Higher Mediterranean diet score is associated with longer time between relapses in Australian females with multiple sclerosis

A higher Mediterranean diet score has been associated with lower likelihood of multiple sclerosis. However, evidence regarding its association with disease activity and progression is limited. Using data from the AusLong Study, we tested longitudinal associations (over 10 years follow-up) between the alternate Mediterranean diet score (aMED) and aMED-Red (including moderate consumption of unprocessed red meat) and time between relapses and disability measured by Expanded Disability Status Scale (EDSS) (n=132; 27 males, 105 females). We used covariate-adjusted survival analysis for time between relapses, and time series mixed-effects negative binomial regression for EDSS. After adjusting for covariates, both higher aMED (aHR=0.94, 95%CI: 0.90, 0.99, p=0.009) and higher aMED-Red (aHR=0.93, 95%CI: 0.89, 0.97, p=0.001) were associated with significantly longer time between relapses in females. Whether specific dietary components of a Mediterranean diet are important in relation to relapses merits further study.Comment: Original article, Brief communication, 13 pages, 2 tables (one main table and one supplementary table

Vitamin D and omega-3 fatty acid supplements in children with autism spectrum disorder: a study protocol for a factorial randomised, double-blind, placebo-controlled trial

Background: There is strong mechanistic evidence to suggest that vitamin D and omega-3 long chain polyunsaturated fatty acids (n-3 LCPUFAs), specifically docosahexaenoic acid (DHA), have the potential to significantly improve the symptoms of autism spectrum disorder (ASD). However, there are no trials that have measured the effect of both vitamin D and n-3 LCPUFA supplementation on autism severity symptoms. The objective of this 2 × 2 factorial trial is to investigate the effect of vitamin D, n-3 LCPUFAs or a combination of both on core symptoms of ASD. Methods/design Children with ASD living in New Zealand (n = 168 children) will be randomised to one of four treatments daily: vitamin D (2000 IU), n-3 LCPUFAs (722 mg DHA), vitamin D (2000 IU) + n-3 LCPUFAs (722 mg DHA) or placebo for 12 months. All researchers, participants and their caregivers will be blinded until the data analysis is completed, and randomisation of the active/placebo capsules and allocation will be fully concealed from all mentioned parties. The primary outcome measures are the change in social-communicative functioning, sensory processing issues and problem behaviours between baseline and 12 months. A secondary outcome measure is the effect on gastrointestinal symptoms. Baseline data will be used to assess and correct basic nutritional deficiencies prior to treatment allocation. For safety measures, serum 25-hydroxyvitamin D 25(OH)D and calcium will be monitored at baseline, 6 and 12 months, and weekly compliance and gastrointestinal symptom diaries will be completed by caregivers throughout the study period. Discussion To our knowledge there are no randomised controlled trials assessing the effects of both vitamin D and DHA supplementation on core symptoms of ASD. If it is shown that either vitamin D, DHA or both are effective, the trial would reveal a non-invasive approach to managing ASD symptoms. Trial registration Australian New Zealand Clinical Trial Registry, ACTRN12615000144516. Registered on 16 February 2015. Electronic supplementary material The online version of this article (doi:10.1186/s13063-016-1428-8) contains supplementary material, which is available to authorized users

Middle Eastern Women's Health Study-Phase II : the effect of monthly 50,000 IU or 100,000 IU vitamin D supplements on Vitamin D status in pre-menopausal Middle Eastern women living in Auckland : a research report presented in partial fulfilment of the requirements for the degree of Master of Sciences in Human Nutrition at Massey University, Albany, New Zealand

Background: Middle Eastern women are at increased risk of vitamin D deficiency/insufficiency due to a number of specific lifestyle risk factors. Vitamin D supplements (50,000 IU/month) are prescribed by General Practitioners to correct vitamin D deficiency in this population in New Zealand. However, no research has investigated whether this dose of vitamin D supplement is useful for vitamin D deficiency treatment in Middle Eastern women or if larger doses are needed. Objectives: The primary objective of this study was to conduct a double-blind, randomised, placebo-controlled trial with vitamin D supplementation for 6 months. We aimed to assess the adequacy of supplementation with monthly 50,000 IU and 100,000 IU in optimising serum 25(OH)D concentrations (= 50 nmol/L and = 75 nmol/L) in a group of Middle Eastern premenopausal women living in Auckland. The secondary objective was to identify those factors affecting serum 25(OH)D response to the given doses of vitamin D supplements. Results from this study will help medical practitioners to provide the best options for treating vitamin D deficiency in Middle Eastern women living in New Zealand. Method: Women of Middle Eastern origin, = 20 years old and in premenopausal stage, having no major illness, living in Auckland (n=62) were recruited for the study in winter 2013. All were required to take study tablets (50,000, 100,000 IU or placebo/month) for 6 months and were required to visit the Human Nutrition Research Unit at Massey University on 3 occasions (baseline, 3-months, and 6-months). Blood samples were collected to measure serum 25(OH)D concentrations and calcium levels. Participants were required to complete questionnaires about their demographics, medical history, skin colour, lifestyle change and physical activity level. Height, weight, body fat percentage (BFP) and blood pressure were measured. Participants were also required to complete four day food dairies. The primary outcomes were the changes in serum 25(OH)D concentration and serum calcium level. Results: Mean baseline serum 25(OH)D was 46.0±15.0 nmol/L. Supplementation with 50,000 IU/month and 100,000 IU raised the mean serum 25(OH)D concentrations from a baseline of 44.0±16.0 and 48.0±11.0 nmol/L to 70.0±15.0 and 82.0±17.0 nmol/L at 6 months, respectively (P<0.001 for both treatment groups). The mean serum 25(OH)D concentration of women assigned to placebo group increased from 45.0±18.0 nmol/L at baseline to 54.0±18.0 nmol/L at 6 months (P<0.01). The mean serum 25(OH)D concentrations reached a Hajar Mazahery MEWH Study-Phase II Abstract plateau after 3 months of supplementation. Of 62 women, 59.7% had serum 25(OH)D concentrations 225 nmol/L) or hypercalcemia (serum calcium = 2.7 mmol/L). Response to vitamin D supplementation varied widely (increasing 1.0 to 80.0 nmol/L). In a regression analysis, dose (P<0.001), baseline serum 25(OH)D concentration (P<0.001) and baseline BFP (P=0.01) were the only variables to reach statistical significance as predictors of the change in serum 25(OH)D over 6 months. Conclusion: The prevalence of vitamin D deficiency/insufficiency was high in this study population highlighting the significance of the situation. Monthly intake of 100,000 IU vitamin D for 6 months was more effective than 50,000 IU in achieving serum 25(OH)D concentrations of 75 nmol/L, though it did not ensure a serum 25(OH)D concentration of 75 nmol/L or more in all people. Factors affecting serum 25(OH)D response to supplementation should be taken into account when an optimal dose for individuals is determined. The unexpectedly large variance in serum 25(OH)D response to a fixed dose of vitamin D highlights the importance of follow up and measurements of serum 25(OH)D when supplementation is used in clinical practice

The role of vitamin D and Omega-3 long chain polyunsaturated fatty acids in children with Autism Spectrum Disorder : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Nutritional Science, Massey University, Albany, New Zealand

Background: The efficacy of vitamin D and omega-3 long chain polyunsaturated fatty acid (omega-3 LCPUFA), each individually, in Autism Spectrum Disorder (ASD) has been tested in a few trials and the results are inconclusive. Furthermore, several observational studies have observed low vitamin D and omega-3 LCPUFA status in populations with ASD. Children with ASD are susceptible to nutritional issues and poor diet quality due to sensory, behavioural and gastrointestinal issues associated with the condition, though no information regarding these children’s nutritional status is available in New Zealand. Also, no validated nutritional quality assessment tools are available for this population. Aim and Objectives: The overall aim of this study was to investigate the role of vitamin D (VID), omega-3 LCPUFA (OM), or both (VIDOM) in ASD in children through systematically reviewing literature and conducting an intervention trial with these nutrients. The primary objective was to investigate the efficacy of vitamin D, omega-3 LCPUFA, both on core symptoms and sensory issues after correcting major nutritional deficiencies and secondary objectives were to investigate the efficacy of intervention on irritability and hyperactivity, to study dietary adequacy/nutritional status of children with ASD, and to validate a Dietary Index of Children’s Eating (DICE) questionnaire against 4-day estimated food record (4DFR). Methods/Design: New Zealand children with ASD (age 2.5-8.0 years) participated in a 12- month randomised, double-blind, placebo-controlled, 2x2 factorial trial. Prior to trial entry, children’s dietary adequacy and nutritional status were assessed by 4DFR, DICE questionnaire (designed based on New Zealand Ministry of Health Food and Nutrition guidelines), and nutritional biomarkers (25(OH)D, red blood cell fatty acids, iron, calcium, albumin, vitamin B12, and folate). Data regarding dietary supplement use and special/exclusion diet, demographics and anthropometrics (height and weight) were also collected. Children then were randomly assigned to one of four treatment groups; daily 2000IU vitamin D3, 722 mg docosahexaenoic acid (DHA), both supplements, or placebo, and behaviours were assessed. Core symptoms were assessed using Social Responsiveness Scale (SRS), sensory issues using Sensory Processing Measure (SPM), problem behaviours including irritability and hyperactivity using Aberrant Behaviour Checklist (ABC). Outcome measures were analysed pre- and post-intervention. Pair-wise mixed effects longitudinal models were used for data analysis. Results: 309 families registered their interest in the study, of whom 190 families were either excluded or not enrolled. The children of remaining families (n=119) were screened for nutritional deficiencies and high serum 25(OH)D concentrations, of whom two children were excluded. Overall, 62% (73/117) of children completed the trial (placebo 16, VID 19, OM 23, VIDOM 15). The mean serum 25(OH)D concentrations (nmol/L) increased in the VID (27±14, P<0.001) and VIDOM (36±17, P0.05) and placebo (8.9±23, P>0.05) groups. The median omega-3 index (%) increased in the OM [4.4 (3.3, 5.9), P<0.001] and VIDOM [4.0 (2.0, 6.0), P<0.001] groups and decreased in the VID [-0.2 (-1.0, 0.1)] and placebo [-0.5 (-0.9, -0.1), P>0.05] groups. Compared to placebo, a greater improvement in multiple outcomes in the intervention groups was observed: SRS-social awareness for OM (0.4±2.9 vs. -1.4±2.3, P=0.03) and VIDOM (0.4±2.9 vs. -1.7±3.5, P=0.03); SRS-social communicative functioning for VIDOM (-5.6±10 vs. -16±24, P=0.07); SRS-total for OM (-5.8±12 vs. -17±18, P=0.08); SPM-taste and smell for VIDOM (-0.3±1.7 vs. -2.5±4.3, P=0.06), SPM-balance and motion for OM (-0.1±4.7 vs. -2.6±4.3, P=0.09), ABC-irritability for VID (0.8±6.1 vs. -4.0±4.9 P=0.01) and OM (0.8±6.1 vs. -5.0±5.0, P=0.001); and ABChyperactivity for VID (-0.8±5.6 vs. -5.2±6.3, P=0.047). Out of 86 children whose food records were available, approximately 50% (39/86) reported taking dietary supplements and 15% (13/86) were on a special/exclusion diet. A large proportion of children had dietary intake for vitamin D below the Adequate Intake (AI, 96%), protein below the Average Macronutrient Distribution Range (AMDR, 65%), and iodine below the Estimated Average Requirement (EAR, 54%). Dietary intake of fibre (43%) and vitamin E (37%) was also below the AI by at least one third of children. All or most children exceeded the recommendations for sodium (100%), total saturated fat (80%) and sugar (52%). There was a significant and positive correlation (r=0.7; P<0.001) and good agreement (ĸ=0.6) between total scores from DICE (64±16) and 4DFR (58±11). Participants in the highest tertile of DICE had higher intakes of magnesium (P=0.02), vitamin A (P=0.03) and fibre (P=0.06). Conclusions: Vitamin D and omega-3 LCPUFA, each individually or together, improved some behavioural symptoms of ASD. However, large attrition rates and resultant loss of statistical power preclude definitive conclusion and warrant further trials. Also, the baseline assessment of nutrition confirms nutritional issues and poor diet quality in children with ASD. Given the importance of nutrition in growth and development and in the management of ASD, screening of the nutritional status of children with ASD for nutrient adequacy to reduce under- or over-consumption of nutrients is recommended. DICE is a valid tool for the assessment of diet quality in children with ASD living in New Zealand

Factors Affecting 25-Hydroxyvitamin D Concentration in Response to Vitamin D Supplementation

Sun exposure is the main source of vitamin D. Due to many lifestyle risk factors vitamin D deficiency/insufficiency is becoming a worldwide health problem. Low 25(OH)D concentration is associated with adverse musculoskeletal and non-musculoskeletal health outcomes. Vitamin D supplementation is currently the best approach to treat deficiency and to maintain adequacy. In response to a given dose of vitamin D, the effect on 25(OH)D concentration differs between individuals, and it is imperative that factors affecting this response be identified. For this review, a comprehensive literature search was conducted to identify those factors and to explore their significance in relation to circulating 25(OH)D response to vitamin D supplementation. The effect of several demographic/biological factors such as baseline 25(OH)D, aging, body mass index(BMI)/body fat percentage, ethnicity, calcium intake, genetics, oestrogen use, dietary fat content and composition, and some diseases and medications has been addressed. Furthermore, strategies employed by researchers or health care providers (type, dose and duration of vitamin D supplementation) and environment (season) are other contributing factors. With the exception of baseline 25(OH)D, BMI/body fat percentage, dose and type of vitamin D, the relative importance of other factors and the mechanisms by which these factors may affect the response remains to be determined

Sarcopenia Prevalence and Risk Factors among Residents in Aged Care

The aim of this study was to investigate the prevalence of sarcopenia and associated risk factors among older adults living in three residential aged care (RAC) facilities within Auckland, New Zealand. A total of 91 older adults (63% women, mean age &plusmn; SD; 86.0 &plusmn; 8.3 years) were recruited. Using the European Working Group on Sarcopenia in Older People criteria, sarcopenia was diagnosed from the assessment of: appendicular skeletal muscle mass/height2, using an InBody S10 body composition analyser and a SECA portable stadiometer or ulna length to estimate standing height; grip strength using a JAMAR handheld dynamometer; and physical performance with a 2.4-m gait speed test. Malnutrition risk was assessed using the Mini Nutrition Assessment&ndash;Short Form (MNA-SF). Most (83%) of residents were malnourished or at risk of malnutrition, and 41% were sarcopenic. Multivariate regression analysis showed lower body mass index (Odds Ratio (OR) = 1.4, 95% CI: 1.1, 1.7, p = 0.003) and lower MNA-SF score (OR = 1.6, 95% CI: 1.0, 2.4, p = 0.047) were predictive of sarcopenia after controlling for age, level of care, depression, and number of medications. Findings highlight the need for regular malnutrition screening in RAC to prevent the development of sarcopenia, where low weight or unintentional weight loss should prompt sarcopenia screening and assessment

Air displacement plethysmography (pea pod) in full-term and pre-term infants: a comprehensive review of accuracy, reproducibility, and practical challenges

Abstract Air displacement plethysmography (ADP) has been widely utilised to track body composition because it is considered to be practical, reliable, and valid. Pea Pod is the infant version of ADP that accommodates infants up to the age of 6 months and has been widely utilised to assess the body composition of full-term infants, and more recently pre-term infants. The primary goal of this comprehensive review is to 1) discuss the accuracy/reproducibility of Pea Pod in both full- and pre-term infants, 2) highlight and discuss practical challenges and potential sources of measurement errors in relation to Pea Pod operating principles, and 3) make suggestions for future research direction to overcome the identified limitations

Vitamin D and Autism Spectrum Disorder: A Literature Review

Low vitamin D status in early development has been hypothesised as an environmental risk factor for Autism Spectrum Disorder (ASD), given the concurrent increase in the prevalence of these two conditions, and the association of vitamin D with many ASD-associated medical conditions. Identification of vitamin D-ASD factors may provide indications for primary and secondary prevention interventions. We systematically reviewed the literature for studies on vitamin D-ASD relationship, including potential mechanistic pathways. We identified seven specific areas, including: latitude, season of conception/birth, maternal migration/ethnicity, vitamin D status of mothers and ASD patients, and vitamin D intervention to prevent and treat ASD. Due to differences in the methodological procedures and inconsistent results, drawing conclusions from the first three areas is difficult. Using a more direct measure of vitamin D status—that is, serum 25(OH)D level during pregnancy or childhood—we found growing evidence for a relationship between vitamin D and ASD. These findings are supported by convincing evidence from experimental studies investigating the mechanistic pathways. However, with few primary and secondary prevention intervention trials, this relationship cannot be determined, unless randomised placebo-controlled trials of vitamin D as a preventive or disease-modifying measure in ASD patients are available

Relationship between Long Chain n-3 Polyunsaturated Fatty Acids and Autism Spectrum Disorder: Systematic Review and Meta-Analysis of Case-Control and Randomised Controlled Trials

Omega-3 long chain polyunsaturated fatty acid supplementation (n-3 LCPUFA) for treatment of Autism Spectrum Disorder (ASD) is popular. The results of previous systematic reviews and meta-analyses of n-3 LCPUFA supplementation on ASD outcomes were inconclusive. Two meta-analyses were conducted; meta-analysis 1 compared blood levels of LCPUFA and their ratios arachidonic acid (ARA) to docosahexaenoic acid (DHA), ARA to eicosapentaenoic acid (EPA), or total n-6 to total n-3 LCPUFA in ASD to those of typically developing individuals (with no neurodevelopmental disorders), and meta-analysis 2 compared the effects of n-3 LCPUFA supplementation to placebo on symptoms of ASD. Case-control studies and randomised controlled trials (RCTs) were identified searching electronic databases up to May, 2016. Mean differences were pooled and analysed using inverse variance models. Heterogeneity was assessed using I2 statistic. Fifteen case-control studies (n = 1193) were reviewed. Compared with typically developed, ASD populations had lower DHA (−2.14 [95% CI −3.22 to −1.07]; p &lt; 0.0001; I2 = 97%), EPA (−0.72 [95% CI −1.25 to −0.18]; p = 0.008; I2 = 88%), and ARA (−0.83 [95% CI, −1.48 to −0.17]; p = 0.01; I2 = 96%) and higher total n-6 LCPUFA to n-3 LCPUFA ratio (0.42 [95% CI 0.06 to 0.78]; p = 0.02; I2 = 74%). Four RCTs were included in meta-analysis 2 (n = 107). Compared with placebo, n-3 LCPUFA improved social interaction (−1.96 [95% CI −3.5 to −0.34]; p = 0.02; I2 = 0) and repetitive and restricted interests and behaviours (−1.08 [95% CI −2.17 to −0.01]; p = 0.05; I2 = 0). Populations with ASD have lower n-3 LCPUFA status and n-3 LCPUFA supplementation can potentially improve some ASD symptoms. Further research with large sample size and adequate study duration is warranted to confirm the efficacy of n-3 LCPUFA

Inflammation (Il-1β) modifies the effect of vitamin d and omega-3 long chain polyunsaturated fatty acids on core symptoms of autism spectrum disorder-an exploratory pilot study

Background: The role of vitamin D and omega-3 long chain polyunsaturated fatty acids (omega-3 LCPUFA) in improving core symptoms of autism spectrum disorder (ASD) in children has been investigated by a few randomised controlled trials and the results are mixed and inconclusive. The response to treatment with these nutrients is heterogenous and may be influenced by inflammatory state. As an exploratory analysis, we investigated whether inflammatory state would modulate the effect of these nutrients on core symptoms of ASD. Methods: Seventy-three New Zealand children with ASD (2.5–8.0 years) completed a 12-month randomised, double-blind, placebo-controlled trial of vitamin D (VID, 2000 IU/day), omega-3 LCPUFA; (OM, 722 mg/day docosahexaenoic acid), or both (VIDOM). Non-fasting baseline plasma interleukin-1β (IL-1β) was available for 67 children (VID = 15, OM = 21, VIDOM = 15, placebo = 16). Children were categorised as having undetectable/normal IL-1β (\u3c3.2 pg/ml, n = 15) or elevated IL-1β (≥3.2 pg/mL, n = 52). The Social Responsiveness Scale (SRS) questionnaire was used to assess core symptoms of ASD (baseline, 12-month). Mixed model repeated measure analyses (including all children or only children with elevated IL-1β) were used. Results: We found evidence for an interaction between baseline IL-1β and treatment response for SRS-total, SRS-social communicative functioning, SRS-awareness and SRS-communication (all Pinteraction \u3c 0.10). When all children were included in the analysis, two outcome comparisons (treatments vs. placebo) showed greater improvements: VID, no effect (all P \u3e 0.10); OM and VIDOM (P = 0.01) for SRS-awareness. When only children with elevated IL-1β were included, five outcomes showed greater improvements: OM (P = 0.01) for SRS-total; OM (P = 0.03) for SRS-social communicative functioning; VID (P = 0.01), OM (P = 0.003) and VIDOM (P = 0.01) for SRS-awareness. Conclusion: Inflammatory state may have modulated responses to vitamin D and omega-3 LCPUFA intervention in children with ASD, suggesting children with elevated inflammation may benefit more from daily vitamin D and omega-3 LCPUFA supplementation