In Canada, many individuals are unable or do not meet the recommended nutrient intake from food alone, supplements may be one intervention strategy to help compensate for some of these inadequacies. The 2004 Canadian Community Health Survey found that 28 to 60 percent of individuals use supplements. Supplement use is positively associated with income and education level, with higher income individuals consuming a higher amount of supplements and supplement use increasing with education level. Previous research has identified several barriers to supplement usage, one of them being knowledge. The purpose of this qualitative research study was to develop a resource to help inform and educate consumers to select a supplement. A total of 31 participants were included in data collection. Three focus groups with participants residing in low income neighbourhoods in Saskatoon, Saskatchewan, as well as, seven key informant interviews were conducted using a semi-structured interview guide. Audio tapes were transcribed and analyzed using thematic analysis to identify emergent themes. Data analysis yielded over 400 codes from the focus groups and key informant interviews. These codes were then grouped into themes and then further divided into three major topics: Barriers to Use, Resource, and Other. These data were subsequently used to create a new tool to help consumers choose an appropriate multivitamin. The aim of this resource is not to convince individuals that they need a supplement, but rather to provide information to help them choose an appropriate supplement once they have already decided to take one. This study will help to enhance the quality of information available regarding supplement selection through the use of an innovative online tool which is user friendly and meets the consumers’ needs. A newly created resource based on the expressed needs, ideas, and beliefs of community members and health care professionals will serve to help to fill a void in currently available information. This provides individuals with a resource to educate themselves to select an appropriate multivitamin.

It is highly recommended for women to take multivitamin/mineral supplements during the periconceptional and prenatal periods. Studies have confirmed that taking prenatal multivitamins prevents maternal iron deficiency anemia, and reduces the risk for neural tube defects (NTDs). To date, research aimed at optimizing the use of multivitamins before and during pregnancy has been minimal. My thesis focused on two challenges of periconceptional and prenatal multivitamin supplementation. The first challenge was gastrointestinal (GI) adverse events such as nausea and constipation which may be attributed to iron content and tablet size. Pregnant women are highly susceptible to GI adverse events since 80% experience nausea and vomiting of pregnancy. A prospective, randomized, controlled, open-label study was conducted to investigate whether a low-iron, small-tablet prenatal multivitamin can reduce GI adverse events, and improve supplement tolerability and adherence, relative to a high-iron, small-tablet prenatal multivitamin. We determined that low iron dose did not produce a significant difference, while small tablet size could be considered an important factor. Moreover, our results confirmed that adherence was poor in pregnant women. We were prompted to identify determinants which could predict adherence to prenatal multivitamins. Our retrospective study determined that predictors of adherence are rooted in women’s prior experiences with multivitamin use. The second challenge we addressed was achieving adequate blood folate concentrations for prevention of NTDs. If adherence is poor, standard dosing of 0.4-1 mg folic acid may not produce the blood folate concentrations needed in women prior to conception. We investigated the pharmacokinetics of 5 mg folic acid. Our prospective, parallel, open-labeled study, comparing a single dose of 5 mg to 1.1 mg folic acid, confirmed that folic acid follows linear (proportional) pharmacokinetics. However, our prospective, randomized, controlled, open-labeled, multiple-dose study determined that repeated use of folic acid at these 2 doses followed non-linear pharmacokinetics. Nevertheless, our data confirmed that 5 mg folic acid can produce higher blood folate concentrations, with a faster rate, which can counter the effect of poor adherence. In conclusion, optimal use of prenatal multivitamins requires improvements in supplement tolerability, adherence, and pharmacokinetics which depend on supplement formulations, and individualized assessment and counseling.

It is highly recommended for women to take multivitamin/mineral supplements during the periconceptional and prenatal periods. Studies have confirmed that taking prenatal multivitamins prevents maternal iron deficiency anemia, and reduces the risk for neural tube defects (NTDs). To date, research aimed at optimizing the use of multivitamins before and during pregnancy has been minimal. My thesis focused on two challenges of periconceptional and prenatal multivitamin supplementation. The first challenge was gastrointestinal (GI) adverse events such as nausea and constipation which may be attributed to iron content and tablet size. Pregnant women are highly susceptible to GI adverse events since 80% experience nausea and vomiting of pregnancy. A prospective, randomized, controlled, open-label study was conducted to investigate whether a low-iron, small-tablet prenatal multivitamin can reduce GI adverse events, and improve supplement tolerability and adherence, relative to a high-iron, small-tablet prenatal multivitamin. We determined that low iron dose did not produce a significant difference, while small tablet size could be considered an important factor. Moreover, our results confirmed that adherence was poor in pregnant women. We were prompted to identify determinants which could predict adherence to prenatal multivitamins. Our retrospective study determined that predictors of adherence are rooted in women’s prior experiences with multivitamin use. The second challenge we addressed was achieving adequate blood folate concentrations for prevention of NTDs. If adherence is poor, standard dosing of 0.4-1 mg folic acid may not produce the blood folate concentrations needed in women prior to conception. We investigated the pharmacokinetics of 5 mg folic acid. Our prospective, parallel, open-labeled study, comparing a single dose of 5 mg to 1.1 mg folic acid, confirmed that folic acid follows linear (proportional) pharmacokinetics. However, our prospective, randomized, controlled, open-labeled, multiple-dose study determined that repeated use of folic acid at these 2 doses followed non-linear pharmacokinetics. Nevertheless, our data confirmed that 5 mg folic acid can produce higher blood folate concentrations, with a faster rate, which can counter the effect of poor adherence. In conclusion, optimal use of prenatal multivitamins requires improvements in supplement tolerability, adherence, and pharmacokinetics which depend on supplement formulations, and individualized assessment and counseling.

No description available.

Gestational Hypertension and Preeclampsia are significant causes of morbidity and mortality among pregnant women and neonates. This study examined the relationship between multivitamin use and incidence of reported high blood pressure or preeclampsia using data from the 2007 Oregon State Pregnancy Risk Assessment Monitoring System (PRAMS). Overall there were n=1894 women included in the study. Women were asked two to four months after delivery to report their multivitamin or prenatal vitamin usage in the month prior to conception and were categorized as daily users, or less than daily users. The unadjusted prevalence of high blood pressure or preeclampsia was 13.4% among daily users and 11.9% among nonusers. The study showed that the association between multivitamin use and preeclampsia was modified by BMI. Upon adjustment for parity, diabetes, pregnancy intent, abuse, and maternal age, analysis stratified by maternal pre-pregnancy BMI revealed a borderline significant protective effect among daily multivitamin users with a BMI less than 30 (OR 0.48, 95% CI [0.22,1.04]), and a significant risk for women with a BMI greater than 30 (OR 2.74, 95% CI [1.02,7.40]). This study showed the potential impact of multivitamin on preeclampsia among obese and non-obese women. Additional investigations are needed to examine the association and potential biologic mechanisms for this association need to be explored.

Made available in DSpace on 2014-06-11T19:29:51Z (GMT). No. of bitstreams: 0 Previous issue date: 2009-02-09Bitstream added on 2014-06-13T18:39:54Z : No. of bitstreams: 1 maia_fa_me_botfm.pdf: 761192 bytes, checksum: af7cd1654f8ff045bdb288b848b037dc (MD5) / A infertilidade é definida pela inabilidade de engravidar após 12 meses ou mais de coito regular não protegido. O uso de polivitamínico e polimineral parece influenciar na qualidade seminal. Dados da literatura sobre o uso oral isolado ou combinado desses micronutrientes na melhoria dos parâmetros seminais e eventual fertilidade são controversos e escassos. Analisar os parâmetros seminais de indivíduos inférteis em uso de polivitamínico e polimineral e compará-los com indivíduos normais, comprovadamente férteis sem uso destas substâncias. Foram analisados os parâmetros Seminais de 57 casais inférteis acompanhados no ambulatório de esterilidade do Hospital das Clínicas da Faculdade de Medicina de Botucatu, no período de 2003 a 2007. Nos indivíduos inférteis a análise seminal foi realizada antes e com 90 dias de micronutrientes por via oral os quais foram comparados com 50 indivíduos saudáveis comprovadamente férteis sem uso destas substâncias. A avaliação do sêmen foi feita de acordo com os critérios da Organização Mundial de Saúde - OMS (1999) e morfologia de Kruger et al. (1986). A análise estatística foi feita utilizando os testes t de Student, Mann-Whitney e Wilcoxon, considerando um nível de significância de 5%. Os indivíduos inférteis e os comprovadamente férteis apresentaram similaridade quanto a idade (31,0±5,6 versus 30,3±6,5) (p=0,55) e ao tabagismo (29,8% versus 22,0) (p=0,36). Nos indivíduos inférteis, o uso desses micronutrientes aumentou significativamente a morfologia tanto pelos critérios estabelecidos pela OMS (18,3±9,6 para 22,6±11,8) (p=0,006) e por Kruger (6,9±4,1 para 9,1±5,2) (p=0,002). Verificou-se que os homens inférteis antes do uso de micronutrientes quando comparados aos férteis apresentavam significantemente uma menor concentração de espermatozóides/ml (68,0[37,8;101,2]... / Infertility is defined as the inability to become pregnant after 12 months or more of regular unprotected intercourse. The use of multivitamin/multimineral supplements seems to influence semen quality. Data on the isolated or combined use of these micronutrients to improve semen parameters and eventual fertility are controversial and scarce. To assess semen parameters in infertile individuals using multivitamin and multimineral supplements in comparison with healthy proven fertile individuals not using these substances. Semen parameters were evaluated in 57 infertile couples followed up in the Sterility Outpatient Clinic of Botucatu Medical School between 2003 and 2007. Semen analysis was performed before and after 90 days of oral micronutrient use in infertile individuals that were compared with 50 healthy proven fertile individuals not using these substances. Semen was evaluated according to the recommendations of the World Health Organization- WHO (1999) and the criteria described by Kruger et al. (1986). Statistical analysis was carried out using Student’s t test and the tests of Mann-Whitney and Wilcoxon with significance set at 5%. Infertile and proven fertile individuals showed similar age (31.0±5.6 versus 30.3±6.5) (p=0.55) and smoking status (29.8% versus 22.0) (p=0.36). In infertile individuals, the use of micronutrients significantly improved morphology according to the criteria of WHO (18.3±9.6 to 22.6±11.8) (p=0.006) and Kruger (6.9±4.1 to 9.1±5.2) (p=0.002). Before micronutrient use, infertile individuals compared with fertile males showed lower spermatozoa/ml concentration (68.0[37.8;101.2] versus 96.5[49.0;144.2]) and vitality (85,4±9,2 versus 89.6±6.9) and higher leukocyte count (600.0 [300.0;121.5] versus 350.0[100.0;675.0]). In infertile individuals using multivitamin and multimineral supplements, semen parameters... (Complete abstract click electronic access below)

Orientador: Anaglória Pontes / Banca: Antonio Alberto Nogueira / Banca: Edilberto de Araújo Filho / Resumo: A infertilidade é definida pela inabilidade de engravidar após 12 meses ou mais de coito regular não protegido. O uso de polivitamínico e polimineral parece influenciar na qualidade seminal. Dados da literatura sobre o uso oral isolado ou combinado desses micronutrientes na melhoria dos parâmetros seminais e eventual fertilidade são controversos e escassos. Analisar os parâmetros seminais de indivíduos inférteis em uso de polivitamínico e polimineral e compará-los com indivíduos normais, comprovadamente férteis sem uso destas substâncias. Foram analisados os parâmetros Seminais de 57 casais inférteis acompanhados no ambulatório de esterilidade do Hospital das Clínicas da Faculdade de Medicina de Botucatu, no período de 2003 a 2007. Nos indivíduos inférteis a análise seminal foi realizada antes e com 90 dias de micronutrientes por via oral os quais foram comparados com 50 indivíduos saudáveis comprovadamente férteis sem uso destas substâncias. A avaliação do sêmen foi feita de acordo com os critérios da Organização Mundial de Saúde - OMS (1999) e morfologia de Kruger et al. (1986). A análise estatística foi feita utilizando os testes t de Student, Mann-Whitney e Wilcoxon, considerando um nível de significância de 5%. Os indivíduos inférteis e os comprovadamente férteis apresentaram similaridade quanto a idade (31,0±5,6 versus 30,3±6,5) (p=0,55) e ao tabagismo (29,8% versus 22,0) (p=0,36). Nos indivíduos inférteis, o uso desses micronutrientes aumentou significativamente a morfologia tanto pelos critérios estabelecidos pela OMS (18,3±9,6 para 22,6±11,8) (p=0,006) e por Kruger (6,9±4,1 para 9,1±5,2) (p=0,002). Verificou-se que os homens inférteis antes do uso de micronutrientes quando comparados aos férteis apresentavam significantemente uma menor concentração de espermatozóides/ml (68,0[37,8;101,2]... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Infertility is defined as the inability to become pregnant after 12 months or more of regular unprotected intercourse. The use of multivitamin/multimineral supplements seems to influence semen quality. Data on the isolated or combined use of these micronutrients to improve semen parameters and eventual fertility are controversial and scarce. To assess semen parameters in infertile individuals using multivitamin and multimineral supplements in comparison with healthy proven fertile individuals not using these substances. Semen parameters were evaluated in 57 infertile couples followed up in the Sterility Outpatient Clinic of Botucatu Medical School between 2003 and 2007. Semen analysis was performed before and after 90 days of oral micronutrient use in infertile individuals that were compared with 50 healthy proven fertile individuals not using these substances. Semen was evaluated according to the recommendations of the World Health Organization- WHO (1999) and the criteria described by Kruger et al. (1986). Statistical analysis was carried out using Student's t test and the tests of Mann-Whitney and Wilcoxon with significance set at 5%. Infertile and proven fertile individuals showed similar age (31.0±5.6 versus 30.3±6.5) (p=0.55) and smoking status (29.8% versus 22.0) (p=0.36). In infertile individuals, the use of micronutrients significantly improved morphology according to the criteria of WHO (18.3±9.6 to 22.6±11.8) (p=0.006) and Kruger (6.9±4.1 to 9.1±5.2) (p=0.002). Before micronutrient use, infertile individuals compared with fertile males showed lower spermatozoa/ml concentration (68.0[37.8;101.2] versus 96.5[49.0;144.2]) and vitality (85,4±9,2 versus 89.6±6.9) and higher leukocyte count (600.0 [300.0;121.5] versus 350.0[100.0;675.0]). In infertile individuals using multivitamin and multimineral supplements, semen parameters... (Complete abstract click electronic access below) / Mestre

While all women hope to deliver a healthy baby, approximately 3-5% babies are affected by birth defects. Birth defects can occur naturally or be induced by teratogens. Alcohol is a known teratogen that causes fetal alcohol spectrum disorder (FASD), the most commonly known cause of neurobehavioural and neurodevelopmental deficits. Individuals affected with FASD are likely to be involved with or require additional assistance from healthcare, education, social services, and justice sectors. Due to this immense burden, effective prevention of FASD can have a major public impact. Prevention of FASD can occur at different levels: primary prevention (preventing alcohol-induced birth defects from occurring in the first place); secondary prevention (preventing alcohol-induced birth defects from developing or progressing); tertiary prevention (improving the outcome of individuals affected with FASD); and quaternary prevention (preventing another child from being affected with FASD). The objective of this thesis was to explore a multilevel birth defect and FASD prevention strategy. Primary prevention by was investigated by maternal multivitamin supplementation to optimize fetal growing conditions, as alcoholics are commonly deficient in nutrients. A meta-analysis of maternal multivitamin supplementation demonstrated a decreased risk for certain congenital anomalies and pediatric cancers. Secondary prevention was investigated by a randomized double-blinded placebo-controlled evaluating the ability of high doses of antioxidants (vitamin C and vitamin E) to mitigate the effects of prenatal alcohol exposure. The study was ceased due to safety concerns regarding high doses of vitamin C and vitamin E in preeclamptic studies. Tertiary prevention was investigated by anonymous meconium screening of babies of Grey-Bruce, Ontario residents delivering at or transferred to St. Joseph’s Health Care in London, Ontario. A 30% prevalence of fatty acid ethyl esters (FAEE) positive meconium was observed at this high-risk unit. Meconium screening is also a means of quaternary prevention since positive screens also identify mothers who were unable to stop consuming alcohol after 13 weeks of pregnancy, and therefore are at risk of delivering another child who is prenatally exposed to alcohol. The identification and engagement of these mothers into treatment programs constitutes primary prevention of FASD in subsequent pregnancies.

The hypothesis that high multivitamin gestational (HV) diets affect the development of central serotonergic regulatory systems in female offspring, and that this is due to its high folic acid content, was investigated. Dams were fed the AIN-93G diet containing the recommended multivitamin mix (RV), 10-fold the RV amount (HV), or the RV diet with 10-fold the folic acid (Hfol). Serotonergic control of food intake and macronutrient selection was assessed by measuring long-term intake and selection, short-term intake and selection following injections of serotonin receptor agonists, and hypothalamic serotonin receptor expression. Offspring from Hfol dams selected more protein and were less responsive to agonist injections, but showed no altered serotonin receptor expression. In contrast, those born to HV fed dams were not different from the RV controls in any measure. In conclusion, the Hfol, but not HV gestational diet affects serotonergic regulation of food intake in female rat offspring.

The hypothesis that high multivitamin gestational (HV) diets affect the development of central serotonergic regulatory systems in female offspring, and that this is due to its high folic acid content, was investigated. Dams were fed the AIN-93G diet containing the recommended multivitamin mix (RV), 10-fold the RV amount (HV), or the RV diet with 10-fold the folic acid (Hfol). Serotonergic control of food intake and macronutrient selection was assessed by measuring long-term intake and selection, short-term intake and selection following injections of serotonin receptor agonists, and hypothalamic serotonin receptor expression. Offspring from Hfol dams selected more protein and were less responsive to agonist injections, but showed no altered serotonin receptor expression. In contrast, those born to HV fed dams were not different from the RV controls in any measure. In conclusion, the Hfol, but not HV gestational diet affects serotonergic regulation of food intake in female rat offspring.