Gießener Vollwert-Ernährungs-Studie Teil II : Einfluß der Kostform auf den Vitamin-B12- und Folatstatus in der Schwangerschaft

Fragestellung: Hat die Kostform einen Einfluß auf den Vitamin-B12- und Folatstatus in der Schwangerschaft? Kann die Vollwert-Ernährung auch für schwangere Frauen eine ausreichende Versorgung gewährleisten? Untersuchungsmethoden: Die vorliegenden Studie ist als prospektive longitudinale Kohortenstudie angelegt. In die Studie aufgenommen wurden Frauen, die mindestens zwei Jahre Vollwert-Ernährung praktizieren (VWK; n = 76), und Frauen, die sich etwa gemäß dem Bundesdurchschnitt ernähren (CG; n = 43). Die VWK wurden zusätzlich in Ovo-Lakto-Vegetarierinnen (OLV; n = 30) und Nicht-Vegetarierinnen (NVEG; n = 46) unterteilt. Die Erfassung von Nährstoffaufnahme (BLS Version II.2) und Blutuntersuchungen wurden in jedem Schwangerschaftstrimenon (9.-12., 20.-22. und 36.-38. Schwangerschaftswoche) durchgeführt. Bestimmt wurden die Vitamin B12-Konzentrationen im Serum und Erythro-zyten sowie die gesättigten Vitamin-B12-Fraktionen holo-Transcobalamin II (holo-TC II) und holo-Haptocorrin (holo-Hap). Zusätzlich wurden die ungesättigte Vitamin B12 Bindungs-kapazität UBBC sowie die einzelnen Transcobalamin-Fraktionen (apo-TC II und apo-TC I/III) gemessen und daraus die prozentualen Sättigungskapazitäten der einzelnen Proteinfraktionen errechnet. Zur Erfassung des Folatstatus wurden die Folatkonzen-trationen in Plasma und Erythrozyten bestimmt. Ergebnisse: Der Lebensmittelverzehr der VWK unterschied sich gegenüber der CG besonders durch einen höheren Verzehr von Vollkornprodukten, Gemüse und Obst. Ein bedeutender Teil des Obstes und Gemüses wurde in Form von unerhitzter Frischkost verzehrt. Fleisch und Fisch spielt in der Ernährung der NVEG eine sehr viel geringere Rolle als bei der CG, die OLV vermieden diese Lebensmittel definitionsgemäß ganz. Die OLV nahmen etwa 2.5 µg/d, die NVEG 3.8 µg/d und die CG 5.3 µg/d Cobalamin mit der Nahrung auf. Die Folatzufuhr betrug bei den OLV durchschnittlich 350 µg DFE/d, bei den NVEG 347 µg DFE/d und bei der CG 319 µg DFE/d. Der Vitamin-B12-Status wurde signifikant durch die Ernährungsform beeinflußt. OLV, NVEG und CG zeigten signifikante Unterschiede in den meisten Parametern des Vitamin-B12-Status. Die niedrigsten Vitamin-B12-Konzentrationen im Serum wiesen die OLV auf, gefolgt von den NVEG. Einen Vitamin-B12-Mangel hatten in der vorliegenden Studie 44% der OLV, 16 % der NVEG und 8 % der CG. Die unterschiedlichen Ernährungsweisen der Untersuchungsgruppen und die damit verbundenen unterschiedliche Folatzufuhr wirkte sich deutlich auf den Folatstatus aus. Die Kostgruppen unterschieden sich signifikant hinsichtlich der Folatkonzentrationen in Plasma und Erythrozyten. Die höchsten mittleren Folatkonzentrationen in Plasma und Erythrozyten wurden bei den OLV gemessen, gefolgt von den NVEG. Im gesamten Schwanger-schaftsverlauf wurde ein Folatmangel bei 7.5 % der OLV, bei 20.3 % der NVEG und bei 29.0 % der CG beobachtet. Die Kostform hatte auch einen signifikanten Einfluß auf die Homocysteinkonzentrationen. Besonders im ersten Trimenon lagen die OLV am höchsten, gefolgt von den NVEG und der CG. Gegen Ende der Schwangerschaft unterschieden sich die Konzentrationen dagegen kaum. Homocysteinkonzentrationen außerhalb des Normalbereiches kamen am häufigsten bei den OLV vor. Das Risiko für erhöhte Homocysteinkonzentrationen war für OLV 4.6 mal und für NVEG 2.2 mal so hoch wie für die CG. Ein Vitamin-B12-Mangel wirkte sich ebenso wie ein Folatmangel negativ auf die Homocysteinkonzentrationen aus. Die höchsten Homocysteinkonzentrationen wurden bei den Teilnehmerinnen gemessen, die sowohl einen Vitamin-B12- als auch einen Folatmangel hatten. Empfehlungen: Die vorliegende Studie zeigt, daß eine Vollwert-Ernährung, die sich durch eine hohen Zufuhr von folatreichem Gemüse und einen hohen Frischkostanteil auszeichnet, den Folatstatus verbessern und das Risiko eines Folatmangels reduzieren kann. Die optimale Folatzufuhr liegt nach den vorliegenden Ergebnissen bei etwa 300 µg FFE/d und deckt sich mit den internationalen Empfehlungen für die Folatzufuhr während der Schwangerschaft. Die vegetarische Variante der Vollwert-Ernährung kann aber auch ein Risiko für einen Vitamin-B12-Mangel während der Schwangerschaft darstellen und zu einem funktionellen Folsäuremangel sowie erhöhten Homocysteinkonzentrationen führen. Vegetarierinnen sollten besonders auf eine ausreichende Vitamin-B12-Versorgung achten und regelmäßig ausreichend Milch und Milchprodukte und eventuell Fisch verzehren. Die optimale Cobalaminzufuhr liegt bei etwa 4 µg/d und ist besonders für Vegetarierinnen während der Schwangerschaft zum Ausgleich für entleerte Vitamin-B12-Speicher wichtig. In den ersten Wochen der Schwangerschaft und bei einem geringem Verzehr von Milch und Milchprodukten sollte bei Vegetarierinnen eine generelle Supplementation mit Vitamin B12 in Erwägung gezogen werden.Wholesome Nutrition meets international recommendations on food consumption regarding a healthy diet and is characterised by a high consumption of foods of plant origin and a high consumption of raw food as well as whole grain products. At the same time the consumption of meat and eggs is reduce significantly compared to the average diet. The question is, whether Wholesome Nutrition ensures an adequate nutrient supply for persons with a high nutrient requirement such as pregnant women. The supply of vitamin B12 and folate is of special interest because of the association with the occurrence of neural tube defects, low birth weight, intrauterine growth retardation, delayed maturation of the nervous system and anaemia. The study conducted was a prospective longitudinal cohort study in which a questionnaire, an estimated food record and a pregnancy diary were used as instruments. In addition blood samples were analysed. Women were admitted to the study, when adhering to a Wholesome Nutrition (WN; n = 76) for a minimum of 2 years, or eating an average German diet (CG; n = 43). WN group was subdivided into ovo-lacto vegetarians (OLV; n = 30) and low-meat eaters (LME; n = 46). Dietary and nutrient intake was assessed in every trimester of pregnancy (9.-12., 20.-22. and 36.-38. gestational week) by an estimated 4-day food record. Nutrient intake was calculated based on the German food code and nutrient data base (BLS Version II.2, BGVV 1996). Folate intake was calculated as free folate equivalents (FFE) as well as dietary foalte equivalents (DFE). The food record was linked to blood samples to assess biochemical parameters throughout pregnancy. Serum and red blood cell (RBC) vitamin B12 concentrations, vitamin B12 bound transcobalamin II (holo-TC II) and vitamin B12 bound haptocorrin (holo-Hap) were analysed. Additionally the unsaturated vitamin B12 binding capacity (UBBC) and trans-cobalamins (apo-TC II and apo-TC I/III) were determined to calculate the percentage saturation of the transcobalamins. Folate status was assessed by the measurement of plasma and RBC folate. The food consumption of WN group and CG differed significantly. WN group consumed more whole grain products, vegetables and fruits than the CG. A high amount of vegetables and fruits were eaten unheated. LME ate less meat and fish than the CG; OLV avoid meat and fish totally. The preference of foods of plant origin and the low consumption of foods of animal origin lead to a lower dietary intake of cobalamin in OLV and LME than in the CG. The mean dietary intake of cobalamin was 2.5 µg/d for OLV, 3.8 µg/d for LME and 5.3 µg/d for the CG. Only half of the OLV met the recommendations for vitamin B12 of the Institute of Medicine (1998) and only 1/3 of OLV met the recommendations of the German Nutrition Society (1991). About ¼ of OLV showed a dietary cobalamin intake below the recommendations for pregnant women of the WHO. The WN group showed a higher dietary intake of folate than the CG. The mean folate intake was 350 µg DFE/d (173 µg FFE/d) for OLV, 347 µg DFE/d (166 µg FFE/d) for LME and CG 319 µg DFE/d (140 µg FFE/d) for the CG. The Vitamin B12 status was significantly affected by the diet. OLV, LME and the CG showed significant differences in most biochemical parameters of vitamin B12 status. Low cobalamin intake of OLV was reflected in low vitamin B12 concentrations in serum as well as low percentage saturation of transcobalamins. The lowest vitamin B12 concentrations in serum showed the OLV followed by the LME. Additionally the absolute saturation of haptocorrin as well as the total saturation was lower in OLV than in LME and the CG. The apo-Hap concentrations were highest in OLV, followed by LME and the CG. Holo TC II as well as RBC vitamin B12 concentrations were not affected by the diet. The unsaturated trans-cobalamin concentrations were strongly affected by pregnancy and were not ideal for the assessment of vitamin B12 status during pregnancy. A vitamin B12 deficiency showed 44% of OLV, 16 % of LME and 8 % of the CG. The risk of vitamin B12 deficiency during pregnancy was higher in OLV (9.2) and LME (2.3) compared to the CG. The different diets and the different dietary folate intakes also affected folate status. The diet groups differed significantly in plasma as well as RBC folate concentrations. The mean folate concentrations in plasma and RBCs were highest in OLV, followed by LME. In the total course of pregnancy folate deficiency was observed in 7.5 % of OLV, in 20.3 % of LME and 29.0 % of the CG. The diet also significantly affected homocysteine concentrations. Especially in the first trimester of pregnancy homocysteine concentrations were highest in OLV, followed by LME and the CG. At the end of pregnancy homocysteine concentrations hardly differered between the diet groups. Homocysteine concentrations above normal range were mostly observed in OLV. The risk for raised homocysteine concentrations was higher for OLV (4.6) and for LME (2.2) than for the CG. Homocysteine concentrations were negatively affected by vitamin B12 deficiency as well as folate deficiency. Highest homocysteine concentrations were observed in participants with vitamin B12 and folate deficiency. The results suggest that Wholesome Nutrition characterised by a high intake of folate-rich vegetables and a high amount of raw food optimises folate status and reduces the risk of folate deficiency during pregnancy. The data also suggest an optimum in folate intake at 300 µg FFE/d, which is similar to the international recommendation for folate intake during pregnancy. On the other hand a vegetarian variant of Wholesome Nutrition may also be a risk for vitamin B12 deficiency during pregnancy and may lead to a functional folate deficiency as well as raised homocysteine concentrations. Vegetarians should assure an adequate cobalamin intake and a sufficient consumption of dairy products and, if acceptable, fish. The data also suggest an optimum in cobalamin intake at 4 µg/d. A cobalamin intake of 4 µg/d should be met by all vegetarians during pregnancy to compensate low vitamin B12 storage. In the first weeks of pregnancy and in persons with a low consumption of dairy products a vitamin B12 supplementation for vegetarian women should be considered

Severity and Phenotype of Bullous Pemphigoid Relate to Autoantibody Profile Against the NH2- and COOH-Terminal Regions of the BP180 Ectodomain

Bullous pemphigoid, the most common autoimmune subepidermal bullous disorder, is associated with autoantibodies targeting antigenic sites clustered within the extracellular domain of BP180. To investigate epitope and subclass specificity of autoantibodies in bullous pemphigoid, we developed an enzyme-linked immunosorbent assay utilizing baculovirus-expressed recombinant forms of the NH2- and COOH-terminal regions of the extracellular domain of BP180 and examined sera obtained from patients with active bullous pemphigoid (n=116) and controls (n=100). Ninety-three (80%) and 54 (47%) of the 116 bullous pemphigoid sera recognized the NH2- and COOH-terminal regions, respectively, of the extracellular domain of BP180. Detailed analysis demonstrates that (i) this novel enzyme-linked immunosorbent assay is highly specific (98%) and sensitive (93%) as 108 of 116 bullous pemphigoid sera reacted with at least one of the baculovirus-derived recombinants, (ii) in active bullous pemphigoid, autoantibodies against the NH2-terminus of the extracellular domain of BP180 were predominantly of the IgG1 class, whereas a dual IgG1 and IgG4 response to this region was related to a more severe skin involvement, (iii) autoreactivity against both the NH2- and COOH-terminal regions was more frequently detected in patients with mucosal lesions, and (iv) levels of IgG (and IgG1) against the NH2-terminal, but not against the COOH-terminal portion of the extracellular domain of BP180, reflected disease severity indicating that autoantibodies against the NH2-terminus are critical in the pathogenesis of bullous pemphigoid. In conclusion, this novel enzyme-linked immunosorbent assay represents a highly sensitive and specific assay for rapid diagnosis of bullous pemphigoid and related disorders and may provide predictive parameters for the management of bullous pemphigoid patients

Higher Prevalence of Obesity Among Children With Asthma

The aim of this study is to investigate the association between childhood obesity and asthma, and whether this relationship varies by race/ethnicity. For this population-based, cross-sectional study, measured weight and height, and asthma diagnoses were extracted from electronic medical records of 681,122 patients aged 6–19 years who were enrolled in an integrated health plan 2007–2009. Weight class was assigned based on BMI-for-age. Overall, 18.4% of youth had a history of asthma and 10.9% had current asthma. Adjusted odds of current asthma for overweight, moderately obese, and extremely obese youth relative to those of normal weight were 1.22 (95% confidence interval (CI): 1.20, 1.24), 1.37 (95% CI: 1.34, 1.40), and 1.68 (95% CI: 1.64, 1.73), respectively (P trend < 0.001). Black youth are nearly twice as likely (adjusted odds ratio (OR) = 1.93, 95% CI: 1.89, 1.99), and Hispanic youth are 25% less likely (adjusted OR = 0.75, 95% CI: 0.74, 0.77), to have current asthma than to non-Hispanic white youth. However, the relationship between BMI and asthma was strongest in Hispanic and weakest in black youth. Among youth with asthma, increasing body mass was associated with more frequent ambulatory and emergency department visits, as well as increased inhaled and oral corticosteroid use. In conclusion, overweight, moderate, and extreme obesity are associated with higher odds of asthma in children and adolescents, although the association varies widely with race/ethnicity. Increasing BMI among youth with asthma is associated with higher consumption of corticosteroids and emergency department visits

Health plan administrative records versus birth certificate records: quality of race and ethnicity information in children

<p>Abstract</p> <p>Background</p> <p>To understand racial and ethnic disparities in health care utilization and their potential underlying causes, valid information on race and ethnicity is necessary. However, the validity of pediatric race and ethnicity information in administrative records from large integrated health care systems using electronic medical records is largely unknown.</p> <p>Methods</p> <p>Information on race and ethnicity of 325,810 children born between 1998-2008 was extracted from health plan administrative records and compared to birth certificate records. Positive predictive values (PPV) were calculated for correct classification of race and ethnicity in administrative records compared to birth certificate records.</p> <p>Results</p> <p>Misclassification of ethnicity and race in administrative records occurred in 23.1% and 33.6% children, respectively; the majority due to missing ethnicity (48.3%) and race (40.9%) information. Misclassification was most common in children of minority groups. PPV for White, Black, Asian/Pacific Islander, American Indian/Alaskan Native, multiple and other was 89.3%, 86.6%, 73.8%, 18.2%, 51.8% and 1.2%, respectively. PPV for Hispanic ethnicity was 95.6%. Racial and ethnic information improved with increasing number of medical visits. Subgroup analyses comparing racial classification between non-Hispanics and Hispanics showed White, Black and Asian race was more accurate among non-Hispanics than Hispanics.</p> <p>Conclusions</p> <p>In children, race and ethnicity information from administrative records has significant limitations in accurately identifying small minority groups. These results suggest that the quality of racial information obtained from administrative records may benefit from additional supplementation by birth certificate data.</p

Association of Type 1 Diabetes vs Type 2 Diabetes Diagnosed During Childhood and Adolescence With Complications During Teenage Years and Young Adulthood

The burden and determinants of complications and comorbidities in contemporary youth-onset diabetes are unknown

Odour and taste sensitivity is associated with body weight and extent of misreporting of body weight

International audienceBackground: Sensory factors are important determinants of appetite and food choices but little is known about the relationship between body weight and sensory capabilities. Objective: To investigate the relationship between measured body weights, misreporting of body weight and sensory capabilities. Design: In a cross-sectional sensory study, body weight was assessed by measured and self-reported body weight in healthy men ( n = 130) and women ( n = 181). Sensory capabilities were assessed as odour detection and identification, and detection for salty, sweet, sour and bitter taste. Results: Odour detection, odour identification and taste perception scores were lower in subjects with a BMI >= 28 kg/m(2) than in subjects with a BMI = 65 years scores were higher in subjects with a BMI >= 28 kg/m(2) than in subjects with a BMI = 65 years). At any age, however, subjects who under reported their body weight show higher sensory capabilities

The Accuracy of Self-Reported Body Weight Is High but Dependent on Recent Weight Change and Negative Affect in Teenage Girls

Background: Research studies often rely on self-reported weight to calculate body mass index. The present study investigated how the accuracy of self-reported body weight in adolescent girls is affected by overweight/obesity, race/ethnicity, and mental health factors. Methods: In a cohort of girls who participated in the Trial of Activity for Adolescent Girls at ages 11 and 17 (n = 588), self-reported and measured weight were compared, and linear regression models were fitted to model the over- or underreporting. The Center for Epidemiological Studies-Depression Scale (CES-D) was used to calculate depressive symptom subscales for negative affect, anhedonia and somatic symptoms. Results: Allowing 3% difference between self-reported and measured weight for the correct reporting of body weight, 59.2% of girls reported their weight correctly, 30.3% underreported (&minus;5.8 &plusmn; 4.8 kg), and 10.5% overreported (4.3 &plusmn; 3.5 kg). The average difference between self-reported and measured body weight was &minus;1.5 &plusmn; 4.3 kg (p &lt; 0.001). Factors for misreporting body weight were overweight (&beta; &plusmn; SE &minus; 2.60 &plusmn; 0.66%), obesity (&beta; &plusmn; SE &minus; 2.41 &plusmn; 0.71%), weight change between ages 11 and 17 (&beta; &plusmn; SE &minus; 0.35 &plusmn; 0.04% for each kg), height change between ages 11 and 17 (&beta; &plusmn; SE 0.29 &plusmn; 0.10% for each cm), and negative affect (&beta; &plusmn; SE &minus; 0.18 &plusmn; 0.08% for each score unit). Conclusions: The difference between self-reported and measured body weight in adolescent girls is relatively small. However, the accuracy of self-reported body weight may be lower in girls with overweight or obesity, recent weight and height change, and higher negative affect