Suchergebnisse

There is growing interest in preconception health as a crucial period for influencing not only pregnancy outcomes, but also future maternal and child health, and prevention of long-term medical conditions. Successive national and international policy documents emphasise the need to improve preconception health, but resources and action have not followed through with these goals. We argue for a dual intervention strategy at both the public health level (eg, by improving the food environment) and at the individual level (eg, by better identification of those planning a pregnancy who would benefit from support to optimise health before conception) in order to raise awareness of preconception health and to normalise the notion of planning and preparing for pregnancy. Existing strategies that target common risks factors, such as obesity and smoking, should recognise the preconception period as one that offers special opportunity for intervention, based on evidence from life-course epidemiology, developmental (embryo) programming around the time of conception, and maternal motivation. To describe and monitor preconception health in England, we propose an annual report card using metrics from multiple routine data sources. Such a report card should serve to hold governments and other relevant agencies to account for delivering interventions to improve preconception health.

Objective: Dietary intake of toddlers has been of growing interest due to its long-term consequences on health. However, previous works have focused largely on Caucasian populations and less is known about Asian toddlers. We aimed to validate a semi-quantitative FFQ designed to assess dietary intakes of 18-month-old toddlers in a multi-ethnic Asian cohort. Design: An FFQ of ninety-four food items, identified based on food records of 12-month-old GUSTO children, the Southampton Women's Survey 12 Month Infancy Questionnaire and inputs from paediatric dietitians, was filled out two weeks before the 18th-month clinic visit. As the reference method, two non-consecutive 24 h recalls (24HR) were administered during and two weeks after the clinic visit. FFQ nutrient intakes were validated against averaged 24HR nutrient intakes, using the Wilcoxon signed-rank test, Spearman's rank-order correlation, cross-classification and the Bland–Altman method. Setting: Data from the Singapore Growing Up in Singapore Towards Healthy Outcomes (GUSTO) mother–offspring birth cohort. Participants: Toddlers (n 188) aged 18 months. Results: Absolute nutrient intakes from the FFQ were significantly higher than from the 24HR, except for vitamin A. After energy adjustments, r range was 0·56–0·78 (macronutrients) and 0·40–0·54 (micronutrients). De-attenuation increased r to 0·58–0·96 and 0·45–0·65 for macro- and micronutrients, respectively. Of participants, ≥82·4 % (macronutrients) and ≥77·7 % (micronutrients) were classified in the same and adjacent quartiles. No clear systematic increase in intake differences with increasing mean intake was observed in Bland–Altman plots. Conclusions: This FFQ can provide a satisfactory assessment of toddlers' energy-adjusted nutrient intakes, as well as accurately rank them in a group. ; Agency for Science, Technology and Research (A*STAR) ; Ministry of Health (MOH) ; National Medical Research Council (NMRC) ; National Research Foundation (NRF) ; Published version ; This research is supported by the Singapore National Research Foundation under its Translational and Clinical Research (TCR) Flagship Programme and administered by the Singapore Ministry of Health's National Medical Research Council (NMRC), Singapore (grant numbers NMRC/TCR/004-NUS/2008 and NMRC/TCR/012-NUHS/2014). K.M.G. is supported by the UK Medical Research Council (grant number MC_UU_12011/4); the National Institute for Health Research (as an NIHR Senior Investigator (grant number NF-SI-0515-10042) and through the NIHR Southampton Biomedical Research Centre); and the European Union's Erasmus+ Capacity-Building ENeASEA Project and Seventh Framework Programme (FP7/2007-2013), projects EarlyNutrition and ODIN (grant agreement numbers 289346 and 613977). Additional funding is provided by the Singapore Institute for Clinical Sciences, Agency for Science Technology and Research (A*STAR), Singapore.

Vitamin D is an essential micronutrient whose demand is heightened during pregnancy to support the growth of the fetus. Furthermore, the fetus does not produce vitamin D and hence relies exclusively on the supply of maternal vitamin D through the placenta. Vitamin D inadequacy is linked with pregnancy complications and adverse infant outcomes. Hence, early predictive markers of vitamin D inadequacy such as genetic vulnerability are important to both mother and offspring. In this multi-ethnic Asian birth cohort study, we report the first genome-wide association analysis (GWAS) of maternal and fetal vitamin D in circulation. For this, 25-hydroxyvitamin D (25OHD) was measured in the antenatal blood of mothers during mid gestation (n=942), and the cord blood of their offspring at birth (n=812). Around ~7 million single nucleotide polymorphisms (SNPs) were regressed against 25OHD concentrations to identify genetic risk variants. About 41% of mothers had inadequate 25OHD (≤75nmol/L) during pregnancy. Antenatal 25OHD was associated with ethnicity [Malay (Β=-22.32nmol/L, p=2.3×10-26); Indian (Β=-21.85, p=3.1×10-21); reference Chinese], age (Β=0.47/year, p=0.0058), and supplement intake (Β=16.47, p=2.4×10-13). Cord blood 25OHD highly correlated with antenatal vitamin D (r=0.75) and was associated with ethnicity [Malay (Β=-4.44, p=2.2×10-7); Indian (Β=-1.99, p=0.038); reference Chinese]. GWAS analysis identified rs4588, a missense variant in the group-specific component (GC) gene encoding vitamin D binding protein (VDBP), and its defining haplotype, as a risk factor for low antenatal (Β=-8.56/T-allele, p=1.0×10-9) and cord blood vitamin D (Β=-3.22/T-allele, p=1.0×10-8) in all three ethnicities. We also discovered a novel association in a SNP downstream of CYP2J2 (rs10789082), a gene involved in 25-hydroxylation of vitamin D, with vitamin D in pregnant women (Β=-7.68/G-allele, p=1.5×10-8), but not their offspring. As the prevention and early detection of suboptimal vitamin D levels are of profound importance to both mother and offspring's health, the genetic risk variants identified in this study allow risk assessment and precision in early intervention of vitamin D deficiency. ; National Research Foundation (NRF) ; Published version ; This research is supported by the Singapore National Research Foundation under its Translational and Clinical Research (TCR) Flagship Program on Developmental Pathways to Metabolic Disease and administered by the Singapore Ministry of Health's National Medical Research Council (NMRC), Singapore-NMRC/TCR/004-NUS/2008; NMRC/TCR/012-NUHS/2014. KMG is supported by the UK Medical Research Council (MC_UU_12011/4), the National Institute for Health Research (NIHR Senior Investigator (NF-SI-0515-10042) and NIHR Southampton Biomedical Research Centre (IS-BRC-1215-20004)), the European Union (Erasmus+ Programme ImpENSA 598488-EPP-1-2018-1-DE-EPPKA2-CBHE-JP) and the British Heart Foundation (RG/15/17/3174, SP/F/21/150013). Additional funding is provided by the Singapore Institute for Clinical Sciences (SICS), Joint Council Office (JCO) Grant (JCO1431AFG110), and Strategic Positioning Fund (SPF) awarded to NK by the Agency for Science, Technology and Research (A*STAR), Singapore.

In preterm infants, poor postnatal growth is associated with adverse neurocognitive outcomes; conversely, rapid postnatal growth is supposedly harmful for future development of metabolic diseases. CONCLUSION: In this systematic review, observational studies reported consistent positive associations between postnatal weight or head growth and neurocognitive outcomes; however, there was limited evidence from the few intervention studies. Evidence linking postnatal weight gain to later adiposity and other cardiovascular disease risk factors in preterm infants was also limited. ; The expert group received funding from the ILSI Europe Metabolic Imprinting Task Force (please see acknowledgements for further information). Industry members of this task force are listed on the ILSI Europe website at www.ilsi.eu. KMG is supported by the National Institute for Health Research through the NIHR Southampton Biomedical Research Centre and by the European Union's Seventh Framework Programme (FP7/2007-2013), project EarlyNutrition under grant agreement no 289346. ; This is the final version of the article. It first appeared from Wiley via http://dx.doi.org/10.1111/apa.13128

Time spent in movement behaviours, including physical activity (PA), sedentary behaviour (SB) and sleep, across the 24-h day may have distinct health consequences. We aimed to describe 24-h movement behaviour (24 h-MB) profiles in children and how profile membership changed from age 5.5 to 8 years. ; Agency for Science, Technology and Research (A*STAR) ; Ministry of Health (MOH) ; National Research Foundation (NRF) ; Published version ; This research is supported by the Singapore National Research Foundation under its Translational and Clinical Research (TCR) Flagship Programme and administered by the Singapore Ministry of Health's National Medical Research Council (NMRC), Singapore- NMRC/TCR/004-NUS/2008; NMRC/TCR/012NUHS/2014. Additional funding is provided by the Singapore Institute for Clinical Sciences, Agency for Science Technology and Research (A*STAR), Singapore. KMG is supported by the UK Medical Research Council (MC_ UU_12011/4), the National Institute for Health Research (NIHR Senior Investi‑ gator (NF-SI-0515-10042), NIHR Southampton 1000DaysPlus Global Nutrition Research Group (17/63/154) and NIHR Southampton Biomedical Research Centre (IS-BRC-1215-20004)), the British Heart Foundation (RG/15/17/3174) and by the European Union's Erasmus+ Capacity-Building ENeASEA Project ImpENSA (598488-EPP-1-2018-1-DE-EPPKA2-CBHE-JP).

Lutein and zeaxanthin play important roles in visual functions, but their influence on early visual development is unclear. We related maternal lutein and zeaxanthin concentrations during pregnancy to offspring visual acuity (VA) in 471 mother-child pairs from the Growing Up in Singapore Towards healthy Outcomes (GUSTO) cohort. Maternal concentrations of plasma lutein and zeaxanthin were determined at delivery. We measured uncorrected distance of VA in 3-year old children using a LEA Symbols chart; readings were converted to the logarithm of Minimum Angle of Resolution (logMAR), with >0.3 logMAR indicating poor VA. Associations were examined using linear or Poisson regression adjusted for confounders. The median (inter-quartile range) of maternal lutein and zeaxanthin concentrations were 0.13 (0.09, 0.18) and 0.09 (0.07, 0.12) µmol/L, respectively. A total of 126 children had poor VA. The highest tertile of maternal zeaxanthin concentration was associated with 38% lower likelihood of poor VA in children (95% CI: 0.42, 0.93, p-Trends = 0.02). Higher maternal lutein concentrations were associated with a lower likelihood of poor VA in children (RR 0.60 (95% CI: 0.40, 0.88) for middle tertile; RR 0.78 (95% CI: 0.51, 1.19) for highest tertile (p-Quadratic = 0.02)). In conclusion, lutein and zeaxanthin status during pregnancy may influence offspring early visual development; but the results require confirmation with further studies, including more comprehensive measurements of macular functions. ; Agency for Science, Technology and Research (A*STAR) ; Ministry of Education (MOE) ; National Medical Research Council (NMRC) ; National Research Foundation (NRF) ; Published version ; GUSTO was funded by the Singapore National Research Foundation's Translational and Clinical Research (TCR) Flagship Programme and administered by the Singapore Ministry of Health's National Medical Research Council (NMRC), Singapore—NMRC/TCR/004-NUS/2008; NMRC/TCR/012-NUHS/2014. Singapore Institute for Clinical Sciences, A*STAR, and MOE Academic Research Fund provided additional funding. KMG is supported by the National Institute for Health Research through the NIHR Southampton Biomedical Research Centre and by the European Union's Seventh Framework Programme (FP7/2007–2013), project Early Nutrition under grant agreement n◦289346.

Abnormalities of red blood cell (RBC) indices may affect glycated haemoglobin (HbA1c) levels. We assessed the influence of haemoglobin (Hb) and mean corpuscular volume (MCV) on the performance of HbA1c in detecting dysglycaemia among reproductive aged women planning to conceive. Women aged 18-45 years (n = 985) were classified as normal (12 ≤ Hb ≤ 16 g/dL and 80 ≤ MCV ≤ 100 fL) and abnormal (Hb < 12 g/dL and/or MCV < 80 fL). The Area Under the Receiver Operating Characteristic (AUROC) curve was used to determine the performance of HbA1c in detecting dysglycaemic status (prediabetes and diabetes). There were 771 (78.3%) women with normal RBC indices. The AUROCs for the normal and abnormal groups were 0.75 (95% confidence interval 0.69, 0.81) and 0.80 (0.70, 0.90), respectively, and were not statistically different from one another [difference 0.04 (- 0.16, 0.08)]. Further stratification by ethnicity showed no difference between the two groups among Chinese and Indian women. However, Malay women with normal RBC indices displayed lower AUROC compared to those with abnormal RBC indices (0.71 (0.55, 0.87) vs. 0.98 (0.93, 1.00), p = 0.002). The results suggest that the performance of HbA1c in detecting dysglycaemia was not influenced by abnormal RBC indices based on low Hb and/or low MCV. However, there may be ethnic variations among them. ; Agency for Science, Technology and Research (A*STAR) ; National Medical Research Council (NMRC) ; National Research Foundation (NRF) ; Published version ; This research is supported by the Singapore National Research Foundation under its Translational and Clinical Research (TCR) Flagship Programme and administered by the Singapore Ministry of Health's National Medical Research Council (NMRC), Singapore—NMRC/TCR/004-NUS/2008; NMRC/TCR/012-NUHS/2014. Additional funding is provided by the Singapore Institute for Clinical Sciences, Agency for Science Technology and Research (A*STAR), Singapore. YBC is supported by a Clinician Scientist Award from the Singapore NMRC (NMRC/CSA/0039/2012). KMG is supported by the UK Medical Research Council (MC_UU_12011/4), the National Institute for Health Research (NIHR Senior Investigator (NF-SI-0515-10042)) and NIHR Southampton Biomedical Research Centre (IS-BRC-1215-20004)), the European Union (Erasmus+ Programme ImpENSA 598488-EPP-1-2018-1-DE-EPPKA2-CBHE-JP) and the British Heart Foundation (RG/15/17/3174). SYC is supported by a Clinician Scientist Award from the Singapore NMRC (NMRC/CSA-INV/0010/2016). JKYC is supported by a Clinician Scientist Award from the Singapore NMRC (CSA(SI)/008/2016). The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results.

Nausea and vomiting of pregnancy (NVP) is common and underlying mechanisms are poorly understood. Longer-term offspring outcomes are also not well documented. This study aimed to determine if NVP, even in milder forms, is associated with adverse pregnancy and childhood growth outcomes. ; Agency for Science, Technology and Research (A*STAR) ; National Medical Research Council (NMRC) ; National Research Foundation (NRF) ; Published version ; Singapore National Research Foundation (NMRC/TCR/004-NUS/2008; NMRC/ TCR/012-NUHS/2014). Additional funding is provided by the Singapore government-funded Agency for Science Technology and Research (A*STAR).

Funding Information: Conflicts of Interest: K.M.G., Y.-S.C. and S.-Y.C. report being part of an academic consortium that has received research funding from Abbott Nutrition, Nestle and Danone. K.M.G. and Y.-S.C. report receiving reimbursement for speaking at conferences sponsored by companies selling nutritional products. The other authors declared no conflict of interests. The funders had no role in the choice of research project, design of this study, data collection and statistical analyses, preparation of manuscript and decision to publish. Funding Information: Funding: The GUSTO cohort study was funded by the Singapore National Research Foundation's Translational and Clinical Research (TCR) Flagship Programme and was administered by the Singapore Ministry of Health's National Medical Research Council (NMRC), Singapore— NMRC/TCR/004-NUS/2008; NMRC/TCR/012-NUHS/2014. Additional funding was given by the Singapore Institute for Clinical Sciences, Agency for Science Technology and Research (A*STAR), Singapore. KMG is supported by the UK Medical Research Council (MC_UU_12011/4), the National Institute for Health Research (NIHR Senior Investigator NF-SI-0515-10042), NIHR Southampton 1000DaysPlus Global Nutrition Research Group (17/63/154) and NIHR Southampton Biomedical Research Centre (IS-BRC-1215-20004), the British Heart Foundation (RG/15/17/3174) and by the European Union (Erasmus+ Programme Early Nutrition eAcademy Southeast Asia-573651-EPP-1-2016-1-DE-EPPKA2-CBHE-JP and ImpENSA. Publisher Copyright: © 2021 by the authors. Licensee MDPI, Basel, Switzerland. ; Childcare arrangements shape behavioural patterns that influence the risk of childhood obesity. However, little is known of its influence on childhood obesity in Singapore. We aim to examine the associations between childcare arrangements at the age of 5 years and childhood adiposity at age 6 years. Children from the GUSTO study were grouped into three childcare arrangements at age 5: Full-time centre-based childcare (FC), partial centre-based with parental care (PCP), and partial centre-based with non-parents (grandparents and domestic helpers) as caregivers (PCN). Diet, physical activity and sedentary behaviour information were collected at age 5, while anthropometric measurements were collected at age 6. Associations were analysed using multivariable regression models. Among 540 children, those in PCN had higher BMI z-scores (β: 0.34; 95% CI: 0.01, 0.66), greater sum of skinfold thicknesses (mm) (β: 3.75; 95% CI: 0.53, 6.97) and were 3.55 times (95% CI: 1.78, 7.05) more likely to be overweight/obese than those in FC. Adiposity measures in PCP children did not differ from those in FC. PCN children were reported to have more screen time and greater fast-food intake. Children in PCN tended to have higher adiposity measures. Greater engagement of non-parental caregivers should be considered in interventions targeting child obesity. ; publishersversion ; published

Research on health involves evaluating the disparities that are systematically associated with the experience of risk, including genetic and physiological variation, environmental exposure to poor nutrition and disease, and social marginalization. This volume provides a unique perspective - a comparative approach to the analysis of health disparities and human adaptability - and specifically focuses on the pathways that lead to unequal health outcomes. From an explicitly anthropological perspective situated in the practice and theory of biosocial studies, this book combines theoretical rigor with more applied and practice-oriented approaches and critically examines infectious and chronic diseases, reproduction, and nutrition