ALBERT

Description: Background Stress reactivity can be different in women compared to men, which might consequently influence disease risk.Stress in women may also generate adverse physiological effects on their offspring during pregnancy or lactation. The objective of this study was to compare the effects of different relaxation interventions on physiological outcomes and perceived relaxation in healthy young women, to assist in identifying the most appropriate intervention(s) for use in a subsequent trial for mothers who deliver prematurely. Methods A within-subject study was conducted in 17 women of reproductive age comparing five different relaxation interventions (guided-imagery meditation audio (GIM), music listening (ML), relaxation lighting (RL), GIM+RL, ML+RL), with control (silence/sitting), assigned in random order over a 3–6 week period. Subjective feelings of relaxation (10-point scale), heart rate (HR), systolic and diastolic blood pressure (SBP, DBP), and fingertip temperature (FT) were measured before and after each technique Results All interventions significantly increased perceived relaxation and FT, while music also significantly reduced SBP (p 

Description: Lack of preformed long-chain polyunsaturated fatty acids (LCPUFA) in infant formula has been hypothesised as contributing to cognitive differences between breast-fed and formula-fed infants. Previous systematic reviews found no cognitive differences between infants fed formula with LCPUFA and those fed formula without, but focused on early developmental measures, such as Bayley Scales of Infant Development, which are poorly differentiating and not predictive of cognitive ability in childhood. This systematic review examined the effect of randomising infants to formula supplemented with LCUFA vs unsupplemented formula on cognitive function ≥ age 2.5 years. We searched Medline, Embase the Cochrane Central Register of Controlled Trials without date limit, following a pre-published protocol according to PRISMA guidelines. We conducted random effects meta-analyses in RevMan v5.4 and followed GRADE and Cochrane Guidelines to evaluate strength of evidence and potential for bias. We included 8 trial cohorts which randomised participants between 1993 and 2004 and analyse 6 previously unpublished outcomes provided by various trialists. Age at the last available cognitive test ranged from 3.3 to 16 years. The pooled mean difference in Wechsler Preschool and Primary Scale of Intelligence-Revised from four trials in term-born children showed no benefit of LCPUFA: -0.04 points (95% confidence interval -5.94 to 5.85, 95% prediction interval -14.17 to 14.25). The pooled mean difference in Wechsler Abbreviated Scale of Intelligence score from two trials in preterm-born children also showed no benefit of LCPUFA: -7.71 (95% CI -24.63 to 9.22, 95% PI -97.80 to 82.38). Overall quality of evidence was low, due to substantial heterogeneity, low rates of follow-up, and indications of selective publication. The long-term effect of LCPUFA supplementation in term and preterm-born infants on cognition is highly uncertain and includes potential for large benefit as well as large harm. Based on our findings, LCPUFA supplementation of infant formula is not recommended until further robust evidence excludes long-term harm. Study registration PROSPERO registration numbers CRD42018105196 and CRD42018088868.

Description: Background: An accurate and reliable measurement of nutrient intake is the first and foremost step in order to optimise infant nutrition and evaluate its impact on health outcomes. However, research on the validity of dietary assessment tools used during the weaning period is limited, especially in lower-middle income countries. The primary aim of this study was to evaluate relative validity of a 24-h recall method (24-HR) using a 3-day food record (3-DFR). A secondary aim was to investigate association between protein intake from 3-DFR and plasma amino acids as a potential protein biomarker. Methods A multicentre, prospective cohort study was conducted in Chiang Mai, Thailand from June 2018 to May 2019. Food consumption data were collected in healthy infants using 24-HR and 3-DFR at 9 and 12 months of age. Blood samples were obtained at 12 months (M). Plasma amino acids were analysed using high performance liquid chromatography. Results Of 145 infants, 49% were female. At group level, paired t-tests/Wilcoxon signed rank tests did not show significant differences between average nutrient intakes from the 2 dietary assessment methods, except for vitamin A and vitamin C. Weighted kappa (Kw) was acceptable for all nutrients, except for vitamin A intake at 9 M (Kw = 0.15). The Bland–Altman analyses were unbiased for most nutrients with variable limits of agreement. At individual level, correlation coefficients (r) ranged from acceptable to excellent (r = 0.37–0.87) while cross-classifications showed acceptable outcomes, except for vitamin A. Multivariate analyses showed significant associations between protein intake at 12 M from the 3-DFR and plasma concentrations of branched-chain amino acids (BCAA) and essential amino acids (EAA), even after adjusting for gender, milk feeding type and energy intake. Conclusions For infants aged 9–12 M, a 24-HR can be used as a more practical alternative to a 3-DFR for most nutrients although caution is required for some micronutrients, especially vitamin A. A repeated interview might further improve the accuracy. Furthermore, protein intake, particularly animal-based protein, significantly predicted plasma BCAA and EAA concentrations regardless of gender, type of milk feeding and energy consumption.

Description: Serum calcium (Ca), bone biomarkers and radiological imaging do not allow accurate evaluation of bone mineral balance (BMB), a key determinant of bone mineral density (BMD) and fracture risk. We studied naturally occurring stable (non‐radioactive) Ca isotopes in different body pools as a potential biomarker of BMB. 42Ca and 44Ca are absorbed from our diet and sequestered into different body compartments following kinetic principles of isotope fractionation; isotopically light 42Ca is preferentially incorporated into bone, whereas heavier 44Ca preferentially remains in blood and is excreted in urine and feces. Their ratio (δ44/42Ca) in serum and urine increases during bone formation and decreases with bone resorption. In 117 healthy participants we measured Ca isotopes, biomarkers, and BMD by DXA and tibial peripheral quantitative CT (pQCT). 44Ca and 42Ca were measured by multi‐collector ionization‐coupled plasma mass‐spectrometry in serum, urine and feces. The relationship between bone Ca gain and loss was calculated using a compartment model. δ44/42Caserum and δ44/42Caurine were higher in children (n=66, median age 13 years) compared to adults (n=51, median age 28 years; p〈0.0001 and p=0.008 respectively). δ44/42Caserum increased with height in boys (p〈0.001, R2=0.65) and was greatest at Tanner stage 4. δ44/42Caserum correlated positively with biomarkers of bone formation (25‐hydroxyvitaminD [p〈0.0001, R2=0.37] and alkaline phosphatase [p=0.009, R2=0.18]) and negatively with bone resorption marker PTH (p=0.03, R2=0.13). δ44/42Caserum strongly positively correlated with tibial cortical BMD‐Z‐score (n=62; p〈0.001, R2=0.39), but not DXA. Independent predictors of tibial cortical BMD‐Z‐score were δ44/42Caserum (p=0.004, β=0.37), 25‐hydroxyvitaminD (p=0.04, β=0.19) and PTH (p=0.03, β=‐0.13), together predicting 76% of variability. In conclusion, naturally occurring Ca isotope ratios in different body compartments may provide a novel, non‐invasive method of assessing bone mineralization. Defining an accurate biomarker of BMB could form the basis of future studies investigating Ca dynamics in disease states and the impact of treatments that affect bone homeostasis.

Description: Dysregulated calcium homeostasis is common in chronic kidney disease and causally associated with disorders of bone mineralization. However, radiological measures and biomarkers do not allow accurate evaluation of bone calcium balance. Non-radioactive calcium isotopes, 42Ca and 44Ca, are present in our diet and sequestered into body compartments following principles of kinetic isotope fractionation. Isotopically light 42Ca is preferentially incorporated into bone, while heavier 44Ca is excreted. The ratio (44/42Caserum) increases when bone formation exceeds resorption and vice versa, reflecting bone calcium balance. We measured these calcium isotopes by inductively coupled plasma mass-spectrometry in blood, urine and feces of 42 children with chronic kidney disease and 92 receiving dialysis therapy. We compared the isotope ratios with bone biomarkers and determined total bone mineral content by dual-energy x-ray absorptiometry and peripheral quantitative CT expressed as age-adjusted z-scores. The 44/42Caserum ratio positively correlated with serum calcium, 25-hydroxyvitamin D and alkaline phosphatases and inversely with serum parathyroid hormone and other bone resorption markers. The 44/42Caserum ratio positively correlated with age-adjusted z-scores of tibial trabecular bone mineral density and total bone mineral content measured by peripheral quantitative CT, and hip bone mineral density measured by dual-energy X-ray absorptiometry. Significant and independent predictors of total bone mineral content, measured by, were the 44/42Caserum ratio and parathyroid hormone. The 44/42Caserum ratio, repeated after four weeks, highly correlated with baseline values. When adjusted for calcium-containing medications and kidney impairment, the 44/42Caserum ratio in patients receiving dialysis was 157% lower than that of age-matched children and 29% lower than levels in elderly women with osteoporosis, implying significantly lower bone mineral content. Thus, calcium isotope ratios may provide a novel, sensitive and non-invasive method of assessing bone calcium balance in chronic kidney disease.