Abitudini alimentari e composizione del latte materno: Lo studio MediDiet

Transcription

1 DIPARTIMENTO DI SCIENZE CLINICHE E DI COMUNITA Department of Clinical Sciences and Community Health Abitudini alimentari e composizione del latte materno: Lo studio MediDiet Ferraroni Monica 1, Bravi Francesca 1, Wiens Frank 2, Stahl Bernd 2, Bertino Enrico 3, Decarli Adriano 1, Moro Guido 4 1 Dipartimento di Scienze Cliniche e di Comunità, Università degli Studi di Milano, Milano 2 Human Milk Research, Danone, Utrecht, The Netherlands 3 S.C. Neonatologia dell'università Città della Salute e della Scienza. Torino 4 Associazione Italiana delle Banche del Latte Donato ONLUS, Milano

2 MediDietStudy This is an exploratory, non-comparative, multi-centre, mono-country study. Cooperation between: - Research Line of AIBLUD - Department of Human Milk Research, Danone Nutricia - Early Life Nutrition - Branch of Medical Statistics, Biometry and Epidemiology G.A. Maccacaro - University of Milan. DIPARTIMENTO DI SCIENZE CLINICHE E DI COMUNITA Department of Clinical Sciences and Community Health

3 MediDietStudy: Centers involved Torino Firenze Roma San Giovanni Rotondo Palermo

4 MedidietStudy : Objectives Primary : - to investigate the association of the Mediterranean diet with the oxidative status and antioxidative capacity of human milk - the association of the Mediterranean diet with fatty acid (FA) profile and/or cholesterol level of human milk. Secondary : - to analyze the association between the oxidative status and antioxidativecapacity of human milk and lifestyle parameters other than diet, i.e. (non-)smoking status or exposure to smoking of the lactating woman and her level of physical activity.

5 Medidiet Study : Subjects Ca. 300 Italian mothers, aged 25-40, of healthy termborn infants each providing one milk sample at 6 weeks ±1 week of delivery.

6 Medidiet: Study Diagram Subject information, eligibility criteria ICF signature, eligibility, milk sample collection, FFQ Record of Medical events from V1 to Follow -up call N ~ 300 Prescreening Lactation N= 300 Time: V0 = V1 = Birth+ 6 wk/ Follow -up Call = Birth+ 7wk/ Prescreening/ Birth Enrollment End of study

7 Inclusion criteria Ethnicity: healthyitalianwomen (bornand permanentlyliving in Italy withbothparentsbornin Italy). Agedbetween25and 40 years. Delivery less than 7 weeks before milk sample. Givenbirth tohealthytermbornbabies(gestationalage: 37 to42 weeks, Weight: g, Length: cm). Exclusive breastfeeding and not giving any complementary food. Written informed consent.

8 Exclusion Criteria -1 Active smoker during pregnancy or lactation Use of drugs of abuse(cannabinoids, stimulants, opioids) Mastitis, fungal infections or viral infections of the nipple or areola or mammary region History of blood transfusion Eliminationdiet(due to chronicallergicdiseasesor vegan) Participation in other interventional clinical studies

9 Exclusion Criteria -2 Disease - Endocrinologic, particularly diabetes mellitus (exception: gestational diabetes) - Metabolic, particularly obesity(bmi >35) - Chronic diseases(renal, cardiovascular, hypertension) -Autoimmune diseases (Lupus Eritematoso, scleroderma, colitis ulcerosa, Crohn) - Underlying disease requiring medical intervention - Acute infective disease or neoplastic disease

10 Milk sample collection Only 1 sample of milk was collected per subject. Mothers expressed 50 ml of their breast milk by breast pump into sterile hard plastic containers. Milk was stirred and aliquoted into sterile 10 ml plastic containers. These containers were half filled with 5 ml milk and overlaid with 5 ml of nitrogen gas to prevent milk oxidation. They were tightly closed immediately after expression, kept at -20 C for a maximum of 25 minutes before being transferred to another freezer for storage between -70 C and -80 C. The frozen samples were transported to several laboratories for analyses.

11 Analyses Lab analysis milk samples ongoing: Macro nutrients Lipids Volatiles Oxidative damage to proteins Lipid peroxidation Antioxidative capacity Dietary data analysis started Food Frequency Questionnaires

12 Is the relation stronger with usual or recent diet? to assess usual diet after delivery/during lactation to assess recent diet Food frequency questionnaire (FFQ) FFQ in the last 2 days before milk donation and list of food consumed for the last dinner and breakfast before milk donation

13 Food frequency questionnaire Food frequency questionnaire (FFQ) tested for validity and reproducibility including 14 questions on general dietary habits; 78 foods/ beverages; 5 questions on alcohol Using Italian food composition database Macro-nutrients and Micro-nutrients

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17 Description of the population Mother age, height, weight before pregnancy (body mass index) socioeconomic factors number of children gestational age time since delivery physical activity smoking habit history use of drugs and supplements (particularly iron and folic acid) Infant sex weight and length at birth

18 Characteristics of the mothers Mean + standard deviation Age (years) Body mass index (kg/m 2 ) Time since delivery (days) Profession 0 Housewife, student, unemployed 1 Managers/intellectual professionals 2 Technicians/clerical workers 3 Service and sale workers 4 Agricultural/craft/trade workers, machine operators, elementary occupations

19 Use of food supplements or drugs Types of food supplements and drugs 1 Vit or Minerals or Probiotics 2 Vit or Minerals and Omega 3 3 Galattogogues 4 Only Drugs 5 Vit or Minerals and Drugs

20 Characteristics of the infants Number Percentage Sex Boys Girls Mean + Standard deviation Birth weight (g) 3, Birth length (cm)

21 Usual diet after delivery What type of fat do you use to: 1st type of fat: 2nd type of fat: (similar intake) To dress raw vegetables Olive / / oil (99.97%) / / To cook or season cooked vegetables Olive / / oil (98.33%) Butter / / (6.00%) To cook meat Olive / / oil (93.00%) Butter / / (5.33%) To fry Olive / / oil (43.67%) Seeds / / Oil (37.33%) To season pasta or rice Olive / / oil (99.33%) Butter / / (5.33%) (also used for the sauce)

22 Usual diet after delivery Yes Do you tend to discard the fat in meat? 27.00% Do you tend to discard the fat in ham (also cooked)? Do you tend to discard the skin in chicken meat? Do you tend to leave the food condiments in your plate? 36.67% 21.33% 27.00%

23 Usual diet after delivery

24 Usually diet after delivery (with open items). Portion/week. Total (n=300) Food Groups Median P10 P90 Milk Bread First dishes Soups White meat Red meat Processed meat Fish Cheese Total vegetables Row vegetables Cooked vegetables Total fruits Sweets P10 = 10 th percentile; P90 = 90 th percentile 24

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26 Pasta/rice white Pasta/rice tomato Pasta/rice ragù Pasta/rice pesto Risotto Lasagne/ tortellini

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28 Poultry, boiled or grilled Poultry, rabbit, friedor stewed Red meat, grilled Boiled beef Beefor vealstew, meat balls Wiener Schnitzel Pork chop/ paillard or pork roasted Liver

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30 Green salad Row Carrots Tomato Mixed salad Cooked carrots Artichokes Onions Broccoli, cabbage, cauliflower, Brussels sprout Spinach Zucchini, aubergine, peppers

31 Mean portion/week Selected food groups by Geoghaphical area Milk Bread Row Vegetables Cooked Vegetables Fruits Total. North Centre South

32 Primary study aim To investigate the association of the Mediterranean diet with the oxidative status and antioxidative capacity of human milk 32

33 Traditional Mediterranean diet Abundant and variable plant foods High consumption of cereals and legumes High consumption of fish Olive oil as the main (added) fat Low intake of (red) meat Low intake of diary products Moderate consumption of wine

34 The protective effect of the Mediterranean diet has been suggested in the 50 by an American physician (Ancel Keys) who observed a lower mortality from cardiovascular diseases in a countries of the Mediterranean area (Creta), notwithstanding the high consumption of olive oil and hypothesized that this was attributable to the typical diet of this geographic area.

35 Mediterranean Dietary pattern As a dietary pattern cannot be measured directly, one must rely on statistical methods to characterize dietary patterns using collected dietary information. Three approaches have been used in the literature: - Factor analysis - Cluster analysis - Dietary indices Typically constructed on the basis of prevailing dietary reccomandations Focus on the calculation of a graded score: the maximum value describes the ideal diet as conceptualised on the basis of the best available scientific evidence Uncertainty in selecting components of the score and subjectivity in defining cut-off points

36 MDS (Mediterranean diet score) 1 based on nine dietary components of the traditional Mediterranean diet: - high consumption of cereals, fruit, vegetables, legumes and fish - high monounsaturated/saturated fat ratio - low consumption of milk (including dairy products) - low consumption of red meat (including processed meat) - moderate alcohol intake ¹ Trichopoulou A, Kouris-Blazos A, Wahlqvist M, et al. Diet and overall survival in elderly people. British Medical Journal 1995; 311:

37 Mediterranean diet score - methods Consumption above the median Scoring Consumption at or below the median Score component Vegetables 1 0 Fruit and nuts 1 0 Legumes 1 0 Cereals 1 0 Fish and seafood 1 0 Ratio of monounsaturated to saturated lipids 1 0 Red meat 0 1 Dairy products 0 1 Alcohol a 0 1 a A value of 1 was given to women consuming 5 g to less than 25 g of ethanol/day.

38 Alcohol consumption g of ethanol/day N (%) No consumption 212 (70.67) (24.33) (4.67) (0.33)

39 % Mediterranean diet score 69, ,18 48,76 48,76 37,67 33,64 24,64 8,18 5,33 5,8 2,48 Low (0-3) Medium (4-6) High (7-9) Tot. North Centre South

40 131 healthy subjects (50% women) living in Southern and Central Italy MDS Low (0-3) Medium (4-5) High (6-9) 26% 46% 28%

41 3247 adults (60,6% women) admitted to a network of hospitals. Average MDS of about 4 among women younger than 45 years. MDS (women years) Low (0-3) Medium (4-5) High (6-9) 28.4% 57.07% 14.53%

42 Grazie per l attenzione This study has been sponsored by Nutricia Research - Utrecht, The Netherlands. The Department of Clinical Science and Community Health has signed a contract of to cover a post-doc scholarship. 42

43 Thank you very much for your attention