition and obesity were not statistically significant. MNA? increased in the dementia group (+0.29±0.8 points/month p=0.003). All other changes were comparable, and nutritional status did not differ more between the two groups at T4 than at T0.

Conclusion

The prevalence of dementia was high in the population studied. Malnutrition was the main problem, particularly if residents had dementia. Protein intake was satisfactory, but energy intake often insufficient. The nutritional status of dementia patients improved after 4 months of follow-up, suggesting that effective action to support such services would be worthwhile.     

Vitamin B12 status,dietary protein intake and proton pump inhibitor use in geriatric rehabilitation subjects

Aim: To compare the dietary intake and nutritional status of users and non‐users of proton pump inhibitor medications. Methods: Cross‐sectional study of subacute rehabilitation inpatients. Forty‐nine patients (nine men and 40 women) without dementia fulfilled the study criteria. Information was collected on admission and included medical history, duration of proton pump inhibitor medication use, nutritional status and cognitive scores. Dietary data were collected by food frequency questionnaire and blood samples were analysed for vitamin B₁₂, homocysteine and methylmalonic acid concentrations. Results: Age was 80.4 ± 7.7 (mean ± SD) years and body mass index was 26 ± 6.7 kg/m². Twenty‐one (of 49) subjects had subclinical vitamin B₁₂ deficiency, which was defined as serum vitamin B₁₂ <148 pmol/L or 148–258 pmol/L and methylmalonic acid >0.30 µmol/L or tHcy >13 µmol/L (women) and >15 µmol/L (men). Subjects were stratified according to proton pump inhibitor use and vitamin B₁₂ status. The presence of subclinical deficiency was similar between the groups (χ²‐test P= 0.17). Proton pump inhibitor users had higher dietary protein and calcium intakes (but not supplement calcium intakes) compared with non‐users (93 vs 81 g/day, P= 0.002 and 968 vs 742 mg/day, P= 0.038, respectively). Conclusions: Subjects using proton pump inhibitor medications did not have lower vitamin B₁₂ status, but had higher dietary protein intakes suggesting higher intakes of meats, eggs and dairy foods may reduce the risk of developing vitamin B₁₂ deficiency whilst taking proton pump inhibitor medications.     

The Impact of Dysphagia on Mortality of Nursing Home Residents: Results From the nutritionDay Project

Objectives

Dysphagia is a frequent finding in nursing home residents. The aim of this study is to evaluate the association of dysphagia and mortality in nursing home residents and identify further risk factors for mortality in residents with dysphagia.

Vitamin and Mineral Intakes in Adults with Mood Disorders: Comparisons to Nutrition Standards and Associations with Sociodemographic and Clinical Variables

Objective: The purpose of this study was to investigate the nutrient intakes of people with mood disorders.

Method: A cross-sectional survey using 3-day food records was carried out in 97 adults with bipolar or major depressive disorder to compare nutrient intakes with Dietary Reference Intakes and British Columbia Nutrition Survey (BCNS) data. Blood levels of selected nutrients were compared to reference ranges. Bivariate and multivariate analyses examined the effects of sociodemographic and clinical variables on nutrient intakes.

Results: The average age of respondents was 46 (±13) years; most were women (n = 69) who had less than a university degree (n = 60) and whose incomes were in the government-defined lower range (n = 39). Compared with the BCNS, a larger proportion of the sample was below the estimated average requirement for thiamin (26% vs 8%), riboflavin (21% vs 4%), folate (64% vs 27%), phosphorous (12% vs 1%), and zinc (39% vs 15%; all P < 0.0001), as well as vitamin B₆ (25% vs 16%) and vitamin B₁₂ (27% vs 8%; both P < 0.05). Combined intakes of food and supplements helped reduce the prevalence of inadequacy; however, with supplementation, the proportion of participants exceeding the tolerable upper intake levels for niacin, vitamin B₆, folate, vitamin C, calcium, magnesium, iron, and zinc ranged from 1%–8%. Income, relationship status, age, gender, and caloric intake were associated with intakes of many nutrients. Types of medications were associated with nutrient intakes, as lower intakes of thiamin and phosphorous (P < 0.05) were found with antidepressant use, higher calcium and iron intakes (P < 0.05) were associated with antianxiety medication use, and magnesium intakes were increased with mood stabilizers (regression coefficient = 52.61, P < 0.05, 95% confidence interval = 0.74 to 104.48).

Conclusions: Adults with mood disorders are at risk for many nutrient inadequacies, as well as occasional excesses; social, demographic, and clinical factors may affect their nutrient intakes.     

Managing Malnutrition in Older Persons Residing in Care Homes: Nutritional and Clinical Outcomes Following a Screening and Intervention Program

This study aimed to establish prevalence of malnutrition in older adult care home residents and investigate whether a nutritional screening and intervention program could improve nutritional and clinical outcomes. A community-based cohort study was conducted in five Newcastle care homes. 205 participants entered; 175 were followed up. Residents already taking oral nutritional supplements (ONS) were excluded from interventions. Those with Malnutrition Universal Screening Tool (MUST) score of 1 received dietetic advice and ≥2 received dietetic advice and were prescribed ONS (220 ml, 1.5 kcal/ml) twice daily for 12 weeks. Body mass index (BMI), MUST, mini nutritional assessment score (MNA)®, mid upper arm muscle circumference (MAMC), and Geriatric Depression Scale (GDS) were recorded at baseline and 12 weeks. Malnutrition prevalence was 36.6% ± 6.6 (95% CI). A higher MUST was associated with greater mortality (p = 0.004). Type of intervention received was significantly associated with change in MUST score (p < 0.001); dietetic advice resulting in the greatest improvement. There were no significant changes in BMI (p = 0.445), MAMC (p = 0.256), or GDS (p = 0.385) following the interventions. Dietitian advice may slow the progression of nutritional decline. In this study oral nutritional supplements over a 3-month period did not significantly improve nutritional status in malnourished care home residents.     

Dysphagia in Nursing Homes—Results From the NutritionDay Project

Objectives

Dysphagia is a major healthcare problem as it increases the risk of malnutrition, dehydration, aspiration pneumonia, and death. The aims of this analysis of data from nursing homes (NHs) worldwide were to examine prevalence rates of dysphagia, to identify characteristics of residents with dysphagia, and to describe which type of nutrition residents with dysphagia receive.

Use of Calcium,Folate, and Vitamin D3–Fortified Milk for 6 Months Improves Nutritional Status But Not Bone Mass or Turnover,in a Group of Australian Aged Care Residents

In residential care, inadequate calcium and folate intakes and low serum vitamin D (25(OH)D) concentrations are common. We assessed whether daily provision of calcium, folate, and vitamin D₃–fortified milk for 6 months improved nutritional status (serum micronutrients), bone quality (heel ultrasound), bone turnover markers (parathyroid hormone, C-terminal collagen I telopeptide, terminal propeptide of type I procollagen), and/or muscle strength and mobility in a group of Australian aged care residents. One hundred and seven residents completed the study (mean (SD) age: 79.9 (10.1) years; body weight: 68.4 (15.4) kg). The median (inter-quartile range) volume of fortified milk consumed was 160 (149) ml/day. At the end of the study, the median daily vitamin D intake increased to 10.4 (8.7) μg (P < .001), which is 70% of the adequate intake (15 μg); and calcium density (mg/MJ) was higher over the study period compared with baseline (161 ± 5 mg/MJ vs. 142 ± 4 mg/MJ, P < .001). Serum 25(OH)D concentrations increased by 23 ± 2 nmol/L (83 (107)%, P < .001), yet remained in the insufficient range (mean 45 ± 2 nmol/L). Consumption of greater than the median intake of milk (160 ml/day) (n = 54, 50%) increased serum 25(OH)D levels into the adequate range (53 ± 2 nmol/L) and reduced serum parathyroid hormone by 24% (P = .045). There was no effect on bone quality, bone turnover markers, muscle strength, or mobility. Consumption of fortified milk increased dietary vitamin D intake and raised serum 25(OH)D concentrations, but not to the level thought to reduce fracture risk. If calcium-fortified milk also was used in cooking and milk drinks, this approach could allow residents to achieve a dietary calcium intake close to recommended levels. A vitamin D supplement would be recommended to ensure adequate vitamin D status for all residents.     

Influence of vitamin intake and MTHFR polymorphism on the levels of DNA damage in tobacco farmers

Background: Genetic damage may occur spontaneously under normal metabolic circumstances, inadequate intake of nutrients, and excessive exposure to environmental mutagens. Objectives: To evaluate the influence of the intake of micronutrients vitamin B₁₂, vitamin B₆, and folate and of the polymorphism methylenetetrahydrofolate reductase (MTHFR) C677T on the induction of DNA damage in tobacco farmers. Methods: The study involved 66 men and 44 women engaged in tobacco cultivation in the region of Venâncio Aires (Rio Grande do Sul state, Brazil). Peripheral blood samples were collected to analyze DNA damage using the Comet assay, the micronucleus (MN) test and MTHFR C677T polymorphism. Dietary intake was evaluated based on the mean values obtained from three 24-h diet recall questionnaires, and nutrient intake data were computerized and estimated in the Food Processor SQL 10.9 program. The statistical tests used to generate the stated results were Kruskal–Wallis test, Exact Fisher’s test, and multivariate linear regression analysis. Results: DNA damage was significantly higher in individuals who had an inadequate intake of folate, vitamin B₁₂, and vitamin B₆ (P < 0.01) assessed by Comet assay. In relation to MN test results, buccal cells showed MN frequency higher in individuals with inadequate intake of vitamin B₆ (P < 0.01). No difference was observed in MN lymphocytes frequency. No significant association was detected between MTHFR C677T polymorphism and DNA damage in tobacco farmers. Conclusion: Our results suggest that folate, vitamin B₁₂, and vitamin B₆ deficiency may be associated with genotoxic effect in individuals exposed to pesticides.     

Mortality in nursing home residents without cognitive impairment and its relation to self-reported health-related quality of life, sociodemographic factors, illness variables and cancer diagnosis: a 5-year follow-up study

Purpose

It is generally known that health-related quality of life (HRQOL) predicts cause-specific mortality. Few studies have explored whether generic self-reported HRQOL, sociodemographic factors and illness variables are independently associated with mortality among cognitively intact nursing home (NH) residents with and without cancer. We hypothesized that sociodemographic factors and illness variables would be associated with mortality and that HRQOL, measured using the SF-36 Health Survey, would predict mortality among NH residents with and without cancer.

Methods

We followed a cohort of 227 cognitively intact (Clinical Dementia Rating scale score ≤0.5) older residents (60 with cancer and 167 without) from 30 NH from 2004–2005 to 2010. We collected data by face-to-face interview. We obtained sociodemographic variables and medical diagnoses from the records.

Results

Survival did not differ between residents with and without cancer (P = 0.31). Twenty percent of the residents with cancer and 13% without cancer were still alive. After adjustment for sociodemographic and illness variables, increasing age (P < 0.001), higher education (P = 0.009), comorbidity (P = 0.04) and the subdimension physical functioning (P = 0.009) predicted mortality. Bodily pain was only marginally associated with mortality (P = 0.08).

Conclusions

Independent of cancer, HRQOL and comorbidity predicted mortality among NH residents without cognitive impairment.     

Effects of different open cryo-carriers on embryo survival and clinical outcome in frozen embryo transfer cycle patients

The purpose of this study was to compare the efficacy of different open cryo-carriers: the CryoloopTM, CryotopTM, and CryoleafTM, in embryo survival and clinical outcome in patients with frozen embryo transfer (FET) cycle. We analyzed the embryo survival rate and clinical outcome in 325 patients of 348 FET cycles vitrified with the CryoloopTM (160 cycles), CryotopTM (105 cycles), or CryoleafTM (83 cycles). No significant differences were observed in embryo survival rate (98.8% vs. 100% vs. 97.7%, p > 0.05), HCG positive rate (58.8% vs. 63.8% vs. 57.8%, p > 0.05), biochemical pregnancy rate (6.9% vs. 11.4% vs. 9.6%, p > 0.05), or implantation rate (33.2% vs. 37.4% vs. 34.1%, p > 0.05) in the three groups respectively. The early abortion rate of the CryoloopTM group was significantly higher than that of the CryotopTM and CryoleafTM group (27.1% vs. 3.6% and 7.5%, p < 0.05). At the same time, the average female age of the CryoloopTM group was significantly older by 1 year than that of the CryotopTM and CryoleafTM group (33.29 ± 4.71 years vs. 31.96 ± 4.27 years and 31.1 ± 4.28 years, p < 0.05). There was no significant difference in take home baby rate (38.1% vs. 46.7% vs. 43.4, p > 0.05) or birth weight among the groups (2893.5 ± 780.8 g vs. 2778.4 ± 710.0 g vs. 2724.5 ± 838.8 g, p > 0.05). No case of neonatal malformation was observed in the present study. Overall, CryotopTM and CryoleafTM were effective for embryo vitrification at both the cleavage and blastocyst stage according to the results of clinical outcome and infant characteristics. However, CryoloopTM led to a decreased positive HCG rate and increased early abortion rate, heightened at the cleavage stage.

Abbreviations: LN₂: liquid nitrogen; CPA: cryoprotectant; ART: assisted reproductive technology; IVF: in vitro fertilization; ICSI: intracytoplasmic sperm injection; BMI: body mass index; FSH: follicular stimulation hormone; COH: controlled ovarian hyperstimulation; FET: frozen embryo transfer; mm: millimeter; HCG: human chorionic gonadotropin; RCT: randomized clinical trial; NC: natural cycle; AC: artificial cycle; EM: equilibration medium; DMSO: dimethyl sulphoxide; EG: ethylene glycol; VM: vitrification medium; WM: warming medium     

Impact of a daily legume-based meal on dietary and nutritional intake in a group of omnivorous adults

Adopting eco-friendly diets will demand the consumption of more plant-based protein food sources such as legumes. However, assessing the impact of such a dietary shift on the dietary and nutritional intake of traditionally omnivorous populations is needed. The objective of this study was to assess the impact of substituting a traditional omnivorous-based lunch for a vegetarian, legume-based meal on the daily dietary and nutritional intake in a group of omnivorous adults in the city of Porto, Portugal. Nineteen, non-vegetarian, healthy young adults consumed a vegetarian, legume-based meal from Monday to Friday, for 8 consecutive weeks. Socio-demographic data, health status, lifestyle-related information and anthropometric parameters were recorded. Three-day food records were used to collect food intake at baseline and week 8. European Food Safety Authority and World Health Organization reference values were used to assess nutritional inadequacies. Variables were described as medians (P₂₅ and P₇₅). Wilcoxon signed-rank and Mann–Whitney tests were used for statistical comparisons. A p-value of <0.05 was considered statistically significant. Participants consumed 38.0 (P₂₅ = 35.0; P₇₅ = 40.0) meals, resulting in an intake of 84.5 g (P₂₅ = 74.9; P₇₅ = 98.4) of cooked legumes per meal, meaning 11 subjects (57.9%) met the Portuguese guidelines for legume consumption (≥80 g/day of legumes). The current dietary intervention did not seem to aggravate the prevalence of nutritional inadequacies for the macro- and micronutrients tested, except for the case of vitamin B₁₂ (52.6% [95% CI: 28.9–75.6] vs. 78.9% [95% CI: 54.4–94.0]). This could be linked to the reduction of dietary sources of this vitamin which is an expected consequence of vegetarian meals. Dietary changes towards grain legume-based diets are desirable yet need to be carefully implemented to prevent exacerbating potential nutrient inadequacies, especially of vitamin B₁₂.     

Consumption of Low-Fat Dairy Products and Energy and Protein Intake in Cancer Patients at Risk of Malnutrition

Current nutritional guidelines encourage the reduction of fat intake from animal sources like dairy products. The aim was to determine whether the consumption of low-fat dairy is related to poorer dietary intake and nutritional status in cancer patients at risk of malnutrition. This cross-sectional included patients with solid or hematological malignancies at risk of malnutrition. Nutritional status was studied using Subjective Global Assessment, anthropometry, and grip strength. Dietary intake was evaluated with a 24-h recall and dairy consumption with a structured questionnaire. Seventy-four patients were recruited; 71.6% males of 64.8 yr, most with gastrointestinal malignancies. Only 37.8% consumed whole milk, and 61.4% consumed whole yogurt. Reasons for consumption of low-fat dairies were healthy diet (58.0%), hypercholesterolemia (20.0%), and digestive intolerance (10.0%). There were similar rates of malnutrition according the type of dairy (whole 60.9% vs. low-fat 66.7%, P = 0.640). Low-fat dairies were related to a reduction in energy (whole 1980.1 kcal vs. low-fat 1480.9, P = 0.007) and protein intake (whole 86.0 g vs. low-fat 63.0 g, P = 0.030).     

Nutritional,immunological and antioxidant defense status of outpatients diagnosed with colorectal cancer – a case–control study of the little-studied population

Abstract

This cross-sectional study was conducted to investigate nutritional and immunological status of colorectal cancer (CRC) patients in a little-studied population from developing country, Pakistan. Data on 81 CRC patients and 37 healthy controls (HCs) were collected on nutritional status, nutrient intake, percent body fat (%BF), selected immunological parameters, phytochemical index (PI), healthy eating index (HEI), and prognostic nutrition index (PNI). Blood samples were used for immunological and antiradical defense potential (expressed as 50% hemolysis time; HT₅₀). Results show 40/81 (49.4%) patients reported weight loss in past 3–6?mo, Significant differences were found in HEI values between patients vs. HCs, and between patients in low vs. high PNI groups (P, for all trends <0.05). Patients in the higher PNI group were heavier, had higher % BF, higher energy intake, and higher PI score as compared to patients in the low PNI group (P?<?0.05). Low PNI was positively associated with non-significantly lower CD4:CD8 ratios, higher B-cells and NK cells (P, for all trends >0.05), but with significantly higher hs-CRP levels, and lower HT₅₀ values (P, for all trends <0.001). In conclusion, CRC patients in a little-studied population have compromised nutritional and immunological health with lower HEI and PNI scores.     

The Correlation Between the Comprehensive Nutrition Index and Quality of Life of Patients with Nasopharyngeal Carcinoma Treated by Intensity-Modulated Radiotherapy

The purpose of this study was to compare the changing tendency of nutrition with 54 nasopharyngeal carcinoma patients during intensity-modulated radiation therapy (IMRT), and to investigate the correlation between comprehensive nutritional status and quality of life (QoL), which was assessed by the European Organization for Research and Treatment of Cancer Core Quality-of-Life Questionnaire. The nutritional index, including body mass index, ideal body weight percentage, usual body weight percentage, albumin, hemoglobin, and total lymphocyte count (TLC), was evaluated at 2 time points: within 48 h after admission (T₁) and at the end of treatment with IMRT (T₂). A statistically significant downgrade of every index was observed during IMRT. A comprehensive nutritional model was established by principal components analysis at T₂. QoL scores of functional (P = 0.002) and the global QoL scales (P = 0.001) existed a positive correlation with comprehensive nutritional status. QoL scores of symptom scales (P = 0.002) and 6 single items (P = 0.005) had a negative correlation with it. The scores of global QoL scales in comprehensive nutrition of normal (20.4%), moderate (55.6%), and severe malnutrition (24.1%) were 69.70 ± 17.98, 48.33 ± 19.25, and 37.18 ± 24.67, respectively. Patients with different nutritional status had different QoL (B = 10.405, SE = 2.828, t = 3.680, P = 0.001). Multiaspect nutritional supports should be enhanced to improve patients’ comprehensive nutritional status during treatment.     

Plasma cobalamin and folate and their metabolic markers methylmalonic acid and total homocysteine among Egyptian children before and after nutritional supplementation with the probiotic bacteria Lactobacillus acidophilus in yoghurt matrix

Objective To evaluate the biopotency of the viable probiotic Lactobacillus acidophilus (La1) in yoghurt matrix consumed by Egyptian children on their plasma vitamin B₁₂ and folate levels, and their metabolic markers methylmalonic acid (MMA) and total homocysteine (t-Hcy).

Methods A randomized nutritional supplementation trial (42 days duration) was performed in free-living children of both sexes (11 years old). The La1 in yoghurt matrix was administered to provide 10¹² colony-forming units/subject/day. Blood sampling for the analysis of plasma vitamin B₁₂, folate and t-Hcy was performed by standardized methods. Five-hour urine collection was used for the analysis of MMA and t-Hcy.

Results Initially 33.3% of the children presented with biochemical vitamin B₁₂ deficiency (<208 pg/ml), while one-fifth (21%) were biochemically deficient in folate (<3 ng/ml folate/ml plasma or 0.68 nmol/l). Fifty percent of the children presented with high plasma t-Hcy (>15.0 µmol/l). The daily consumption of the probiotic La1 yoghurt for 42 days significantly improved the mean levels of plasma vitamin B₁₂ (P<0.05) and folate (P<0.01) among the studied children compared with the respective baseline data. On the other hand, the average levels of plasma t-Hcy and urinary MMA decreased significantly (P<0.05) at the termination of the 42-day nutritional supplementation, compared with the respective initial mean levels. The consumption of the probiotic yoghurt was also associated with a significant (χ²=8.0; P<0.01) reduction in the percentage prevalence of anemia (hemoglobin <120 g/l).

Conclusion The long-term ingestion of viable probiotic La1 potentially promoted the overall nutritional status of the studied children.     

Antenatal Screening for Mother to Child Infections in Immigrants and Residents: The Case of Toxoplasmosis in Northern Italy

In Italy, serological screening is recommended to prevent congenital toxoplasmosis as part of the antenatal care protocol. Our study investigates (1) adherence to screening among Italian and migrant women and (2) specific T. gondii seroprevalence among hospitalized puerperas in Brescia and Udine, in northern Italy. All migrants (Group B) and a random Italian sample (Group A) filled in a questionnaire. Serological screening was rated as adequate when performed before conception or by the 12th week of gestation, and periodically repeated during pregnancy whenever negative. Ninehundred and twenty-two (922) puerperas were enrolled (Group A: 743; Group B: 179). Mean gestational age at first antenatal visit was 9.3 week, significantly more delayed in migrants (11.2w vs 8.9w; P < 0.0001). Toxoplasmosis was mentioned as a potential vertically transmitted infection by 380/922 (41.2%), but only by 13.4% of migrants (P < 0.0001). Anti-Toxoplasma IgG-Ab tested positive in 319/892 (35.8%), while the information was missing for 9 and 21 women resulted untested. Patients from northern Africa had an higher (AOR 3.63%; P = 0.002), while Asian patients a lower (AOR 0.33; P = 0.045) probability of being immune. A late screening was recorded in 115/848 (13.6%) women (Group A: 9.35%; Group B: 31.9%; P < 0.0001) and 82.1% of eligible migrants were not correctly monitored for toxoplasmosis during pregnancy. A late toxoplasma serological test in migrant women precludes the timely application of preventive measure and may represent an indicator of suboptimal antenatal care.     

Effects of 12-week supplementation of marine Omega-3 PUFA-based formulation Omega3Q10 in older adults with prehypertension and/or elevated blood cholesterol

Backgrounds

To study the effects of supplementation of a marine omega-3 poly-unsaturated fatty acids (n3-PUFA) formulation (Omega3Q10) in older adults with hypertension and/or hypercholesterolemia.

Methods

A total of 97 people were enrolled to receive 12-week supplementation of either Omega3Q10 (n?=?48) or soybean oil (n?=?49). Total cholesterol (TC), low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C), and hypertension-related symptoms were determined before and after the supplementation.

Results

There were no baseline differences between the two groups. Omega3Q10 supplementation significantly reduced diastolic blood pressure (DBP) (from 81.6?±?5.3 mmHg to 79.3?±?5.2 mmHg, P?<?0.05). Blood concentrations of TC and LDL-C decreased significantly and blood HDL-C level increased significantly after 12 weeks of Omega3Q10 (5.5?±?0.7 vs. 5.3?±?0.5, P?<?0.05; 3.7?±?0.8 vs. 3.3?±?0.6, P?<?0.05; 1.2?±?0.6 vs. 1.3?±?0.5, P?<?0.05, respectively) and soybean oil supplementation (5.7?±?0.8 vs. 5.6?±?0.7, P?<?0.05; 3.6?±?0.7 vs. 3.4?±?0.8, P?<?0.05; 1.0?±?0.8 vs. 1.2?±?0.7, P?<?0.05, respectively) but no group differences were found. A significantly greater proportion of the people in the Omega3Q10 group became free from headache and palpitations & chest tightness symptoms after the 12-week supplementation compared to that of the soybean oil group (95.5% vs. 71.4%, P?<?0.01; 95.8 vs. 75.5%, P?<?0.01, respectively).

Conclusion

12-week supplementation of Fish oil-based PUFA appear to be more effective in improving DBP and hypertension-related symptoms than soybean oil in old adults with hypertension and hypercholesterolemia although both supplementation improved TC, LDL-C and HDL-C concentrations.

     

Evaluation of vitamin B12 status in Egypt IV: Food consumption patterns among lactating mothers and their impact on the intake of the vitamin

The adequacy of vitamin B₁₂ intake was assessed among 62 lactating mothers in the 2–32 weeks of lactation by an interactive 24-h recall and an open-ended food frequency questionnaire. Double portions of the foods consumed were sampled and assayed microbiologically for its vitamin B₁₂ content. Based on the food item and its respective vitamin B₁₂ content, combined with the usual portion size in grams and the frequency of consumption, a rapid calculator of approximate dietary vitamin B₁₂ intake was developed. The estimated vitamin B₁₂ intake averaged 4.17±0.74?µg/d. Only 25.8% of the lactating mothers had adequate vitamin B₁₂ intake (>2.5?µg vitamin B₁₂ daily). Three quarter of the studied population were consuming vitamin B₁₂<2.5?µg/d. Out of those, 50% had estimated daily intake <2.0?µg/d. This percentage prevalence confirms the additional burden on the lactating mothers to satisfy the daily vitamin B₁₂ requirement for its breast-fed baby.