Trimethoprim use in early pregnancy and the risk of miscarriage: a register-based nationwide cohort study.

The antibiotic trimethoprim acts as a folate antagonist. Since trophoblasts are very sensitive to drugs that interfere with the folic acid cycle and thereby inhibit DNA synthesis, use of trimethoprim during the first trimester could be associated with miscarriage. A nationwide cohort study including all women in Denmark with a registered pregnancy between 1997 and 2005 was conducted. We used nationwide registers to identify all women giving birth, having a record of miscarriage or induced abortion. Data on exposure to trimethoprim were obtained from the National Prescription Register. Cox proportional hazard regression analysis with exposure to trimethoprim as a time-dependent variable was used to estimate the risk of miscarriage. The adjusted hazard ratio of having a miscarriage after exposure to trimethoprim in the first trimester compared to non-exposure was 2∙04 (95% confidence interval 1∙43-2∙91). Our results indicate that trimethoprim exposure in the first trimester is associated with a doubling of the hazard of miscarriage.

A safe strategy for addition of vitamins and minerals to foods.

Addition of vitamins and minerals to foods must be done without health risk to any consumer group. International expert groups have aimed at establishing tolerable upper intake levels (ULs) for vitamins and minerals although lack of solid data on their safety is a major obstacle to this work. In this paper, we summarize the existing ULs and suggest the use of guidance levels (GLs) set by others and temporary guidance levels (TGLs) proposed here, whenever no consensus UL has been established for adults. We suggest the use of body surface area ratios to establish similar levels for younger age groups. The levels are applied in a model for calculation of safe fortification levels for all ages. We have estimated the upper 95(th) percentile intake of vitamins and minerals from food in various Danish age and gender groups and suggest that a daily multivitamin-mineral pill is included in the calculation of total dietary intake levels of all vitamins and minerals. By subtracting this dietary intake level from the UL, GL or TGL, we calculate the amount that can be safely used for fortification. Since safety must be assured for all age groups, the smallest difference relative to energy intake calculated for any age group is proposed as the maximal allowance (MA) for fortification with each nutrient. We suggest that the MA should be expressed in weight units per energy unit in order to distribute it equally between potentially fortifiable food groups according to their usual contribution to total energy intakes.

Intake of ruminant trans fatty acids in the Danish population aged 1-80 years.

OBJECTIVE: To estimate the intake of ruminant trans fatty acids (TFA) in the Danish population aged 1-80 years. DESIGN: Descriptive study. SUBJECTS: A sex- and age-stratified random sample drawn from the Danish Civil Registration System. A total of 3098 participants (51% female) aged 1-80 years were included. The participation was 66%. DIETARY INFORMATION: A 7-day dietary record. RESULTS: The estimated median intake of ruminant TFA was 1.4 g/day with the 80% central range being from 0.9 to 2.1 among children aged 1-6 years and 1.6 g/day (1.0-2.4) among children aged 7-14 years. The median TFA intake was 1.8 g/day (0.9-2.9) among adults aged 15-29 years and among adults aged 30-80 years. The intake expressed as percentage of energy intake was 0.8, 0.6, 0.7, and 0.7, respectively. Dairy products were the main source of ruminant TFA. CONCLUSIONS: The median intake of ruminant TFA in the Danish population aged 1-80 years is estimated to be 1.7 g/day (0.9-2.7), corresponding to 0.7% of energy intake (0.5-1.0), with dairy products being the main source of ruminant TFA. SPONSORSHIP: The Danish Heart Foundation (Grants 02-2-9-8-22010 and 03-2-9-4-22087) and the Female Researchers in Joint Action (FREJA) programme from the Danish Medical Research Council.

Monitoring the content and intake of trace elements from food in Denmark.

The content of cadmium, lead, nickel, mercury and selenium in 83 foods was monitored from 1993 to 1997. In comparison with similar results from 1988 to 1992, a general decrease in lead levels had occurred, whereas the contents of cadmium, nickel, mercury and selenium were stable or declined only slightly. The distribution in dietary intake of the five trace elements was estimated by combining the mean trace element concentrations with food consumption data from 1837 Danes aged 15-80 years. The lead intake for 1993-97 showed a decrease in comparison with similar estimates from the previous monitoring cycles: 1983-87 and 1988-92. The intake of cadmium and mercury decreased to a lesser extent, whereas the intake of selenium and nickel remained unchanged in the same period. The dietary intake of trace elements was compared with the provisional tolerable weekly intake (PTWI). The 95th percentile of the distribution in cadmium intake amounts to 34% of PTWI, which is relatively high, and therefore calls for a more detailed future risk assessment. The intakes of lead and mercury were 11% of PTWI and, like the intake of nickel, did not cause any health concern in the adult population. The Danes ingest close to 100% of the Nordic Nutrition Recommendation for selenium at 50 microg day(-1), and no individuals had an intake less than the lower limit of 20 microg day(-1).

[The significance of diet and physical activity for the development of obesity in Denmark from 1985 to 1995]. / Betydningen af kost og fysisk aktivitet for fedmeudviklingen i Danmark fra 1985 til 1995.

MATERIAL AND METHODS: Trends in the prevalence of overweight and obesity in Denmark were compared to changes in diet and physical activity by using data from the nationwide dietary surveys of 1985 and 1995 comprising 2,000 adults, aged 15-80 years. RESULTS: The prevalence of overweight and obesity has increased by more than 20% in men (1985: 35.7% vs 1995: 44.1%) and women (1985: 22.3% vs 1995: 29.4%). The prevalence of obesity rose especially in men from 1985 (5.0%) to 1995 (8.8%), less dramatically in women (1985: 5.3% vs 1995: 6.6%). A decrease of 20% and 5% in energy intake has been registered, respectively in men and women. At the same time, sedentary work increased considerably from 1995 (19.5%) to 1985 (38.2%), whereas leisure time physical activity was higher than before. DISCUSSION: The increasing prevalence of overweight and obesity is probably explained by a decrease in the total energy expenditure, owing to the fact that sedentary work has doubled. Hence, a rise in the level of leisure time physical activity did not compensate for the lower expenditure of energy during working hours.

Folate and neural tube defects. Recommendations from a Danish working group.

A working group was established to evaluate the need for an increased folate intake in Danish women to decrease the risk of neural tube defects (NTDs). NTD are birth defects which include anencephaly, encephalocele and spina bifida. In Denmark the incidence is about 1.4 per 1,000 pregnancies. Folate is a B-vitamin found in most food groups. In case-control studies and randomised studies, a protective effect of folic acid supplements on NTDs has been found. The studies show that a periconceptional folic acid supplement of 360 micrograms to 4 mg daily decreases the recurrence rate of NTDs. Likewise, in the few studies which calculate folate intake from the diet, a lower risk of NTD with higher intake of folate from the diet has been found. The folate intake can be increased by the diet, by folic acid supplements or by fortification of food with folic acid. It is concluded that the incidence of NTDs in Denmark will decrease if the folate intake in fertile women increases. All women planning pregnancy should receive dietary counselling. Women who do not eat according to the Nordic Nutrition Recommendations, and women with an increased risk due to diseases are recommended a supplement of 400 micrograms folic acid daily from a multivitamin/folic acid tablet. Women who have had a child with NTD and women who themselves have NTDs are recommended a supplement of 5 mg folic acid daily. Dietary changes and supplements should be initiated when pregnancy is planned.