naturopathydigest.com -- Critical Research

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Critical Research

Critical Research is a regular feature in Naturopathy Digest. Each month, we provide abstracts from studies published in the top peer-reviewed journals; each abstract includes the complete citation and an online link to the journal. Whenever possible, this link directs you to a page where you can order the full text of the study, if desired.

This Month's Featured Abstract

Influence of maternal vitamin D status on infant oral health.

Schroth R, Lavelle C, Moffatti ME

Objectives: Inadequate maternal 25(OH)D levels during pregnancy may affect primary tooth calcification, predisposing enamel hypoplasia (EH), a risk factor for early-childhood caries (ECC). The purpose of the study was to determine the 25(OH)D status of expectant mothers, the incidence of EH and ECC among their infants and the relationship between prenatal 25(OH)D levels and both EH and ECC.

Methods: This prospective study recruited participants during pregnancy. A prenatal questionnaire was completed and serum sample drawn for 25(OH)D assay. Infant dental exams were completed at follow-up appointments; EH and ECC were recorded while the parent/caregiver completed a questionnaire. The examiner was blinded to each mother's vitamin D status. EH and ECC were defined by established indices. A p value of ≤ 0.05 denoted significance.

Results: 206 women were enrolled during their second trimester. The mean serum 25(OH)D was 48.1 ± 24.4 nmol/L. 34.5% had levels ≤ 35 nmol/L, a formerly defined threshold of deficiency. Only 21 women (10.5%) had concentrations ≥ 80 nmol/L, denoting adequacy. Vitamin-D concentrations were related to the frequency of milk consumption and prenatal vitamin use (p<.001). 135 infants (55.6% male) were examined at 16.1 ± 7.4 months of age. 21.6% had EH while 33.6% had ECC. Mothers of children with EH had lower but not significantly different mean serum 25(OH)D concentrations during pregnancy than those of children without EH (43.2 vs. 51.4 nmol/L, p=.07). However, mothers of children with ECC had significantly lower 25(OH)D levels than those whose children were caries-free (43.9 vs. 52.8 nmol/L, p=.034). Infants with EH were significantly more likely to have ECC (p<.001).

Conclusions: This study shows for the first time that maternal vitamin-D levels may have an influence on the primary dentition and the development of ECC.

Source: 2008 International Association for Dental Research Annual Meeting, July 4, Toronto.

Weight loss with a low-carbohydrate, Mediterranean, or low-fat diet.

Shai I, Schwarzfuchs D, Henkin Y, et al.

Background: Trials comparing the effectiveness and safety of weight-loss diets are frequently limited by short follow-up times and high dropout rates.

Methods: In this 2-year trial, we randomly assigned 322 moderately obese subjects (mean age, 52 years; mean body-mass index [the weight in kilograms divided by the square of the height in meters], 31; male sex, 86%) to one of three diets: low-fat, restricted-calorie; Mediterranean, restricted-calorie; or low-carbohydrate, non-restricted-calorie.

Results: The rate of adherence to a study diet was 95.4% at 1 year and 84.6% at 2 years. The Mediterranean-diet group consumed the largest amounts of dietary fiber and had the highest ratio of monounsaturated to saturated fat (P<0.05 for all comparisons among treatment groups). The low-carbohydrate group consumed the smallest amount of carbohydrates and the largest amounts of fat, protein, and cholesterol, and had the highest percentage of participants with detectable urinary ketones (P<0.05 for all comparisons among treatment groups). The mean weight loss was 2.9 kg for the low-fat group, 4.4 kg for the Mediterranean-diet group, and 4.7 kg for the low-carbohydrate group (P<0.001 for the interaction between diet group and time); among the 272 participants who completed the intervention, the mean weight losses were 3.3 kg, 4.6 kg, and 5.5 kg, respectively. The relative reduction in the ratio of total cholesterol to high-density lipoprotein cholesterol was 20% in the low-carbohydrate group and 12% in the low-fat group (P=0.01). Among the 36 subjects with diabetes, changes in fasting plasma glucose and insulin levels were more favorable among those assigned to the Mediterranean diet than among those assigned to the low-fat diet (P<0.001 for the interaction among diabetes and Mediterranean diet and time with respect to fasting glucose levels).

Conclusions: Mediterranean and low-carbohydrate diets may be effective alternatives to low-fat diets. The more favorable effects on lipids (with the low-carbohydrate diet) and on glycemic control (with the Mediterranean diet) suggest that personal preferences and metabolic considerations might inform individualized tailoring of dietary interventions.

Source: N Engl J Med, July 17, 2008;359(3):229-41.

Dietary fiber intake in early pregnancy and risk of subsequent preeclampsia.

Qiu C, Coughlin KB, Frederick IO, et al.

Background: Substantial epidemiological evidence documents diverse health benefits, including reduced risks of hypertension, associated with diets high in fiber. Few studies, however, have investigated the extent to which dietary fiber intake in early pregnancy is associated with reductions in preeclampsia risk. We assessed the relationship between maternal dietary fiber intake in early pregnancy and risk of preeclampsia. We also evaluated cross-sectional associations of maternal early pregnancy plasma lipid and lipoprotein concentrations with fiber intake.

Methods: The study population comprised 1,538 pregnant Washington state residents. A 121-item food frequency questionnaire (FFQ) was used to assess maternal dietary intake, 3 months before and during early pregnancy; and generalized linear regression procedures were used to derive relative risk (RR) and 95% confidence intervals (CIs).

Results: Dietary total fiber intake was associated with reduced preeclampsia risk. After adjusting for confounders, the RR of preeclampsia for women in the highest (>/=21.2 g/day) vs. the lowest quartile (<11.9 g/day) was 0.28 (95% CI = 0.11-0.75). We observed associations of similar magnitude when the highest vs. the lowest quartiles of water-soluble fiber (RR = 0.30; 95% CI = 0.11-0.86) and insoluble fiber (RR = 0.35; 95% CI = 0.14-0.87) were evaluated. Mean triglyceride concentrations were lower (-11.9 mg/dl, P = 0.02) and high-density lipoprotein cholesterol concentrations were higher (+2.63 mg/dl, P = 0.09) for women in the highest quartile vs. those in the lowest quartile.

Conclusions: These findings of reduced preeclampsia risk with higher total fiber intake corroborate an earlier report and expand the literature by providing evidence which suggests that dietary fiber may attenuate pregnancy-associated dyslipidemia, an important clinical characteristic of preeclampsia.

Source: Am J Hypertens. August 2008;21(8):903-9.

Sleep disturbance during the menopausal transition in a multi-ethnic community sample of women.

Kravitz HM, Zhao X, Bromberger JT, et al.

Study Objectives: Examine age-adjusted odds and racial/ethnic differences in self-reported difficulties falling and staying asleep and early morning awakening in midlife women to determine whether difficulty sleeping increased with progression through the menopausal transition.

Design: Longitudinal analysis.

Setting: Community-based.

Participants: 3,045 Caucasian, African American, Chinese, Japanese, and Hispanic women, aged 42-52 years and pre- or early peri-menopausal at baseline, participating in the Study of Women's Health Across the Nation (SWAN).

Interventions: None.

Measurements and Results: Self-reported number of nights of difficulty falling asleep, staying asleep, and early morning awakening during the previous 2 weeks were obtained at baseline and 7 annual assessments. Random effects logistic regression was used to model associations between each of the 3 sleep measures and the menopausal transition, defined by bleeding patterns, vasomotor symptoms (VMS), and estradiol (E2) and follicle stimulating hormone (FSH) serum levels. Adjusted odds ratios (ORs) for difficulty falling asleep and staying asleep increased through the menopausal transition, but decreased for early morning awakening from late perimenopause to postmenopause. Naturally and surgically postmenopausal women using hormones, compared with those who were not, generally had lower ORs for disturbed sleep. More frequent VMS were associated with higher ORs of each sleep difficulty. Decreasing E2 levels were associated with higher ORs of trouble falling and staying asleep, and increasing FSH levels were associated with higher ORs of trouble staying asleep. Racial/ethnic differences were found for staying asleep and early morning awakening.

Conclusions: Progression through the menopausal transition as indicated by 3 menopausal characteristics–symptoms, bleeding-defined stages, and endogenous hormone levels–is associated with self-reported sleep disturbances.

Source: Sleep 2008;31(7):979-90.

Weight loss during the intensive intervention phase of the weight-loss maintenance trial.

Hollis JF, Gullion CM, Stevens VJ, et al.

Background: To improve methods for long-term weight management, the Weight Loss Maintenance (WLM) trial, a four-center randomized trial, was conducted to compare alternative strategies for maintaining weight loss over a 30-month period. This paper describes methods and results for the initial 6-month weight-loss program (Phase I).

Methods: Eligible adults were aged >/=25, overweight or obese (BMI=25-45 kg/m(2)), and on medications for hypertension and/or dyslipidemia. Anthropomorphic, demographic, and psychosocial measures were collected at baseline and 6 months. Participants (n=1685) attended 20 weekly group sessions to encourage calorie restriction, moderate-intensity physical activity, and the DASH (dietary approaches to stop hypertension) dietary pattern. Weight-loss predictors with missing data were replaced by multiple imputation.

Results: Participants were 44% African American and 67% women; 79% were obese (BMI>/=30), 87% were taking anti-hypertensive medications, and 38% were taking antidyslipidemia medications. Participants attended an average of 72% of 20 group sessions. They self-reported 117 minutes of moderate-intensity physical activity per week, kept 3.7 daily food records per week, and consumed 2.9 servings of fruits and vegetables per day. The Phase-I follow-up rate was 92%. Mean (SD) weight change was -5.8 kg (4.4), and 69% lost at least 4 kg. All race-gender subgroups lost substantial weight: African-American men (-5.4 kg +/- 7.7); African-American women (-4.1 kg +/- 2.9); non-African-American men (-8.5 kg +/- 12.9); and non-African-American women (-5.8 kg +/- 6.1). Behavioral measures (e.g., diet records and physical activity) accounted for most of the weight-loss variation, although the association between behavioral measures and weight loss differed by race and gender groups.

Conclusions: The WLM behavioral intervention successfully achieved clinically significant short-term weight loss in a diverse population of high-risk patients.

Source: Am J Prev Med, August 2008;35(2):118-26.

Weight gain in older adolescent females: the Internet, sleep, coffee, and alcohol.

Berkey CS, Rockett HR, Colditz GA

Objectives: To examine whether excessive recreational Internet time, insufficient sleep, regular coffee consumption, or alcoholic beverages promote weight gain.

Study Design: A longitudinal cohort of >5,000 girls (Growing Up Today Study), from all over the United States and aged 14 to 21 years returned surveys in 2001 reporting typical past-year recreational Internet time, sleep, coffee (with caffeine), and alcohol consumption. We estimated correlations among these 4 exposures. Each girl also reported her height and weight in 2000 and again in 2001. Multivariate models investigated associations between 1-year change in body mass index and same-year exposures, adjusted for adolescent growth/development, activity, and inactivity.

Results: The exposures were highly (P < .0001) correlated with each other, except for coffee with Internet time (P > .50). More Internet time, more alcohol, and less sleep were all associated (P < .05) with same-year increases in body mass index. Females, aged 18+ years, who slept
Conclusions: Older girls may benefit from replacing recreational Internet time with sleep and by avoiding alcohol.

Source: J Pediat, July 7, 2008. [Epub ahead of print].

Assessing "fun foods": nutritional content and analysis of supermarket foods targeted at children.

Elliott C

This article provides a nutritional profile of foods targeted specifically at children in the Canadian supermarket. Excluding confectionery, soft drinks and bakery items, 367 products were assessed for their nutritional composition. The article examines the relationship between "fun food" images/messages, product claims and actual product nutrition. Among other findings, it concludes that approximately 89% of the products analyzed could be classified as of poor nutritional quality owing to high levels of sugar, fat and/or sodium. Policy considerations need to be made in light of the fact that "fun food" is a unique category that poses special challenges; as such, recommendations regarding food labeling and packaging are presented.

Source: Obes Rev, July 2008;9(4):368-77.