[Show abstract][Hide abstract] ABSTRACT: Background:
Human milk is typically low in vitamin D activity (VDA). Whether the vitamin D content of breast milk at birth can be increased by supplementing the mother during pregnancy has not been reported to the best of our knowledge.
We examined the effect of vitamin D supplementation during pregnancy on breast-milk VDA in the first 2 mo of lactation.
Breast-milk samples were obtained from women who were enrolled in a randomized, double-blinded, placebo-controlled trial of vitamin D supplementation during pregnancy. Pregnant women were enrolled at 27 wk of gestation and randomly assigned to the following 3 groups: a placebo group, a group who received one dosage of daily oral vitamin D3 (1000 IU), or a group who received 2 dosages of daily oral vitamin D3 (2000 IU). Serum 25-hydroxyvitamin D [25(OH)D] was measured at enrollment, at 36 wk of gestation, and in cord blood at birth. Study participants who were breastfeeding were invited to provide breast-milk samples for VDA measurement [concentration of vitamin D2, vitamin D3, 25(OH)D2, and 25(OH)D3] at 2 wk and 2 mo postpartum. A linear mixed model was used to compare breast-milk VDA between the 3 study groups.
A total of 75 women provided breast-milk samples (44 women provided breast-milk samples at both 2 wk and 2 mo postpartum). The mean (95% CI) VDA at age 2 wk was 52 IU/L (12, 217 IU/L) in the placebo group, 51 IU/L (17, 151 IU/L) in the 1000-IU group, and 74 IU/L (25, 221 IU/L) in the 2000-IU group; and at age 2 mo, the mean (95% CI) VDA was 45 IU/L (16, 124 IU/L), 43 IU/L (18, 103 IU/L), and 58 IU/L (15, 224 IU/L), respectively. There was no significant interaction in VDA between the sample-collection time and treatment (P = 0.61), but there was a difference between lower- and higher-dosage treatment groups (P = 0.04).
Maternal vitamin D supplementation during pregnancy of 2000 IU/d (compared with 1000 IU/d and with a placebo) results in a higher VDA of breast milk ≥2 mo postpartum. This trial was registered at the Australian New Zealand Clinical Trials Registry as ACTRN12610000483055.
Full-text · Article · Dec 2015 · American Journal of Clinical Nutrition
[Show abstract][Hide abstract] ABSTRACT: Introduction:
Newborn vitamin D status is largely determined by maternal vitamin D status during pregnancy. New Zealand (NZ) has a sun avoidance health policy and minimal dietary vitamin D fortification. Vitamin D deficiency (serum 25-hydroxyvitamin D (25(OH)D) concentration <50nmol/L) is present in 57% of a sample of newborns from Christchurch and Wellington. To inform vitamin D supplementation policy, our aim was to describe the frequency of, and factors associated with, vitamin D deficiency during pregnancy.
We enrolled an ethnically diverse sample of pregnant women from a community maternity clinic in south Auckland NZ with serum 25(OH)D concentration measured at 27 weeks gestation. We examined the associations of enrolment season, maternal demographics, health, sunlight exposure and vitamin D intake with vitamin D deficiency.
Vitamin D deficiency was present in 109/259 (42%). Enrolment season (P<0.001) and ethnicity (P=0.003) were independently associated with the odds of vitamin D deficiency but not sunlight exposure or dietary vitamin D intake. Of those enrolled in winter (June-August)/spring (September-November), vitamin D deficiency was present in 43% of European, 67% of Māori, 80% of Pacific and 59% of women of other ethnic groups.
These findings suggest that NZs targeted strategy for vitamin D supplementation may miss up to 42% of women with vitamin D deficiency in our population. Supplementation for all pregnant women during winter/spring could be an appropriate intervention for prevention of vitamin D deficiency during pregnancy in NZ.
Full-text · Article · Sep 2015 · The New Zealand medical journal
[Show abstract][Hide abstract] ABSTRACT: OBJECTIVE: We evaluate the association of blood 25(OH)D 3 with Acute Respiratory Infection (ARI) severity in early childhood, hypothesizing that children hospitalized with ARI have lower levels of vitamin D.
Low vitamin D status is prevalent among NZ children with ARI.
Vitamin D deficiency was more frequent among children hospitalized for ARI, as compared to those with outpatient ARI.
Vitamin D status may be a contributing factor to the severity of ARI amongst NZ children.
[Show abstract][Hide abstract] ABSTRACT: Results have been conflicting whether long-term ambient hydrogen sulfide (H2S) affects lung function or is a risk factor for asthma or chronic obstructive pulmonary disease (COPD). Rotorua city, New Zealand, has the world's largest population exposed to ambient H2S-from geothermal sources.
We investigated associations of H2S with lung function, COPD and asthma in this population.
1,204 of 1,639 study participants, aged 18-65 years during 2008-2010, provided satisfactory spirometry results. Residences, workplaces and schools over the last 30 years were geocoded. Exposures were estimated from data collected by summer and winter H2S monitoring networks across Rotorua. Four metrics for H2S exposure, representing both current and long-term (last 30 years) exposure, and also time-weighted average and peak exposures, were calculated. Departures from expected values for pre-bronchodilator lung function, calculated from prediction equations, were outcomes for linear regression models using quartiles of the H2S exposure metrics. Separate models examined participants with and without evidence of asthma or COPD, and never- and ever-smokers. Logistic regression was used to investigate associations of COPD (a post-bronchodilator FEV1/FVC < 70% of expected) and asthma (doctor-diagnosed or by FEV1 response to bronchodilator) with H2S exposure quartiles.
None of the exposure metrics produced evidence of lung function decrement. The logistic regression analysis showed no evidence that long-term H2S exposure at Rotorua levels was associated with either increased COPD or asthma risk. Some results suggested that recent ambient H2S exposures were beneficially associated with lung function parameters.
The study found no evidence of reductions in lung function, or increased risk of COPD or asthma, from recent or long-term H2S exposure at the relatively high ambient concentrations found in Rotorua. Suggestions of improved lung function associated with recent ambient H2S exposures require confirmation in other studies.
[Show abstract][Hide abstract] ABSTRACT: There is strong evidence to support a genetic predisposition to eczema and more recently studies have suggested that probiotics might be used to prevent eczema by modifying the expression of putative allergy-associated genes. The aim of this present study was to investigate if two probiotics, Lactobacillus rhamnosus HN001 (HN001) and Bifidobacterium animalis subsp. lactis HN019 (HN019), can modify the known genetic predisposition to eczema conferred by genetic variation in the Toll-like receptor (TLR) genes in a high risk infant population.
We selected 54 SNPs in the toll-like receptor genes. These SNPs were analysed in 331 children of sole European ancestry as part of a double-blind, randomised, placebo-controlled trial examining the effects of HN001 and HN019 supplementation on eczema development and atopic sensitisation.
The data showed that 26 TLR SNPs interacted with HN001 resulting in a significantly reduced risk of eczema, 18 for eczema severity as defined by SCORAD ≥10 and 20 for atopic sensitisation compared to placebo. There were only two SNPs that interacted with HN019 resulting in a reduced risk of eczema, eczema severity or atopy.
This is the first study to show that the negative impact of specific TLR genotypes may be positively affected by probiotic supplementation. HN001 exhibits a much stronger effect than HN019 in this respect. This article is protected by copyright. All rights reserved.
This article is protected by copyright. All rights reserved.
Full-text · Article · Mar 2015 · Pediatric Allergy and Immunology
[Show abstract][Hide abstract] ABSTRACT: β-(1,3)-glucan exposure from household dust has been shown to be associated with respiratory symptoms and thus is increasingly being measured in epidemiological studies. Various factors are known to influence its measurement; however, no studies have assessed the effects of sample extract freeze-thawing on β-(1,3)-glucan. The aim of this study was to assess the effects of repeated freeze-thawing of household dust extracts on levels of β-(1,3)-glucan. Forty random household dust samples were extracted with 0.3 M NaOH and aliquots of extracts stored at -20°C were subjected to one, two, and three freeze-thaw cycles. They were analyzed for β-(1,3)-glucan by the Limulus amoebocyte assay (LAL) and results compared to freshly extracted samples (paired Pearson's t-test on logged values). Initial freezing of house dust extracts results in a significant decline in β-(1,3)-glucan. However, repeated freeze/thawing (up to three times) does not results in any further decline in β-(1,3)-glucan levels.
Full-text · Article · Jan 2015 · Journal of Occupational and Environmental Hygiene
[Show abstract][Hide abstract] ABSTRACT: Background
There is non-experimental evidence that paracetamol (acetaminophen) use may increase the risk of developing asthma. However, numerous methodological issues need to be resolved before undertaking a randomized controlled trial to investigate this hypothesis.Objective
To establish the feasibility of a randomized controlled trial of liberal paracetamol as usually given by parents/guardians vs. a comparator (restricted paracetamol in accordance with WHO guidelines, ibuprofen or placebo), and childhood asthma risk.Methods
Questionnaires were completed by parents/guardians of infants admitted to Wellington Hospital with bronchiolitis to assess views about comparator treatments. Subsequently, infants of parents/guardians who provided informed consent were randomized to restricted or liberal paracetamol use for 3 months with paracetamol use recorded.ResultsOf 120 eligible participants, 72 (60%) parents/guardians completed the questionnaire. Ibuprofen, restricted paracetamol and placebo were acceptable to 42 (58%), 29 (40%) and 9 (12%) parents/guardians, respectively. 36 (30%) infants were randomized to restricted or liberal paracetamol. Paracetamol use was greater for the liberal vs. restricted group for reported [Hodges-Lehmann estimator of difference 0.94 mg/kg/day (95% CI 0.2-3.52), P = 0.02] and measured use [Hodges-Lehmann estimator of difference 2.11 mg/kg/day (95% CI 0.9-4.18), P = 0.004]. The median reported and measured use of paracetamol was 2.0-fold and 3.5-fold greater in the liberal vs. restricted group.Conclusions and Clinical RelevanceAlthough separation in paracetamol dosing is likely to be achieved with a liberal vs. restricted paracetamol regime, ibuprofen is the preferred comparator treatment in the proposed RCT of paracetamol use and risk of asthma in childhood.
No preview · Article · Oct 2014 · Clinical & Experimental Allergy
[Show abstract][Hide abstract] ABSTRACT: AimTo determine whether vitamin D supplementation reduces primary care visits for acute respiratory infection (ARI).MethodsA randomised, double-blind, placebo-controlled trial was conducted inNew Zealandand powered to determine the vitamin D dose needed to achieve normal vitamin D status during infancy.Healthy pregnant women, from 27weeksgestation to birth, and their infants, from birth to age 6months, were assigned to placebo or one of two dosages of daily oral vitamin D3. Woman/infant pairs were randomised to: placebo/placebo, 1000IU/400IU, or 2000IU/800IU.For this ad hoc analysis, the primary care records of enrolled children were audited to age 18 months.ResultsTwo-hundred-and-sixty pregnant women were randomised to placebo (n=87), lower-dose (n=87) or higher-dose (n=86) vitamin D3. In comparison with the placebo group (99%), the proportion of children making any ARIvisitswas smaller in the higher-dose (87%, P=0.004), but not the lower-dose vitamin D3 group (95%, P=0.17). The median number of ARIvisits/child was less in the higher-dose vitamin D3group from age 6-18 months (placebo 4, lower-dose 3, higher-dose 2.5; P=0.048 for higher-dose vitamin D3 vs. placebo).Conclusion
Vitamin D3 supplementation during pregnancy and infancyreduces primary care visits for ARIduring early childhood.This article is protected by copyright. All rights reserved.
No preview · Article · Oct 2014 · Acta Paediatrica
[Show abstract][Hide abstract] ABSTRACT: Background
In a double-blind, randomized, placebo-controlled birth cohort, we have recently shown a beneficial effect of Lactobacillus rhamnosus HN001 (HN001) for the prevention of eczema in children through to 6 years of age but no effect of Bifidobacterium animalis subsp lactis HN019 (HN019).Objective
Among this cohort of children, we aim to investigate whether these probiotics could modify the expression of genetic predisposition to eczema conferred by genetic variation in susceptibility genes.Methods
Thirty three eczema susceptibility SNPs (in eleven genes) were genotyped in 331 children of European ancestry.ResultsChildren who carried a genetic variant that put them at a high risk of developing eczema were less likely to develop eczema if they had been randomised to the HN001 intervention group compared to those in the placebo group. HN019 was also able to protect against the effects of some SNPs. As well as modifying genetic susceptibility to childhood eczema, HN001 was also found to modify genetic susceptibility to eczema severity and atopy risk.Conclusion and Clinical RelevanceThis is the first study to show an effect of a probiotic on reducing eczema risk amongst those with particular eczema-associated genotypes. Our findings suggest that Lactobacillus rhamnosus HN001 may be particularly effective in preventing eczema in children with specific high risk genotypes.This article is protected by copyright. All rights reserved.
[Show abstract][Hide abstract] ABSTRACT: INTRODUCTION: Moisture damage and visible mould in buildings are consistently linked with ill health, and microbes are suggested to be a key factor in the adverse exposure. Practical tools to reliably assess moisture related microbial contamination in buildings and to potentially predict health hazardous situations are lacking. The aim of this study was to evaluate a simple passive sampling approach in combination with quantitative PCR as a tool to objectively assess moisture damage and mould contamination in homes.
METHODS: Airborne settled dust passively collected over four weeks on electrostatic wipes placed in 93 residential homes in New Zealand were analysed for fungal and bacterial content using quantitative PCR (qPCR). The log transformed microbial measurement data were analysed against a home mould score using Pearson’s correlation test and home characteristics using Student’s T-Test, with a focus on researcher and parent reported observations of moisture damage, dampness and mould.
RESULTS: Levels of following fungal and bacterial groups were determined from airborne settled dust collected in children’s bedrooms: Cladosporium cladosporioides (median 4.00x102 cells/wipe), Aspergillus versicolor (86% of samples <LOD), Penicillium spp./ Aspergillus spp./Paecilomyces variotii group (Pen/Asp; median 3.98x104 cells/wipe), universal fungi (median 4.90x104 cells/wipe), Gram-positive (median 1.98x106 cells/wipe) and Gram-negative bacteria (median 8.66x105 cells/wipe). Levels of universal fungi and Pen/Asp groups were significantly elevated in homes in which mould odour, visible dampness and leaks or moisture damage were reported, and moreover correlated with a mould score calculated based on the extent of visible mould observed. Both Gram-positive and negative bacterial levels were significantly higher in homes where leaks or moisture damage and mould odour were observed, and where more than one child slept in the bedroom. Levels of C. cladosporioides were higher in homes with reported leaks or moisture damage.
CONCLUSIONS: Quantitative PCR analyses in combination with a standardized passive sampling approach for settled dust is a promising tool to objectively measure mould contamination in residential homes, both in epidemiological study settings and to support building inspections for moisture and mould damage in practical situations. Specifically, measurements of universal fungi and Penicillium/Aspergillus group were strongly associated with observations of visible mould, mould odour and moisture damage.
[Show abstract][Hide abstract] ABSTRACT: Introduction:
Improved smoking cessation rates are urgently required if New Zealand is to reach its target of a smokefree nation by 2025, during which some 600,000 smokers will need to quit. Nicotine replacement therapy remains a core part of the pharmacological approach to smoking cessation. Oral nicotine solutions with rapid onset have recently become available. We have examined the effect of a nicotine spray and a nicotine patch on smoking cessation for 12 months.
We enrolled potential participants-smokers wanting to quit aged 18-70 years, who smoked ≥9 cigarettes per day-with Fagerström Test of Nicotine Dependence score ≥3 in a double-blind trial in 3 trial sites. Smokers were randomized to a nicotine or placebo spray for 6 months, and all received nicotine patches daily for 5 months. They were followed at regular intervals for 12 months.
A total of 1,423 subjects were randomized to nicotine oral spray (1mg of nicotine free base per spray) plus nicotine patch or a placebo spray and nicotine patch. The nicotine mouth spray plus nicotine patch showed significant improvements in prolonged abstinence for all measures to 6 months (7 consecutive days at each visit for 6 months: 15.5% vs. 10.6%; p = .006) for the combination versus placebo and nicotine patch. Thereafter, the differences were not significant.
The addition of a nicotine mouth spray to a nicotine replacement patch in a population of smokers receiving a low level of behavioral support improved early quitting, but the effects were not sustained.
No preview · Article · May 2014 · Nicotine & Tobacco Research
[Show abstract][Hide abstract] ABSTRACT: Background
Exposures to hydrogen sulfide gas (H2S) have been inconclusively linked to a variety of negative cognitive outcomes. We investigated possible effects on cognitive function in an urban population with chronic, low-level exposure to H2S.
Participants were 1,637 adults, aged 18–65 years from Rotorua city, New Zealand, exposed to ambient H2S from geothermal sources. Exposures at homes and workplaces were estimated from data collected by summer and winter H2S monitoring networks across Rotorua in 2010/11. Metrics for H2S exposure at the time of participation and for exposure over the last 30 years were calculated. H2S exposure was modeled both as continuous variables and as quartiles of exposure covering the range of 0 – 64 ppb (0–88 μg/m3). Outcomes were neuropsychological tests measuring visual and verbal episodic memory, attention, fine motor skills, psychomotor speed and mood. Associations between cognition and measures of H2S exposure were investigated with multiple regression , while covarying demographics and factors known to be associated with cognitive performance.
The consistent finding was of no association between H2S exposure and cognition. Quartiles of H2S exposure had a small association with simple reaction time: higher exposures were associated with faster response times. Similarly, for digit symbol, higher H2S exposures tended to be marginally associated with better performance.
The results provide evidence that chronic H2S exposure, at the ambient levels found in and around Rotorua, is not associated with impairment of cognitive function.
Full-text · Article · Mar 2014 · Neurotoxicology and Teratology
[Show abstract][Hide abstract] ABSTRACT: To investigate the effect of regular paracetamol on bronchial hyper-responsiveness (BHR) and asthma control in adult asthma.
Single research-based outpatient clinic.
94 adults with mild-to-moderate asthma received randomised treatment; 85 completed the study. Key inclusion criteria were age 18-65 years, forced expiratory volume in 1 s (FEV1) >70% predicted, provocation concentration of methacholine causing a 20% reduction in FEV1 (PC20) between 0.125 and 16 mg/mL. Key exclusion criteria included an asthma exacerbation within the previous 2 months, current regular use of paracetamol, use of high-dose aspirin or non-steroidal anti-inflammatory drugs, current or past cigarette smoking >10 pack-years.
In a 12-week randomised, double-blind, placebo-controlled, parallel-group study, participants received 12 weeks of 1 g paracetamol twice daily or placebo twice daily.
The primary outcome variable was BHR, measured as the PC20 at week 12. Secondary outcome variables included FEV1, fractional exhaled nitric oxide (FeNO) and asthma control questionnaire (ACQ) score.
At 12 weeks, the mean (SD) logarithm base two PC20 was 1.07 (2.36) in the control group (N=54) and 0.62 (2.09) in the paracetamol group (N=31). After controlling for baseline PC20, the mean difference (paracetamol minus placebo) was -0.48 doubling dose worsening in BHR in the paracetamol group (95% CI -1.28 to 0.32), p=0.24. There were no statistically significant differences (paracetamol minus placebo) in log FeNO (0.09 (95% CI -0.097 to 0.27)), FEV1 (-0.07 L (95% CI -0.15 to 0.01)) or ACQ score (-0.04 (95% CI -0.27 to 0.18)).
There was no significant effect of paracetamol on BHR and asthma control in adults with mild-to-moderate asthma. However, the study findings are limited by low power and the upper confidence limits did not rule out clinically relevant adverse effects.
Australia New Zealand Clinical Trials Registry Number: NZCTR12609000551291.