Showing papers by "Tor A. Strand published in 2015"

Irisin in blood increases transiently after single sessions of intense endurance exercise and heavy strength training.

Abstract: Purpose Irisin is a recently identified exercise-induced hormone that increases energy expenditure, at least in rodents. The main purpose of this study was to test the hypothesis that Irisin increases acutely in blood after singular sessions of intense endurance exercise (END) and heavy strength training (STR). Secondary, we wanted to explore the relationship between body composition and exercise-induced effects on irisin, and the effect of END and STR on muscular expression of the irisin gene FNDC5.

Blood flow-restricted strength training displays high functional and biological efficacy in women: a within-subject comparison with high-load strength training

Abstract: Limited data exist on the efficacy of low-load blood flow-restricted strength training (BFR), as compared directly to heavy-load strength training (HST). Here, we show that 12 wk of twice-a-week un...

Low dietary diversity and micronutrient adequacy among lactating women in a peri-urban area of Nepal

Abstract: OBJECTIVE: The main objectives were to assess the adequacy of the micronutrient intakes of lactating women in a peri-urban area in Nepal and to describe the relationships between micronutrient intake adequacy dietary diversity and sociodemographic variables. DESIGN: A cross-sectional survey was performed during 2008-2009. We used 24 h dietary recall to assess dietary intake on three non-consecutive days and calculated the probability of adequacy (PA) of the usual intake of eleven micronutrients and the overall mean probability of adequacy (MPA). A mean dietary diversity score (MDDS) was calculated of eight food groups averaged over 3 d. Multiple linear regression was used to identify the determinants of the MPA. SETTING: Bhaktapur municipality Nepal. SUBJECTS: Lactating women (n 500) 17-44 years old randomly selected. RESULTS: The mean usual energy intake was 8464 (sd 1305) kJ/d (2023 (sd 312) kcal/d) while the percentage of energy from protein fat and carbohydrates was 11 % 13 % and 76 % respectively. The mean usual micronutrient intakes were below the estimated average requirements for all micronutrients with the exception of vitamin C and Zn. The MPA across eleven micronutrients was 0.19 (sd 0.16). The diet was found to be monotonous (MDDS was 3.9 (sd 1.0)) and rice contributed to about 60 % of the energy intake. The multiple regression analyses showed that MPA was positively associated with energy intake dietary diversity womens educational level and socio-economic status and was higher in the winter. CONCLUSIONS: The low micronutrient intakes are probably explained by low dietary diversity and a low intake of micronutrient-rich foods.

Vitamin B12 and folic acid improve gross motor and problem-solving skills in young North Indian children: A randomized placebo-controlled trial

Abstract: Compared to placebo, children who received both vitamin B12 and folic acid had 0.45 (95% CI 0.19, 0.73) and 0.28 (95% CI 0.02, 0.54) higher SD-units in the domains of gross motor and problem solving functioning, respectively. The effect was highest in susceptible subgroups consisting of stunted children, those with high plasma homocysteine (> 10 μmol/L) or in those who were younger than 24 at end study. With the exception of a significant improvement on gross motor scores by vitamin B12 alone, supplementation of either vitamin alone had no effect on any of the outcomes.

Vitamin B-12, folic acid, and growth in 6- to 30-month-old children: a randomized controlled trial.

Abstract: BACKGROUND: Folate and vitamin B-12 are important for growth. Many children in low- and middle-income countries have inadequate intakes of these nutrients. METHODS: We undertook a randomized, placebo controlled double-blind trial in 1000 North Indian children, 6 to 35 months of age, providing twice the recommended daily allowance of folic acid and/or vitamin B-12, or placebo, daily for 6 months. By using a factorial design, we allocated children in a 1:1:1:1 ratio in blocks of 16. We measured the effect of giving vitamin B-12, folic acid, or the combination of both on linear and ponderal growth. We also identified predictors for growth in multiple linear regression models and effect modifiers for the effect of folic acid or vitamin B-12 supplementation on growth. RESULTS: The overall effect of either of the vitamins was significant only for weight; children who received vitamin B-12 increased their mean weight-for-age z scores by 0.07 (95% confidence interval: 0.01 to 0.13). Weight-for-age z scores and height-for-age z scores increased significantly after vitamin B-12 supplementation in wasted, underweight, and stunted children. These subgrouping variables significantly modified the effect of vitamin B-12 on growth. Vitamin B-12 status at baseline predicted linear and ponderal growth in children not receiving vitamin B-12 supplements but not in those who did (P-interaction CONCLUSIONS: We provide evidence that poor vitamin B-12 status contributes to poor growth. We recommend studies with larger doses and longer follow-up to confirm our findings.

Cytokine Concentrations in Plasma from Children with Severe and Non-Severe Community Acquired Pneumonia.

Abstract: Background Children in low and middle-income countries have a high burden of pneumonia. Measuring the cytokine responses may be useful to identify novel markers for diagnosing, monitoring, and treating pneumonia.

Predictors of duration and treatment failure of severe pneumonia in hospitalized young Nepalese children.

Abstract: Background Pneumonia in young children is still the most frequent cause of death in developing countries. We aimed to identify predictors for recovery and treatment failure in children hospitalized with severe pneumonia. Methods We enrolled 610 Nepalese children, aged 2 - 35 months from February 2006 to June 2008. Study participants were provided with standard treatment for pneumonia and followed up until discharge. Three multiple regression models representing clinical variables, clinical and radiological combined and all variables, including C-reactive protein (CRP) and viral etiology were used to assess the associations. Results The median age of study participants was 6 months with 493 (82%) infants and 367 (61%) males. The median time (IQR) till recovery was 49 (31, 87) hours and treatment failure was experienced by 209 (35%) of the children. Younger age, hypoxia on admission and radiographic pneumonia were independent predictors for both prolonged recovery and risk of treatment failure. While wasting and presence of any danger sign also predicted slower recovery, Parainfluenza type 1 isolated from the nasopharynx was associated with earlier resolution of illness. Gender, being breastfed, stunting, high fever, elevated CRP, presence of other viruses and supplementation with oral zinc did not show any significant association with these outcomes. Conclusion Age, hypoxia and consolidation on chest radiograph were significant predictors for time till recovery and treatment failure in children with severe pneumonia. While chest radiograph is not always needed, detection and treatment of hypoxia is a crucial step to guide the management of hospitalized children with pneumonia.

Bioavailability of iron, vitamin A, zinc, and folic acid when added to condiments and seasonings.

Abstract: Seasonings and condiments can be candidate vehicles for micronutrient fortification if consumed consistently and if dietary practices ensure bioavailability of the nutrient. In this review, we identify factors that may affect the bioavailability of iron, vitamin A, zinc, and folic acid when added to seasonings and condiments and evaluate their effects on micronutrient status. We take into consideration the chemical and physical properties of different forms of the micronutrients, the influence of the physical and chemical properties of foods and meals to which fortified seasonings and condiments are typically added, and interactions between micronutrients and the physiological and nutritional status of the target population. Bioavailable fortificants of iron have been developed for use in dry or fluid vehicles. For example, sodium iron ethylenediaminetetraacetic acid (NaFeEDTA) and ferrous sulfate with citric acid are options for iron fortification of fish and soy sauce. Furthermore, NaFeEDTA, microencapsulated ferrous fumarate, and micronized elemental iron are potential fortificants in curry powder and salt. Dry forms of retinyl acetate or palmitate are bioavailable fortificants of vitamin A in dry candidate vehicles, but there are no published studies of these fortificants in fluid vehicles. Studies of zinc and folic acid bioavailability in seasonings and condiments are also lacking.

Diarrhea, Stimulation and Growth Predict Neurodevelopment in Young North Indian Children

Abstract: Background and Objective Infants and young children in low to middle-income countries are at risk for adverse neurodevelopment due to multiple risk factors. In this study, we sought to identify stimulation and learning opportunities, growth, and burden of respiratory infections and diarrhea as predictors for neurodevelopment. Methods We visited 422 North Indian children 6 to 30 months old weekly for six months. Childhood illnesses were assessed biweekly. At end study, we assessed neurodevelopment using the Ages and Stages Questionnaire 3rd ed. (ASQ-3) and gathered information on stimulation and learning opportunities. We identified predictors for ASQ-3 scores in multiple linear and logistic regression models. Results We were able to explain 30.5% of the variation in the total ASQ-3 score by the identified predictors. When adjusting for child characteristics and annual family income, stimulation and learning opportunities explained most of the variation by 25.1%. Height for age (standardized beta: 0.12, p<.05) and weight for height z-scores (std. beta: 0.09, p<.05) were positively associated with the total ASQ-3 score, while number of days with diarrhea was negatively associated with these scores (std. beta: -0.13, p<0.01). Conclusion Our results support the importance of early child stimulation and general nutrition for child development. Our study also suggests that diarrhea is an additional risk factor for adverse neurodevelopment in vulnerable children.

Risk assessment of folic acid in food supplements.

Abstract: The Norwegian Scientific Committee for Food Safety (VKM) received a request from the Norwegian Food Safety Authority to assess whether the Tolerable Upper Intake Level (UL) of folic acid should be amended in light of new scientific evidence suggesting a possible link between high intake levels of folic acid and risk of cancer. Folic acid obtained from both food supplements and fortified foods should be assessed. Folic acid is a synthetic form of folate and is commonly used in food supplements and in food fortification because of its stability and bioavailability. Folic acid is reduced, methylated and released into the circulation. Natural folates occur in reduced forms, e.g. as tetrahydrofolate (THF), which are unstable and may thus loose biochemical activity during harvesting, storage, processing, and preparation. Folate is cofactor for enzymes in one-carbon metabolism where it provides one-carbon units for the formation of RNA and DNA. Folate is also essential for the normal functioning of the methionine cycle, which is responsible for both the conversion of homocysteine to methionine and the production of the universal methyl donor S-adenosylmethionine (SAM). SAM donates its methyl group to more than 100 methyltransferases for a wide range of substrates such as DNA, hormones, proteins, neurotransmitters and membrane phospholipids. While no Tolerable Upper Intake Level (UL) has been derived for natural dietary folates, the Scientific Committee on Food (SCF, 2000) set an UL of 1000 μg folic acid per day in 2000. The UL was set because it was found that high intakes of folic acid could correct megaloblastic anemia, which is the hallmark manifestation of vitamin B12 deficiency. In this way folic acid may mask vitamin B12 deficiency which again may cause irreversible neurological damage. The ULs for Grey Literature Haugen et al.; EJNFS, 5(4): 305-307, 2015; Article no.EJNFS.2015.028 306 children and adolescents (1-17 years) were adjusted on the basis of body weight and range from 200 to 800 μg/day. The UL for folic acid has been reassessed by other authorities, most recently in 2009 by EFSA (EFSA, 2009), who upheld an UL of 1000 μg/day. In 2009, Ebbing et al. published results from combined analyses of two randomised, placebocontrolled trials with B-vitamin supplementation in patients with ischemic heart disease. They found an increased risk of cancer in those who were randomised to receive folic acid in combination with vitamin B12 (Ebbing et al. 2009). Folates are important for cell division. It is therefore possible that tumor growth or growth of premalignant cells may be stimulated by high concentrations of folate in the blood. Another concern with use of folic acid is circulating unmetabolised folic acid (UMFA) which is often found at intakes of more than 200 μg per day (Kelly et al. 1997). It has been argued that UMFA could affect homeostatic regulation of folate (Smith et al. 2008), and that it may reduce natural-killer cell cytotoxicity (Troen et al. 2006). In vitro studies have also demonstrated that folic acid can down-regulate tumor suppressor genes (Lubecka-Pietruszewska et al. 2013). This opinion addresses the question whether the current UL for folic acid should be amended based on new scientific evidence. Furthermore, VKM has been requested to estimate folic acid intake from food supplements and from foods that are fortified with folic acid, in all age groups in the population above 1 year. In addition, possible consequences of amending the maximum limit for folic acid in food supplements should be discussed. In the literature search for this opinion (articles published from 2009 to 15 October 2014 were obtained), we found eight meta-analyses and five single studies where the aims were to study the relation between folic acid supplementation and incidence of cancer. Meta-analyses including studies in which folic acid was used in combination with other supplements were not included in the final evaluation, as the effect of folic acid could not be distinguished from the effect of the other substances. Only one meta-analysis was therefore considered relevant for the evaluation of UL for folic acid; a meta-analysis of patients with colorectal adenomas who received 1 mg folic acid per day for 3-6 years (Figueiredo et al. 2011). No increased risk of colorectal adenomas or cancer was found in this meta-analysis. Nor did the included single studies report increased risk of colorectal cancer following folic acid supplementation (Gao et al. 2013; Wu et al. 2009). Brain tumor and childhood leukemia were investigated in two case-control studies in offspring of women using folic acid supplementation during pregnancy (Amigou et al. 2012; Milne et al. 2012). Both studies indicated no negative effects of folic acid supplementation during pregnancy. A secondary analysis of one of the single studies on colorectal adenomas found a statistically significant increased risk of prostate cancer following folic acid supplementation (Figueiredo et al. 2009). However, the small number of prostate cancer cases in this single study does not make this result robust. In six studies circulating UMFA was reported among subjects who used folic acid supplements or who were subjected to folic acid food fortification. Whether UMFA contributes to the development of cancer or other undesirable health effects is not known. These studies do not provide new evidence for amending the existing UL for folic acid. About 26% of women and 18% of men aged 18-70 years participating in the nationwide dietary survey Norkost 3, reported to take folic acid supplements. The mean intake of folic acid among users was149 μg/day among women and 172 μg/day among men. Among pregnant women participating in The Norwegian Mother and Child Cohort Study, 62% reported use of folic acid supplements in 2008. Mean folic acid intake was 388 μg/day, and the 95 th percentile was 800 μg/day. Information on intake of folic acid from supplements for other age groups is not available. Intake of folic acid from fortified foods is not available in the national food consumption surveys for any age groups. However, according to a Norwegian model for food fortification from 2006 and later updates (last update in 2013), 53 μg folic acid per 100 kcal can be added to food and drinks Haugen et al.; EJNFS, 5(4): 305-307, 2015; Article no.EJNFS.2015.028 307 without exceeding the UL for folic acid in any age groups. With the current levels of folic acid in food supplements and current levels in fortified products, the UL for folic acid will not be exceeded. VKM was also requested to assess the impact of any increase of the current maximum limit of 200 μg for folic acid in supplements. Increasing the maximum limits in food supplements to 400 μg will imply exceedance of UL for children younger than 6 years and an intake close to UL in children 7-10 years. An increase in the maximum limits in food supplements to 600 μg will imply exceedance of UL for children younger than 10 years and an intake close to UL in children 11-14 years. Increasing the maximum limits in food supplements to 400 μg or 600 μg will not imply exceedance of UL among adults as evaluated in the Norwegian food fortification model (VKM, 2013). No new evidence for increased risk of cancer related to folic acid was found in the reviewed literature. Studies in subjects who had a history of colorectal adenomas, a group considered particularly vulnerable to develop cancer, reported no increased risk of colon cancer or adenomas after 3-5 years of treatment with 1000 μg of folic acid per day. VKM therefore concludes that studies published after 2009 and until 15 October 2014 examining cancer do not provide support to alter the existing UL for folic acid.

Predictors of time to recovery in infants with probable serious bacterial infection.

Abstract: Introduction Serious bacterial infections continue to be an important cause of death and illness among infants in developing countries. Time to recovery could be considered a surrogate marker of severity of the infection. We therefore aimed to identify clinical and laboratory predictors of time to recovery in infants with probable serious bacterial infection (PSBI). Methods We used the dataset of 700 infants (7-120 days) enrolled in a randomised controlled trial in India in which 10mg of oral zinc or placebo was given to infants with PSBI. PSBI was defined as signs/symptoms of possible serious bacterial infection along with baseline C-reactive protein(CRP) level >12mg/L. Time to recovery was defined as time from enrolment to the end of a 2-day period with no symptoms/signs of PSBI and daily weight gain of at least 10g over 2 succesive days on exclusive oral feeding. Cox proportional hazard regression was used to measure the associations between relevant variables and time to recovery. Results Infants who were formula fed prior to illness episode had 33% longer time to recovery (HR-0.67, 95%CI-0.52, 0.87) than those who were not. Being underweight (HR-0.84, 95%CI-0.70, 0.99), lethargic (HR-0.77, 95%CI-0.62, 0.96) and irritable (HR-0.81, 95%CI-0.66, 0.99) were independent predictors of time to recovery. Baseline CRP was significantly associated with time to recovery (P Conclusion Simple clinical and laboratory parameters such as formula feeding prior to the illness, being underweight, lethargic, irritable and having elevated CRP levels could be used for early identification of infants with PSBI at risk for protracted illness and could guide prompt referral to higher centers in resource limited settings. This also provides prognostic information to clinicians and family as longer recovery time has economic and social implications on the family in our setting. Trial registration ClinicalTrials.gov NCT00347386.

Risk assessment of “other substances” – eicosapentaenoic acid, docosapentaenoic acid and docosahexaenoic acid. Opinion of the Panel on Nutrition, Dietetic Products, Novel Food and Allergy of the Norwegian Scientific Committee for Food Safety

Abstract: The Norwegian Scientific Committee for Food Safety (Vitenskapskomiteen for mattrygghet, VKM) has, at the request of the Norwegian Food Safety Authority (Mattilsynet; NFSA), assessed the risk of “other substances” in food supplements and energy drinks sold in Norway. VKM has assessed the risk of doses given by NFSA. These risk assessments will provide NFSA with the scientific basis while regulating the addition of “other substances” to food supplements and other foods. “Other substances” are described in the food supplement directive 2002/46/EC as substances other than vitamins or minerals that have a nutritional or physiological effect. The substance is added mainly to food supplements, but also to energy drinks and other foods. VKM has not in this Grey Literature Frøyland et al.; EJNFS, 9(1): 18-21, 2019; Article no.EJNFS.2019.004 19 series of risk assessments of “other substances” evaluated any potential beneficial effects from these substances, only possible adverse effects. The present report is a risk assessment of eicosapentaenoic acid (EPA), docosapentaenoic acid (DPA) and docosahexaenoic acid (DHA) in food supplements, and is based on previous risk assessments and a literature search. It is emphasised that this risk assessment concerns the single fatty acids EPA, DPA or DHA separately and not mixtures of these as found in e.g. fish oil/cod liver oil. For risk assessment of combined mixtures of n-3 LCPUFAs in e.g. fish oil/cod liver oil, see the EFSA opinion from 2012 or the VKM assessment from 2011 (EFSA, 2012; VKM, 2011). In the reviewed literature of this risk assessment, no studies investigating ratios between EPA, DPA, DHA or other fatty acids in mixtures have been identified. EPA, DPA and DHA are long chain n-3 polyunsaturated fatty acids (n-3 LCPUFA) and in food these fatty acids are incorporated in triacylglycerols (TAGs) and phospholipids (PLs). Dietary sources are fatty fish, cod liver-, seal-, whale-, fishand krill oils and human milk, containing various ratios of these fatty acids in combination. EPA can be metabolised to eicosanoids such as prostaglandins, prostacyclins and leukotrienes, all groups are biologically active substances. The eicosanoids participate in the regulation of blood pressure, renal function, blood coagulation, inflammatory and immunological reactions. DHA is an essential structural component of the brain, skin, sperm, testicles and retina. DPA can be retro-converted to EPA or converted to DHA. Still little is known of the biological effects of DPA. Humans have a limited capacity to synthesise EPA, DPA and subsequently DHA from the precursor alpha-linolenic acid (ALA), and this endogenous production is negligible in comparison to the doses used in supplementation studies. According to information from the NFSA, EPA, DPA and DHA are food supplement ingredients in Norway, and NFSA has requested a risk assessment of these fatty acids in the following doses in food supplements: EPA: 1500, 1750 and 1825 mg/day DPA: 100, 125 and 150 mg/day DHA: 1050 and 1290 mg/day Children below 10 years were not included in the terms of reference. Information about intake of EPA, DPA and DHA from the diet is scarce, but calculations performed in the Norwegian Mother and Child Cohort Study indicate a mean total intake (SD) from food and supplements of EPA around 330 (340) mg/day, DPA 43 (30) mg/day and DHA 430 (380) mg/day among pregnant women (2002 to 2008). Mean combined intake of EPA, DPA and DHA from fish oil/ cod liver oil in adults participating in a nationally representative dietary survey was 735 mg/day (VKM, 2014). The major concerns with high intake of EPA and DHA have been increased bleeding time, adverse effects related to immune function, lipid peroxidation and glucose homeostasis. EFSA concluded in 2012 that long-term supplemental intakes of 5 g/day of the n-3 LCPUFA do not raise safety concerns for adults with regard to an increased risk of spontaneous bleeding episodes or bleeding complications, or affect glucose homeostasis, immune function or lipid peroxidation. In 2011, VKM concluded that an intake n-3 LCPUFA up to 6.9 g/day was not associated with increased risk of any serious adverse events. Some adverse health effects related to gastrointestinal function, including abdominal cramps, flatulence, eructation, vomiting and diarrhea have been reported, but seem to be associated with intake of an oily substance and not related specifically to EPA, DPA and/or DHA. Frøyland et al.; EJNFS, 9(1): 18-21, 2019; Article no.EJNFS.2019.004 20 EPA: In the report from 2012, EFSA concluded that 1.8 g/day of supplemental EPA does not raise safety concerns in adults. None of the included studies from our literature searches limited to 2012 and onwards have investigated bleeding complications. The dosages of EPA in the three included studies in this report range from 1.8 to 3.8 g/day for 12 weeks. The main endpoints in the studies included lipid peroxidation, inflammation biomarkers of cardiovascular diseases and no serious adverse events were found related to the main endpoints. In general, adverse events were described as gastrointestinal discomforts and not related to dosage. Studies of longer duration are necessary before an intake above 1.8 g of EPA can be considered safe. The Norwegian Scientific Committee for Food Safety (VKM) concludes that the specified doses of 1500, 1750, 1825 mg/day of EPA in food supplements are unlikely to cause adverse health effects in adults (≥18 years). In 2012, EFSA did not make conclusions for children or adolescents for EPA. No new studies with EPA supplementation have been identified in children or adolescents after 2012, and therefore no risk assessment can be made for children (≥10 years) or adolescents. DPA: No dosage of DPA in food supplements can be evaluated due to lack of data. DHA: EFSA concluded that 1 g/day of supplemental DHA does not raise safety concerns for the general population (including children and adolescents). The dosages of DHA in the included trials in this report range from 1.0 to 3.6 g/day and the duration from five weeks to four years. Six out of seven studies have used dosages from 1 to 2 g DHA/day. The last study included up to 3.6 g DHA/day for four years and the age spanned from 7 to 31 years. The main endpoints in all studies included lipid peroxidation, inflammation, cognitive performance, blood pressure and biomarkers of cardiovascular diseases and no serious adverse events were found related to the main endpoints. In general, adverse events were described as gastrointestinal discomforts and not related to dosage. VKM therefore considers that the specified daily doses of DHA that moderately exceed 1 g per day (1050 and 1290 mg/day) are unlikely to cause adverse health effects in the general population including children ≥10 years and adolescents. VKM concludes that the specified doses of 1050 and 1290 mg/day of DHA in food supplements are unlikely to cause adverse health effects in the general population including children (≥10 years), adolescents and adults (≥18 years).