Objective: To assess the effectiveness (extent to which an intervention works in daily medical pr... more Objective: To assess the effectiveness (extent to which an intervention works in daily medical practice) of the use of phytosterol/phytostanol-enriched margarines to lower total and non-HDL cholesterol levels in users and non-users of statins. Design: Retrospective cohort study. Setting: Data were obtained from questionnaires on health and food intake from a population-based longitudinal cohort linked to pharmacy-dispensing records. Subjects: The analysis included 3829 men and women (aged 31-71 years) who were examined during 1998-2002 and re-examined at 5-year follow-up during 2003-2007. Results: Recommended doses of margarines were consumed by only 9 % of the subjects. Serum total cholesterol decreased by respectively 20?16 (95 % CI 20?26, 20?05) mmol/l, 21?40 (95 % CI 21?51, 21?30) mmol/l and 21?64 (95 % CI 21?91, 21
To study the relationship between diet and growth, a longitudinal anthropometric study was conduc... more To study the relationship between diet and growth, a longitudinal anthropometric study was conducted in a Dutch population consuming a macrobiotic diet. Measurements (anthropometry and food habit questionnaire) were taken in 1985 (0-7 y), 1987, and in 1993 (7-16 y, n = 209). Z-scores were calculated for anthropometric measures and changes expressed as the differences between 1993 and the mean of 1985 and 1987. Analysis indicated significant (P < 0.002) catch-up in height [(mean Z-score +/-sEM) +0.59 +/- 0.071 and arm circumference (+0.34 +/- 0.09) for age (boys and girls combined). In 1993, both girls and boys were still significantly (P < 0.05) below the reference for height and sum of four skinfolds for age, and girls were below reference for weight-for-height and arm circumference for age. In girls, multiple regression analyses showed a significant positive effect of the consumption frequency of dairy products on catch-up growth in height, weight and arm circumference, afte...
The primary aim of this study was to assess the biochemical vitamin B12 and folate status of a re... more The primary aim of this study was to assess the biochemical vitamin B12 and folate status of a representative group of elderly women (70-80 y) living in Dunedin, New Zealand. A second aim was to determine the prevalence of hyperhomocysteinaemia and to explore the determinants of homocysteine (hcy) concentration in this population. A cross-sectional study was carried out between June and August of 2000. Two hundred and fifty women were randomly selected from the 1998 electoral roll. Fasting blood samples were analysed for folate, vitamin B12, total hcy, creatinine, and haematological parameters. Of the women selected, 87 did not respond, 37 were not traceable, 23 were not eligible or had died, and 103 agreed to participate. The overall response rate was 46%. Based on a cut-off of 150 pmol/L for serum B12, 13% of participants would be classified as having sub-optimal vitamin B12 status. Of the women, 3 and 5%, respectively, had low serum (< 6.6 nmol/L) and erythrocyte folate (< ...
The fish ingredient N3-docosahexaenoic acid 22:6 n-3 (DHA) stimulates brain development. On the o... more The fish ingredient N3-docosahexaenoic acid 22:6 n-3 (DHA) stimulates brain development. On the other hand methylmercury (MeHg) in fish disturbes the developing central nervous system.Here the IQ score in children is considered as an aggregate measure of in utero brain development.To determine the effect of DHA exposure on prenatal neurodevelopment the maternal DHA intake during pregnancy was compared with its
The regulations and/or directives in force for functional foods primarily focus on the warrant of... more The regulations and/or directives in force for functional foods primarily focus on the warrant of safety before the particular foods reach the consumer. Aspects that come into the picture after marketing are not structurally and/or regulatory dealt with at this moment. This absence of clear guidelines about responsibility, timing and contents of a postlaunch monitoring (PLM) system hamper the establishment of an internationally standardized and stakeholder-adopted framework. The current paper describes a proposal for PLM and is illustrated with a case study on phytosterols/-stanols.
The importance of selenium and zinc in the immune functioning of the aged is widely recognized. S... more The importance of selenium and zinc in the immune functioning of the aged is widely recognized. Seniors in New Zealand are at particularly high risk of low selenium status because of the low selenium soil environment. The zinc status of the New Zealand elderly has never been assessed. In this cross-sectional study, the biochemical selenium, zinc and lipid levels, physical
Current regulations focus on the mandatory safety evaluation of functional foods before they come... more Current regulations focus on the mandatory safety evaluation of functional foods before they come to market, but Nynke de Jongand colleagues argue that the effects of such foods should also be evaluated after they have been launched
With the introduction of novel and functional foods, there is increasing need for an integrated q... more With the introduction of novel and functional foods, there is increasing need for an integrated quantitative risk–benefit assessment of foods. Consensus about a quantitative risk–benefit assessment mirroring the risk assessment approach has been reached during a recent EFSA workshop. In line, we propose a risk–benefit model that consists of: (1) hazard and benefit identification, (2) hazard and benefit characterization through
After total laryngectomy the absence of a nasal airflow results in a decrease in olfaction and pe... more After total laryngectomy the absence of a nasal airflow results in a decrease in olfaction and perception of flavors. Materials and Methods: Odor perception was assessed in 63 laryngectomized patients with two different olfactory tests. "he methods used by patients to smell were observed during olfactory testing. Patients' judgment about their olfaction and gustation was assessed by means of a structured questionnaire, semistructured interview, and self-rating. Results: Based on the results of the olfactory tests, patients were categorized as "Smellers" and "nonsmellers." Approximately one third of the patients were able to smell the odorous substances used in the olfactory tests. The smellers more often used a variety of methods to smell than the nonsmellers (P c .002); in most patients the method consisted of active use of facial muscles. Patients appeared well able to judge their own odor perception. Compared with the smellers, the nonsmellers judged their odor perception as worse (P c .003) and reported a more severe decrease in gustation after the operation (P < .033). The results of this study in laryngectomized patients confirm the interrelation between olfaction and gustation: the nonsmellers reported a poorer gustation and a more severe decrease in gustation and appetite than both the smellers and a reference group of elderly persons (P c ,061. Patients who reported a deterioration of olfaction and gustation tended to experience negative consequences such as the inability to smell smoke, leaking gas, or agreeable odors. Conclusion: Olfaction and odor-related flavor sensation are seriously deteriorated after total laryngectomy.
This present study investigated the effect of a 17-week intervention programme with nutrient-dens... more This present study investigated the effect of a 17-week intervention programme with nutrient-dense foods (enriched with vitamins and minerals at 25-100% of the Dutch recommended dietary allowance) and/or physical exercise in 159 frail elderly subjects (forty-six men, 113 women, mean age 78.7 (SD 5.6) years). Subjects were randomized into four groups: (1) control, (2) nutrition intervention, (3) exercise or (4) both nutrition intervention and exercise. Main outcome variables were sensory perception (smell test and questionnaire), appetite (questionnaire), energy intake (3 d food record) and body weight (on a weighing scale and with dual energy X-ray absorptiometry measurements). At baseline, moderate but significant correlations were found between appetite and energy intake (r 0.30, P &lt; 0.0001), between smell test and smell perception assessed by questionnaire (r 0.40, P &lt; 0.0001) and between lean body weight and energy intake (r 0.50, P &lt; 0.0001). Results after 17-weeks intervention revealed neither change in smell test scores (P = 0.19) nor in appetite (P = 0.17). A slight positive effect of exercise compared with non-exercising groups on energy intake (difference 0.5 MJ, P = 0.05) was shown next to a preserving effect of exercise on lean body mass (+0.08 kg) compared with a decrease (-0.4 kg) in non-exercisers (P &lt; 0.02). The correlation between the change in lean body mass and change in energy intake was 0.18 (P = 0.05). In conclusion, an interesting preserving effect on lean body mass in frail elderly subjects due to 17 weeks of exercise was shown. Since a decline in lean body mass was observed in the non-exercisers, effects may be attributable to change in activity pattern. Changes in lean mass were also slightly, but significantly, correlated with changes in energy intake. In turn, energy intake was not related to a change in reported appetite or sensory perception. Nutrient-dense foods were not able to improve any of the outcome variables in this study.
Risk-benefit analyses are introduced as a new paradigm for old problems. However, in many cases i... more Risk-benefit analyses are introduced as a new paradigm for old problems. However, in many cases it is not always necessary to perform a full comprehensive and expensive quantitative risk-benefit assessment to solve the problem, nor is it always possible, given the lack of required date. The choice to continue from a more qualitative to a full quantitative risk-benefit assessment can be made using a tiered approach. In this article, this tiered approach for riskbenefit assessment will be addressed using a decision tree. The tiered approach described uses the same four steps as the risk assessment paradigm: hazard and benefit identification, hazard and benefit characterization, exposure assessment, and risk-benefit characterization, albeit in a different order. For the purpose of this approach, the exposure assessment has been moved upward and the dose-response modeling (part of hazard and benefit characterization) is moved to a later stage. The decision tree includes several stop moments, depending on the situation where the gathered information is sufficient to answer the initial risk-benefit question. The approach has been tested for two food ingredients. The decision tree presented in this article is useful to assist on a case-by-case basis a risk-benefit assessor and policymaker in making informed choices when to stop or continue with a risk-benefit assessment.
Background. Cholesterol-lowering drugs may metabolically interact with cholesterol-lowering bread... more Background. Cholesterol-lowering drugs may metabolically interact with cholesterol-lowering bread spreads. This study analyses the prevalence of use of drugs, bread spreads or the combination of both in people aware of their high/elevated cholesterol level, and compares users of the three therapies on health behavior and demographics.
j o u r n a l h o m e p a g e : w w w . e l s e v i e r . c o m / l o c a t e / f o o d c h e m t... more j o u r n a l h o m e p a g e : w w w . e l s e v i e r . c o m / l o c a t e / f o o d c h e m t o x
If a diet, food or food constituent is recognised to have both health benefits and health risks, ... more If a diet, food or food constituent is recognised to have both health benefits and health risks, the benefits have to be compared with the risks to develop coherent scientific evidence-based dietary advice. This means that both risk and benefit assessment should follow a similar paradigm and that benefits and risks are expressed in a common currency. Dose-response functions are vital for that purpose. However, the construction of these functions is often of second interest in the currently available (epidemiological) literature. In order to bring forward the potential of epidemiological studies for the construction of the dose-response functions for benefit-risk purposes, the scientific (nutrition and health) community is asked to expand on their data presentation, either by presenting more detailed data focusing on dose-response necessities, and/or by sharing primary data.
Postlaunch monitoring of functional foods can encompass monitoring of effectiveness under conditi... more Postlaunch monitoring of functional foods can encompass monitoring of effectiveness under conditions of customary use. To this end, the effectiveness of phytosterol/-stanol enriched margarine consumption in free-living conditions was investigated with data from the Dutch "Doetinchem cohort study". In total, 4505 subjects (aged 26-70 years) were examined in 1994-1998 and re-examined during 1999-2003. A general and a food frequency questionnaire and non-fasting blood samples for total and HDL cholesterol determination were obtained. Subjects were stratified into phytosterol/-stanol enriched margarine users (n = 84) and non-users (n = 4421) based on the re-examination data, as these margarines were available on the Dutch market from 1999 onwards.
Background: Studies on effectiveness of phytosterol/-stanol-enriched margarines in the community ... more Background: Studies on effectiveness of phytosterol/-stanol-enriched margarines in the community have received low priority. For postlaunch monitoring purposes including risk-benefit analyses, it is needed to investigate both exposure and effectiveness of these margarines. Objective: To study the use and effectiveness of phytosterol/-stanol-enriched margarine. Design, setting and subjects: The study population consisted of 2379 subjects that participated in a community intervention study ('Hartslag Limburg') aged 28-76 years. In 1998 and 2003, blood samples for total and high-density lipoprotein (HDL) cholesterol were obtained. A general questionnaire and food frequency questionnaire (FFQ) were administered. From 1999 onwards, phytosterol/-stanol-enriched margarines were introduced on the Dutch market. On the basis of 2003 data, subjects were classified in users of (a) phytosterol/-stanol-enriched margarine, (b) cholesterol-lowering drugs, (c) the combination (both enriched margarine and drugs) and (d) neither enriched margarines nor cholesterol-lowering drugs. Results: Mean (7s.d.) daily intake of phytosterol-enriched margarine (n ¼ 99) and phytostanol-enriched margarine (n ¼ 16) was 1479 g. From 1998 to 2003, total serum cholesterol concentration changed significantly different among the four groups: in the combination users À2.0471.50 mmol/l (À29%), in cholesterol-lowering drug users À1.0971.17 mmol/l (À17%), in the enriched margarine users À0.2470.75 mmol/l (À4%) and in non-users þ 0.1070.72 mmol/l ( þ 2%)(Po0.05). Conclusion: Recommended doses are not consumed, but phytosterol/-stanol-enriched margarines can modestly reduce serum total cholesterol in the community. These margarines cannot equal the effect of cholesterol-lowering drugs, but may act additively. Further investigation of the health effects that may occur during simultaneous cholesterol lowering drugs and phytosterol-or -stanol-enriched margarines usage is important, as well as community education about the cholesterol lowering foods and drugs.
Low birthweight is associated with maternal anaemia and, in some circumstances, with low iron and... more Low birthweight is associated with maternal anaemia and, in some circumstances, with low iron and zinc status, but this relationship has not been investigated in the Philippines. In this study, we assessed the prevalence of anaemia and suboptimal iron and zinc status in pregnant women from three geographical regions (mountain, coast, city) of Zamboanga del Sur province at 24 weeks (n = 305), and again at 36 weeks (n = 127), gestation. At 24 weeks, 34% were anaemic (i.e., haemoglobin < 105 g/L) from all causes, of whom only 14% had concomitant low serum ferritin values (i.e., < 12 µg/L). The presence of infection was low, based on both elevated white blood cell count (> 11 × 10 9 /L; 19%) and serum C-reactive protein (> 15 mg/L; 3%). Of the women surveyed, 20% were iron depleted but not anaemic, and 15% were zinc deficient (i.e., serum zinc < 7.1 µmol/L). The mean (± SD) birthweight of the infants (n = 250) was 3074 g ± 408 g, of whom 5% were of low birthweight (< 2500 g). No differences existed for biochemical indices or birthweight among the three regions, or between women consuming maize or rice-based diets. Women with low haemoglobin (P = 0.05) and low serum zinc (P = 0.14) values at 24 weeks gestation had infants with lower birthweights than those with values ≥ 105 g/L and ≥ 7.1 µmol/L, respectively. However, in the multivariate model, the contribution of maternal haemoglobin to the variance in birthweight at 24 weeks gestation was non-significant, although modest for serum zinc. Anaemia and/or suboptimal zinc status during pregnancy may be related to low birthweight in the Philippines, and their aetiology deserves further study.
Objective: To assess the effectiveness (extent to which an intervention works in daily medical pr... more Objective: To assess the effectiveness (extent to which an intervention works in daily medical practice) of the use of phytosterol/phytostanol-enriched margarines to lower total and non-HDL cholesterol levels in users and non-users of statins. Design: Retrospective cohort study. Setting: Data were obtained from questionnaires on health and food intake from a population-based longitudinal cohort linked to pharmacy-dispensing records. Subjects: The analysis included 3829 men and women (aged 31-71 years) who were examined during 1998-2002 and re-examined at 5-year follow-up during 2003-2007. Results: Recommended doses of margarines were consumed by only 9 % of the subjects. Serum total cholesterol decreased by respectively 20?16 (95 % CI 20?26, 20?05) mmol/l, 21?40 (95 % CI 21?51, 21?30) mmol/l and 21?64 (95 % CI 21?91, 21
To study the relationship between diet and growth, a longitudinal anthropometric study was conduc... more To study the relationship between diet and growth, a longitudinal anthropometric study was conducted in a Dutch population consuming a macrobiotic diet. Measurements (anthropometry and food habit questionnaire) were taken in 1985 (0-7 y), 1987, and in 1993 (7-16 y, n = 209). Z-scores were calculated for anthropometric measures and changes expressed as the differences between 1993 and the mean of 1985 and 1987. Analysis indicated significant (P < 0.002) catch-up in height [(mean Z-score +/-sEM) +0.59 +/- 0.071 and arm circumference (+0.34 +/- 0.09) for age (boys and girls combined). In 1993, both girls and boys were still significantly (P < 0.05) below the reference for height and sum of four skinfolds for age, and girls were below reference for weight-for-height and arm circumference for age. In girls, multiple regression analyses showed a significant positive effect of the consumption frequency of dairy products on catch-up growth in height, weight and arm circumference, afte...
The primary aim of this study was to assess the biochemical vitamin B12 and folate status of a re... more The primary aim of this study was to assess the biochemical vitamin B12 and folate status of a representative group of elderly women (70-80 y) living in Dunedin, New Zealand. A second aim was to determine the prevalence of hyperhomocysteinaemia and to explore the determinants of homocysteine (hcy) concentration in this population. A cross-sectional study was carried out between June and August of 2000. Two hundred and fifty women were randomly selected from the 1998 electoral roll. Fasting blood samples were analysed for folate, vitamin B12, total hcy, creatinine, and haematological parameters. Of the women selected, 87 did not respond, 37 were not traceable, 23 were not eligible or had died, and 103 agreed to participate. The overall response rate was 46%. Based on a cut-off of 150 pmol/L for serum B12, 13% of participants would be classified as having sub-optimal vitamin B12 status. Of the women, 3 and 5%, respectively, had low serum (< 6.6 nmol/L) and erythrocyte folate (< ...
The fish ingredient N3-docosahexaenoic acid 22:6 n-3 (DHA) stimulates brain development. On the o... more The fish ingredient N3-docosahexaenoic acid 22:6 n-3 (DHA) stimulates brain development. On the other hand methylmercury (MeHg) in fish disturbes the developing central nervous system.Here the IQ score in children is considered as an aggregate measure of in utero brain development.To determine the effect of DHA exposure on prenatal neurodevelopment the maternal DHA intake during pregnancy was compared with its
The regulations and/or directives in force for functional foods primarily focus on the warrant of... more The regulations and/or directives in force for functional foods primarily focus on the warrant of safety before the particular foods reach the consumer. Aspects that come into the picture after marketing are not structurally and/or regulatory dealt with at this moment. This absence of clear guidelines about responsibility, timing and contents of a postlaunch monitoring (PLM) system hamper the establishment of an internationally standardized and stakeholder-adopted framework. The current paper describes a proposal for PLM and is illustrated with a case study on phytosterols/-stanols.
The importance of selenium and zinc in the immune functioning of the aged is widely recognized. S... more The importance of selenium and zinc in the immune functioning of the aged is widely recognized. Seniors in New Zealand are at particularly high risk of low selenium status because of the low selenium soil environment. The zinc status of the New Zealand elderly has never been assessed. In this cross-sectional study, the biochemical selenium, zinc and lipid levels, physical
Current regulations focus on the mandatory safety evaluation of functional foods before they come... more Current regulations focus on the mandatory safety evaluation of functional foods before they come to market, but Nynke de Jongand colleagues argue that the effects of such foods should also be evaluated after they have been launched
With the introduction of novel and functional foods, there is increasing need for an integrated q... more With the introduction of novel and functional foods, there is increasing need for an integrated quantitative risk–benefit assessment of foods. Consensus about a quantitative risk–benefit assessment mirroring the risk assessment approach has been reached during a recent EFSA workshop. In line, we propose a risk–benefit model that consists of: (1) hazard and benefit identification, (2) hazard and benefit characterization through
After total laryngectomy the absence of a nasal airflow results in a decrease in olfaction and pe... more After total laryngectomy the absence of a nasal airflow results in a decrease in olfaction and perception of flavors. Materials and Methods: Odor perception was assessed in 63 laryngectomized patients with two different olfactory tests. "he methods used by patients to smell were observed during olfactory testing. Patients' judgment about their olfaction and gustation was assessed by means of a structured questionnaire, semistructured interview, and self-rating. Results: Based on the results of the olfactory tests, patients were categorized as "Smellers" and "nonsmellers." Approximately one third of the patients were able to smell the odorous substances used in the olfactory tests. The smellers more often used a variety of methods to smell than the nonsmellers (P c .002); in most patients the method consisted of active use of facial muscles. Patients appeared well able to judge their own odor perception. Compared with the smellers, the nonsmellers judged their odor perception as worse (P c .003) and reported a more severe decrease in gustation after the operation (P < .033). The results of this study in laryngectomized patients confirm the interrelation between olfaction and gustation: the nonsmellers reported a poorer gustation and a more severe decrease in gustation and appetite than both the smellers and a reference group of elderly persons (P c ,061. Patients who reported a deterioration of olfaction and gustation tended to experience negative consequences such as the inability to smell smoke, leaking gas, or agreeable odors. Conclusion: Olfaction and odor-related flavor sensation are seriously deteriorated after total laryngectomy.
This present study investigated the effect of a 17-week intervention programme with nutrient-dens... more This present study investigated the effect of a 17-week intervention programme with nutrient-dense foods (enriched with vitamins and minerals at 25-100% of the Dutch recommended dietary allowance) and/or physical exercise in 159 frail elderly subjects (forty-six men, 113 women, mean age 78.7 (SD 5.6) years). Subjects were randomized into four groups: (1) control, (2) nutrition intervention, (3) exercise or (4) both nutrition intervention and exercise. Main outcome variables were sensory perception (smell test and questionnaire), appetite (questionnaire), energy intake (3 d food record) and body weight (on a weighing scale and with dual energy X-ray absorptiometry measurements). At baseline, moderate but significant correlations were found between appetite and energy intake (r 0.30, P &lt; 0.0001), between smell test and smell perception assessed by questionnaire (r 0.40, P &lt; 0.0001) and between lean body weight and energy intake (r 0.50, P &lt; 0.0001). Results after 17-weeks intervention revealed neither change in smell test scores (P = 0.19) nor in appetite (P = 0.17). A slight positive effect of exercise compared with non-exercising groups on energy intake (difference 0.5 MJ, P = 0.05) was shown next to a preserving effect of exercise on lean body mass (+0.08 kg) compared with a decrease (-0.4 kg) in non-exercisers (P &lt; 0.02). The correlation between the change in lean body mass and change in energy intake was 0.18 (P = 0.05). In conclusion, an interesting preserving effect on lean body mass in frail elderly subjects due to 17 weeks of exercise was shown. Since a decline in lean body mass was observed in the non-exercisers, effects may be attributable to change in activity pattern. Changes in lean mass were also slightly, but significantly, correlated with changes in energy intake. In turn, energy intake was not related to a change in reported appetite or sensory perception. Nutrient-dense foods were not able to improve any of the outcome variables in this study.
Risk-benefit analyses are introduced as a new paradigm for old problems. However, in many cases i... more Risk-benefit analyses are introduced as a new paradigm for old problems. However, in many cases it is not always necessary to perform a full comprehensive and expensive quantitative risk-benefit assessment to solve the problem, nor is it always possible, given the lack of required date. The choice to continue from a more qualitative to a full quantitative risk-benefit assessment can be made using a tiered approach. In this article, this tiered approach for riskbenefit assessment will be addressed using a decision tree. The tiered approach described uses the same four steps as the risk assessment paradigm: hazard and benefit identification, hazard and benefit characterization, exposure assessment, and risk-benefit characterization, albeit in a different order. For the purpose of this approach, the exposure assessment has been moved upward and the dose-response modeling (part of hazard and benefit characterization) is moved to a later stage. The decision tree includes several stop moments, depending on the situation where the gathered information is sufficient to answer the initial risk-benefit question. The approach has been tested for two food ingredients. The decision tree presented in this article is useful to assist on a case-by-case basis a risk-benefit assessor and policymaker in making informed choices when to stop or continue with a risk-benefit assessment.
Background. Cholesterol-lowering drugs may metabolically interact with cholesterol-lowering bread... more Background. Cholesterol-lowering drugs may metabolically interact with cholesterol-lowering bread spreads. This study analyses the prevalence of use of drugs, bread spreads or the combination of both in people aware of their high/elevated cholesterol level, and compares users of the three therapies on health behavior and demographics.
j o u r n a l h o m e p a g e : w w w . e l s e v i e r . c o m / l o c a t e / f o o d c h e m t... more j o u r n a l h o m e p a g e : w w w . e l s e v i e r . c o m / l o c a t e / f o o d c h e m t o x
If a diet, food or food constituent is recognised to have both health benefits and health risks, ... more If a diet, food or food constituent is recognised to have both health benefits and health risks, the benefits have to be compared with the risks to develop coherent scientific evidence-based dietary advice. This means that both risk and benefit assessment should follow a similar paradigm and that benefits and risks are expressed in a common currency. Dose-response functions are vital for that purpose. However, the construction of these functions is often of second interest in the currently available (epidemiological) literature. In order to bring forward the potential of epidemiological studies for the construction of the dose-response functions for benefit-risk purposes, the scientific (nutrition and health) community is asked to expand on their data presentation, either by presenting more detailed data focusing on dose-response necessities, and/or by sharing primary data.
Postlaunch monitoring of functional foods can encompass monitoring of effectiveness under conditi... more Postlaunch monitoring of functional foods can encompass monitoring of effectiveness under conditions of customary use. To this end, the effectiveness of phytosterol/-stanol enriched margarine consumption in free-living conditions was investigated with data from the Dutch "Doetinchem cohort study". In total, 4505 subjects (aged 26-70 years) were examined in 1994-1998 and re-examined during 1999-2003. A general and a food frequency questionnaire and non-fasting blood samples for total and HDL cholesterol determination were obtained. Subjects were stratified into phytosterol/-stanol enriched margarine users (n = 84) and non-users (n = 4421) based on the re-examination data, as these margarines were available on the Dutch market from 1999 onwards.
Background: Studies on effectiveness of phytosterol/-stanol-enriched margarines in the community ... more Background: Studies on effectiveness of phytosterol/-stanol-enriched margarines in the community have received low priority. For postlaunch monitoring purposes including risk-benefit analyses, it is needed to investigate both exposure and effectiveness of these margarines. Objective: To study the use and effectiveness of phytosterol/-stanol-enriched margarine. Design, setting and subjects: The study population consisted of 2379 subjects that participated in a community intervention study ('Hartslag Limburg') aged 28-76 years. In 1998 and 2003, blood samples for total and high-density lipoprotein (HDL) cholesterol were obtained. A general questionnaire and food frequency questionnaire (FFQ) were administered. From 1999 onwards, phytosterol/-stanol-enriched margarines were introduced on the Dutch market. On the basis of 2003 data, subjects were classified in users of (a) phytosterol/-stanol-enriched margarine, (b) cholesterol-lowering drugs, (c) the combination (both enriched margarine and drugs) and (d) neither enriched margarines nor cholesterol-lowering drugs. Results: Mean (7s.d.) daily intake of phytosterol-enriched margarine (n ¼ 99) and phytostanol-enriched margarine (n ¼ 16) was 1479 g. From 1998 to 2003, total serum cholesterol concentration changed significantly different among the four groups: in the combination users À2.0471.50 mmol/l (À29%), in cholesterol-lowering drug users À1.0971.17 mmol/l (À17%), in the enriched margarine users À0.2470.75 mmol/l (À4%) and in non-users þ 0.1070.72 mmol/l ( þ 2%)(Po0.05). Conclusion: Recommended doses are not consumed, but phytosterol/-stanol-enriched margarines can modestly reduce serum total cholesterol in the community. These margarines cannot equal the effect of cholesterol-lowering drugs, but may act additively. Further investigation of the health effects that may occur during simultaneous cholesterol lowering drugs and phytosterol-or -stanol-enriched margarines usage is important, as well as community education about the cholesterol lowering foods and drugs.
Low birthweight is associated with maternal anaemia and, in some circumstances, with low iron and... more Low birthweight is associated with maternal anaemia and, in some circumstances, with low iron and zinc status, but this relationship has not been investigated in the Philippines. In this study, we assessed the prevalence of anaemia and suboptimal iron and zinc status in pregnant women from three geographical regions (mountain, coast, city) of Zamboanga del Sur province at 24 weeks (n = 305), and again at 36 weeks (n = 127), gestation. At 24 weeks, 34% were anaemic (i.e., haemoglobin < 105 g/L) from all causes, of whom only 14% had concomitant low serum ferritin values (i.e., < 12 µg/L). The presence of infection was low, based on both elevated white blood cell count (> 11 × 10 9 /L; 19%) and serum C-reactive protein (> 15 mg/L; 3%). Of the women surveyed, 20% were iron depleted but not anaemic, and 15% were zinc deficient (i.e., serum zinc < 7.1 µmol/L). The mean (± SD) birthweight of the infants (n = 250) was 3074 g ± 408 g, of whom 5% were of low birthweight (< 2500 g). No differences existed for biochemical indices or birthweight among the three regions, or between women consuming maize or rice-based diets. Women with low haemoglobin (P = 0.05) and low serum zinc (P = 0.14) values at 24 weeks gestation had infants with lower birthweights than those with values ≥ 105 g/L and ≥ 7.1 µmol/L, respectively. However, in the multivariate model, the contribution of maternal haemoglobin to the variance in birthweight at 24 weeks gestation was non-significant, although modest for serum zinc. Anaemia and/or suboptimal zinc status during pregnancy may be related to low birthweight in the Philippines, and their aetiology deserves further study.
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