CHASE: Cardiovascular health in mothers and offspring after pregnancies complicated by preeclampsia or diabetes mellitus. : Focus on diet and physical activity.

Abstract Background: Epidemiological evidence suggests an increased risk of cardiovascular associated diseases (CVAD) in both mother and offspring after pregnancies complicated by preeclampsia (PE) and diabetes mellitus (DM). The mechanisms behind this altered risk in health status are still scarcely unravelled. However, PE, DM and cardiovascular diseases (CVD) have several features in common, including shared risk factors and similar pathophysiology. Components of the metabolic syndrome and endothelial dysfunction, assumed to be closely related to nutritional intake and physical activity level, have gained increased attention as unifying mechanisms. Foetal programming in utero, as well as birth weight and growth pattern in the early postnatal period, may also predict future disease risk. The knowledge regarding the relative contribution from intrauterine programming and nutritional and metabolic risk factors for the development of cardiovascular health and disease is limited, and is a subject for further research. Objectives: In the present study we wanted to explore if there are any differences in lifestyle factors 5-8 years after delivery between women previously diagnosed with PE or DM in pregnancy and women without these complications, and likewise between their offspring. The lifestyle factors included in the master thesis were nutrition and physical activity. Also, associated risk factors for CVAD, including anthropometrics, blood pressure (BP), glucose levels and non-invasive measurements of endothelial function were evaluated. Subjects: Women previously recruited to a caesarean section biobank in 2001-2004, 18 of which where diagnosed with PE, 14 of which had DM (8 gestational diabetes mellitus (GDM) and 6 DM1) and 9 subjects with uncomplicated pregnancies serving as a comparator group, agreed to participate in the present follow-up study, together with the child that was delivered and recruited to the original study in 2001-2004. Methods: Height, weight, waist and hip circumferences, BP, endothelial function (non-invasive technique; EndoPAT) were measured in both mother and child. Both also delivered a urine sample (which was analysed with a urine stix to detect glucosuria or proteinuria), and venous blood samples were collected (for future analysis in other planned sub studies). An oral glucose challenge test (OGT) was performed in the mother, with one reading in the fasting state at baseline and one reading 2 hours later after oral intake of 75 mg glucose in 300 ml water. Additional clinical information, as well as information regarding nutritional intake and physical activity level in both mother and child, were obtained from standardized questionnaires. The children also had a cardiac tissue Doppler ultrasound examination performed by a paediatrician, but the findings obtained from the Doppler study and the endothelial function assessment are not reported in the present master thesis (as the analyses will take another 6 months and exceed the scope of this master thesis). Main outcomes/findings: In the CHASE follow-up study, a higher proportion of women and children in the DM-group were overweight and obese compared to the other groups. More women in the DM- and PE-group had abdominal obesity according to waist-to-hip ratio (WHR) measurements compared to the C-group. We also detected significant higher systolic BP and a lower physical activity level in women with previous PE or DM. Low intakes of vegetables were identified in all groups. However, a larger proportion of children in the C-group followed the fruit dietary guidelines of two or more portions a day compared to the DM-group (p = 0.02) and the PE-group (p = 0.08) of children. Also, a non-significant larger proportion of the women in the C-group reported adhering to the fruit dietary guidelines compared to the two other groups of women. Women and children in the C-group had a higher consumption of cod liver oil and lean milk types as compared to the other study groups. Conclusion: Preliminary results of the CHASE clinical study have identified aims for potential intervention strategies in women and children after pregnancies complicated by PE, GDM or DM1. Such intervention could focus on maternal weight reduction and prevention of excessive weight gain in the children, increase in physical activity level among the women, and advice to increase the consumption of fruit/berries and vegetables, less sugar-sweetened beverages, promotion of lean milk types rather than higher fat milk types and possibly the use of cod liver oil supplements. Key words: Preeclampsia (PE), diabetes mellitus (DM), gestational diabetes mellitus (GDM), cardiovascular disease (CVD), Cardiovascular associated diseases (CVAD) metabolic syndrome, endothelial dysfunction, foetal programming, nutrition, physical activity

Hypertension after preeclampsia and relation to the C1114G polymorphism (rs4606) in RGS2 : data from the Norwegian HUNT2 study

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Is perceived intolerance to milk and wheat associated with the corresponding IgG and IgA food antibodies? A cross sectional study in subjects with morbid obesity and gastrointestinal symptoms

Background: Serum IgG and IgA food antibodies have been used for dietary advice to subjects with gastrointestinal symptoms and perceived food intolerance, but the role of these antibodies in mediating intolerance is controversial. The present study investigated associations between perceived gastrointestinal intolerance to milk-or wheat and the corresponding s-IgG and s-IgA food antibodies in subjects with morbid obesity. Methods: Subjects with morbid obesity (BMI ≥ 40 kg/m2 or ≥35 kg/m2 with obesity-related complications) were included. Irritable Bowel Syndrome (IBS) was diagnosed based on the Rome III criteria. Severity of specific gastrointestinal symptoms were measured with the Gastrointestinal Symptom Rating Scale (GSRS)-IBS. S-IgG against cow's milk, cheese, wheat and gluten, and s-IgA against casein and gliadin were measured. Results: Ninety-seven subjects (80 females) with mean age 45 (SD 8.4) years were included, 70 had gastrointestinal complaints, 25 had IBS, and 22 and 20 reported milk- and wheat- intolerance respectively. There were no significant differences in serum concentrations or proportions of subjects above defined cut-off values for the antibodies between subjects with and without gastrointestinal complaints. In the group with gastrointestinal complaints, no significant differences were found between subjects with and without perceived food intolerance. Except for a significant correlation between IgG against cheese and GSRS-diarrhea (Rho: -0.25, P = 0.04), no significant correlations were found between the antibodies and type or degree of gastrointestinal symptoms, including IBS. Conclusions: The study showed no associations between perceived milk or wheat intolerance and the corresponding s-IgG and s-IgA food antibodies in subjects with morbid obesity.The study has received funding from Innlandet Hospital Trust, Brumunddal, Norway, and Lab1 AS, Sandvika, NorwaypublishedVersio

Anti-Saccharomyces cerevisae antibodies (ASCA) are associated with body fat mass and systemic inflammation, but not with dietary yeast consumption: a cross-sectional study

Baker’s/brewer’s yeast, Saccharomyces cerevisiae, has been used as an alternative to antibiotic growth promoters to improve growth performance in animals. In humans, Saccharomyces cerevisiae is among the most commonly detected fungi in fecal samples and likely originates from food. Recently, an association between anti-Saccharomyces cerevisiae antibodies (ASCA) and obesity in humans was suggested, but the cause of the elevated ASCA levels is not clear. Our aim was to study ASCA in morbidly obese subjects and explore potential associations with anthropometrics, diet, co-morbidities and biomarkers of inflammation and gut permeability. Methods Subjects with morbid obesity referred to a specialized hospital unit were included. Diet and clinical data were recorded with self-administered questionnaires. Main dietary sources of baker’s/brewer’s yeast (e.g. bread and beer) were used as a proxy for the intake of yeast. Laboratory analyses included ASCA, serum zonulin (reflecting gut permeability), C-reactive protein and a routine haematological and biochemical screening. Results One-hundred-and-forty subjects; 109 (78%) female, 98 with dietary records, mean age 43 years and BMI 42 kg/m2 were included. The number of ASCA positive subjects was 31 (22%) for IgG, 4 (2.9%) for IgA and 3 (2.1%) for IgM. Age, body fat mass and C-reactive protein were significantly higher in IgG-positive compared to IgG-negative subjects (P < 0.05). A borderline significant association was found between elevated zonulin and ASCA IgG-positivity (P = 0.06). No association was found between yeast-containing food and ASCA IgG-positivity, or between yeast-containing food and fat mass. Conclusions The findings indicate that ASCA IgG-positivity may be linked to the generalized inflammation commonly seen with increased adiposity, but not to dietary yeast intake. Other potential causes for the raised ASCA IgG concentrations, such as genetic predisposition, deviations in the gut microbiota and cross-reactivity of ASCA with other antigens, were not explored.Funding The study has received funding from Innlandet Hospital Trust, Brumunddal, NorwaypublishedVersio

Changes in gastrointestinal symptoms and food tolerance 6 months following weight loss surgery: associations with dietary changes, weight loss and the surgical procedure.

Background Gastrointestinal (GI) co-morbidity is common in obese patients, but the effect of weight loss surgery on GI symptoms is incompletely elucidated. The aims of the present study were to explore changes in GI symptoms and food tolerance following weight loss surgery and to study whether such changes were associated with dietary modifications and/or the type of surgical procedure [Roux-en-Y Gastric Bypass (RYGB) versus Vertical Sleeve Gastrectomy (VSG)]. Methods Participants: Patients with morbid obesity scheduled for weight loss surgery.The patients filled in paper-based questionnaires addressing diet, GI symptoms (bloating, pain, satiety, constipation and diarrhea) and food tolerance/quality of alimentation (satisfaction about current food intake, tolerance to specific foods and frequency of vomiting/regurgitation/reflux) 6 months prior to and 6 months after the surgery. Patients with pre-existing major GI co-morbidity or previous major GI surgery were excluded. Results Fifty-four patients (RYGB/VSG: 43/11) were included. Constipation and satiety increased and food tolerance decreased significantly after the surgery (all p-values  0.05). Pre-operatively, total energy intake correlated with bloating and abdominal pain (rho = 0.343 and 0.310 respectively, p  0.05 for both). Conclusion A high caloric intake may explain some of the GI symptoms experienced by non-operated obese patients. The worsening or new-onset of symptoms post-surgery is likely due to anatomical or physiological alterations following surgery. The increase in satiety and the decrease in food tolerance are likely explained by the restrictive nature of the surgeries, as satiety increased more after VSG than after RYGB and correlated with an overall reduction in food tolerance

Anti-Saccharomyces cerevisae antibodies (ASCA) are associated with body fat mass and systemic inflammation, but not with dietary yeast consumption: a cross-sectional study

Baker’s/brewer’s yeast, Saccharomyces cerevisiae, has been used as an alternative to antibiotic growth promoters to improve growth performance in animals. In humans, Saccharomyces cerevisiae is among the most commonly detected fungi in fecal samples and likely originates from food. Recently, an association between anti-Saccharomyces cerevisiae antibodies (ASCA) and obesity in humans was suggested, but the cause of the elevated ASCA levels is not clear. Our aim was to study ASCA in morbidly obese subjects and explore potential associations with anthropometrics, diet, co-morbidities and biomarkers of inflammation and gut permeability. Methods Subjects with morbid obesity referred to a specialized hospital unit were included. Diet and clinical data were recorded with self-administered questionnaires. Main dietary sources of baker’s/brewer’s yeast (e.g. bread and beer) were used as a proxy for the intake of yeast. Laboratory analyses included ASCA, serum zonulin (reflecting gut permeability), C-reactive protein and a routine haematological and biochemical screening. Results One-hundred-and-forty subjects; 109 (78%) female, 98 with dietary records, mean age 43 years and BMI 42 kg/m2 were included. The number of ASCA positive subjects was 31 (22%) for IgG, 4 (2.9%) for IgA and 3 (2.1%) for IgM. Age, body fat mass and C-reactive protein were significantly higher in IgG-positive compared to IgG-negative subjects (P < 0.05). A borderline significant association was found between elevated zonulin and ASCA IgG-positivity (P = 0.06). No association was found between yeast-containing food and ASCA IgG-positivity, or between yeast-containing food and fat mass. Conclusions The findings indicate that ASCA IgG-positivity may be linked to the generalized inflammation commonly seen with increased adiposity, but not to dietary yeast intake. Other potential causes for the raised ASCA IgG concentrations, such as genetic predisposition, deviations in the gut microbiota and cross-reactivity of ASCA with other antigens, were not explored

Anti-Saccharomyces cerevisae antibodies (ASCA) are associated with body fat mass and systemic inflammation, but not with dietary yeast consumption: a cross-sectional study

Baker’s/brewer’s yeast, Saccharomyces cerevisiae, has been used as an alternative to antibiotic growth promoters to improve growth performance in animals. In humans, Saccharomyces cerevisiae is among the most commonly detected fungi in fecal samples and likely originates from food. Recently, an association between anti-Saccharomyces cerevisiae antibodies (ASCA) and obesity in humans was suggested, but the cause of the elevated ASCA levels is not clear. Our aim was to study ASCA in morbidly obese subjects and explore potential associations with anthropometrics, diet, co-morbidities and biomarkers of inflammation and gut permeability. Methods Subjects with morbid obesity referred to a specialized hospital unit were included. Diet and clinical data were recorded with self-administered questionnaires. Main dietary sources of baker’s/brewer’s yeast (e.g. bread and beer) were used as a proxy for the intake of yeast. Laboratory analyses included ASCA, serum zonulin (reflecting gut permeability), C-reactive protein and a routine haematological and biochemical screening. Results One-hundred-and-forty subjects; 109 (78%) female, 98 with dietary records, mean age 43 years and BMI 42 kg/m2 were included. The number of ASCA positive subjects was 31 (22%) for IgG, 4 (2.9%) for IgA and 3 (2.1%) for IgM. Age, body fat mass and C-reactive protein were significantly higher in IgG-positive compared to IgG-negative subjects (P < 0.05). A borderline significant association was found between elevated zonulin and ASCA IgG-positivity (P = 0.06). No association was found between yeast-containing food and ASCA IgG-positivity, or between yeast-containing food and fat mass. Conclusions The findings indicate that ASCA IgG-positivity may be linked to the generalized inflammation commonly seen with increased adiposity, but not to dietary yeast intake. Other potential causes for the raised ASCA IgG concentrations, such as genetic predisposition, deviations in the gut microbiota and cross-reactivity of ASCA with other antigens, were not explored