Use Of Multivitamin Supplements Research Articles

Abstract MP27: Use of Multivitamin Supplements and Risks of Total and Cause-Specific Mortality Among U.S. Adults

As the most commonly consumed dietary supplement, how multivitamin use associates with risk of mortality remains inconclusive. Methods: We used data from three cohort studies to examine the association of time-varying multivitamin use with risk of mortality. We also emulated a target trial to estimate the association by applying the parametric g-formula. Results: Of 241,068 eligible participants (mean age at baseline: 50 for NHS, 37 for NHSII, and 53 for HPFS), there were 44,415 deaths over 30-years of follow up. Compared to non-users, the pooled age-adjusted harzard ratio (HR) of mortality was 0.92 (95% CI: 0.89, 0.94) and 0.89 (95% CI: 0.88, 0.91) for users who used <1 and ≥1 pill/day, respectively. These results were attenuated after multivariable adjustment (0.97 [0.95, 1.00] and 0.98 [0.96, 0.99], respectively), and the inverse association was primarily due to lower risk of CVD mortality ( table 1 ). In the emulated target trial, the estimated 30-y all-cause mortality under a multivitamin intervention was slightly lower than no intervention ( table 2 ). Conclusions: Multivitamin use may relate to a small reduction in mortality among middle-aged adults.

Post-diagnostic multivitamin supplement use and colorectal cancer survival: A prospective cohort study.

Use of multivitamin supplements has been associated with lower incidence of colorectal cancer (CRC). However, its influence on CRC survival remains unknown. Among 2424 patients with stage I-III CRC who provided detailed information about multivitamin supplements in the Nurses' Health Study and Health Professionals Follow-up Study, the authors calculated multivariable hazard ratios (HRs) of multivitamin supplements for all-cause and CRC-specific mortality according to post-diagnostic use and dose of multivitamin supplements. During a median follow-up of 11years, the authors documented 1512 deaths, among which 343 were of CRC. Compared to non-uses, post-diagnostic users of multivitamin supplements at a dose of 3-5 tablets/week had lower CRC-specific mortality (HR, 0.55; 95% confidence interval [CI], 0.36-0.83, p=.005), and post-diagnostic users at doses of 3-5 and 6-9 tablets/week had lower all-cause mortality (HR, 0.81; 95% CI, 0.67-0.99, p=.04; HR, 0.79; 95% CI, 0.70-0.88), p<.001). The dose-response analysis showed a curvilinear relationship for both CRC-specific (pnonlinearity < .001) and all-cause mortality (pnonlinearity =.004), with the maximum risk reduction observed at 3-5 tablets/week and no further reduction at higher doses. Compared to non-users in both pre- and post-diagnosis periods, new post-diagnostic users at dose of <10 tablets/week had a lower all-cause mortality (HR, 0.81; 95% CI, 0.71-0.94, p=.005), whereas new users at a dose of ≥10 tablets/week (HR, 1.58; 95% CI, 1.07-2.33) and discontinued users (HR, 1.35; 95% CI, 1.14-1.59) had a higher risk of mortality. Use of multivitamin supplements at a moderate dose after a diagnosis of nonmetastatic CRC is associated with lower CRC-specific and overall mortality, whereas a high dose (≥10 tablets/week) use is associated with higher CRC-specific mortality.

The relationship of dietary inflammatory index and dietary patterns with premenstrual syndrome among women in Kermanshah: An analytical cross-sectional study.

Premenstrual syndrome (PMS) is a common psychological condition that occurs continuously during the luteal phase of the menstrual cycle. Potential factors in this syndrome comprise the central nervous system, hormones, genetic background, and nutritional indicators. Little is known about foods or eating patterns that may be associated with this syndrome, yet nutritional factors can be considered in strategies for the management of PMS. The current study purposed to investigate the relationship between PMS and dietary inflammation index as well as PMS and food patterns. The present cross-sectional study was conducted on 125 women and girls aged 20-46 years who experienced symptoms of PMS. The inclusion criteria included cooperation and consent to enter the study, a body mass index of 18.5-25 kg/m2, no underlying disease, no use of contraceptives or antidepressants, and no use of multivitamin or mineral supplements. In the first stage of this study, participants' height, weight, waist circumference, and hip circumference were measured. In the second stage, eating habits were examined using a semiquantitative Food Frequency Questionnaire. This study found a significant correlation between glycemic load quintiles as well as between energy and macronutrient intake and the dietary inflammatory index; however, it revealed a direct correlation between PMS and both Western-mixed dietary and high-salt-high-sugar dietary patterns. Moreover, the Western food pattern was found to have a direct correlation with dietary inflammatory index, and the healthy food pattern had an inverse correlation with this index. This study showed that PMS symptoms are more severe with the consumption of high-salt-high-sugar or a Western-mixed food dietary pattern. It seems that an imbalance in hormones and neurotransmitters can affect the metabolism of proteins, carbohydrates, and fats. Also, some foods, such as vegetables, and low-fat and high-fiber diets reduce plasma estrogen levels and the duration of PMS symptoms.

Investigating iron intake in risk of progression from islet autoimmunity to type 1 diabetes: The diabetes autoimmunity study in the young.

Studies of the role of iron in the risk of type 1 diabetes (T1D) have been inconsistent. Given that iron generates reactive oxygen radicals, which can lead to oxidative damage and apoptosis in the beta cells of the pancreas, we examined whether iron intake was associated with the risk of progressing to T1D in individuals with islet autoimmunity (IA), the pre-clinical phase of T1D. DAISY is a prospective cohort following 2,547 children at increased risk for IA and progression to T1D. IA is defined as at least two consecutive serum samples positive for at least one autoantibody (insulin, GAD, IA-2, or ZnT8). We measured dietary intake at the time of IA seroconversion in 175 children with IA, and of these, 64 progressed to T1D. We used Cox regression to examine the association between energy-adjusted iron intake and progression to T1D, adjusting for HLA-DR3/4 genotype, race/ethnicity, age at seroconversion, presence of multiple autoantibodies at seroconversion, and multiple vitamin use. In addition, we tested whether this association was modified by vitamin C or calcium intake. In children with IA, high iron intake (as defined as above the 75th percentile, > 20.3 mg/day) was associated with decreased risk of progression to T1D compared to moderate iron intake (as defined by the middle 25-75th percentiles, 12.7-20.3 mg/day) (adjusted hazard ratio (HR): 0.35; 95% confidence interval (CI): 0.15, 0.79). The association between iron intake and T1D was not modified by vitamin C nor calcium intake. In a sensitivity analysis, the removal of six children who had been diagnosed with celiac disease prior to IA seroconversion did not affect this association. Higher iron intake at the time of IA seroconversion is associated with a lower risk of progression to T1D, independent of multivitamin supplement use. Further research that includes plasma biomarkers of iron status is needed to investigate the relationship between iron and the risk of T1D.

Multivitamin-multimineral supplements' effect on total nutrient intake

Use of multivitamin-multimineral supplements is widespread and can contribute substantially to total nutrient intakes. In the Hawaii-Los Angeles Multiethnic Cohort (MEC), 48% of men and 56% of women without chronic diseases reported use of multivitamin supplements at least weekly over the past year. We calculated the prevalence of nutrient adequacy for 17 nutrients based on responses to a self-administered quantitative food-frequency questionnaire administered to MEC participants at baseline in 1993–1996. Although the prevalence of nutrient adequacy from food only was higher for multivitamin supplement users (n = 21 056) than for nonusers (n = 69 715), differences averaged only 2 percentage points. For multivitamin users, the prevalence of adequacy improved by an average of 8 percentage points for both men and women when intake from supplements was included. Users were also more likely to have potentially excessive intakes, particularly for iron, zinc, vitamin A, and niacin. The 26 735 MEC participants in Hawaii who answered an open-ended question about multivitamin use in 1999–2001 reported using 1246 different products. The nutrient profile of these products varied widely, and the composition of products at the 90th percentile was 10-fold greater than the composition at the median for some nutrients. We conclude that analyses of nutrient adequacy and excess for supplement users should be extended to national samples and that composition data on actual supplements used are preferable to assuming a default nutrient profile for multivitamin supplements. Multivitamin products could be better formulated to reduce the prevalence of inadequacy and also to reduce the risk of excessive intakes.

Prevalence of Multivitamin Supplements useAmong General Population of Rawalpindiand Islamabad

Objective: To determine the prevalence of multivitamin supplement use among prescribed and non-prescribed population of Rawalpindi and Islamabad Pakistan.&#x0D; Study Design: It was a Quantitative analytical cross-sectional study.&#x0D; Place and Duration of Study: The study was carried out among general population of Rawalpindi and Islamabad Pakistan,from Jan till Apr 2022.&#x0D; Methodology: Nonprobability convenient sampling technique was used. The sample size was 385. The data was gathered through an online survey and was analyzed using IBM SPSS statistics version 25. Chi-square test was applied on qualitative variables with p-value significant at &lt;0.05. &#x0D; Results: Only 41% of people were prescribed multivitamins by their doctors while 59% were self-medicated. An overall prevalence of multivitamin supplementation among the population was 66.9%. About 48.3% of people are aware of their harmful effects. Majority (88.1%) of population consider vitamins good for their health. 70% of people buy supplements via pharmacist and almost half of the people do not read the leaflets that come with supplements. Male gender was statistically significantly associated with awareness of vitamin supplement use and encouraging its use to others (p≤0.05).&#x0D; Conclusion: There exists a high prevalence of multivitamins use amongst the twin cities of Rawalpindi/Islamabad. Although most of the population had an awareness of what multivitamins are essentially, half the population do not know about the harmful effects of vitamins. Males had more awareness of multivitamins supplement use as compared to females.

The association between dietary insulin index and load with mental health

BackgroundDepression, anxiety, and stress are common mental problems. The aim of this cross-sectional study was to investigate the association between two indexes that measure postprandial insulin response to different food, dietary insulin index (DII) and insulin load (DIL), with psychological disorders.MethodParticipants (n = 10,000) aged 20–69 were randomly selected from 200 clusters in Yazd from the recruitment phase of the Yazd Health Study. The dietary intake of participants was collected by a reliable and validated food frequency questionnaire (FFQ) consisting of 178 food items. DII and DIL were calculated from the FFQ data using previously published reference values. To assess psychological disorders an Iranian validated short version of a self-reported questionnaire (Depression Anxiety Stress Scales 21 [DASS21]) was used.ResultsNo significant association was observed between DIL and DII with odds of depression or anxiety using crude or adjusted models. However, individuals in the highest quartiles of DIL had the lowest odds of stress (OR: 0.69; 95% CI 0.48–1.01, P-trend = 0.047). This association remained significant after adjustment for potential confounders in model II including marital status, smoking, education, job status, salt intake, and multi-vitamin supplement use (OR: 0.38; 95% CI 0.16–0.91, P-trend = 0.039) and the third and final model which is further adjusted for BMI (OR: 0.39; 95% CI 0.16–0.91, P-trend = 0.041).ConclusionOverall, consumption of foods with higher DII as well as DIL were associated with lower stress scores; however, no significant relationship was observed between DII or DIL with respective depression or anxiety scores.

Postdiagnosis Multivitamin and Individual Vitamin Supplement Use and Mortality Among Patients With Colorectal Cancer in the NIH-AARP Diet and Health Study

ObjectivesWe aimed to evaluate the association of postdiagnostic multivitamin and individual vitamin supplement use with total and cancer-specific mortality among colorectal cancer (CRC) survivors.MethodsIn the National Institutes of Health (NIH)–AARP Diet and Health Study, we estimated the associations between vitamin use and total mortality and cancer-specific mortality risk among 2,136 CRC survivors. Use of multivitamin and individual vitamins (vitamin A, vitamin C, vitamin E, beta-carotene, and calcium) were assessed by a food-frequency questionnaire at baseline in 1995–1996 and follow-up questionnaire in 2004–2005. Participants reported frequency of use as never, < 1 time per week, 1–3 times per week, 4–6 times per week, or every day and categories were assigned a corresponding value (never = 0, < 1 time per week = 0.5, 1–3 times per week = 2, 4–6 times per week = 5, and every day = 7). Based on the sum of these values, participants were assigned to one of the following groups: never use (0 times/week), casual use (>0 to 6 times/week), consistent use (7 times/week), or heavy use (>7 times/week). Vital status was ascertained annually by linkage to the Social Security Administration Death Master File and the National Death Index Plus through December 31, 2019. Hazard ratios (HRs) and 95% CIs were estimated using Cox proportional hazards models with age as the underlying time metric and adjusting for potential confounders.ResultsPostdiagnosis multivitamin use was not associated with all-cause mortality or CRC-specific mortality, but consistent, as compared with never, postdiagnosis vitamin A use was associated with a 12% lower risk of total mortality (HR: 0.88, 95% CI: 0.78–1.00). Consistent, as compared with never, postdiagnosis vitamin C and calcium use were also associated with lower risk of total mortality (HR: 0.86, 95% CI: 0.75–0.99 and HR: 0.84 95% CI: 0.73–0.97, respectively). Use of vitamin E or beta-carotene supplements were not associated with total mortality or CRC-specific mortality.ConclusionsIn the NIH-AARP cohort, consistent use of vitamin A, vitamin C, and calcium but not multivitamins was associated with lower total mortality and CRC-specific mortality among CRC cancer survivors.Funding SourcesThis work was supported by the NCI Intramural Research Program.

The Impact of Preconception Gastric Bypass Surgery on Maternal Micronutrient Status before and during Pregnancy: A Retrospective Cohort Study in the Netherlands between 2009 and 2019

Post-bariatric weight loss can cause iatrogenic malnutrition and micronutrient depletion. In this study, we evaluated the impact of gastric bypass surgery (GB) and multivitamin supplement use on maternal micronutrient status before and across pregnancy. A retrospective medical chart review of 197 singleton pregnancies after GB with a due date between 2009 and 2019 was performed at a bariatric expertise center in the Netherlands. Hemoglobin, calcium, iron status, folate, vitamin D, vitamin B12 and ferritin levels were determined before and after GB during standard follow-up and at all gestational trimesters and analyzed using linear mixed models. Patients were prescribed standard multivitamin supplements or multivitamins specifically developed for post-bariatric patients (FitForMe WLS Forte (FFM)). Overall, hemoglobin and calcium levels decreased after surgery and during pregnancy, whereas folate, vitamin D, and vitamin B12 levels increased, and iron levels remained stable. FFM use was associated with higher hemoglobin, folate, vitamin D, and ferritin levels. In conclusion, through adequate supplementation and follow-up, GB does not have to result in impaired micronutrient status. Supplements developed specifically for post-bariatric patients generally result in higher micronutrient values than regular multivitamins before and during pregnancy. These data emphasize the urgent need for nutritional counseling including dietary and multivitamin supplement advise for post-bariatric women contemplating and during pregnancy.

Prenatal folic acid supplementation and autism spectrum disorder in 3-year-old offspring: the Japan environment and children’s study

Objective We evaluated the relationship between prenatal folic acid supplementation and autism spectrum disorder (ASD) in 3-year-old offspring. Methods We used data from the Japan Environment and Children’s Study, a nationwide prospective birth cohort study. We analyzed the data to determine the association between folic acid supplement use and the incidence of ASD in offspring, and classified participants into three groups based on the time of initiation of folic acid supplementation, as follows: (1) preconception users of folic acid supplements and (2) post-conception users, and (3) non-users. The dietary folate intake of study participants was also classified into three groups (<200 µg, 200 µg to <400 µg, ≥400 µg). Results Overall, 361 offspring of 96,931 participants with single pregnancies were diagnosed with ASD (0.37%). A total of 7,046 participants (7.3%) used folic acid supplements before conception, 29,984 (30.9%) took them after detection of pregnancy, and 59,901 (61.8%) never received them. Multivariate logistic regression analyses demonstrated no association between prenatal folic acid supplementation and ASD in offspring (preconception use: adjusted odds ratio [AOR], 1.189; 95% confidence interval [CI], 0.819–1.727 and post-conception use: AOR, 1.072; 95% CI, 0.840–1.368); additionally, no association was observed with the use of folic acid supplements and/or multivitamin supplements (preconception use: AOR, 1.273; 95% CI, 0.921–1.760 and post-conception use: AOR, 1.132; 95% CI, 0.885–1.449). Moreover, no significant association was observed in participants with combined prenatal supplement use and dietary folate intake. Conclusions Maternal use of folic acid supplements from the pre- or post-conception period was not significantly associated with ASD in 3-year-old offspring in Japan. Evaluation of the dietary folate intake from preconception also showed no significant association.

Early prenatal use of a multivitamin diminishes the risk for inadequate vitamin D status in pregnant women: results from the Maternal-Infant Research on Environmental Chemicals (MIREC) cohort study

ABSTRACTBackgroundReports on the adequacy of vitamin D status of pregnant women are not available in Canada.ObjectivesThe objectives of this study were to examine vitamin D status across pregnancy and identify the correlates of vitamin D status of pregnant women in Canada.MethodsPregnant women (≥18 years) from 6 provinces (2008–2011) participating in a longitudinal cohort were studied. Sociodemographic data, obstetrical histories, and dietary and supplemental vitamin D intakes were surveyed. Plasma 25-hydroxyvitamin D (25OHD) was measured using an immunoassay standardized to LC-MS/MS from samples collected during the first (n = 1905) and third trimesters (n = 1649) and at delivery (n = 1543). The proportion of women with ≥40 nmol/L of plasma 25OHD (adequate status) was estimated at each time point, and factors related to achieving this cut point were identified using repeated-measures logistic regression. Differences in 25OHD concentrations across trimesters and at delivery were tested a using repeated-measures ANOVA with a post hoc Tukey's test.ResultsIn the first trimester, 93.4% (95% CI: 92.3%–94.5%) of participants had 25OHD ≥40 nmol/L. The mean plasma 25OHD concentration increased from the first to the third trimester and then declined by delivery (69.8 ± 0.5 nmol/L, 78.6 ± 0.7 nmol/L, and 75.7 ± 0.7 nmol/L, respectively; P < 0.0001). A lack of multivitamin use early in pregnancy reduced the odds of achieving 25OHD ≥40 nmol/L (ORadj = 0.33; 95% CI: 0.25–0.42) across all time points. Factors associated with not using a prenatal multivitamin included multiparity (ORadj = 2.08; 95% CI: 1.42–3.02) and a below-median income (ORadj = 1.39; 95% CI: 1.02–1.89).ConclusionsThe results from this cohort demonstrate the importance of early multivitamin supplement use to achieve an adequate vitamin D status in pregnant women.

Factors Affecting Patient Adherence to Multivitamin Intake After Bariatric Surgery: a Multicentre Survey Study from the Patient's Perspective.

PurposeLifelong multivitamin supplementation is recommended to prevent nutritional deficiencies. Despite this advice, deficiencies are common which may be due to poor adherence to MVS intake. The aim of this study was to identify which factors affect patient adherence to Multivitamin Supplement (MVS) intake after bariatric surgery.Materials and MethodsA 42-item questionnaire was sent to 15,424 patients from four Dutch bariatric center. In total, 4975 patients wanted to participate of which 361 patients were excluded. A total of 4614 patients were included, and MVS users (n=4274, 92.6%) were compared to non-users (n=340, 7.4%). Most patients underwent Roux-en-Y gastric bypass (64.3%) or sleeve gastrectomy (32.3%).ResultsSeven hundred and ten patients (15.4%) reported inconsistent MVS use and 340 patients (7.4%) did not use any MVS at all. For inconsistent MVS users, most reported reasons included forgetting daily intake (68.3%), gastro-intestinal side effects (25.6%) and unpleasant taste or smell (22.7%), whereas for non-users gastro-intestinal side effects (58.5%), high costs (13.5%) and the absence of vitamin deficiencies (20.9%) were most frequently reported. Overall, 28.5% were dissatisfied about instructions on MVS use, attention paid to MVS use during medical consultation and the extent to which personal preferences were taken into account.ConclusionThe attitude of bariatric patients towards MVS use is predominantly negative. It is important to provide accurate information on different options for MVS intake and collect information about patient’s personal preferences when prescribing supplements. Improving adherence to MVS intake is challenging and requires implementation of a shared decision-making process, further optimization of MVS formulas and exploring options for reimbursement.Graphical abstract

Impact of Educational Level on Changes in Dietary and Lifestyle Factors in Relation to Mental Distress Pre–And During COVID-19 Pandemic

ObjectivesHaving a graduate degree during the COVID-19 pandemic may bring job and financial security, which is potentially reflected in dietary and lifestyle factors as well as mental wellbeing. Those who lost their job during the pandemic are more likely to experience changes in their daily routine and behaviors, and face shifts in their mental health status. The purpose of this study was to assess trends in dietary and lifestyle factors in relation to mental distress pre- vs during the COVID-19 pandemic in a sample of adults based on education level.MethodsThis study is part of a larger study on dietary patterns and mood. Data collection started prior to the pandemic with a pre-COVID-19 sample size of 2,853 and COVID-19 sample size of 692. Data were collected anonymously via several social media platforms using the validated Food-Mood Questionnaire. Data collected since March 2020 was considered COVID-19 data as most of the major restrictions that may have impacted job security around the world started around this date. We examined trends in population characteristics using two-sample Welch's t test for all the variables to identify statistically significant changes (P < 0.05) due to the pandemic.ResultsThose with a graduate degree were more likely to eat more vegetables, less fast food, exercise more frequently and use more multivitamin and fish oil supplement and less likely to experience an increase in mental distress. Those without a graduate degree were more likely to skip breakfast, eat more fruits, meat, high glycemic index food, increase use of multivitamin and fish oil supplements and exercise frequently. They were also less likely to eat nuts. Interestingly, this group had seen an increase in mental distress.ConclusionsThose with a graduate degree experienced minimal disruption in their dietary and lifestyle factors, which may explain the lower likelihood of mental distress in this population. In addition, all the changes noted were beneficial to physical and mental health. However, those with no graduate degree have experienced greater dietary and lifestyle changes, which may explain the upsurge of their mental distress. In essence, education level during COVID-19 pandemic allegedly contributed to changes in dietary and lifestyle factors that in turn may have impacted mental wellbeing.Funding SourcesExperiment.com

Association between health risk factors and dietary flavonoid intake in cohort studies

The aim of this study was to identify the health risk factors associated with flavonoid intake in cohort studies investigating the association between dietary polyphenols and the risk of cardiovascular disease (CVD). A systematic search of the PubMed and EMBASE databases was performed. Prospective studies with the background characteristics given for categories of flavonoid intake were eligible to inclusion. A bivariate meta-analysis summarising the intercepts and slopes of the linear regression and a dose-response meta-analysis of differences in means were used to analyse the relationships. The intake of total flavonoids was inversely associated with BMI, alcohol consumption, saturated fat intake, and current smoking, and positively associated with vitamin E, folate, fibre, beta-carotene intake, multivitamin supplement use, and high physical activity. The results of this study underline the importance of considering the association between dietary flavonoid consumption and CVD risk in the context of a healthy lifestyle.

Prevalence and Predictors of Multivitamin Supplement Use After Stroke in Ghana

BackgroundMultivitamins are commonly used supplements in high income countries, but their net benefit-risk, remains inconclusive. Little is known about the prevalence and predictors of multivitamin supplementation among individual with chronic illnesses in sub-Saharan Africa, especially stroke. PurposeTo assess the frequency and factors associated with of use of multivitamin supplement among stroke survivors in Ghana. MethodsWe analyzed prospectively collected data on consecutively encountered stroke survivors seen at an out-patient clinic in Ghana between January 2018 and March 2020. We collected baseline demographic and clinical details, and use of multivitamins among other secondary prevention medications prescribed. We assessed factors associated with multivitamin supplementation using a multivariable logistic regression analysis. ResultsAmong 1,101 stroke survivors, 324 (29.4%) were on multivitamin supplements. Factors independently associated with multivitamin use were being divorced (OR 2.88; 95% CI: 1.52–5.47), time since diagnosis of index per each month increase (OR 0.99; 95% CI: 0.99–1.00), and number of prescribed classes of antihypertensive medications (OR 0.81; 95% CI: 0.72–0.92). ConclusionNearly a third of stroke survivors in this Ghanaian sample were on multivitamin supplementation, with select socio-clinical factors being linked to this practice. Future studies should examine how/if this practice is interfering with optimal stroke outcomes.

Prevalence and associated risk factors of symptomatic dry eye in Ghana: A cross-sectional population-based study

PurposeThis study sought to estimate the prevalence and associated risk factors of symptomatic dry eye in the general non-clinical Ghanaian population. MethodsThis was a cross-sectional population-based study conducted from November 2019 to February 2020. A stratified, multistage, random sampling technique was used to select participants aged 18 years and above from the capital cities of eight administrative regions in Ghana. Symptomatic dry eye was assessed using the Ocular Surface Disease Index questionnaire (OSDI). A study specific structured questionnaire was administered to collect information on participants’ demographics and self-reported risk factors of dry eye disease such as smoking, diabetes, hypertension, arthritis, ocular allergies, pregnancy, contact lens wear, use of topical glaucoma medication and multivitamin supplement. Multiple linear regression analysis was used to explore associations between symptomatic dry eye and participant characteristics. A p-value of 0.05 was considered statistically significant. ResultsA total of 1316 individuals participated in the study [mean (SD) age 37.0 (15.72) years; range 18–90 years; 50.2 % males]. The prevalence of symptomatic dry eye was 69.3 % [95 % CI: 66.7 % - 71.7 %; mean (SD) OSDI score of 26.97 (21.52)]: 19.8 %, 16.6 % and 32.9 % mild, moderate and severe symptoms respectively. The most common ocular symptom was sensitivity to light (experienced at least some of the time), reported by 67.1 % of participants; most affected vision-related activity was reading (49.3 %); most common environmental trigger of dry eye symptoms was windy conditions (61.3 %). There was a significant positive association between symptomatic dry eye and age (p < .0001), female sex (p = .026), arthritis (p = .031), ocular surface allergy (p = .036) and regional zone (p = .043). ConclusionThere is a high prevalence of dry eye symptoms in Ghana. This represents a high dry eye disease burden and a significant public health problem that needs immediate attention.

Diet in pregnant women that delivered prematurely and preterm newborn’s bone status

Objectives Inadequate maternal dietary pattern has been associated to negative pregnancy and fetal outcomes. With this study, we aimed to evaluate the adequacy of diet in pregnant women that delivered prematurely and its possible correlations with bone status of preterm newborns. Study design We prospectively enrolled women who delivered prematurely (≤than 34 gestational weeks) and their newborns (Neonatal Intensive Care, University Hospital of Padova) from January 2017 to May 2018. Maternal nutritional status and diet supplementations were assessed using a validated questionnaire. The preterm newborns were evaluated with anthropometric measurements and bone status by Quantitative Ultrasound of the second metacarpal bone within 72 h from birth. Results One hundred and eighty mothers and 202 preterm newborns were evaluated. The mothers assumed more calories, proteins, total lipids and simple sugars compared to the revised National Guidelines. The intake of calcium, phosphorus and Vitamin D was inadequate despite the use of multivitamin supplements. The mothers assumption of vitamin D and zinc positively correlated with bone status and mothers with very low intake of vitamin D during gestation (<7 µg/die) had preterm newborns with a worst bone status at birth compared to those with a better intake (>7 µg/die). Conclusions Nutrition of pregnant women could be improved and maternal intakes of Vitamin D and zinc positively correlated with preterm newborn’s bone status.

Recommendations Based on Evidence by the Andalusian Group for Nutrition Reflection and Investigation (GARIN) for the Pre- and Postoperative Management of Patients Undergoing Obesity Surgery.

In order to develop evidence-based recommendations and expert consensus for nutrition management of patients undergoing bariatric surgery and postoperative follow-up, we conducted a systematic literature search using PRISMA methodology plus critical appraisal following the SIGN and AGREE-II procedures. The results were discussed among all members of the GARIN group, and all members answered a Likert scale questionnaire to assess the degree of support for every recommendation. Patients undergoing bariatric surgery should be screened preoperatively for some micronutrient deficiencies and treated accordingly. A VLCD (Very Low-Calorie Diet) should be used for 4–8 weeks prior to surgery. Postoperatively, a liquid diet should be maintained for a month, followed by a semi-solid diet also for one month. Protein requirements (1–1.5 g/kg) should be estimated using adjusted weight. Systematic use of specific multivitamin supplements is encouraged. Calcium citrate and vitamin D supplements should be used at higher doses than are currently recommended. The use of proton-pump inhibitors should be individualised, and vitamin B12 and iron should be supplemented in case of deficit. All patients, especially pregnant women, teenagers, and elderly patients require a multidisciplinary approach and specialised follow-up. These recommendations and suggestions regarding nutrition management when undergoing bariatric surgery and postoperative follow-up have direct clinical applicability.

Medium term post-bariatric surgery deficit of vitamin B12 is predicted by deficit at time of surgery.

Patients with morbid obesity have a high risk of deficits in micronutrients, after bariatric surgery. The reasons why systematic use of multivitamin and trace element supplements cannot prevent all deficits are complex and should deserve more attention. Little is known about the influence of micronutrient deficits at surgery. This present study aimed to explore the deficit in vitamin B12 vs other micronutrients during the follow-up of a French cohort of cases with bariatric surgery under systematic multivitamin/trace elements supplementation and to determine whether it was influenced by clinical, metabolic characteristics at surgery. We prospectively enrolled obese patients with bariatric surgery (laparoscopic gastric bypass or laparoscopic sleeve gastrectomy) between 2013 and 2018 (OBESEPI/ALDEPI Cohort, NCT02663388). They received a daily multivitamin/micronutrients supplement. Follow-up data at 4 visits, 2, 12, 18 and 24 months after surgery, were collected. The highest rate of deficits was observed at visit 1 for vitamin D (35.7%), iron (21.9%) and folate (10.2%). Except B12, the deficits of all micronutrients decreased in later visits. In contrast, cases with vitamin B12 deficit decreased from 13.5% at surgery to 2.0% at visit 1, and increased in later visits, with a maximum of 12.0% at visit 3. Vitamin B12 concentration at surgery was the single predictor of B12 deficit at visit 3. It was also associated with age, and APRI score, an index of nonalcoholic fatty liver disease (NAFLD), in multivariate analysis. The failure of systematic supplementation with multivitamin/trace elements tablets to prevent specific deficits illustrates the need for adapted specific supplementations, in some cases. The worsening of B12 deficit rate in the 18-24 months follow-up depends in part to low B12 at time of surgery. A special consideration should be devoted to this subset of patients. The cohort study was registered at clinicaltrials.gov as NCT02663388.

Maternal use of folic acid and multivitamin supplements and infant risk of birth defects in Norway, 1999-2013.

The association between folic acid supplementation and birth defects other than neural tube defects (NTD) remains unclear. We used a log-binomial regression model to investigate if periconceptional folic acid and/or multivitamin use was associated with birth defects in Norway with prospectively collected data from the Medical Birth Registry of Norway (MBRN) during 1999-2013. We used the European Surveillance of Congenital Anomalies (EUROCAT) classification system to define eleven organ-specific major birth defect groups (nervous system, eye, ear-face-neck, cardiovascular system, respiratory system, oral clefts, digestive system, abdominal wall, urinary system, genital organs and limb), with additional subgroups. Fetuses or infants whose mothers used folic acid and/or multivitamin supplements before and during pregnancy were classified as exposed. During the years 1999-2013, 888 294 (99·0 %) live-born infants, 6633 (0·7 %) stillborn infants and 2135 (0·2 %) fetuses from terminated pregnancies due to fetal anomalies were registered in the MBRN. Among the live- and stillborn infants of women who used vitamin supplements compared with infants of non-users, the adjusted relative risk (aRR) was 0·94 (95 % CI 0·91, 0·98) for total birth defects (n 18 382). Supplement use was associated with reduced risk of abdominal wall defects (aRR 0·58; 95 % CI 0·42, 0·80, n 377), genital organ defects (aRR 0·81; 95 % CI 0·72, 0·91, n 2299) and limb defects (aRR 0·81; 95 % CI 0·74, 0·90, n 3409). Protective associations were also suggested for NTD, respiratory system defects and digestive system defects although CI included the null value of 1. During the full study period, statistically significant associations between supplement use and defects in the eye, ear-face-neck, heart or oral clefts were not observed.