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Vitamin B12 concentrations in milk from Norwegian women during the six first months of lactation
Get PDFBackground: Human milk vitamin B12 (B12) concentrations depend on maternal status and intake; only few data are available in high-income countries. Objective: We assessed human milk B12 concentrations during the first 6 months postpartum in Norwegian women and its association with maternal dietary B12 intake and maternal urinary methylmalonic acid (MMA) concentration. Methods: In this cross-sectional study, 175 mothers, exclusively (80%) or partially (20%) breastfeeding, were included. Milk B12 was measured by IMMULITE®/IMMULITE® 1000 B12 competitive protein binding assay and urinary MMA relative to creatinine (MMA/Cr) by liquid chromatography-tandem-mass spectrometry. Maternal habitual B12 intake and supplement use were estimated using a food frequency questionnaire. Results: Mean human milk B12 concentration was 327 pmol/L (range 140-1089), with 402 pmol/L at 1 month (n = 21), 333 pmol/L at four months (n = 32), and 299 pmol/L at 6 months (n = 21). Maternal B12 intake was 5 µg/d, 89% met the Estimated Average Requirement, and supplement use did not affect milk B12 concentrations. MMA/Cr was low in all women compared with published data. In exclusively breastfeeding women, MMA/Cr (beta (95% CI) -42.5 (-82.5, -2.5) and time since birth (-4.9 (-9.6, -0.3)) were significant predictors of human milk B12 concentrations. There was no association between total B12 intake and milk B12 concentration or between total B12 intake and MMA/Cr. Conclusions: Maternal B12 status and human milk B12 concentrations are likely sufficient, based on adequate maternal B12 dietary intake combined with low urinary MMA concentrations. Nevertheless, milk B12 concentration fell during 6 months postpartum while maternal B12 status did not change.Funded by Oslo Metropolitan University.publishedVersio
Postmortem toxicological analyses of blood samples from 107 patients receiving opioid agonist treatment: substances detected and pooled opioid and benzodiazepine concentrations
Get PDFAbstract
Aims: To present the substances and their concentrations detected post-mortem in patients receiving opioid agonist treatment (OAT) stratified by cause of death, estimate the pooled opioid and benzodiazepine concentrations using established conversion factors for blood concentrations from the Norwegian Road Traffic Act, and explore the association between drug-induced cause of death and the pooled opioid and benzodiazepine concentrations.
Design: Cross-sectional nationwide study.
Setting: Norway.
Participants: One hundred and seven patients who died during OAT (i.e. within 5 days after the last intake of OAT medication) between 1 January 2014 and 31 December 2015, with post-mortem femoral blood available for toxicology. Data were collected from hospital records, the Norwegian Cause of Death Registry and autopsy reports.
Measurements: Presence of alcohol and non-alcohol substances in the bloodstream at time of death, determined through records of toxicology of post-mortem femoral blood.
Findings: A median of four substances was detected across the causes of death. At least one benzodiazepine was detected in 81 (76%) patients. The median pooled opioid concentration was significantly higher in drug-induced deaths compared with other causes of death (362 ng/mL versus 182 ng/mL, P < 0.001), in contrast to the pooled benzodiazepine concentration (5466 versus 5701 ng/mL, P = 0.353). The multivariate regression analysis showed that only increasing pooled opioid concentration (ng/ML) was associated with increased odds of a drug-induced cause of death (odds ratio, 1.003; 95% confidence interval: 1.001-1.006).
Conclusions: In Norway, overall opioid concentration seems to play an important role in drug-induced deaths during opioid agonist treatment in patients prescribed methadone or buprenorphine. Patients prescribed buprenorphine tend to replace their agonist with full agonists, while patients prescribed methadone tend to have high opioid concentrations from methadone as the only opioid.
This article is protected by copyright. All rights reserved.publishedVersio
Mild to Moderate Iodine Deficiency and Inadequate Iodine Intake in Lactating Women in the Inland Area of Norway
Get PDFBreastfed infants are dependent on an adequate supply of iodine in human milk for the production of thyroid hormones, necessary for development of the brain. Despite the importance of iodine for infant health, data on Norwegian lactating women are scarce. We measured iodine intake and evaluated iodine status and iodine knowledge among lactating women. From October to December 2018, 133 mother–infant pairs were recruited in a cross-sectional study through two public health care centers in Lillehammer and Gjøvik. Each of the women provided two human milk specimens, which were pooled, and one urine sample for analysis of iodine concentration. We used 24-h dietary recall and food frequency questionnaire (FFQ) to estimate short-term and habitual iodine intake from food and supplements. The median (P25, P75) human milk iodine concentration (HMIC) was 71 (45, 127) µg/L—of which, 66% had HMIC <100 µg/L. The median (P25, P75) urinary iodine concentration (UIC) was 80 µg/L (52, 141). The mean (± SD) 24-h iodine intake and habitual intake was 78 ± 79 µg/day and 75 ± 73 µg/day, respectively. In conclusion, this study confirms inadequate iodine intake and insufficient iodine status among lactating women in the inland area of Norway and medium knowledge awareness about iodine.This study was supported by Innlandet Hospital Trust (150421), The Research Council of Norway, Regional Research Fund Innlandet (286442) and OsloMet.publishedVersio
Xenobiotics, trace metals and genetics in the pathogenesis of tauopathies
Get PDFTauopathies are a disease group characterized by either pathological accumulation or release of fragments of hyperphosphorylated tau proteins originating from the central nervous system. The tau hypotheses of Parkinson’s and Alzheimer’s diseases contain a clinically diverse spectrum of tauopathies. Studies of case records of various tauopathies may reveal clinical phenotype characteristics of the disease. In addition, improved understanding of different tauopathies would disclose environmental factors, such as xenobiotics and trace metals, that can precipitate or modify the progression of the disorder. Important for diagnostics and monitoring of these disorders is a further development of adequate biomarkers, including refined neuroimaging, or proteomics. Our goal is to provide an in-depth review of the current literature regarding the pathophysiological roles of tau proteins and the pathogenic factors leading to various tauopathies, with the perspective of future advances in potential therapeutic strategies.This research was partially funded by the Innlandet Hospital Trust, Norway, and by the Oklahoma
State University Center for Health Sciences Seed/Pilot Grant Program, grant number 154357.publishedVersio
Time from dementia diagnosis to nursing-home admission and death among persons with dementia: A multistate survival analysis
Get PDFObjectives: To estimate transition times from dementia diagnosis to nursing-home (NH) admission or death and to examine whether sex, education, marital status, level of cognitive impairment and dementia aetiology are associated with transition times. Design: Markov multistate survival analysis and flexible parametric models. Setting: Participants were recruited from the Norwegian Registry of Persons Assessed for Cognitive Symptoms (NorCog) in specialist healthcare between 2008 and 2017 and followed until August 2019, a maximum of 10.6 years follow-up time (mean 4.4 years, SD 2.2). Participants’ address histories, emigration and vital status were retrieved from the National Population Registry from time of diagnosis and linked to NorCog clinical data. Participants 2,938 home-dwelling persons with dementia, ages 40–97 years at time of diagnosis (mean 76.1, SD 8.5). Results: During follow-up, 992 persons (34%) were admitted to nursing-homes (NHs) and 1,556 (53%) died. Approximately four years after diagnosis, the probability of living in a NH peaked at 19%; thereafter, the probability decreased due to mortality. Median elapsed time from dementia diagnosis to NH admission among those admitted to NHs was 2.28 years (IQR 2.32). The probability of NH admission was greater for women than men due to women´s lower mortality rate. Persons living alone, particularly men, had a higher probability of NH admission than cohabitants. Age, dementia aetiology and severity of cognitive impairment at time of diagnosis did not influence the probability of NH admission. Those with fewer than 10 years of education had a lower probability of NH admission than those with 10 years or more, and this was independent of the excess mortality in the less-educated group. Conclusion: Four years after diagnosis, half of the participants still lived at home, while NH residency peaked at 19%. Those with fewer than 10 years of education were less often admitted to NH.publishedVersio
Dietary Intake and Biomarkers of Folate and Cobalamin Status in Norwegian Preschool Children: The FINS-KIDS Study
Get PDFBackground: Folate and cobalamin (vitamin B-12) are essential for growth and development. However, few populationbased studies have investigated B-vitamin status in children. Objectives: This study aimed to assess biomarkers of folate and vitamin B-12 status and to explore their dietary determinants in healthy Norwegian children. Methods: Using baseline data obtained from a randomized controlled trial on the effect of fish intake on neurodevelopment in children aged 4–6 y, we measured the plasma concentrations of folate, cobalamin, total plasma homocysteine (tHcy), and methylmalonic acid (MMA). Food-frequency questionnaires (FFQs) were used to assess dietary intake. We used unadjusted and multiple linear regression models to explore the determinants of biomarker concentrations. Results: The median (IQR) of plasma folate (n = 197) and plasma cobalamin (n = 195) concentrations were 15.2 (12.2– 21.1) nmol/L and 785 (632–905) pmol/L, respectively. Plasma folate concentrations of 0.26 μmol/L) and 8 children had elevated tHcy concentrations (>6.5 μmol/L). Plasma folate concentration was inversely correlated with tHcy (ρ = −0.24, P < 0.001); we found no correlation between tHcy and cobalamin (ρ = −0.075, P = 0.30). Children who consumed vitamin supplements had 51% higher plasma folate concentrations (P < 0.0001) than those who did not. Consumption of red meat for dinner more than twice a week was associated with 23% lower plasma folate (P < 0.01). No other significant associations between dietary intake and the biomarkers were observed. Conclusions: The Norwegian preschool children from this cohort had adequate vitamin B-12 status. Poor folate status was common and associated with elevated tHcy. The implications of poor folate status during childhood should be a prioritized research question. This trial was registered at ClinicalTrials.gov as NCT02331667. J Nutr 2020;150:1852–1858.publishedVersio
No effect of increasing protein intake during military exercise with severe energy deficit on body composition and performance
Get PDFIn this study, we compare the effects of isocaloric high- (HIGH: 2 g kg−1d−1, n = 19) and low-protein diet (LOW: 1 g kg−1d−1, n = 19) on changes in body composition, muscle strength, and endocrine variables in response to a 10-day military field exercise with energy deficit, followed by 7 days of recovery. Body composition (DXA), one repetition maximum (1RM) bench and leg press, counter-movement jump height (CMJ) and blood variables were assessed before and after the exercise. Performance and blood variables were reassessed after 7days of recov-ery. The 10-day exercise resulted in severe energy deficit in both LOW and HIGH (−4373±1250, −4271±1075kcald−1) and led to decreased body mass (−6.1%, −5.2%), fat mass (−40.5%, −33.4%), 1RM bench press (−9.5%, −9.7%), 1RM leg press (−7.8%, −8.3%), and CMJ (−14.7%, −14.6%), with no differences between groups. No change was seen for fat-free mass. In both groups, the exercise led to a switch toward a catabolic physiological milieu, evident as reduced levels of anabolic hormones (testosterone, IGF-1) and increased levels of cortisol (more pronounced in HIGH, P<.05). Both groups also displayed substantial increases in creatine kinase. After 7days of recovery, most variables had returned to close-to pre-exercise levels, except for CMJ, which remained at reduced levels. In conclusion, increased protein intake during 10-day military field exercise with severe energy deficiency did not mitigate loss of body mass or impairment of physical performanceNorwegian Defence Cyber Academy;
The Norwegian Defence Research Establishment;
Inland Norway University of Applied SciencespublishedVersio
The use of sleep medication in youth residential care
Get PDFObjectives: To investigate the use of sleep medication and concomitant psychotropic medication in children and adolescents placed under residential care (RC). Methods: Participants were youth 0–20 years of age placed in RC institutions at least once during 2016. Data on filled prescriptions were taken from the Norwegian Prescription Database to compare the use of sleep medication in RC with the general child population (GenPop) and how it covaried with gender, age, reasons for RC placement, and concomitant use of other psychotropic medications (antidepressants, anxiolytics, antipsychotics, and psychostimulants). Results: A total of 2171 youths were identified in RC at mean age 14 years (82% ‡ 13 years). Seventeen percent (371/2171) used sleep medications (melatonin 11%, alimemazine 7%, and benzodiazepines/z-hypnotics 2%) significantly more than the 2.3% who used in GenPop. The girl/boy ratio for medication use in RC was 1.8 (95% confidence interval [CI] = 1.5–2.2), not significantly different from the corresponding ratio in GenPop (1.4; 95% CI = 1.3–1.5). The use of sleep medication increased with age. When comparing reasons for placement in RC, medication use was particularly low among unaccompanied minor asylumseekers (2%). About half of the youths used concomitant psychotropic medication, with clear gender differences; Girls used about twice as much antidepressants, anxiolytics, and antipsychotics, whereas boys used 1.3 times more psychostimulants. Conclusion: Youths in RC used more sleep medication and concomitant psychotropic medication than the GenPop, most likely reflecting the increased psychosocial strain and mental disorders reported in this population. Further studies of prevalence, assessment, and treatment of sleep problems in RC populations are warranted.publishedVersio
Mitotic activity index and CD25+ lymphocytes predict risk of stage progression in non-muscle invasive bladder cancer
Get PDFIn urothelial cell type non-muscle invasive urinary bladder carcinoma, TNM stage and WHO grade are widely used to classify patients into low and high‑risk groups for prognostic and therapeutic decision-making. However, stage and grade reproducibility and prediction accuracy are wanting. This may lead to suboptimal treatment. We evaluated whether proliferation features, nuclear area of the epithelial cancer cells and the composition of stromal and tumor infiltrating lymphocytes have independent prognostic value. In 183 primary non-muscle invasive bladder cancer patients with long follow-up (median for stage progression cohort: 119 months, range 5-173; median for tumor recurrence cohort: 82, range 3-165) proliferation features Ki67, PPH3 and Mitotic Activity Index (MAI), Mean Nuclear Area (MNA), lymphocyte subsets (CD8+, CD4+, CD25+) and plasma cells (CD138+) were assessed on consecutive sections. Post-resection instillation treatments (none, mitomycin, BCG) were strictly standardized during the intake period. Risk of recurrence was associated with expression of Ki67 (≤ 39 vs. > 39) and Multifocality (p = 0.01). Patients with low Ki67 had a higher recurrence rate than those with high Ki67. Lymphocyte composition did not predict recurrence. Stage progression was strongly associated with high values for MAI (>15) and CD25+ (>0.2%). In a multivariate analysis the combination of MAI and CD25+ was the single most prognostic feature (p<0.001). Validation of these results in additional, independent studies is warranted.The author(s) received no specific
funding for this work. Jan Baak AS did not provide
support in the form of salaries for authors and did
not have any additional role in study design, data
collection and analysis, decision to publish, or
preparation of the manuscript.publishedVersio
Adaptations to strength training differ between endurance-trained and untrained women
Get PDFPurpose: The purpose of this study was to investigate if endurance athletes, sustaining their normal endurance training, experience attenuated adaptations to strength training compared to untrained individuals. Methods: Eleven non-strength-trained female endurance athletes (E + S) added 11 weeks of strength training to their normal endurance training (5.1 ± 1.1 h per week), and 10 untrained women (S) performed the same strength training without any endurance training. The strength training consisted of four leg exercises [3 × 4 − 10 repetition maximum (RM)], performed twice a week for 11 weeks. Results: E + S and S displayed similar increases in 1RM one-legged leg press (E + S 39 ± 19%, S 42 ± 17%, p < 0.05), maximal isometric torque in knee extension (E + S 12 ± 11%, S 8 ± 10%, p < 0.05) and lean mass in the legs (E + S 3 ± 4%, S 3 ± 3%, p < 0.05). However, S displayed superior increases in peak torque in knee extension at an angular velocity of 240° sec−1 (E + S 8 ± 5%, S 15 ± 7%, p < 0.05) and maximal squat jump height (E + S 8 ± 6%, S 14 ± 7%, p < 0.05). Conclusions: In this study, concurrent training did not impair the adaptations in the ability to develop force at low contraction velocities or muscle hypertrophy. However, concurrent training attenuated strength training-associated changes in the ability to develop force at higher muscular contraction velocities.publishedVersio