Trust and distrust in relation to food risks in Spain: An approach to the socio-cultural representations of pregnant and breastfeeding women through the technique of free listing

In this paper, we explore the socio-cultural representations of trust and distrust in relation to food risks among pregnant and breastfeeding women. We have conducted a study based on an analysis of cultural domains in order to understand how mothers incorporate different social meanings and explore the most important categories they use when talking about trust/distrust in relation to food. We use the technique of free listings to analyse the main shared items or elements regarding trust and distrust in food among these mothers. Through an analysis of cultural domains that refers to concepts and themes related to trust and distrust of foods that are important to these women, and through the study of shared knowledge about these domains, we examine their socio-cultural representations related to health and diet of the 65 free listings on trust and the 64 on distrust collected from mothers. The pregnant and breastfeeding women who participated in the free listings cite foods they trust or distrust based on the specific properties they perceive them to have or other characteristics related to their origin, their handling, processing and distribution. Additionally, trust/distrust often depends on the qualities they attribute to the product. This paper shows aspects of the socio-cultural representations of food risks in periods in the life cycle of women -pregnancy and breastfeeding-characterized by a risk discourse where the precautionary principle is frequently used to manage uncertainty. These results might help the development of public health campaigns as well as adapting the messages of the health authorities to the general population

Bayesian Imputation of Missing Covariates

Missing values are a pervasive problem in almost all kinds of studies. In large cohort studies, the type of study most often conducted in the field of epidemiology, missing observations in covariates pose the major challenge. Since measurements are taken in an uncontrolled environment, typically many covariates need to be considered as potential confounders to filter out unwanted influences that environmental factors may have on the estimates of interest. Due to the large number of variables measured and the fact that measurement often relies on participants recalling and reporting detailed information, large proportions of missing data are common in these types of studies. In light of the above, the research that forms this thesis focuses on the analysis of incomplete cohort study data where missingness is in the covariates. We describe a fully Bayesian approach to analyse and impute data in this setting and discuss a number of naive and more sophisticated approaches to impute such data using multiple imputation with chained equations (MICE). The fully Bayesian approach is applied to multiple applications from the field of Epidemiology, and is further extended to settings with time-varying covariates, in which additional challenges, such as the functional form of the association between outcome and covariate and potential endogeneity arise. Moreover, the implementation of the fully Bayesian approach in the R package JointAI is described and illustrated by mean

Calcium supplementation to prevent pre-eclampsia: protocol for an individual participant data meta- analysis, network meta-analysis and health economic evaluation

The UKRI Medical Research Council supports this work—Global Maternal and Neonatal Health grant number MR/T010185/1. This work is also funded by the UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research (SRH), WHO. JPV is supported by the NHMRC Investigator grant.IntroductionLow dietary calcium intake is a risk factor for pre-eclampsia, a major contributor to maternal and perinatal mortality and morbidity worldwide. Calcium supplementation can prevent pre-eclampsia in women with low dietary calcium. However, the optimal dose and timing of calcium supplementation are not known. We plan to undertake an individual participant data (IPD) meta-analysis of randomised trials to determine the effects of various calcium supplementation regimens in preventing pre-eclampsia and its complications and rank these by effectiveness. We also aim to evaluate the cost-effectiveness of calcium supplementation to prevent pre-eclampsia.Methods and analysisWe will identify randomised trials on calcium supplementation before and during pregnancy by searching major electronic databases including Embase, CINAHL, MEDLINE, CENTRAL, PubMed, Scopus, AMED, LILACS, POPLINE, AIM, IMSEAR, ClinicalTrials.gov and the WHO International Clinical Trials Registry Platform, without language restrictions, from inception to February 2022. Primary researchers of the identified trials will be invited to join the International Calcium in Pregnancy Collaborative Network and share their IPD. We will check each study's IPD for consistency with the original authors before standardising and harmonising the data. We will perform a series of one-stage and two-stage IPD random-effect meta-analyses to obtain the summary intervention effects on pre-eclampsia with 95% CIs and summary treatment-covariate interactions (maternal risk status, dietary intake, timing of intervention, daily dose of calcium prescribed and total intake of calcium). Heterogeneity will be summarised using tau(2), I-2 and 95% prediction intervals for effect in a new study. Sensitivity analysis to explore robustness of statistical and clinical assumptions will be carried out. Minor study effects (potential publication bias) will be investigated using funnel plots. A decision analytical model for use in low-income and middle-income countries will assess the cost-effectiveness of calcium supplementation to prevent pre-eclampsia.Ethics and disseminationNo ethical approvals are required. We will store the data in a secure repository in an anonymised format. The results will be published in peer-reviewed journals.PROSPERO registration numberCRD42021231276.UKRI Medical Research Council MR/T010185/1UNDP/UNFPA/UNICEF/WHO/World BankNHMRC Investigato

Dietary reference values for sodium

Following a request from the European Commission, the EFSA Panel on Nutrition, Novel Foods and Food Allergens (NDA) derived dietary reference values (DRVs) for sodium. Evidence from balance studies on sodium and on the relationship between sodium intake and health outcomes, in particular cardiovascular disease (CVD)-related endpoints and bone health, was reviewed. The data were not sufficient to enable an average requirement (AR) or population reference intake (PRI) to be derived. However, by integrating the available evidence and associated uncertainties, the Panel considers that a sodium intake of 2.0 g/day represents a level of sodium for which there is sufficient confidence in a reduced risk of CVD in the general adult population. In addition, a sodium intake of 2.0 g/day is likely to allow most of the general adult population to maintain sodium balance. Therefore, the Panel considers that 2.0 g sodium/day is a safe and adequate intake for the general EU population of adults. The same value applies to pregnant and lactating women. Sodium intakes that are considered safe and adequate for children are extrapolated from the value for adults, adjusting for their respective energy requirement and including a growth factor, and are as follows: 1.1 g/day for children aged 1\u20133 years, 1.3 g/day for children aged 4\u20136 years, 1.7 g/day for children aged 7\u201310 years and 2.0 g/day for children aged 11\u201317 years, respectively. For infants aged 7\u201311 months, an Adequate Intake (AI) of 0.2 g/day is proposed based on upwards extrapolation of the estimated sodium intake in exclusively breast-fed infants aged 0\u20136 months

Levels of Lead in Breast Milk and Their Relation to Maternal Blood and Bone Lead Levels at One Month Postpartum.

Despite the many well-recognized benefits of breast-feeding for both mothers and infants, detectable levels of lead in breast milk have been documented in population studies of women with no current environmental or occupational exposures. Mobilization of maternal bone lead stores has been suggested as a potential endogenous source of lead in breast milk. We measured lead in breast milk to quantify the relation between maternal blood and bone lead levels and breast-feeding status (exclusive vs. partial) among 310 lactating women in Mexico City, Mexico, at 1 month postpartum. Umbilical cord and maternal blood samples were collected at delivery. Maternal breast milk, blood, and bone lead levels were obtained at 1 month postpartum. Levels of lead in breast milk ranged from 0.21 to 8.02 microg/L (ppb), with a geometric mean (GM) of 1.1 microg/L; blood lead ranged from 1.8 to 29.9 microg/dL (GM = 8.4 microg/dL); bone lead ranged from less than 1 to 67.2 microg/g bone mineral (patella) and from less than 1 to 76.6 microg/g bone mineral (tibia) at 1 month postpartum. Breast milk lead was significantly correlated with umbilical cord lead [Spearman correlation coefficient (r$_S$) = 0.36, p less than 0.0001] and maternal blood lead (r$_S$= 0.38, p less than 0.0001) at delivery and with maternal blood lead (r$_S$ = 0.42, p less than 0.0001) and patella lead (r$_S$= 0.15, p less than 0.01) at 1 month postpartum. Mother's age, years living in Mexico City, and use of lead-glazed ceramics, all predictive of cumulative lead exposure, were not significant predictors of breast milk lead levels. Adjusting for parity, daily dietary calcium intake (milligrams), infant weight change (grams), and breast-feeding status (exclusive or partial lactation), the estimated effect of an interquartile range (IQR) increase in blood lead (5.0 microg/dL) was associated with a 33% increase in breast milk lead [95% confidence interval (CI), 24 to 43%], whereas an IQR increase in patella lead (20 microg/g) was associated with a 14% increase in breast milk lead (95% CI, 5 to 25%). An IQR increase in tibia lead (12.0 microg/g) was associated with a 5% increase in breast milk lead (95% CI, -3% to 14%). Our results indicate that even among a population of women with relatively high lifetime exposure to lead, levels of lead in breast milk are low, influenced both by current lead exposure and by redistribution of bone lead accumulated from past environmental exposures

Effect of simple, targeted diet in pregnant women with metabolic risk factors on maternal and fetal outcomes (ESTEEM): study protocol for a pragmatic multicentre randomised trial

This work was supported by Bart’s Charity. The California Walnut Commission and Blue Diamond Growers donated with thanks the mixed nuts provided to the ESTEEM participants. The trial sponsor is Queen Mary University of London

Scientific Opinion on the risks to public health related to the presence of bisphenol A (BPA) in foodstuffs : Executive summary

Adopted 11 December 2014 Panel members: Claudia Bolognesi, Laurence Castle, Jean-Pierre Cravedi, Karl-Heinz Engel, Paul Fowler, Roland Franz, Konrad Grob, Rainer Gürtler, Trine Husøy, Wim Mennes, Maria Rosaria Milana, André Penninks, Franz Roland, Vittorio Silano, Andrew Smith, Maria de Fátima Tavares Poças, Christina Tlustos, Fidel Toldrá, Detlef Wölfle and Holger Zorn. Acknowledgement: The Panel wishes to thank the members of the Working Groups on BPA Exposure and Toxicology: Claire Beausoleil, Diane Benford, Emma Bradley, Anne Lise Brantsaeter, Gemma Calamandrei, Daniel Doerge, Paul Fowler, Peter Greaves (until July 2012), Ursula Gundert-Remy, Andrew David Hart, Edel Holene, Trine Husøy, Catherine Leclercq (until July 2013), Inger Therese Laugsand Lillegaard, Wim Mennes, Ralph Pirow, Maria de Fátima Tavares Poças, Iona Pratt (deceased in February 2014), Josef Rudolf Schlatter, Catherine Simoneau, Wout Slob, Jacqueline Van Engelen, Henk Van Loveren, Natalie Von Götz, Detlef Wölfle and Rudolf Antonius Woutersen for the preparatory work on this scientific opinion and the hearing experts: Jan Alexander, Pasquale Mosesso and Alfonso Siani, and EFSA staff: Davide Arcella, Anna F. Castoldi, Cristina Croera and Anne Theobald for the support provided to this scientific opinion. Suggested citation: EFSA CEF Panel (EFSA Panel on Food Contact Materials, Enzymes, Flavourings and Processing Aids), 2015. Scientific Opinion on the risks to public health related to the presence of bisphenol A (BPA) in foodstuffs: Executive summary. EFSA Journal 2015;13(1):3978, 22 pp. doi:10.2903/j.efsa.2015.3978Publisher PD