Correlation between forearm bone mineral density and body composition in Japanese females aged 18–40 years

Objective The purpose of this study was to clarify the relationship between forearm bone mineral density (BMD), body mass index (BMI), and body composition focusing on body fat percentage (BF%) in Japanese females 18 to 40 years old. Methods Subjects were 2,280 females 18–40 years old. Anthropometric measurements were taken, and a medical history was obtained by questionnaire, including age at the time of the study and age at menarche. BF% was measured by bioelectrical impedance analysis. Forearm BMD was measured using dual-energy X-ray absorptiometry (DXA). The correlations of BMD with BMI and BF% were analyzed using a structural equation model. Results The standardized regression coefficients for the path from BMI to BMD and the path from BF% to BMD were 0.538 and −0.184 respectively. The squared multiple correlation of BMD was 0.146. In addition, the standardized regression coefficient for the path from BMI to BF% was 0.896. Conclusion The results showed a positive correlation between BMD and BMI and an inverse correlation between BMD and BF%. At the same time, it was noted that BF% increased with BMI. This indicated that BMD is dependant on BF% in subjects who have a similar BMI. Therefore, this study concluded that it is necessary to take body composition measurements into account when examining the relationship between BMI and BMD, especially in young females.     

Correlation between bone mineral density and body composition in Japanese females aged 18–40 years with low forearm bone mineral density

Objectives  To clarify the relationship between bone mineral density (BMD) and body composition in Japanese women aged 18–40 years with low forearm BMD. Methods  The subjects were Japanese199 women who had been selected for inclusion in the study based on a low forearm BMD determined at the Annual Women’s Health Examination. The subjects’ mean (± standard deviation) age, body height, body weight, and body mass index (BMI) were 33.5 (±4.3) years, 158.1 (±5.1) cm, 49.6 (±5.7) kg, and 19.8 (±2.1), respectively. The BMD of the lumbar spine, total body, and left arm were measured using dual-energy X-ray absorptiometry (DXA). Fat mass (FM), bone-free lean tissue mass (LTM), and body fat percentage (BF%) were measured simultaneously with DXA. Results  In the structural equation model, the standardized regression weights for the path from BMI to BMD of all sites were 0.273–0.434. Conversely, the BF% to BMD of the total body and left arm were −0.192 and −0.296, respectively. In multiple regression analysis, the FM index (FMI) was significantly associated with the BMD of the lumbar spine as a weight-bearing site. The LTM index (LTMI) was significantly associated with the BMD of the total body and left arm as a non-weight-bearing site. Conclusions  Young females with low forearm BMD had low body weight and BMI. Thinness was shown to be a risk factor for low BMD, in accordance with results reported elsewhere. A gain in body weight may have the effect of increasing BMD, but our results suggest that to increase BMD, the gain in body weight must include increases in LTM, and not FM alone.     

Anthropometric and Lifestyle Associations of Bone Mass in Healthy Pre-Menopausal Mexican and Asian American Women

Few studies have established the lifestyle predictors of peak bone mineral density (BMD) in Mexican-American (MA) and Asian-American (AA) women. Pre-menopausal MA (n = 48) and AA (n = 58) women aged 30–45 years old were tested for BMD, body composition, aerobic fitness, and muscle function. Socio-demographic characteristics, health status, prevalence of osteoporosis risk factors, physical activity, and diet were determined via questionnaire. Pearson’s correlations and multiple linear regressions were used to test the associations between various osteoporosis risk factors and BMD. Body composition, anthropometric, and BMD differences were noted between groups. Hip, but not spine BMD, remained significantly higher for the MA compared to the AA group after adjustment for age, BMI, income, and physical activity index. Lean body mass was a significant predictor of hip BMD for both groups and this relationship was stronger for the AA group. Lean body mass may explain ethnic differences in BMD.     

Reproductive factors influencing bone mineral density in postmenopausal women

This study examined the relationship between reproductive characteristics and bone mineral density (BMD) in postmenopausal women who had been referred to the menopause clinics of the National Population and Family Development Board and of the Hospital Kuala Lumpur from July 2011 to January 2012. The participants of this study were 201 postmenopausal Malaysian women aged 45–71 years. Some socio-demographic, lifestyle, and reproductive factors were recorded. Calcaneal BMD was measured by quantitative ultra-sonography. Correlations of reproductive factors with BMD were assessed by Pearson’s correlation test and multiple regression analysis. Age at menopause was not significantly correlated with BMD, while the years after menopause, age at the first menstrual period, number of pregnancies, and total lactation periods were inversely correlated with it. Among reproductive factors, only the association between lactation duration and BMD remained significant after adjusting for age, body mass index, activity, and calcium intake. The results indicated that except for prolonged total time of lactation, other reproductive factors were not significantly associated with BMD in postmenopausal women.     

Association between bone mineral density and lifestyle factors or vitamin D receptor gene polymorphism in adult male workers: a cross-sectional study

Objectives  

The aim of this cross-sectional study was to investigate the association between bone mineral density (BMD) and lifestyle factors, as well as the influence of vitamin D receptor (VDR) gene polymorphism, in adult male workers.     

Factors associated with serum total homocysteine level in type 2 diabetes

Objectives The aim of this study was to investigate the determinants of serum total homocysteine level (tHcy) in patients with type 2 diabetes mellitus (DM) according to sex. Methods A total of 1,276 Japanese, diabetics (n = 280) with a control group of non-diabetics (n = 996), were enrolled into the study from 2003 to 2005. This cross-sectional study was conducted for all the subjects, using personal data regarding clinical characteristics and lifestyle. Multiple regression analysis was performed to analyze the association of tHcy with selected factors. Results In diabetic subjects, estimated glomerular filtration rate (eGFR) and serum creatinine levels (Cre), even those within the normal range, were strongly associated with tHcy after adjustment in both sexes; the standardized partial regression coefficient of eGFR for tHcy was −0.251, (p = 0.001) in diabetic men and −0.523, (p < 0.001) in diabetic women. Furthermore, the eGFR of the diabetics, except patients with nephropathy, also had significant association with tHcy in both sexes. Fasting plasma glucose levels and serum triglyceride levels were strongly associated with tHcy in diabetic men only. HbA1c was also associated with tHcy in diabetic men only, though not as significantly. Age and presence of hypertension were significantly associated with tHcy in women. Conclusions This study suggests that there are some differences in the factors associated with tHcy between diabetics and non-diabetics, and between the sexes. There is, therefore, circumstantial evidence that elevated tHcy should be evaluated clinically. Because tHcy was strongly associated with eGFR and Cre, even within the normal ranges, tHcy may have important implications regarding the microangiopathy of the kidney and atherosclerosis.     

中国10个地区成年人跟骨骨密度的描述性分析

目的 描述中国慢性病前瞻性研究（CKB）10个地区人群跟骨骨密度的地区和人群分布差异。方法 在参与第二次重复调查的研究对象中,剔除重要指标缺失者后,分析10个地区38~87岁24 677人经定量超声骨密度仪测定的跟骨骨密度的地区和人群差异。结果 研究人群中,跟骨骨密度指标平均水平：宽带超声衰减（109.7±12.6）dB/MHz,超声声速（1 554.7±45.6）m/s,强度指数（88.3±18.8）,T值（-0.74±1.28）。城市人群跟骨骨密度高于农村;男性高于女性。跟骨骨密度随着年龄增加而降低,女性随年龄降低的幅度比男性更为明显。吸烟者、绝经后妇女的跟骨骨密度更低;常饮牛奶和/或酸奶者、高体力活动水平者的跟骨骨密度更高。结论 CKB的10个项目地区人群的跟骨骨密度存在明显的地区和人群差异。     

Daily lifestyles and anti-mutagenicity of saliva

Objectives The purpose of this study was to investigate the relation between lifestyle and the antimutagenicity of saliva. Methods Subjects were 52 healthy female university students. The collection of the saliva samples and the lifestyle measurements were carried out for them. The anti-mutagenicity of the saliva was measured using the umu test. Results With regard to the lifestyle items, only “nutrient balance” tended to contribute positively to the inhibiting capacity of the saliva on the mutagenicity of AF-2. In addition, there was a significant inverse correlation between the score of 7 other items and the inhibiting capacity of the saliva (r=−0.32; p<0.05). We also found a significant relation between their tea and/or coffee consumption and the inhibiting capacity of the saliva. Conclusions These findings suggest that the inhibiting capacity of saliva worked to decrease mutagen levels that were enhanced by poor lifestyle. In addition, “nutrient balance” may contribute to the inhibiting capacity of the saliva independent of 7 other items. With regard to the tea and/or coffee consumption. further studies should be carried out.     

Assessment of airborne asbestos fiber concentrations in urban area of Tehran, Iran

Air quality in ambient outdoor air has seldom been evaluated in Iran. Accordingly, we evaluated airborne asbestos fiber concentrations in the urban environment of Tehran, Iran between January 2006 and March 2007. The airborne fiber concentrations of 80 air samples collected from 40 different sites in five areas of Tehran were analyzed by energy-dispersive X-ray analysis in combination with phase-contrast optical microscopy (PCM) and scanning electron microscopy (SEM). The geometric means of the airborne asbestos fiber concentrations were 3.4 × 10⁻³ PCM f/ml (0.1 SEM f/ml) and 3.3 × 10⁻³ PCM f/ml (0.20 SEM f/ml) according to areas and seasons, respectively. There were significant differences in the asbestos fiber concentrations between the areas and seasons (p = 0.02; p = 0.04), respectively. In the areas, the average concentration was 3.4 × 10 ⁻³ PCM f/ml (0.1 SEM f/ml), which is considerably higher than those reported for the levels of asbestos in outdoor air in the USA and the urban environment of the Europe. The SEM analyses revealed that the fibrous particles consisted, approximately, of chrysotile (60%), tremolite (10%), anthophyllite (10%), and non-asbestos fibers (20%). We conclude that the high volume of traffic, industrial consumption of asbestos, and geographical and climate conditions are responsible for the high airborne asbestos levels in non-occupational environments in Tehran. Thus, it is to be expected that inhabitants of Tehran will suffer negative health effects due to exposure to asbestos airborne fibers.     

The relationship of absolute poverty and bone mineral density in postmenopausal Iranian women

Summary Objective:  It is increasingly recognized that socioeconomic inequalities play an important role in bone health, with significantly higher fracture rates being reported in lower income groups. But the relationship between absolute poverty and bone mineral density (BMD) and/or osteoporosis has not been investigated. Methods:  A total of 1135 postmenopausal women under absolute poverty lines who received financial support from the Imam Khomeini Relief Foundation (IKRF) and 406 randomly selected healthy postmenopausal women were screened for osteoporosis using BMD testing. Results:  At all BMD sites, women under the absolute poverty lines had the lowest mean BMD values (p < 0.0001). According to the WHO criteria, 252 subjects under absolute poverty lines (22.4%) and 35 healthy postmenopausal women from the general population (8.7%) were considered osteoporotic (p < 0.0001). After adjustment for lifestyle factors for osteoporosis in logistic regression models, absolute poverty was associated with the age-adjusted prevalence of femoral neck osteoporosis and lumbar osteoporosis [OR = 2.50 (CI, 1.38–4.51; p = 0.002); OR = 2.40 (CI, 1.56–3.70; p < 0.0001), respectively]. Conclusion:  Postmenopausal women under the absolute poverty lines had lower BMDs at all skeletal sites, independent of established osteoporosis risk factors. Submitted: 13 February 2008; Revised: 03 June 2008; Accepted: 09 June 2008     

Physical Activity in Adolescence Has a Positive Effect on Bone Mineral Density in Young Men

Objectives

Little is yet known about the determinants of bone mineral density (BMD) in young adults. Thus, in this study, we aimed to determine the factors that have an impact on BMD in young men.

Methods

Questionnaires were sent out to 111 male medical students. Information on age, socio-economic status, medical history, lifestyle, physical activity during adolescence, school club participation, current physical activity, and dietary intake were collected by the survey. Height, weight, percent body fat and muscle mass were estimated by bioelectrical impedance, and BMD was obtained using calcaneal quantitative ultrasound. Using the Poisson regression model, prevalence ratios (PRs) were used to estimate the degree of association between risk factors and osteopenia.

Results

The height and current physical activity showed a correlation to the Osteoporosis Index. Among the categorized variables, past physical activity during adolescence (p=0.002) showed a positive effect on the bone mineral content. In the multivariate model, past physical activity (≥1 time/wk) had a protective effect on osteopenia (PR, 0.37; 95% confidence interval [CI], 0.18 to 0.75) and present physical activity (1000 metabolic equivalent of task-min/wk) decreased the risk of osteopenia (PR, 0.64; 95% CI, 0.44 to 0.91).

Conclusions

Past physical activity during adolescence is as important as physical activity in the present for BMD in young men.     

The Validity and Reliability of the Functional Impairment Checklist (FIC) in the Evaluation of Functional Consequences of Severe Acute Respiratory Distress Syndrome (SARS)

Severe acute respiratory distress syndrome (SARS) contributed to significant mortality and morbidity worldwide. We aimed to establish the validity, reliability and responsiveness of the functional impairment checklist (FIC) as a measurement tool for physical dysfunction in SARS survivors. One hundred and sixteeen (65 females and 51 males, mean age 45.6) patients who joined the SARS rehabilitation programme were analysed. The factor analysis yielded two latent factors. The mean FIC-symptom and FIC-disability score were 24.12 (SD ± 20.2) and 26.11 (SD ± 27.32), respectively. Based on the item-scale correlation coefficients, the Cronbach’s alpha coefficients reflecting the internal consistency reliability of scale score were 0.75 for FIC-symptom and 0.86 for FIC-disability. Test–retest reliability in 23 patients showed no statistical significant difference in the FIC scores between tests with intraclass correlation coefficient (ICC) 0.49–0.57. The FIC scales correlated both with 6 munute walking test (6MWT) distance (−0.26 and −0.38) and handgrip strength (HGS) (−0.20 and −0.27). Moreover, the FIC scales correlated with St. George’s respiratory questionnaire (SGRQ) (0.19 to 0.52) and short form 36 Hong Kong (SF-36) domains (−0.19 to −0.59). Both FIC scales correlated stronger with physical component summary (PCS) (−0.41 and −0.55) than with mental component summary (MCS) (−0.30 and −0.23). FIC reduced significantly at 6 months while the SF-36 PCS and MCS did not show any change. In conclusion, the study results indicate the FIC is reliable, valid and responsive to change in symptom and disability as a consequence of SARS, suggesting it may provide a means of assessing health related quality of life (HRQOL) outcomes in a longitudinal follow up.     

Adherence to the dietary approaches to stop hypertension (DASH) dietary pattern and mental health in Iranian university students

Examining the association between adherence to the dietary approaches to stop hypertension (DASH) dietary pattern and mental health in Iranian university students. This cross-sectional study was conducted among 240 university students (mean age 21.5 years; 86.7% female). Mental health was evaluated using validated Persian versions of the 12-item general health questionnaire (GHQ-12) and the 21-item depression, anxiety, and stress scale (DASS-21). The lower the subjects’ scores on these questionnaires, the better their mental health. Usual past-year dietary intakes were assessed by a validated 168-item semi-quantitative food frequency questionnaire. The DASH score was computed based on energy-adjusted intakes of eight major dietary components emphasized or minimized in the DASH pattern. The higher the DASH score of a subject, the greater his/her adherence to the DASH pattern. The Pearson’s correlation coefficients of DASH score with GHQ-12 total score, DASS-21 total score, and DASS-21 depression, anxiety, and stress subscale scores were − 0.431, − 0.441, − 0.434, − 0.325, and − 0.408, respectively (all P < 0.001). Compared to those in the lowest tertile, subjects in the highest tertile of DASH score had lower means of GHQ-12 total score (mean difference − 4.6; P < 0.001), DASS-21 total score (mean difference − 9.1; P < 0.001), and DASS-21 depression, anxiety, and stress subscale scores (mean differences for depression, anxiety, and stress − 3.6, − 2.4, and − 3.2, respectively; all P < 0.001). The findings indicate that greater adherence to the DASH dietary pattern is associated with better mental health in Iranian university students. However, prospective studies of sufficient methodological quality are needed to confirm these findings.     

Relationships Between Leaching of Methylmercury from the Soil and the Basic Characteristics of Alkali Soil Polluted by Mercury in Guizhou China

To determine the relationship between soluble methylmercury and soil characteristics which was contaminated by mercury, several experiments were conducted. As a result, a good correlation was founding between the leached methylmercury level from soil and the EC (electronic conductivity) level of soil. Moreover, to grasp the relationship between soluble methylmercury and soluble anions from soil, several anions (Cl⁻, NO³⁻, SO₄ ²⁻) were measured using the ion chromatography method. Although the correlation coefficient was small (r = 0.40), only a correlation between the level of SO₄ ²⁻ and leached methylmercury was recognized.     

Effect of genetic variation in the leptin gene promoter and the leptin receptor gene on obesity risk in a population-based case-control study in Spain

There are no good genetic markers for incorporating the study of genetic susceptibility to obesity in epidemiological studies. In animal models, the leptin (LEP) and the leptin receptor (LEPR) genes have been shown to be very important in obesity because leptin functions as a negative feedback signal in regulating body-weight through reducing food intake and stimulating energy expenditure. In humans, several polymorphisms in these genes have been described. However, their association with obesity is still very controversial because there are no good case-control studies designed to specifically test this association. Our objective has been to conduct a population-based case-control study to estimate the risk of obesity arising from the −2548G > A and Q223R polymorphisms in the LEP and LEPR genes, respectively. 303 obese cases (101 men and 202 women) and 606 controls (202 men and 404 women) were selected from a Spanish Mediterranean population. Genetic, clinical and life-style characteristics were analyzed. No association was found between the −2548G > A polymorphism and obesity. However, the Q223R variant was significantly associated with obesity in a recessive model, the RR genotype being more prevalent in controls than in obese subjects. The inverse association between the Q223R polymorphism and obesity (OR = 0.62; 95% CI: 0.39–0.99) remained significant even after additional adjustment for education, tobacco smoking, alcohol, physical activity, origin of the obese patient, and the −2548G > A polymorphism in the LEP gene (OR = 0.54; 95% CI: 0.32–0.89). In conclusion, the −2548G > A polymorphism is not a relevant obesity marker in this Mediterranean population, although Q223R does seen to be so.     

Association of hip fracture incidence and intake of calcium,magnesium, vitamin D,and vitamin K

Objective To analyze the association between hip fracture incidence in 12 regional blocks within Japan and dietary intake of four key nutrients: calcium, magnesium, vitamin D, and vitamin K. Design An ecological study. Methods Using data from the 2002 national survey on the incidence of hip fracture and the National Nutritional Survey of Japan, a standardized incidence ratio of hip fracture was calculated, and the association between the standardized incidence ratio and each nutritional intake was assessed for each region using Pearson’s correlation coefficient and partial correlation analysis. Results There were significant correlations between the standardized incidence ratio by region and magnesium, vitamin D, and vitamin K in both men and women, and calcium in women. The strongest inverse correlations were found in vitamin K in both men and women (r = −0.844, P = 0.001, and r = −0.834, P = 0.001, respectively). After adjusting for calcium, magnesium, and vitamin D, the partial correlation between the standardized incidence ratio by regional block and vitamin K was strongest in both men and women (partial correlation coefficient, pcc = −0.673, P = 0.04; pcc = −0.575, P = 0.106, respectively). Conclusions The significant correlation between hip fracture incidence and vitamin K intake, and also regional variations in food patterns, suggest that increasing intake of vegetables and legumes might lead to a decrease in hip fracture incidence in the future. Further, this study suggests that a review of the dietary reference value of vitamin K from the perspective of osteoporosis would be useful.     

Intake of fermented soybeans, natto, is associated with reduced bone loss in postmenopausal women: Japanese Population-Based Osteoporosis (JPOS) Study

Japanese fermented soybeans (natto in Japanese), which contain a large amount of menaquinone-7, may help prevent the development of osteoporosis. We assessed the possibility of an association between habitual natto intake and bone mineral density (BMD) and BMD change over time in healthy Japanese women who participated in a large representative cohort study (Japanese Population-based Osteoporosis Study: JPOS study). The BMD was measured at the spine, hip, and forearm in 944 women (20-79 y old) at baseline and at a follow-up conducted 3 y later. Dietary natto intake was assessed by a FFQ on both occasions. Additional covariates including age, height, weight, lifestyle factors, dietary calcium intake, and the intake of other soybean products, were also measured. The total hip BMD at baseline increased (P for trend = 0.0034) with increasing habitual natto intake in the postmenopausal women, although this was not the case at other skeletal sites. There were significant positive associations between natto intake and the rates of changes in BMD at the femoral neck (P < 0.0001) and at the distal third of the radius (P = 0.0002) in the postmenopausal women. The association in the femoral neck persisted even after adjusting for covariates. No significant association was observed between the intake of tofu or other soybean products and the rate of BMD change in the postmenopausal women. Natto intake may help prevent postmenopausal bone loss through the effects of menaquinone 7 or bioavailable isoflavones, which are more abundant in natto than in other soybean products.     

Environmental noise exposure and population health: a cross-sectional study in the Province of Rome

Background The aim of the present study is to analyse the relationship between exposure to environmental noise and population health-perceived status in a cross-sectional setting in Italy. Methods A cross-sectional study was carried out, in a population in the Province of Rome (Castelnuovo di Porto), in order to evaluate the auditory impact of road and railway infrastructures on population quality of life (QOL). Environmental noise due to road and railway traffic was assessed by phonometric samples during 1 week. Health status of participants was assessed using the Italian version of the Short-Form 36 item questionnaire (SF-36). Differences between groups in the SF-36 scales were tested using the Mann-Whitney test. Furthermore, we conducted a multiple linear regression analysis in order to assess the influence on the SF-36 scales (dependent variable) of the explanatory variables age (continuous variable), gender (dichotomous variable with males as reference group), educational level (low level as reference group), hours spent at home (continuous variable) and acoustic exposure level (low level as reference group). Results One hundred and fifty-nine people entered into the study (81 males and 78 females, mean age 41.28 years). We found a significantly lower (worse) Mental Health Scale score in those highly exposed to environmental noise (level over 65 dBA) (inverse association), both at univariate (mean scores: 66.4 vs 68.9) and multivariate analysis (beta = − 4.779; p < 0.05). Conclusions The use of the SF-36 questionnaire for measuring the association between physical and social factors in the built environment and mental well-being is very recent. Our study, to our knowledge, is the first attempt in Italy to find a relationship between environmental noise exposure and health status, measured with a standard questionnaire, in a specific population. The results for the Mental Health Scale of SF-36 are particularly interesting, as we found an inverse association with level of environmental noise exposure.     

Investigating Environmental Determinants of Diet,Physical Activity,and Overweight among Adults in Sao Paulo,Brazil

There is worldwide recognition that the burden of noncommunicable diseases (NCDs) and obesity-related health problems is rapidly increasing in low- and middle-income countries. Environmental determinants of obesity are likely to differ between countries, particularly in those undergoing rapid socioeconomic and nutrition transitions such as Brazil. This study aims to describe some built environment and local food environment variables and to explore their association with the overweight rate and diet and physical activity area-level aggregated indicators of adults living in the city of Sao Paulo, the largest city in Brazil. This formative study includes an ecological analysis of environmental factors associated with overweight across 31 submunicipalities of the city of Sao Paulo using statistical and spatial analyses. Average prevalence of overweight was 41.69% (95% confidence interval 38.74, 44.64), ranging from 27.14% to 60.75% across the submunicipalities. There was a wide geographical variation of both individual diet and physical activity, and indicators of food and built environments, favoring wealthier areas. After controlling for area socioeconomic status, there was a positive correlation between regular fruits and vegetables (FV) intake and density of FV specialized food markets (r = 0.497; p < 0.001), but no relationship between fast-food restaurant density and overweight prevalence was found. A negative association between overweight prevalence and density of parks and public sport facilities was seen (r = −0.527; p < 0.05). Understanding the relationship between local neighborhood environments and increasing rates of poor diet, physical activity, and obesity is essential in countries undergoing rapid economic and urban development, such as Brazil, in order to provide insights for policies to reduce increasing rates of NCDs and food access and health inequalities.     

Oral clefts and life style factors — A case-cohort study based on prospective Danish data

This study examines the association between oral clefts and first trimester maternal lifestyle factors based on prospective data from the Danish National Birth Cohort. The cohort includes approximately 100,000 pregnancies. In total 192 mothers gave birth to child with an oral cleft during 1997–2003. Information on risk factors such as smoking, alcohol consumption, tea, coffee, cola, and food supplements was obtained during pregnancy for these and 828 randomly selected controls. We found that first trimester maternal smoking was associated with an increased risk of oral clefts (odds ratio (OR): 1.50; 95% confidence interval (CIs): 1.05, 2.14). Although not statistically significant, we also saw associations with first trimester consumption of alcohol (OR: 1.11; CIs: 0.79, 1.55), tea (OR: 1.31; CIs: 0.93, 1.86), and drinking more than 1 l of cola per week (OR: 1.40; CIs: 0.92, 2.12). Furthermore supplementation with ≥400 mcg folic acid daily during the entire first trimester (OR: 0.75; CIs: 0.46, 1.22) suggested an inverse associated with oral clefts, similar to our results on coffee drinking. No effects were found for smaller doses of folic acid, vitamin A, B6 or B12 in this study. The present study found an association between oral clefts and smoking and, although not conclusive, supports an association of oral cleft with alcohol.