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The Cochrane Database of Systematic... Oct 2013Postnatal depression is a medical condition that affects many women and the development of their infants. There is a lack of evidence for treatment and prevention... (Review)
Review
BACKGROUND
Postnatal depression is a medical condition that affects many women and the development of their infants. There is a lack of evidence for treatment and prevention strategies that are safe for mothers and infants. Certain dietary deficiencies in a pregnant or postnatal woman's diet may cause postnatal depression. By correcting these deficiencies postnatal depression could be prevented in some women. Specific examples of dietary supplements aimed at preventing postnatal depression include: omega-3 fatty acids, iron, folate, s-adenosyl-L-methionine, cobalamin, pyridoxine, riboflavin, vitamin D and calcium.
OBJECTIVES
To assess the benefits of dietary supplements for preventing postnatal depression either in the antenatal period, postnatal period, or both.
SEARCH METHODS
We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30 April 2013).
SELECTION CRITERIA
Randomised controlled trials, involving women who were pregnant or who had given birth in the previous six weeks, who were not depressed or taking antidepressants at the commencement of the trials. The trials could use as intervention any dietary supplementation alone or in combination with another treatment compared with any other preventive treatment, or placebo, or standard clinical care.
DATA COLLECTION AND ANALYSIS
Two review authors independently assessed trials for inclusion and assessed the risk of bias for the two included studies. Two review authors extracted data and the data were checked for accuracy.
MAIN RESULTS
We included two randomised controlled trials.One trial compared oral 100 microgram (µg) selenium yeast tablets with placebo, taken from the first trimester until birth. The trial randomised 179 women but outcome data were only provided for 85 women. Eighty-three women were randomised to each arm of the trial. Sixty-one women completed the selenium arm, 44 of whom completed an Edinburgh Postnatal Depression Scale (EPDS). In the placebo arm, 64 women completed the trial, 41 of whom completed an EPDS. This included study (n = 85) found selenium had an effect on EPDS scores but did not reach statistical significance (P = 0.07). There was a mean difference (MD) of -1.90 (95% confidence interval (CI) -3.92 to 0.12) of the self-reported EPDS completed by participants within eight weeks of delivery. There was a high risk of attrition bias due to a large proportion of women withdrawing from the study or not completing an EPDS. This included study did not report on any of the secondary outcomes of this review.The other trial compared docosahexanoic acid (DHA) and eicosapentaenoic acid (EPA) with placebo. The trial randomised 126 women at risk of postpartum depression to three arms: 42 were allocated to EPA, 42 to DHA, and 42 to placebo. Three women in the EPA arm, four in the DHA arm, and one woman in the placebo arm were lost to follow-up. Women who were found to have major depressive disorder, bipolar disorder, current substance abuse or dependence, suicidal ideation or schizophrenia at recruitment were excluded from the study. The women who discontinued the intervention (five in the EPA arm, four in the DHA arm and seven in the placebo arm) were included in the intention-to-treat analysis, while those who were lost to follow-up were not. Women received supplements or placebo from recruitment at a gestational age of 12 to 20 weeks until their final review visit six to eight weeks postpartum. The primary outcome measure was the Beck Depression Inventory (BDI) score at the fifth visit (six to eight weeks postpartum). No benefit was found for EPA-rich fish oil (MD 0.70, 95% CI -1.78 to 3.18) or DHA-rich fish oil supplementation (MD 0.90, 95% CI -1.33 to 3.13) in preventing postpartum depression. No difference was found in the effect on postnatal depression comparing EPA with DHA (MD -0.20, 95% CI -2.61 to 2.21). No benefit or significant effect was found in terms of the secondary outcomes of the presence of major depressive disorder at six to eight weeks postpartum, the number of women who commenced antidepressants, maternal estimated blood loss at delivery or admission of neonates to the neonatal intensive care unit.
AUTHORS' CONCLUSIONS
There is insufficient evidence to conclude that selenium, DHA or EPA prevent postnatal depression. There is currently no evidence to recommend any other dietary supplement for prevention of postnatal depression.
Topics: Depression, Postpartum; Dietary Supplements; Docosahexaenoic Acids; Eicosapentaenoic Acid; Female; Humans; Patient Dropouts; Pregnancy; Prenatal Care; Randomized Controlled Trials as Topic; Selenium
PubMed: 24158923
DOI: 10.1002/14651858.CD009104.pub2 -
Revista Brasileira de Hematologia E... 2012The aim of this study was to conduct a systematic review on the photoinactivators used in hemotherapy, with action on viral genomes. The SciELO, Science Direct, PubMed...
The aim of this study was to conduct a systematic review on the photoinactivators used in hemotherapy, with action on viral genomes. The SciELO, Science Direct, PubMed and Lilacs databases were searched for articles. The inclusion criterion was that these should be articles on inactivators with action on genetic material that had been published between 2000 and 2010. The key words used in identifying such articles were "hemovigilance", "viral inactivation", "photodynamics", "chemoprevention" and "transfusion safety". Twenty-four articles on viral photoinactivation were found with the main photoinactivators covered being: methylene blue, amotosalen HCl, S-303 frangible anchor linker effector (FRALE), riboflavin and inactin. The results showed that methylene blue has currently been studied least, because it diminishes coagulation factors and fibrinogen. Riboflavin has been studied most because it is a photoinactivator of endogenous origin and has few collateral effects. Amotosalen HCl is effective for platelets and is also used on plasma, but may cause changes both to plasma and to platelets, although these are not significant for hemostasis. S-303 FRALE may lead to neoantigens in erythrocytes and is less indicated for red-cell treatment; in such cases, PEN 110 is recommended. Thus, none of the methods for pathogen reduction is effective for all classes of agents and for all blood components, but despite the high cost, these photoinactivators may diminish the risk of blood-transmitted diseases.
PubMed: 23049426
DOI: 10.5581/1516-8484.20120056 -
The Journal of Nutrition Nov 2010A systematic review was conducted to identify all studies that were published between 1988 and 2008 reporting micronutrient intakes of women in resource-poor settings.... (Review)
Review
A systematic review was conducted to identify all studies that were published between 1988 and 2008 reporting micronutrient intakes of women in resource-poor settings. Inclusion criteria were study location (resource-poor), dietary assessment method (24-h recall, estimated/weighed record, or locally validated FFQ), energy and 1 or more micronutrient intakes reported (vitamin A, vitamin B-6, vitamin B-12, vitamin C, thiamin, riboflavin, niacin, folate, iron, or zinc), age range (15-50 y), sample size (≥30), and sex (female). Of the 1560 papers identified, 52 papers were included. Results showed that, except for vitamin A (29%), vitamin C (34%), and niacin (34%), the reported mean/median intakes in over 50% of studies were below the Estimated Average Requirement (EAR). Folate intake was most often below EAR (91% of studies). Regional differences were apparent for intakes of vitamins A, C, and B-6 and riboflavin; mean/median intakes in Latin America exceeded the EAR, whereas in Asia, reported mean/median intakes of vitamin C, vitamin A, and riboflavin were below the EAR in 47, 50, and 77% of the studies, respectively, as was the case for vitamin B-6 in 75% of the studies in Africa. These results suggest that inadequate intakes of multiple micronutrients are common among women living in resource-poor settings and emphasize the need for increased attention to the quality of women's diets. There is a need for more high-quality studies of women's micronutrient intakes.
Topics: Adolescent; Adult; Deficiency Diseases; Developing Countries; Diet; Female; Humans; Micronutrients; Middle Aged; Poverty Areas; Risk Factors; Young Adult
PubMed: 20881075
DOI: 10.3945/jn.110.123463 -
The Cochrane Database of Systematic... Apr 2010Protein Energy Malnutrition is an important cause of child morbidity and mortality in middle- and low-income countries. It has been suggested that excessive free radical... (Review)
Review
BACKGROUND
Protein Energy Malnutrition is an important cause of child morbidity and mortality in middle- and low-income countries. It has been suggested that excessive free radical activity may be responsible for the clinical manifestation of kwashiorkor. Antioxidants may be able to curb excessive free radical activity and prevent the development of kwashiorkor in susceptible children.
OBJECTIVES
To evaluate the benefits of supplementation of vitamin E, selenium, cysteine and riboflavin (alone or in combination) in preventing kwashiorkor.
SEARCH STRATEGY
We conducted searches of CENTRAL 2009 (The Cochrane Library 2009 Issue 2), MEDLINE 1966 to 2009, EMBASE 1980 to 2009, CINAHL 1982 to 2009, LILACS 1982 to 2009, Meta register of Controlled trials, Open Sigle, African Index Medicus.
SELECTION CRITERIA
Randomised controlled trials (RCTs) and quasi-RCTs evaluating vitamin E, selenium, cysteine and riboflavin alone or in combination in healthy pre-school children in middle- and low-income countries.
DATA COLLECTION AND ANALYSIS
Two authors extracted and independently analysed data.
MAIN RESULTS
One cluster-RCT including 2372 children met our inclusion criteria. Children were randomised, based on household, either to a supplement containing all four micronutrients or to placebo. No statistically significant difference in the incidence of kwashiorkor between the intervention and control groups could be demonstrated at 20 weeks (RR 1.70; 95% CI 0.98 to 2.42). Nor could any statistically significant difference in all-cause mortality be demonstrated (RR 0.75; 95% CI 0.17 to 3.36).
AUTHORS' CONCLUSIONS
Based on the one available trial, we could draw no firm conclusion for the effectiveness of supplementary antioxidant micronutrients for the prevention of kwashiorkor in pre-school children.
Topics: Antioxidants; Child, Preschool; Cysteine; Humans; Infant; Kwashiorkor; Micronutrients; Riboflavin; Selenium; Vitamin E
PubMed: 20393967
DOI: 10.1002/14651858.CD008147.pub2 -
The American Journal of Clinical... Jun 2009To explore the relation between micronutrient status and health, it is important to understand which markers of micronutrient status can be relied on and under what...
BACKGROUND
To explore the relation between micronutrient status and health, it is important to understand which markers of micronutrient status can be relied on and under what circumstances.
OBJECTIVE
The objective of this article was to develop a common systematic review methodology for use in the assessment of micronutrient status for selenium, iodine, copper, zinc, riboflavin, vitamin B-12, vitamin D, and omega-3 (n-3) long-chain polyunsaturated fatty acids.
DESIGN
We developed a methodology on the basis of defining studies that clearly altered micronutrient status and then pooled data on the effects of this intervention on each specific biomarker to assess objectively the response of various status markers to changes in intake.
RESULTS
The generic methodology included defining, and systematically searching for, studies that resulted in a change in micronutrient status. Study inclusion, data extraction, and assessment of validity were conducted with a minimum of 10% independent duplication. For each study and each potential biomarker, the highest dose and longest duration intervention data were selected to assess the statistical significance of any change in intake on the status biomarker. The consistency of biomarker response was explored by subgrouping the studies according to baseline micronutrient status, sex, population group, supplementation type, dose, duration, and analytic method.
CONCLUSION
This methodology allows systematic assessment of the usefulness of a number of biomarkers for a selection of micronutrients.
Topics: Humans; Biomarkers; Clinical Trials as Topic; Methods; Micronutrients; Nutrition Assessment; Nutritional Status; Review Literature as Topic
PubMed: 19403633
DOI: 10.3945/ajcn.2009.27230A -
The American Journal of Clinical... Jun 2009National survey data of erythrocyte glutathione reductase activation coefficient (EGRac) indicate that suboptimal riboflavin status may be a problem in all population... (Review)
Review
BACKGROUND
National survey data of erythrocyte glutathione reductase activation coefficient (EGRac) indicate that suboptimal riboflavin status may be a problem in all population age groups, but the cutoff for deficiency is controversial. In addition, the effectiveness of different biomarkers of riboflavin status has not been critically evaluated.
OBJECTIVE
We aimed to assess the effectiveness of different biomarkers of riboflavin status through a systematic review of published riboflavin supplementation trials.
DESIGN
We structured our search strategy on Ovid MEDLINE, EMBASE (Ovid), and Cochrane databases; formal inclusion and exclusion criteria; data extraction; validity assessment; and meta-analysis.
RESULTS
Eighteen supplementation studies reporting up to 14 biomarkers were included. Sufficient data were available to show that EGRac (14 studies) and basal glutathione reductase activity (5 studies) were effective biomarkers of altered riboflavin intake (P < 0.00001), although substantial heterogeneity (I2 > 66%) that could not be explained by the subgroup analysis was observed. Plasma total homocysteine was not an effective biomarker of riboflavin status in the general population, but some evidence identified its potential usefulness specifically in those homozygous for a common polymorphism in the MTHFR gene.
CONCLUSIONS
The evidence suggests that EGRac is an effective biomarker of a change in riboflavin intake in populations with severe-to-normal baseline status. Studies of healthy populations that compare the response to low-dose supplementation among different age, sex, and MTHFR genotype groups are required to provide evidence for generating dietary riboflavin recommendations specific to different population subgroups. Further research into alternative biomarkers to EGRac is also required.
Topics: Biomarkers; Clinical Trials as Topic; Dietary Supplements; Glutathione Reductase; Homocysteine; Humans; Nutrition Assessment; Nutritional Status; Reference Values; Riboflavin; Vitamin B Complex
PubMed: 19403631
DOI: 10.3945/ajcn.2009.27230B