Maria Makrides

University of Adelaide, Tarndarnya, South Australia, Australia

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Publications (179)740.06 Total impact

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    ABSTRACT: Background: In recent years the role of vitamin D status in early life on the development of allergic disease has generated much interest. The aim of this study was to determine whether cord blood vitamin D concentrations were associated with risk of early childhood allergic disease. Methods: Measurements of cord blood 25-hydroxyvitamin D [25(OH)D] concentrations were available in 270 mother-child pairs who were participating in the allergy follow-up (n = 706) of the Docosahexaenoic Acid to Optimise Mother Infant Outcome randomised controlled trial. All of the children had a hereditary risk of allergic disease. The diagnosis of allergic disease was made during medical assessments at 1 and 3 years of age. Results: The mean (standard deviation) standardised cord blood 25(OH)D concentration was 57.0 (24.1) nmol/L. The cumulative incidence of eczema to 3 years of age, n = 101/250 (40 %) was associated with standardised cord blood 25(OH)D concentration, with a 10 nmol/L rise in 25(OH)D concentration reducing the risk of eczema by 8 % (relative risk 0.92, 95 % confidence interval 0.86-0.97; P = 0.005). This association was stronger at 1 year of age, when a 10 nmol/L rise in standardised cord blood 25(OH)D concentration reduced the risk of eczema by 12 % (relative risk 0.88, 95 % confidence interval 0.81-0.96; P = 0.002). No associations between cord blood 25(OH)D concentrations and development of allergic sensitisation, allergic rhinitis or asthma in early childhood were found. Conclusion: In children with a family history of allergic disease, a higher cord blood 25(OH)D concentration appears to be associated with reduced risk of eczema in early childhood. Trial registration: Australian New Zealand Clinical Trials Registry ACTRN12610000735055 (DOMInO trial: ACTRN12605000569606).
    World Allergy Organization Journal 12/2015; 8(1). DOI:10.1186/s40413-015-0077-9
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    Julie Quinlivan · Sonia Kua · Robert Gibson · Andrew McPhee · Maria M Makrides ·
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    ABSTRACT: Health authorities recommend 6 months of fully breastfeeding and continuation of breastfeeding for at least a year. Many women initiate breastfeeding in hospital but discontinue before the six-month period, and therefore do not optimise the public health benefits. The aim of this study was to determine whether these women could be identified at hospital discharge, to enable targeted interventions. A secondary analysis of women who intended to breastfeed and were enrolled in a large randomised trial was undertaken. Women were enrolled in the antenatal period and antenatal, delivery and six month postnatal questionnaires were completed. Univariate and multivariate analyses were undertaken to determine the variables associated with early cessation of breastfeeding within six months, compared to women who continued to breastfeed. Of 2148 women who initiated breastfeeding in hospital, 877 continued to breastfed either partially (N = 262) or fully (N = 615) until six months postpartum and 1271 ceased breastfeeding early. Median breastfeeding duration in women who ceased early was 3(+6) weeks (IQR 1(+1) to 11(+2) weeks). In multivariate analysis, factors that were significantly associated with early cessation of breastfeeding were maternal factors of lower education (less than 12 years of schooling, no completion of further education), smoking (pre-pregnancy or during pregnancy), and newborn factors of preterm birth and low birthweight (all p < 0.01). These variables correctly identify 83% of women. We can identify women who initiate and then prematurely discontinue breastfeeding prior to hospital discharge. Evaluation of additional interventions to support longer duration of breastfeeding in women at risk of ceasing prematurely is needed.
    International Breastfeeding Journal 12/2015; 10(1). DOI:10.1186/s13006-015-0040-y
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    ABSTRACT: Background: Children born preterm are at risk of visual-processing impairments. Several lines of evidence have contributed to the rationale that docosahexaenoic acid (DHA) supplementation of preterm infants may improve outcomes in visual processing. Objective: The aim was to determine whether at 7 y of age children who were born very preterm and who received a high-DHA diet have better visual-processing outcomes than do infants fed a standard-DHA diet. Design: This was a follow-up study in a subgroup of children from a randomized controlled trial. Infants were randomly assigned to milk containing a higher concentration of DHA (1% of total fatty acids; high-DHA group) or a standard amount of DHA (0.2-0.3% of total fatty acids as DHA; control group). The randomization schedule was stratified by sex and birth weights of <1250 or ≥1250 g. A total of 104 (49 in the high-DHA group and 55 in the standard-DHA group) children aged 7 y were assessed on a range of visual-processing measures, including visual acuity, contrast sensitivity, vernier acuity, binocular stereopsis, and visual perception. Results: There was no evidence of differences between the high-DHA and standard-DHA groups in any of the visual-processing measures. In the majority (12 of 13) of variables assessed, the direction of effect favored the control group. The study was large enough to detect a moderate treatment effect, if one truly existed. Conclusion: Supplementing human milk with DHA at a dose of ∼1% of total fatty acids given in the first months of life to very preterm infants does not appear to confer any long-term benefit for visual processing at school age. This trial was registered at as ACTRN12606000327583.
    American Journal of Clinical Nutrition 11/2015; DOI:10.3945/ajcn.115.114710 · 6.77 Impact Factor
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    ABSTRACT: Objective: Recent research emphasized the nutritional benefits of omega-3 long chain polyunsaturated fatty acids (LCPUFAs) during pregnancy. Based on a double-blind randomised controlled trial named "DHA to Optimize Mother and Infant Outcome" (DOMInO), we examined how omega 3 DHA supplementation during pregnancy may affect pregnancy related in-patient hospital costs. Method: We conducted an econometric analysis based on ordinary least square and quantile regressions with bootstrapped standard errors. Using these approaches, we also examined whether smoking, drinking, maternal age and BMI could influence the effect of DHA supplementation during pregnancy on hospital costs. Results: Our regressions showed that in-patient hospital costs could decrease by AUD92 (P<0.05) on average per singleton pregnancy when DHA supplements were consumed during pregnancy. Our regression results also showed that the cost savings to the Australian public hospital system could be between AUD15 - AUD51 million / year. Conclusion: Given that a simple intervention like DHA-rich fish-oil supplementation could generate savings to the public, it may be worthwhile from a policy perspective to encourage DHA supplementation among pregnant women.
    Prostaglandins Leukotrienes and Essential Fatty Acids 09/2015; DOI:10.1016/j.plefa.2015.08.002 · 2.35 Impact Factor
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    ABSTRACT: Egg allergy is a leading cause of food allergy in young infants, however little is known about early allergen specific T cell responses which predate the presentation of egg allergy, and if these are altered by early egg exposure. To investigate the early T cell responses to multiple egg proteins in relation to patterns of egg exposure and subsequent IgE-mediated egg allergy. Egg-specific T cell cytokine responses (IL-5, IL-13, IL-10, IFNγ and TNFα) to ovomucoid (OM), ovalbumin (OVA), conalbumin (CON) and lysozyme (LYS) were measured in infants with eczema at 4 months of age (n=40), before randomisation to receive 'early egg' or a placebo as part of a randomised controlled trial (Australian New Zealand Clinical Trials Registry number 12609000415202), and at 12 months of age (n=58), when IgE-mediated egg allergy was assessed by skin prick test and food challenge. In 4 month old infants, who had not directly ingested egg, those who subsequently developed egg allergy already had significantly higher Th2 cytokine responses to multiple egg allergens, particularly elevated IL-13 responses to OVA (P=0.004), OM (P=0.012) and LYS (P=0.003), and elevated IL-5 to the same antigens (P=0.031, 0.04 and 0.003 respectively). IL-13 responses (to OVA and LYS) and IL-5 responses (to LYS) at 4 months significantly predicted egg allergy at 12 months. All responses significantly declined with age in the egg allergic infants, and this did not appear to be modified by 'early' introduction of egg. Elevated egg-specific Th2 cytokine responses were established prior to egg ingestion at 4 months and were not significantly altered by introduction of egg. Th2 responses at 4 months of age predicted egg allergy at 12 months, suggesting that this could be used as a biomarker to select infants for early prevention and management strategies. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
    Clinical & Experimental Allergy 08/2015; DOI:10.1111/cea.12608 · 4.77 Impact Factor
  • Lenka Malek · Wendy Umberger · Maria Makrides · Shao J Zhou ·
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    ABSTRACT: To assess dietary intake of pregnant women against the Australian Dietary Guidelines with respect to the Five Food Group recommendations and determine predictors of adherence to the recommendations. Cross-sectional web-based survey. Data were analysed using descriptive statistics and logistic regression. Pregnant women living in Australia. A national sample was recruited using an online panel provider and a South Australian sample was recruited through the antenatal clinic of a large public maternity hospital. A total of 857 pregnant women. Fifty-six per cent, 29 % and less than 10 % of women met the recommendations for the fruit, dairy and other core food groups, respectively. None of the women met the recommendations for all Five Food Groups. Women who were born overseas and who were less physically active pre-pregnancy were less likely to adhere to the fruit and dairy recommendations. Women who smoked during pregnancy, were overweight pre-pregnancy and had lower household incomes were also less likely to meet the fruit recommendations; and women living in metropolitan areas were less likely to meet the vegetable recommendations. Sixty-one per cent believed their diet during this pregnancy was healthy. The majority of pregnant women in Australia perceive their diets to be healthy yet they do not consume the recommended daily servings from the Five Food Groups. Intervention strategies are warranted, particularly those that increase women's ability to evaluate their diet and also encourage positive dietary changes. These strategies may increase adoption of dietary guidelines and optimise pregnancy and other long-term health outcomes.
    Public Health Nutrition 07/2015; -1:1-9. DOI:10.1017/S1368980015002232 · 2.68 Impact Factor
  • Anoja W Gunaratne · Maria Makrides · Carmel T Collins ·
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    ABSTRACT: Allergies have become more prevalent globally over the last 20 years. Dietary consumption of n-3 (or omega 3) long chain polyunsaturated fatty acids (LCPUFA) has declined over the same period of time. This, together with the known role of n-3 LCPUFA in inhibiting inflammation, has resulted in speculation that n-3 LCPUFA may prevent allergy development. Dietary n-3 fatty acids supplements may change the developing immune system of the newborn before allergic responses are established, particularly for those with a genetic predisposition to the production of the immunoglobulin E (IgE) antibody. Individuals with IgE-mediated allergies have both the signs and symptoms of the allergic disease and a positive skin prick test (SPT) to the allergen. To assess the effect of n-3 LCPUFA supplementation in pregnant and/or breastfeeding women on allergy outcomes (food allergy, atopic dermatitis (eczema), allergic rhinitis (hay fever) and asthma/wheeze) in their children. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (6 August 2014), PubMed (1966 to 01 August 2014), CINAHL via EBSCOhost (1984 to 01 August 2014), Scopus (1995 to 01 August 2014), Web of Knowledge (1864 to 01 August 2014) and (01 August 2014) and reference lists of retrieved studies. We included randomised controlled trials (RCTs) evaluating the effect of n-3 LCPUFA supplementation of pregnant and/or lactating women (compared with placebo or no treatment) on allergy outcomes of the infants or children. Trials using a cross-over design and trials examining biochemical outcomes only were not eligible for inclusion. Two review authors independently assessed eligibility and trial quality and performed data extraction. Where the review authors were also investigators on trials selected, an independent reviewer assessed trial quality and performed data extraction. Eight trials involving 3366 women and their 3175 children were included in the review. In these trials, women were supplemented with n-3 LCPUFA during pregnancy (five trials), lactation (two trials) or both pregnancy and lactation (one trial). All trials randomly allocated women to either a n-3 LCPUFA supplement or a control group. The risk of bias varied across the eight included trials in this review with only two trials with a low risk of selection, performance and attrition bias.N-3 LCPUFA supplementation showed a clear reduction in the primary outcome of any allergy (medically diagnosed IgE mediated) in children aged 12 to 36 months (risk ratio (RR) 0.66, 95% confidence interval (CI) 0.44 to 0.98; two RCTs; 823 children), but not beyond 36 months (RR 0.86, 95% CI 0.61 to 1.20; one RCT, 706 children). For any allergy (medically diagnosed IgE mediated and/or parental report), no clear differences were seen in children either at 12 to 36 months (RR 0.89, 95% CI 0.71 to 1.11; two RCTs, 823 children) or beyond 36 months of age (RR 0.96, 95% CI 0.84 to 1.09; three RCTs, 1765 children).For the secondary outcomes of specific allergies there were no clear differences for food allergies at 12 to 36 months and beyond 36 months, but a clear reduction was seen for children in their first 12 months with n-3 LCPUFA (both for medically diagnosed IgE mediated and medically diagnosed IgE mediated and/or parental report). There was a clear reduction in medically diagnosed IgE-mediated eczema with n-3 LCPUFA for children 12 to 36 months of age, but not at any other time point for both medically diagnosed IgE mediated and medically diagnosed IgE mediated and/or parental report. No clear differences for allergic rhinitis or asthma/wheeze were seen at any time point for both medically diagnosed IgE mediated, and medically diagnosed IgE mediated and/or parental report.There was a clear reduction in children's sensitisation to egg and sensitisation to any allergen between 12 to 36 months of age when mothers were supplemented with n-3 LCPUFA.In terms of safety for the mother and child, n-3 LCPUFA supplementation during pregnancy did not show increased risk of postpartum haemorrhage or early childhood infections. Overall, there is limited evidence to support maternal n-3 LCPUFA supplementation during pregnancy and/or lactation for reducing allergic disease in children. Few differences in childhood allergic disease were seen between women who were supplemented with n-3 LCPUFA and those who were not.
    Cochrane database of systematic reviews (Online) 07/2015; 7:CD010085. DOI:10.1002/14651858.CD010085.pub2 · 6.03 Impact Factor
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    ABSTRACT: Observational studies have implicated low serum vitamin D (25-hydroxyvitamin D (25(OH)D)) levels in the development of mood disorders. Postpartum depression (PPD) is an important public health issue, although little is known about its association with serum 25(OH)D. To determine the association between 25(OH)D at delivery and the subsequent risk of PPD at six weeks and six months postpartum in a large cohort of Australian women. Cord blood samples from 1040 women participating in the docosahexaenoic acid (DHA) to Optimise Maternal Infant Outcome randomised controlled trial were analysed for 25(OH)D by mass spectroscopy. Maternal PPD was assessed using the Edinburgh Postnatal Depression Scale at six weeks and six months postpartum. The association between standardised 25(OH)D and PPD was assessed, taking into account DHA treatment, social and demographic variables. There was no association between cord blood 25(OH)D concentration at delivery and PPD at either six weeks or six months postpartum. Cord blood 25(OH)D 25-50 and >50 nmol/L at delivery was associated with decreased risk of PPD at six weeks postpartum compared with 25(OH)D <25 nmol/L in the control group, but not the DHA group. There was no association between cord blood 25(OH)D <25 nmol/L at delivery and PPD at six months postpartum. This largest study to date of 25(OH)D levels at delivery and PPD did not reveal a consistent link with PPD. © 2015 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.
    Australian and New Zealand Journal of Obstetrics and Gynaecology 06/2015; 55(5). DOI:10.1111/ajo.12344 · 1.51 Impact Factor
  • Maria Makrides · Ronald E Kleinman ·

    PEDIATRICS 05/2015; 135(6). DOI:10.1542/peds.2015-0813 · 5.47 Impact Factor
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    ABSTRACT: Six Year Follow Up of Children at High Hereditary Risk of Allergy, Born To Mothers Supplemented With Docosahexaenoic Acid (DHA) in the DOMInO Trial Best K1,2, Sullivan T6,Gold M1, Kennedy D4,5, Martin J4,5, Palmer D1,7, Makrides M1,2,3 1Women’s & Children’s Health Research Institute, University of Adelaide, North Adelaide, Australia 2School of Paediatrics and Reproductive Health, University of Adelaide, Adelaide, Australia ³Healthy Mothers, Babies and Children, South Australian Health and Medical Research Institute, Adelaide, Australia 4Discipline of Paediatrics, University of Adelaide, Adelaide, Australia 5 Department of Respiratory and Sleep Medicine, Women’s & Children’s Hospital, North Adelaide, Australia 6 School of Population Health, University of Adelaide, Adelaide, Australia 7 School of Paediatrics and Child Health, University of Western Australia, Subiaco, Australia Email: Background: Dietary omega-3 (n-3) long chain polyunsaturated fatty acids (LCPUFA) modulate neonatal markers of the immune response but there is uncertainty regarding the effect on clinical allergy outcomes. This double blind, randomised controlled trial aimed to determine whether supplementation with DHA rich fish oil during pregnancy to women with a fetus at high risk of allergic disease, will reduce the risk of allergy in the child. Method: Between 2005 and 2008, pregnant women between 18-21 weeks gestation were randomly assigned to consume capsules containing ~1 g/d of DHA or a blended vegetable oil (no DHA) until birth, the DOMInO trial. From 2012-2014, 603 children (90% of eligible) born to mothers in the DOMInO trial, with a family history of allergic disease completed a six year of age follow up assessment . History of asthma, allergic rhinitis and eczema were assessed, along with food and aero-allergen sensitisation by skin prick testing. Results: Preliminary results show no difference in the overall percentage of children with IgE-mediated allergic disease between the DHA and control groups (75/279 (26.8%) vs 79/263 (30.0%); RR 0.95; 95% CI 0.73,1.23; P=0.69), although there were fewer children with parent reported hay fever in the DHA group (68/314 (21.6%) vs 84/289 (29.1%); RR 0.75; 95%CI 0.57, 0.99; P=0.04) and fewer children were sensitised to house dust mite, D.Farinae, in the DHA group 31/246 (12.6%) vs 49/231 (21.2%) control; RR 0.61 (0.41, 0.92); P=0.019. Conclusions: DHA supplementation in pregnancy did not reduce the overall incidence of IgE-mediated allergies at six years of age although parent reported hay fever and D.Farinae sensitisation were lower.
    Perinatal Society of Australia and New Zealand; 04/2015
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    Lenka Malek · Wendy Umberger · Maria Makrides · Jo Zhou ·
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    ABSTRACT: Background: This study aimed to determine pregnant women’s knowledge of and compliance with the recommendations for periconceptional folic acid supplementation (PFS) and iodine supplementation; maternal characteristics associated with compliance; and influential and preferred nutrition information sources. Method: Between June and August 2013, a reputable online consumer panel-provider recruited and administered a web-based survey to 455 pregnant women living in Australia. Data on nutrition knowledge, dietary intake, supplement use, and socio-demographic information were collected. Pearson's chi-square test was used to explore statistically significant relationships between variables. Results: Compliance with folic acid (25%) and iodine (27%) supplement recommendations was low and was associated with higher age, higher income, living with a partner, planning pregnancy, knowing the importance of the nutrients and that supplementation is recommended in preconception and pregnancy. While over half of women were aware of the importance and need for supplementation, knowledge regarding the recommended daily dose of folic acid (33%) and iodine (10%), and the correct timing of PFS (11%) was poor. Main healthcare providers (HCP) were identified as the most influential and preferred nutrition information sources, followed by the internet. Conclusions: The majority of pregnant women do not comply with supplement recommendations. Main HCPs play a pivotal role in increasing nutrition knowledge and adoption of recommendations.
    Perinatal Society of Australia and New Zealand (PSANZ) 19th Annual Conference 2015, Melbourne, Victoria, Australia.; 04/2015
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    C T Collins · T R Sullivan · A.J. McPhee · M J Stark · M. Makrides · R.A. Gibson ·
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    ABSTRACT: Thirty one infants born less than 30 weeks׳ gestational age were randomised to receive either 40 (n=11), 80 (n=9) or 120 (n=11) mg/kg/day of docosahexaenoic acid (DHA) respectively as an emulsion, via the feeding tube, commenced within 4 days of the first enteral feed. Twenty three infants were enroled in non-randomised reference groups; n=11 who had no supplementary DHA and n=12 who had maternal DHA supplementation. All levels of DHA in the emulsion were well tolerated with no effect on number of days of interrupted feeds or days to full enteral feeds. DHA levels in diets were directly related to blood DHA levels but were unrelated to arachidonic acid (AA) levels. All randomised groups and the maternal supplementation reference group prevented the drop in DHA levels at study end that was evident in infants not receiving supplementation. Australian New Zealand Clinical Trials Registry: ACTRN12610000382077. Copyright © 2015 Elsevier Ltd. All rights reserved.
    Prostaglandins Leukotrienes and Essential Fatty Acids 04/2015; 99. DOI:10.1016/j.plefa.2015.04.003 · 2.35 Impact Factor
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    Lenka Malek · Maria Makrides ·

    04/2015: pages 127-33;
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    ABSTRACT: Human milk provides a complex mix of animal lipids, whereas the fat supply of most modern infant formula is based on vegetable oils. We studied the effects of breastfeeding and of feeding infant formula either without or with dairy goat lipids on the composition of infant plasma glycerophospholipids. Healthy term infants were randomized double blind to feeding with infant formula based on whole goats' milk (GIF, approximately 60% milk fat and 40% vegetable oils) or a control cows' milk infant formula based on vegetable oils (VIF) from 2 weeks after birth. A reference group of fully breastfed infants was also followed. At the age of 4 months, blood samples were collected and plasma glycerophospholipids were analysed with liquid chromatography coupled to triple quadrupole mass spectrometry. The group of breastfed infants showed significantly higher contents of glycerophospholipid species containing sn-2 palmitic acid {PC(16:0/16:0) and PC(18:0/16:0)} and significantly higher contents of glycerophospholipid species containing LC-PUFA than infants in both formula groups. The GIF group demonstrated significantly higher glycerophospholipid species containing myristic acid {LPC(14:0), PC(14:0/18:1), PC(16:0/14:0)} and palmitoleic acid {LPC(16:1), PC(16:0/16:1), PC(16:1/18:1)} than the VIF group. We conclude that breastfeeding induces marked differences in infant plasma glycerophospholipid profiles as compared to formula feeding, whereas the studied different sources of formula-fat resulted in limited effects on plasma glycerophospholipids.
    Journal of pediatric gastroenterology and nutrition 03/2015; Publish Ahead of Print. DOI:10.1097/MPG.0000000000000783 · 2.63 Impact Factor
  • Dominique Condo · Maria Makrides · Sheila Skeaff · Shao J Zhou ·
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    ABSTRACT: Adequate iodine is important during pregnancy to ensure optimal growth and development of the offspring. We validated an iodine-specific FFQ (I-FFQ) for use in Australian pregnant women. A forty-four-item I-FFQ was developed to assess iodine intake from food and was administered to 122 pregnant women at 28 weeks gestation. Iodine supplement use was captured separately at 28 weeks gestation. Correlation between iodine intake from food estimated using the I-FFQ and a 4 d weighed food record as well as correlation between total iodine intake and 24 h urinary iodine excretion (UIE), 24 h urinary iodine concentration (UIC), spot UIC and thyroid function were assessed at 28 weeks gestation. A moderate correlation between the two dietary methods was shown (r 0·349, P< 0·001), and it was strengthened with the addition of iodine supplements (r 0·876, P< 0·001). There was a fair agreement (k= 0·28, P< 0·001) between the two dietary measures in the classification of women as receiving adequate ( ≥ 160 μg/d) or inadequate ( < 160 μg/d) iodine intake from food, but the limits of agreement from the Bland-Altman plot were large. Total iodine intake was associated with 24 h UIE (β = 0·488, P< 0·001) but not with spot UIC. Iodine intake from food using the I-FFQ was assessed at study entry ( < 20 weeks gestation) in addition to 28 weeks gestation, and there was a strong correlation in iodine intake at the two time points (r 0·622, P< 0·001), which indicated good reproducibility. In conclusion, the I-FFQ provides a valid tool for estimating iodine intake in pregnant women and can be used to screen women who are at risk of inadequate intake.
    British Journal Of Nutrition 03/2015; 113(06):1-9. DOI:10.1017/S0007114515000197 · 3.45 Impact Factor
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    ABSTRACT: To determine if improvements in cognitive outcome detected at 18 months' corrected age (CA) in infants born <33 weeks' gestation receiving a high-docosahexaenoic acid (DHA) compared with standard-DHA diet were sustained in early childhood. Follow-up of a multicentre randomised controlled trial. Randomisation was stratified for sex, birth weight (<1250 vs ≥1250 g) and hospital. Five Australian tertiary hospitals from 2008 to 2013. 626 of the 657 participants randomised between 2001 and 2005 were eligible to participate. High-DHA (≈1% total fatty acids) enteral feeds compared with standard-DHA (≈0.3% total fatty acids) from age 2-4 days until term CA. Full Scale IQ of the Wechsler Abbreviated Scale of Intelligence (WASI) at 7 years CA. Prespecified subgroup analyses based on the randomisation strata (sex, birth weight) were conducted. 604 (92% of the 657 originally randomised) consented to participate (291 high-DHA, 313 standard-DHA). To address missing data in the 604 consenting participants (22 for primary outcome), multiple imputation was performed. The Full Scale IQ was not significantly different between groups (high-DHA 98.3, SD 14.0, standard-DHA 98.5, SD 14.9; mean difference adjusted for sex, birthweight strata and hospital -0.3, 95% CI -2.9 to 2.2; p=0.79). There were no significant differences in any secondary outcomes. In prespecified subgroup analyses, there was a significant sex by treatment interaction on measures of parent-reported executive function and behaviour. Scores were within the normal range but girls receiving the high-DHA diet scored significantly higher (poorer outcome) compared with girls receiving the standard-DHA diet. Supplementing the diets of preterm infants with a DHA dose of approximately 1% total fatty acids from days 2-4 until term CA showed no evidence of benefit at 7 years' CA. Australian New Zealand Clinical Trials Registry: ACTRN12606000327583. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to
    BMJ Open 03/2015; 5(3):e007314. DOI:10.1136/bmjopen-2014-007314 · 2.27 Impact Factor
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    ABSTRACT: Oral food challenges for diagnosis and management of egg allergy using fresh egg are common; however to limit the risk of food borne infection many allergy units use pasteurized raw egg. Pasteurization and drying processes have the potential to affect the structure of egg proteins in egg powder and thus the allergenicity when compared to fresh egg. Our aim was to compare the binding of serum IgE from egg allergic children to in vitro digested and undigested pasteurized whole raw egg powder with unpasteurized fresh whole raw egg. Egg proteins from in vitro digested or undigested pasteurized whole raw egg powder, fresh whole egg, white and yolk were separated by SDS-PAGE electrophoresis, transferred onto nitrocellulose membrane, and incubated overnight with pooled sera from egg allergic children. In both the raw egg samples and the pasteurized whole egg powder, protein bands corresponding with known molecular weights of the major egg allergens were present. Pasteurized whole raw egg powder was bound by serum IgE in a similar manner to unpasteurized whole raw egg, and was unaffected by in vitro digestion. Serum IgE also bound egg yolk, indicating sensitization to both egg yolk and egg white proteins. The main egg allergens are present in pasteurized whole raw egg powder and serum IgE of egg allergic children binds to them in a similar pattern to fresh whole raw egg. Pasteurized whole raw egg powder is a suitable substitute for raw egg in clinical practice for oral food challenges. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
    Pediatric Allergy and Immunology 02/2015; 26(3). DOI:10.1111/pai.12365 · 3.40 Impact Factor
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    ABSTRACT: The ability of the World Health Organization (WHO) growth standards to represent the growth of South East Asian infants has been questioned. The aim of this study was to provide contemporary data on the growth of Indonesian breast-fed and formula-fed infants, compared with the WHO growth standards. A prospective cohort study of 160 normal healthy infants was undertaken in a suburban area of South Jakarta, Indonesia. Infants from 2-6 weeks of age were recruited, and consumed exclusively either breast milk or infant formula for at least 6 months, with follow-up until 12 months of age. Overall, the infants in this study were lighter (weight-for-age), were shorter (length-for-age) and had smaller head circumferences (head circumference-for-age) than the average WHO Growth Reference Study (WGRS) population but were of similar proportion (weight-for-length). Compared with the WGRS, the z-scores for weight-for-age, length-for-age and head circumference-for-age in the Indonesian children fell from birth to 6 weeks of age and then increased until 3 months of age in both the breast-fed infants and the formula-fed infants. At 6 weeks of age, the weight-for-age z-scores fell below -2 standard deviations (SD) for 16 (20.5%) breast-fed and 40 (51.3%) formula-fed infants, and the length-for-age z-scores fell below -2 SD for 31 (39.7%) breast-fed and 41 (52.6%) formula-fed infants. The WHO growth standards do not reflect the growth of this cohort of Indonesian infants and may overestimate the levels of underweight and stunted children. Identifier: NCT01721512This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial No-Derivatives 4.0 License, where it is permissible to download and share the work, provided it is properly cited. The work cannot be changed in any way or used commercially.
    Journal of Pediatric Gastroenterology and Nutrition 02/2015; Publish Ahead of Print(2). DOI:10.1097/MPG.0000000000000770 · 2.63 Impact Factor
  • Lenka Malek · Wendy Umberger · S.J. Zhou · Maria Makrides ·
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    ABSTRACT: A comprehensive understanding of the factors influencing women's dietary choices is central to motivating positive dietary behavior before, during and after pregnancy. Findings are synthesized from 34 studies which assessed modifiable individual and environmental factors influencing dietary behavior during preconception and pregnancy. Influencing factors included: perceptions regarding benefits, risks and need; psychological factors; self-efficacy and control beliefs; nutrition knowledge; financial constraints; social environment and perceived social pressure; healthcare providers (HCPs), and the food environment. Studies consistently found that the key factors influencing positive dietary behavior were women's desire to optimize maternal and fetal health and advice received from HCPs. HCPs are in a unique position to encourage healthier choices at a time when women are strongly motivated to make positive change. Therefore, strategies targeting the education of HCPs to ensure they have the knowledge and resources to support women to act on evidence-based dietary recommendations are of key importance. Other strategies include: using persuasive communication methods to aid in educating and influencing young women and the wider community; providing pregnant women with automated daily feedback regarding their adherence with dietary recommendations, and changing the food environment to make healthy choices easier. A collaborative, multidisciplinary approach is required to further develop, test and implement the suggested strategies which have the potential to improve maternal and child nutrition beyond the immediate prenatal period.

Publication Stats

5k Citations
740.06 Total Impact Points


  • 1998-2015
    • University of Adelaide
      • • School of Paediatrics and Reproductive Health
      • • Discipline of Paediatrics
      • • Discipline of Obstetrics and Gynaecology
      • • Women's & Children's Health Research Institute (WCHRI)
      Tarndarnya, South Australia, Australia
  • 2014
    • University of Western Australia
      • School of Paediatrics and Child Health
      Perth City, Western Australia, Australia
    • South Australian Health and Medical Research Institute
      Adelaide Hills, South Australia, Australia
  • 2001-2014
    • Women`s and Children`s Hospital
      Tarndarnya, South Australia, Australia
  • 2007-2013
    • Women's and Children's Health Network
      Tarndarnya, South Australia, Australia
  • 2006-2012
    • Flinders Medical Centre
      Tarndarnya, South Australia, Australia
  • 1998-2009
    • Flinders University
      • • Department of Paediatrics and Child Health
      • • Flinders Medical Centre
      Tarndarnya, South Australia, Australia
  • 1997
    • University of South Australia
      Tarndarnya, South Australia, Australia