The role of nutritional status of pregnant women and birth outcomes is ambiguous. Recent studies show that pre-pregnancy body weight is equally important as weight gain during pregnancy. Body mass index (BMI) is the most accessible and easy to check a nutritional status index, which may help to control the gestation and predict infant health outcome. This study aimed to examine the associations between pre-pregnancy body mass index and the infant birth parameters. A presented observational study was offered to 200 pregnant women from Antenatal Clinic at Jersey General Hospital in 2017. Total number of 83 women agreed to take part in this project. Diet, lifestyle, socio-economic, and demographic data were obtained from participants. Delivery and birth data were taken from hospital records. Offspring feeding data and selected anthropometric measurements for mothers and their newborns were also collected. Differences between BMI for delivery type and way of feeding were verified with chi-square test. Differences and correlation between maternal BMI and newborn outcomes were verified with Kruskal-Wallis’ test and Spearman's rank test. Mean BMI of mothers included to the study was 22.8 ± 4.4 with mean weight 61.9 ± 11.6. Before pregnancy BMI was normal in 67% women and about 23% was overweight or obese. We do not observed differences between delivery type and way of feeding during first 48 hours, and women in BMI categories. Also no differences and correlation were observed for the Apgar score, gestational age of birth, and newborn's weight and length at birth. However, newborn weight correlated with newborn length (r = 0.433) and gestational age (r = 0.568) at birth. Concluding, the maternal pre-pregnancy BMI was not correlated with type of delivery, way of feeding and newborn outcomes. Previous studies show that high pre-pregnancy maternal BMI may be associated with adverse offspring outcomes at birth and later life. Future extended research is needed to explain these relations, with inclusion of the specific factors as maternal diet, lifestyle and ethnicity.

It is estimated that in Central and Eastern Europe 8–12% of men are infertile, and in the case of 20% of infertile couples in the region, indicates a 56% part of the malefactor in the occurrence of infertility. Numerous studies have shown that a healthy diet with a high intake of fish and seafood, poultry, vegetables, fruits, legumes, through the high content of antioxidants are associated with better parameters of semen quality and reduced risk of asthenozoospermia. Men's diets may affect spermatogenesis as reflected in semen quality indicators, but the literature on the relation between meat intake and semen quality is limited. Our objective was to prospectively examine the relation between meats including red, poultry, proceesed and fish and indicators of semen quality. Men in subfertile couples presenting for evaluation at the Olsztyn Hospital Fertility Center were invited to participate in an ongoing study of environmental factors and fertility. This cross-sectional study was carried out in 208 men aged 18–55 years from Northern-Eastern Poland. Semen samples were collected at the clinic and analyses were performed by an experienced technician. Semen microscopic measurements were determined with the use of computer-aided semen analysis (CASA) and evaluated according to the World Health Organization (WHO) guidelines. A total of men completed a validated food-frequency questionnaire and subsequently provided semen samples. We used linear mixed regression models to examine the relation between meat intake and semen quality indicators (total sperm count, sperm concentration, progressive motility, morphology, and semen volume) while adjusting for potential confounders. After adjustment for age, BMI, physical activity, residence place and education, one serving increase in intake of processed meat was associated with a 56% higher risk of abnormal progressive sperm motility (OR = 1.56 95%CI:1.09–2.21). Consuming processed meat may have a negative impact on sperm counts and morphology. Potentially, these products may be a significant source of saturated and trans fatty acids, xenobiotics, mainly xenoestrogen, and steroids. Is need to clarify the potential effect of meat products, especially processed meat, on male reproductive potential in RCTs or longitudinal studies. Future findings may be useful to establish a more precise recommendation connected with red and processed meat intake in the context of reproductive health.

With stroke burden increasing rapidly in recent years, the need for therapies that mitigate the acute insult persists(1). Experimental stroke evidence has shown a neuroprotective effect of marine-derived n-3 polyunsaturated fatty acids (PUFAs), resulting in improved functional outcomes(2). However, evidence in humans remains unclear. Therefore, we conducted a systematic review(3) to evaluate the effects of marine-derived n-3 PUFAs on functional outcomes and dependence after stroke. Secondary outcomes included vascular-related death, recurrence, and adverse events.

We searched the Cochrane Stroke Group trials register and the following databases: Cochrane Central Register of Controlled Trials, MEDLINE, Embase, CINAHL EBSCO, and Web of Science (SCI-EXPANDED, CPCI-S, and BIOSIS). We also hand-searched relevant sources and used the Science Citation Index Reference Search. We included randomised controlled trials (RCTs) assessing marine-derived n-3 PUFAs intervention in people with history of stroke and/or transient ischaemic attack. Two authors independently selected trials, extracted data, assessed risk of bias, and evaluated the quality of the evidence. We contacted study authors for clarification and conducted random effects meta-analysis or narrative synthesis, as appropriate. We divided studies by follow-up length (up to three months and more than three months).

Twenty-nine RCTs were included. Of these, nine studies (3,339 participants) provided outcome data with only one study assessing acute stroke (subarachnoid haemorrhage). Doses of marine-derived n-3 PUFAs ranged from 400 to 3,300 mg per day. Functionality was assessed only in two small studies, one in each follow-up category. These trials reported a trend in improvement (RR 0.78, 95% CI 0.36 to 1.68, 40 participants; and mean difference 7.09, 95% CI -5.16 to 19.34, 52 participants; respectively). However, due to imprecision and small sample size, the quality of the evidence was very low. No studies reported on acute ischaemic stroke.

Our results show that, currently, evidence on the effect of marine-derived n-3 PUFAs on functional outcomes of stroke is limited and of very low quality. Therefore, more RCTs are needed, especially in the acute phase, to determine whether such intervention could improve stroke outcomes.

This abstract is based on a post-peer review version of a Cochrane Review. Upon completion and approval, the final version is expected to be published in the Cochrane Database of Systematic Reviews.

Irritable Bowel Syndrome (IBS) is a chronic and debilitating functional disorder of the gastrointestinal tract with serious and detrimental impacts on quality of life. Its aetiology is largely unknown, and the identification of effective management strategies remains far from complete. Research suggests that people with IBS have a high prevalence of vitamin D deficiency, which may impact on symptom severity and quality of life.

A double-blind, placebo-controlled, 2-arm, parallel-design study is underway to investigate the effect of a 12 week, 3,000IU vitamin D p.d. supplementation on symptom severity and quality of life in participants with a clinical diagnosis of IBS. This report assesses whether relationships exist between vitamin D status, IBS severity and quality of life in the baseline (cross-sectional) data.

Eighty males and females with a clinical diagnosis of IBS were recruited in phase I of the trial in January-April 2018. Mixed-type IBS and constipation-predominant IBS were the more frequent subtypes (36% and 33%), while diarrhoea-predominant had a lower prevalence (23%). More females (n = 65) than males (n = 15) were recruited to the study which reflects the reported greater prevalence of IBS in women. Baseline serum 25(OH)D levels in participants were classified as deficient 23.1% (n = 18) (< 30nmol/L), insufficient 37.2% (n = 29) (31–49 nmol/L) and sufficient 39.7% (n = 31) (> 50 nmol/L) respectively. The sample median for serum vitamin D at baseline was 42.2 (± 28.3) nmol/L. Quality of Life was significantly associated with two IBS sub-symptoms: pain (p = 0.037, r = 0.233) and distension severity (p = 0.009, r = 0.291). Neither Quality of Life, nor IBS symptom severity score, correlated with vitamin D status in the sample.

This study found no relationship between baseline vitamin D status and symptom severity or quality of life in this subsample. Two publications report vitamin D intervention improves quality of life in participants with IBS. It is possible that the unusual homogeneity of these studies enabled identification of these relationships.

These initial observations agree with previous reports of widespread vitamin D insufficiency in people with IBS. Analysis of full trial outcomes (July 2019) will determine whether vitamin D supplementation is beneficial for either symptoms severity or quality of life in people with IBS.

The MEDDINI intervention study investigated how advice improved the adoption of a Mediterranean diet (MD) in cardiovascular disease patients. Earlier research profiled the levels of blood metabolites in MEDDINI participants, in the process discovering a number dietary biomarkers indicative of a MD. However, a potential limitation of this approach is that MD scores are semi-quantitative, and don't reflect the absolute amounts of food consumed. Therefore, the present study identified distinct dietary patterns based on quantified food diary data from 58 MEDDINI participants by applying k-means clustering analysis. Previously measured blood metabolites (90) using targeted and untargeted methods were then assessed for their performance as dietary biomarkers. After careful standardisation (z-scores), optimisation and cross-validation dietary data were reduced to 6 specific food groups and this led to the formation of two clusters. Cluster 1 included participants who had the lowest intakes of fruit and vegetables, legumes, fish and whole grain cereals and the highest intake of meat and sweet foods (including carbonated drinks). Cluster 2 comprised the participants with highest intake of fruit and vegetables, legumes, fish and whole grain cereals and the lowest intake of meat and sweet foods (including carbonated drinks). Discriminatory metabolites (p derived from untargeted analysis included Citric acid, Tyrosine, Malonate, Pyroglutamic acid, Succinate, Betaine, L-asparagine and Fumaric acid which were significantly increased in cluster 2, and 2-Hydroxybutyric acid and Pyruvic acid which were significantly decreased in cluster 2. Targeted biomarker analysis showed 8 discriminatory metabolites which were significantly (p increased in cluster 2. These were Docosahexaenoic acid (DHA), alpha-Carotene, beta-Carotene, beta-Cryptoxanthin, Vitamin C, Lutein, alpha-Linolenic acid and Lycopene. Conversely Osbond acid, Cholesterol and Dihomo-γ-linolenic acid (DGLA) were significantly lower in cluster 2. Metabolites significantly correlated with some of the 6 groups in the clusters. For example, Citric acid, Betaine and Vitamin C positively correlated with combined fruit, fruit juice and vegetable intake: (r = 0.20, p = 0.018; r = 0.20, p = 0.02 and r = 0.34, p = 5.7E-5 respectively). DHA, alpha-Carotenoid and beta-Carotenoid significantly correlated with fish intake (r = 0.58, p = 1.94E-13; r = 0.40, p = 2E-6 and r = 0.30, p = 3.5E-4 respectively). The present study demonstrates the utility of clustering analysis for effectively assessing adherence to healthy dietary patterns and the discovery of novel dietary biomarkers.

Riboflavin (vitamin B2), as the coenzymes flavin mononucleotide (FMN) and flavin dinucleotide (FAD), is essential for oxidation-reduction reactions and energy metabolism. Riboflavin also interacts with vitamin B12, B6 and folate in one-carbon metabolism, and is required for the conversion of dietary vitamin B6 forms to the coenzyme pyridoxal 5’-phosphate (PLP). Biochemical riboflavin status is rarely measured given the lack of convenient and accessible biomarkers. The current gold-standard marker is erythrocyte glutathione reductase activation coefficient (EGRac) that involves laborious sample processing. High prevalence of riboflavin deficiency (EGRac ≥ 1.4) and suboptimal status (EGRac of 1.3–1.39) have been reported in the UK and Ireland; yet the functional significance is unclear. Plasma riboflavin concentration may serve as an alternative indicator; its association with related metabolites has not yet been investigated. Secondary analysis was conducted to determine the change-point of plasma riboflavin with EGRac, to derive a reference interval for plasma riboflavin, and to determine the association of riboflavin status with plasma PLP, using data of 223 older adult women from a cross-sectional study. Fasting blood samples and sociodemographic, anthropometric and dietary data were available for a convenience sample of 223 older adult women. Plasma PLP and related metabolites were quantified using isotope-dilution liquid chromatography-tandem mass spectrometry. The change-point (95% CI) between EGRac and plasma riboflavin occurred at plasma riboflavin concentration of 26.5 (20.5; 32.5) nmol/L (with EGRac of 1.25). The median (IQR) plasma riboflavin concentration was 15.7 (11.2, 23.8); and the upper and lower limits (90%CI) of the central 95% reference interval were 6.70 (6.33, 7.79) and 64.2 (55.0, 74.6) nmol/L, respectively. Plasma PLP (geometric mean (95%CI)) was significantly lower in women with riboflavin deficiency, 54.0 (46.8, 62.2) nmol/L (n = 64), and suboptimal riboflavin status, 56.1 (48.9, 64.3) nmol/L (n = 48), compared to those with riboflavin adequacy, 135 (112, 161) nmol/L (n = 110). Plasma PLP was positively associated with plasma riboflavin concentration after adjustment for total B6 intake, age, ethnicity, BMI, education, household income and C-reactive protein concentration [β (95% CI) = 1.92 (.670, 3.17) nmol/L; p = 0.003]; a significant interaction between plasma riboflavin and total dietary B6 intake was observed (p = 0.024). In conclusion, we are presenting for the first time a reference range for plasma riboflavin concentration and its change-point with EGRac in healthy women. Vitamin B6 status is strongly associated with riboflavin status; more research is needed to elucidate this relationship in a larger sample and ideally intervention study.

This study aimed to investigate (1) the accuracy of resting metabolic rate (RMR) prediction equations in female rugby players on a group and individual level; and (2) whether individual differences in the accuracy of prediction equations is associated with muscle damage or energy availability.

RMR was assessed in 14 female provincial and club rugby players (Age: 20–34 years, FFM: 47–63 kg, FM: 15–37%) training a minimum of twice per week. Participants attended the laboratory following an overnight fast and having avoided strenuous exercise for 24 hours. RMR was measured over 30 minutes by indirect calorimetry, and taken as the 10 minutes with the lowest variation. Body composition was assessed by air displacement plethysmography, muscle damage indicated by creatine kinase (CK) and risk of low energy availability assessed by the Low Energy Availability in Females Questionnaire. Accuracy of RMR prediction equations relevant to the general population and athletes were assessed including the Harris Benedict (1919), Cunningham (1980) and Ten Haaf FFM (2014) based equations.

Measured RMR was 1748 ± 146 kcal/day (range: 1474–2010 kcal/day). Predicted RMR determined by the Harris-Benedict equation (1601 ± 120 kcal/day) was significantly lower than measured RMR (p < 0.001), whereas predicted RMR using the Cunningham (1753 ± 146 kcal/day, p = 0.89) and the Ten Haaf (1781 ± 115 kcal/day, p = 0.33) equations did not differ from measured RMR. On an individual level, 50% (n = 7), 86% (n = 12) and 79% (n = 11) of participants fell within 10% of the measured RMR value when RMR was predicted by Harris-Benedict, Cunningham and Ten Haaf equations respectively. CK values were 182 ± 155U/L (range: 25–490U/L). When correlations of the whole group were studied, the difference between predicted and measured RMR was not associated with CK (r = 0.13). However, in the two individuals who fell outside the 10% range of that predicted by the Cunningham equation, one above and one below, CK values were 428U/L and 166U/L respectively. Muscle damage (as indicated by a high CK value) could therefore be one potential explanation for the higher measured RMR in the individual who was above the Cunningham predicted value.

In this cohort of female rugby players, the Cunningham equation showed the best accuracy on a group and individual level, suggesting this may be the most suitable prediction equation for this population. Further studies with larger sample sizes and investigating underlying reasons for why RMR measured values may differ from predicted values are needed.

Vitamin D (vitD) deficiency is the most common nutritional deficiency worldwide. Most patients are treated with oral vitD capsules (either vitD2 or vitD3). A few studies have reported equal efficacy of buccal spray vitD. This is a new formulation that is absorbed via the oral mucosa into the systemic circulation, bypassing the gastrointestinal route. The main objective of this systematic review was to identify RCT evidence for the comparative effectiveness of buccal spray versus oral vitD on serum 25-hydroxyvitaminD [25-OHD] concentrations and any adverse effects of buccal spray vitD. We have published an a priori protocol using Joanna Briggs Institute (JBI) methodology (PROSPERO CRD42018118580). A three-step search strategy to identify RCTs was conducted, which reported serum 25-OHD concentrations from five databases from 2008–2018. Retrieved abstracts were screened; included papers imported into JBI SUMARI and assessed for study quality (GRADE) by two authors. Meta-analysis was planned. Three RCTs met our inclusion criteria. Due to heterogeneity of studies, meta-analysis was not possible. In a RCT crossover study, mean serum 25-OHD concentrations were significantly higher in patients with malabsorption syndrome (n = 20) on 1000IU buccal spray + 117.8%(10.46, 95%CI6.89,14.03ng/ml) vs.1000IU oral vitD3 + 36.02%(3.96, 95%CI2.37, 5.56ng/ml) at 30days (p < 0.0001). Mean serum 25-OHD were also significantly higher in healthy adults (n = 20) on buccal spray + 42.99%(7.995, 95%CI6.86,9.13ng/ml)vs.oral vitD3 + 21.72%(4.06, 95%CI3.41,4.71ng/ml) at 30days (p < 0.0001). In another RCT crossover study, ANCOVA revealed no significant difference in the mean and SD change from baseline total 25-OHD concentrations in adults (n = 22) on 3000IU buccal spray vs. 3000IU oral vitD3 + 44%,26.15 (SD17.85) vs. + 51%,30.38 (SD17.91)nmol/l, respectively;F = 1.044, adjusted r20.493,p = 0.313 at 4 weeks. In a RCT, 800IU buccal spray was equally effective as 750IU oral vitD3 in children with neurodisabilities(n = 24) at 3 months. Both groups had a significant increase in 25-OHD; 11.5 ng/ml(median8–19) to 26.5(13.6–39)ng/ml and 15.5ng/ml(8–20) to 34.5(22–49)ng/ml, respectively (z = 150;p < 0.0001). The overall certainty of evidence was very low to moderate. No adverse effects were reported. The evidence from these studies suggests that 800IU-3000IU doses of buccal spray vitD3 given daily may be an effective alternative as oral vitD3 in obtaining short-term haematological responses in serum 25-OHD concentrations. Buccal spray vitD3 may be a useful alternative for patients with intestinal malabsorption or dysphagia. Future research should compare buccal spray VD3 to intramuscular injections and confirm these findings in well-designed trials.

Using short-term assessment methods to study diet provide too wide population intake distributions leading to overestimation of tail probabilities. Usual intake modelling reduces the variation in the distribution. The objective of this study was to evaluate the amount of bias in proportions of population under average requirement (AR) or recommended intake (RI) using the mean intake of two days compared to usual intake distribution. The FinDiet 2017 Survey was carried out in a nationally representative sample from the population register including adults aged 18–74 years. The data included two non-consecutive 24-hour dietary recalls from 1 655 participants (response rate 53%). Weighing factors were used to correct for non-participation bias. Usual intake was estimated using statistical program SPADE (RIVM, The Netherlands). The proportions of the population below AR or RI (when AR is not available) according to NNR 2012 were evaluated using two days mean intake and the usual intake distribution. These were further compared to evaluate the bias in two days mean intake. The bias associated with two days mean intakes was substantial in some of the nutrients. For example, for vitamin C and D intakes the difference between the proportions using two days mean and usual intake was over 10 percentage points. For vitamin C intake from food the proportions below AR (60 mg/day for men, 50 mg/day for women) were 38% for men and 20% for women using two days mean but 13 percentage points smaller for both sexes based on usual intake. The proportions below AR (7.5 μg/day) for vitamin D from food were 25% for men and 40% for women using two days mean and 14% for men and 30% for women using usual intake. When taking the intake from supplements into account, the proportions for vitamin D intake were 16% for men and 21 % for women based on two days mean but only 7% for both sexes using usual intake. For calcium intake from food the proportion below AR (500 mg/day) was small (7% for men and 8% for women) using two days mean but more than 50% smaller using usual intake (3% for both sexes). Using two days mean intake to estimate nutritional adequacy can lead to considerable biased results due to extraneous day-to-day variation in the intake distribution. Therefore, usual intake modelling should always be applied to intakes derived from short-term dietary assessment methods when evaluating nutritional adequacy.

Ultra-processed food consumption has increased in recent years. The evidence suggests a positive association between consumption of ultra-processed food consumption and low diet-quality and malnutrition, characterized by nutritional deficiencies and high prevalence of obesity and overweight. In México the combined prevalence of overweight and obesity in schoolchildren is 33.2%, and ultra-processed food consumption varies from 40.4% to 81.5% depending on the product. The objective of this study was to describe the association between ultra-processed food consumption, diet-quality and nutritional status in Mexican schoolchildren. We analyzed dietetic and anthropometric data from 364 children (6–12 years) of two communities in the center of México. Four 3d-recalls (three days records followed up for ten months including weekdays and weekends) were used for data collection. Consumed foods were classified according to the level of processing using the NOVA classification. Portions of each food, dietary energy, macro and micronutrients intakes were calculated in accordance with the Mexican equivalent food system, nutrition labelling of each product and software Nutrimind® 15.0. Nutritional status was evaluated according to BMI categories; diet-quality was assessed calculating a dietary score. All data were adjusted by energy. In our study, 32% of foods consumed by schoolchildren were ultra-processed, 49% were minimally processed or unprocessed. 30% of the energy intake derived from ultra-processed foods (95% CI 29.2–33.2%). Major ultra-processed foods in habitual diet were bakery, pastries (23%), sugar-sweetened beverages (dairy and non-dairy) (22%), processed meat (18%), pizzas and pastas (9%), and canned vegetables (4%). Children in the highest quartile of ultra-processed foods consumption, presented lower diet-quality than those in the lowest quartile. In this group of children, 38.0% presented combined overweight or obesity, although there were no statistically significant differences between nutritional status and ultra-processed food consumption. Regular ultra-processed food consumption is associated with a lower diet quality in healthy schoolchildren. It is necessary to implement strategies to reduce intake of these products to avoid possible risks to health in early ages.

The UK Diabetes and Diet Questionnaire (UKDDQ) is a brief dietary questionnaire developed for people with, or at high risk of, type 2 diabetes(1). It consists of 20 items scored from 0–5 (0 healthiest, 5 least healthy). It has been demonstrated to be reliable and compares well with food diaries. A study evaluating sensitivity to change of the UKDDQ was undertaken at the specialist weight management service (WMS) at Musgrove Park Hospital, Taunton. WMS patients receive an initial appointment with an endocrinologist and dietitian, followed by referral to group sessions or dietary advice. Follow up appointments with a WMS specialist occur over the next 26 weeks. Adults attending the service were recruited for the study between September 2016-March 2017. Participants completed the UKDDQ in the waiting room at the initial appointment and the first follow-up. Diabetes status, binge eating assessment and weight at both timepoints were obtained from WMS records. UKDDQ scores from 0–5 were calculated for each participant by summing the score for each item and dividing by 20. Change in UKDDQ scores and absolute and percentage change in weight between appointments were calculated. Paired sample t-tests were used to test differences in means for UKDDQ scores and weight from baseline to follow up. Multivariable regression analysis was used to examine associations between changes in the UKDDQ scores and percentage change in weight. The model was adjusted for age, gender, follow up time, diabetes status and binge eating. Forty-eight White British participants completed the study (67% women, 37% type 2 diabetes, 29% binge eating). Baseline mean weight was 132.4 (29.4)kg, mean BMI 46.5(7.7)kg/m2 and mean UKDDQ score was 1.39 (0.49). Participants lost weight (-2.4 (6.9)kg, p = 0.006) and the UKDDQ score improved between baseline and follow up (-0.27(0.53), p = 0.001). The mean percentage weight change was -1.6 (5.0)%. There was some evidence that a one point deterioration in healthy eating was associated with a 2.4 (-0.2 to 5.1)% increase in weight (p = 0.072). The UKDDQ can measure dietary change in people attending a specialist WMS and there is some evidence that a change in score is associated with a change in weight. The UKDDQ could be used as an outcome measure in these services.