Presentazione sul tema: "Alimentazione Mediterranea"— Transcript della presentazione:
1 Alimentazione Mediterranea Aggiornamento Marzo 2014Prof Pierpaolo Mastroiacovo Professore di Pediatria Direttore ICBD – Alessandra Lisi International Centre on Birth Defects and Prematurity;Centro Collaborativo OMS, Roma
2 RaccomandazioneValutare le abitudini alimentari della donna, della coppia e incoraggiarli ad adottare un’alimentazione mediterranea.Anticipare alla donna l’opportunità di escludere o ridurre l’uso di alcuni specifici alimenti in vista della gravidanza a breve termine:Carni poco cotte, insaccati (non immune alla toxoplasmosi)Formaggi erborinati e patè (listeriosi)Fegato (vitamina A)Pesci di alto mare, es: tonno e pesce spada (metilmercurio)
4 Alcuni Consigli per Realizzare l’Alimentazione Mediterranea Prima parte Assumi almeno 5 porzioni di frutta e verdura al giorno.A colazione puoi consumare, insieme al caffè e a un buon cereale una spremuta d’arancia.Utilizza come spuntino a metà mattinata un frutto a tua scelta invece che snack ricchi di grassi.Accompagna sempre i tuoi pasti con una porzione di verdura e una di frutta. Ricordali di lavarli sempre bene prima del consumo.Pranzo o cena: scegli spesso un minestrone, una bella zuppa di legumi (es.: pasta e ceci o pasta e fagioli). Non dimenticare mai i legumi dalla tua alimentazione: sono ottime fonti di proteine e di fibra.Mangia 2-3 volte a settimana il pesce.Circa la metà dei cereali che assumi giornalmente (es: pane, pasta, riso) dovrebbe essere costituita da cereali integrali: danno maggiore senso di sazietà e ci aiutano a prevenire l’aumento del peso corporeo.
5 Alcuni Consigli per Realizzare l’Alimentazione Mediterranea Seconda parte Utilizza come condimento preferibilmente l’olio extravergine di oliva, evita le margarine.Assumi ogni giorno 1 o 2 bicchieri tra latte e yogurt.Quando consumi formaggi scegli quelli magri, se scegli quelli grassi riduci la loro porzione a g.Quando scegli la carne, privilegia quelle bianche (es: pollo, tacchino) a quelle rosse (es: manzo, maiale), rimuovi il grasso e la pelle prima di cucinare e preferisci cotture veloci come la cottura in padella, la cottura al vapore o arrostiscile senza mai bruciarle.Evita di aggiungere troppo sale alle pietanze, ed usa quello iodato.Non dimenticare durante la settimana di consumare qualche porzione di frutta secca (es.: mandorle, noci) e semi oleosi: sono ricchi di vitamine e di acidi grassi omega 3Bevi molta acqua.
6 AlimentazioneE’ ben dimostrato che l’alimentazione sana diminuisce l’incidenza di diabete, malattie cardio-vascolari (es.: infarto, ictus cerebrale) e tumoraliStudi recenti indicano chiaramente che la sana alimentazione diminuisce anche l’incidenza di esiti avversi della riproduzione.Per sana alimentazione si intende l’alimentazione mediterranea o simili tipologie di alimentazione denominate in altri paesi come: “prudenti” contrapposte a tipologie di alimentazione non sane denominate “occidentali” più ricche di grassi e carne rossa.Pochi italiani adottano un’alimentazione veramente mediterranea.
7 Pattern AlimentareValutare l’effetto sulla salute del “pattern alimentare” è più corretto che non valutare l’effetto dei singoli componenti dell’alimentazione, es.: oligoelementi, vitamine.Nella valutazione del pattern alimentare si valuta, tutto, compresa:L’ interazione tra i vari componenti, equilibrata dalla natura stessa.Sostanze che ancora non sono ben conosciute.La reale abitudine giornaliera.
8 Due domande e due risposte Domanda 1: La sana alimentazione, in particolare quella mediterranea, magari ricca di verdure a foglia verde, sostituisce la necessità di assumere un integratore a base di acido folico?Risposta: No. Purtroppo l’alimentazione da sola non è sufficiente. Per raggiungere sicuramente una folatemia materna sufficiente a proteggere lo sviluppo embrionale è necessario assumere un integratore a base di acido folico, giornalemente, 0,4 mg (400 mcg).Domanda 2: Quali sono gli studi più significativi che indicano un benefico effetto dell’alimentazione mediterranea nella riduzione degli esiti avversi della riproduzione?Risposta: Vedi le prossime diapositive
9 Migliora la qualità dello sperma (Olanda-Vujkovic, 2009). Ricerche che suggeriscono i vantaggi dell’alimentazione mediterranea o equivalente sulla salute riproduttiva Fertilità, complicanze ed esito della gravidanzaMigliora la qualità dello sperma (Olanda-Vujkovic, 2009).Migliora la fertilità (Spagna-Toledo, 2011) e aumenta la probabilità di gravidanza in donne che si sottopongono a PMA (Olanda-Vujkovic, 2010).Livelli di pressione arteriosa più bassi in gravidanza (Olanda-Timmermans, 2011).Diminuisce il rischio di preclampsia del 28% (Norvegia- Brantsaeter 2009).Migliore il peso della placenta (+15g) e del neonato (+72g) (Olanda-Timmermans, 2012).Diminuisce rischio di SGA con un range variabile tra i vari: 14% (Nuova Zelanda-Thompson, 2010), 26% (Danimarca-Knudsen, 2007) e il 50% (Grecia/Spagna- Chatzi L, 2012).Diminuisce il rischio di prematurità del 12% (Norvegia-Englun-Ogge, 2014)Vujkovic M, de Vries JH, Dohle GR, Bonsel GJ, Lindemans J, Macklon NS, van derSpek PJ, Steegers EA, Steegers-Theunissen RP. Associations between dietarypatterns and semen quality in men undergoing IVF/ICSI treatment. Hum Reprod. 2009Jun;24(6): Epub 2009 Feb 19. PubMed PMID:1: Vujkovic M, de Vries JH, Lindemans J, Macklon NS, van der Spek PJ, SteegersEA, Steegers-Theunissen RP. The preconception Mediterranean dietary pattern incouples undergoing in vitro fertilization/intracytoplasmic sperm injectiontreatment increases the chance of pregnancy. Fertil Steril. 2010Nov;94(6): Epub 2010 Mar 1. PubMed PMID:2. Fertil Steril Nov;96(5): Epub 2011 Sep 22.Dietary patterns and difficulty conceiving: a nested case-control study.Toledo E, Lopez-del Burgo C, Ruiz-Zambrana A, Donazar M, Navarro-Blasco I,Martínez-González MA, de Irala J.Department of Preventive Medicine and Public Health, University of Navarra,Pamplona, Navarra, Spain.OBJECTIVE: To investigate potential associations between dietary patterns(defined using factor analysis) and difficulty conceiving.DESIGN: Case-control study nested in a Spanish cohort of university graduates(Seguimiento Universidad de Navarra [SUN] Project).SETTING: Female university graduates all over Spain participating in the SUNProject.PATIENT(S): A total of 485 women, aged years, reporting having presentedwith difficulty getting pregnant, and 1,669 age-matched controls who had at leastone child.INTERVENTION(S): None.MAIN OUTCOME MEASURE(S): Reported difficulty getting pregnant. Data werecollected from baseline and follow-up questionnaires of the SUN Project.RESULT(S): Two dietary patterns were identified. They were labeled as"Mediterranean-type" and "Western-type" patterns. A lower risk of difficultygetting pregnant was apparent in the highest quartile of adherence to theMediterranean-type pattern compared with the lowest quartile (odds ratio 0.56,95% confidence interval ). Greater adherence to the Western-type dietarypattern showed no association with this outcome.CONCLUSION(S): A greater adherence to the Mediterranean-type dietary pattern mayenhance fertility. Further evidence about the relationship between this dietarypattern and fertility is needed to develop nutritional interventions for womendesiring to get pregnant.Timmermans S, Steegers-Theunissen RP, Vujkovic M, Bakker R, den Breeijen H, Raat H, Russcher H, Lindemans J, Hofman A, Jaddoe VW, Steegers EA. Major dietary patterns and blood pressure patterns during pregnancy: the Generation R Study. Am J Obstet Gynecol Oct;205(4):337.e1-12. Epub 2011 May 14. PubMed PMID:AbstractOBJECTIVE:We sought to evaluate associations between dietary patterns and systolic blood pressure (SBP) and diastolic blood pressure during pregnancy.STUDY DESIGN:This was a prospective study of 3187 pregnant women. Participants completed a food-frequency questionnaire in early pregnancy. The Mediterranean dietary pattern, comprising high intake of vegetables, vegetable oils, pasta, fish, and legumes, and the Traditional dietary pattern, comprising high intake of meat and potatoes, were identified using factor analysis.RESULTS:A higher SBP was observed among mothers with high Traditional pattern adherence. Low adherence to the Mediterranean pattern was also associated with higher SBP but only in early and mid pregnancy. A higher diastolic blood pressure throughout pregnancy was observed in mothers with high adherence to the Traditional pattern and low adherence to the Mediterranean pattern. These effect estimates were most pronounced in mid pregnancy.CONCLUSION:Low adherence to a Mediterranean and high adherence to a Traditional dietary pattern is associated with a higher blood pressure in pregnancy.14. J Nutr Jun;139(6): Epub 2009 Apr 15.A dietary pattern characterized by high intake of vegetables, fruits, andvegetable oils is associated with reduced risk of preeclampsia in nulliparouspregnant Norwegian women.Brantsaeter AL, Haugen M, Samuelsen SO, Torjusen H, Trogstad L, Alexander J,Magnus P, Meltzer HM.Division of Environmental Medicine, Norwegian Institute of Public Health, NO-0403Oslo, Norway.Several dietary substances have been hypothesized to influence the risk ofpreeclampsia. Our aim in this study was to estimate the association betweendietary patterns during pregnancy and the risk of preeclampsia in 23,423nulliparous pregnant women taking part in the Norwegian Mother and Child CohortStudy (MoBa). Women participating in MoBa answered questionnaires at gestationalwk 15 (a general health questionnaire) and (a FFQ). The pregnancy outcomeswere obtained from the Medical Birth Registry of Norway. Exploratory factoranalysis was used to assess the associations among food variables. Principalcomponent factor analysis identified 4 primary dietary patterns that werelabeled: vegetable, processed food, potato and fish, and cakes and sweets.Relative risks of preeclampsia were estimated as odds ratios (OR) and confoundercontrol was performed with multiple logistic regression. Women with high scoreson a pattern characterized by vegetables, plant foods, and vegetable oils were atdecreased risk [relative risk (OR) for tertile 3 vs. tertile 1: 0.72; 95% CI:0.62, 0.85]. Women with high scores on a pattern characterized by processed meat,salty snacks, and sweet drinks were at increased risk [OR for tertile 3 vs.tertile 1: 1.21; 95% CI: 1.03, 1.42]. These findings suggest that a dietarypattern characterized by high intake of vegetables, plant foods, and vegetableoils decreases the risk of preeclampsia, whereas a dietary pattern characterizedby high consumption of processed meat, sweet drinks, and salty snacks increasesthe risk.PMCID: PMCPMID: [PubMed - indexed for MEDLINE]Timmermans S, Steegers-Theunissen RP, Vujkovic M, den Breeijen H, Russcher H, Lindemans J, Mackenbach J, Hofman A, Lesaffre EE, Jaddoe VV, Steegers EA. The Mediterranean diet and fetal size parameters: the Generation R Study. Br J Nutr Feb 21:1-11. [Epub ahead of print] PubMed PMID:Developmental adaptations due to early nutritional exposures may have permanent health consequences. Studies of diet and fetal size have mainly focused on individual nutrients despite evidence that the pattern of food consumption may be of significance. Hence, we evaluated the associations of dietary habits in early pregnancy (gestational age < 18 weeks) with fetal size, uteroplacental vascular resistance, placental weight and birth weight in a prospective observational study of 3207 Caucasian pregnant mothers in Rotterdam, the Netherlands. Participants completed a semiquantitative FFQ during early pregnancy. Logistic regression analysis was used to predict the occurrence of intra-uterine growth retardation at birth as a function of food intake. The derived solution was considered as the dietary pattern. As it was characterised by higher intakes of fruit, vegetables, vegetable oil, fish, pasta and rice, and lower intakes of meat, potatoes and fatty sauces, it was labelled the 'Mediterranean' diet. The degree of adherence to the diet was positively associated with plasma folate and serum vitamin B12 concentrations and showed an inverse relationship with homocysteine and high-sensitivity C-reactive protein plasma concentrations (P < 0·05). Important fetal size and placental parameters were associated with the degree of adherence to the diet, revealing a 72 g lower birth weight (95 % CI - 110·8, - 33·3) and a 15 g lower placental weight (95 % CI - 29·8, - 0·2) for women with low adherence to the diet. To conclude, low adherence to a Mediterranean diet in early pregnancy seems associated with decreased intra-uterine size with a lower placental and a lower birth weight.3. Br J Nutr May;107(10): Epub 2011 Sep 20.Maternal dietary patterns in pregnancy and fetal growth in Japan: the OsakaMaternal and Child Health Study.Okubo H, Miyake Y, Sasaki S, Tanaka K, Murakami K, Hirota Y; Osaka Maternal andChild Health Study Group, Kanzaki H, Kitada M, Horikoshi Y, Ishiko O, Nakai Y,Nishio J, Yamamasu S, Yasuda J, Kawai S, Yanagihara K, Wakuda K, Kawashima T,Narimoto K, Iwasa Y, Orino K, Tsunetoh I, Yoshida J, Iito J, Kaneko T, Kamiya T,Kuribayashi H, Taniguchi T, Takemura H, Morimoto Y, Matsunaga I, Oda H, Ohya Y.Department of Social and Preventive Epidemiology, Graduate School of Medicine,University of Tokyo, Hongo 7-3-1, Bunkyo-ku, Tokyo , Japan.Maternal nutritional status during pregnancy is an important determinant of fetalgrowth. Although the effects of several nutrients and foods have been wellexamined, little is known about the relationship of overall maternal diet inpregnancy to fetal growth, particularly in non-Western populations. Weprospectively examined the relationship of maternal dietary patterns in pregnancyto neonatal anthropometric measurements at birth and risk ofsmall-for-gestational-age (SGA) birth among 803 Japanese women with live-born,singleton, term deliveries. Maternal diet in pregnancy was assessed using avalidated, self-administered diet history questionnaire. Dietary patterns fromthirty-three predefined food groups (g/4184 kJ) were extracted by clusteranalysis. The following three dietary patterns were identified: the 'meat andeggs' (n 326), 'wheat products', with a relatively high intake of bread,confectioneries and soft drinks (n 303), and 'rice, fish and vegetables' (n 174)patterns. After adjustment for potential confounders, women in the 'wheatproducts' pattern had infants with the significantly lowest birth weight (P =0·045) and head circumference (P = 0·036) among those in the three dietarypatterns. Compared with women in the 'rice, fish and vegetables' pattern, womenin the 'wheat products' pattern had higher odds of having a SGA infant for weight(multivariate OR 5·2, 95 % CI 1·1, 24·4), but this was not the case for birthlength or head circumference. These results suggest that a diet high in bread,confectioneries, and soft drinks and low in fish and vegetables during pregnancymight be associated with a small birth weight and an increased risk of having aSGA infant.4. Br J Nutr Jan;107(1): Epub 2011 Jun 29.Mediterranean diet adherence during pregnancy and fetal growth: INMA (Spain) andRHEA (Greece) mother-child cohort studies.Chatzi L, Mendez M, Garcia R, Roumeliotaki T, Ibarluzea J, Tardón A, Amiano P,Lertxundi A, Iñiguez C, Vioque J, Kogevinas M, Sunyer J; INMA and RHEA studygroups.Department of Social Medicine, Faculty of Medicine, University of Crete,Heraklion, Greece.Dietary intake of specific nutrients or food groups during pregnancy couldinfluence fetal growth, but scant evidence is available on effects of dietarypatterns. The aim of this study was to evaluate the impact of Mediterranean diet(MD) adherence during pregnancy on fetal growth in two population-basedmother-child cohorts in Spain and Greece. We studied 2461 mother-newborn pairsfrom the Spanish multi-centre 'INMA' study (Atlantic area: INMA-Atlantic;Mediterranean area: INMA-Mediterranean), and 889 pairs from the 'RHEA' study inCrete, Greece. Maternal diet during pregnancy was assessed by FFQ and MDadherence was evaluated through an a priori score. Fetal growth restriction wasbased on a customised model, and multivariate log-binomial and linear regressionmodels were used to adjust for several confounders. MD scores differsignificantly between the cohorts with women in INMA-Atlantic reporting higherintakes of fish and dairy products, while women in the Mediterranean areareported higher intakes of cereals, vegetables and fruits. Women with high MDadherence had a significantly lower risk of delivering a fetal growth-restrictedinfant for weight (risk ratios: 0·5; 95 % CI 0·3, 0·9) in the INMA-Mediterraneancohort. Stratified analysis by smoking revealed that higher MD adherenceincreased birth weight and birth length in smoking mothers, whereas this effectwas not apparent in non-smoking mothers. The results of the present study showthat several types of MD exist across European Mediterranean regions. High MDadherence may modify the detrimental effect of smoking on birth size, but overalleffects of diet were not universal for the studies in this analysis.12. Br J Nutr Jun;103(11): Epub 2010 Mar 9.Maternal dietary patterns in pregnancy and the association withsmall-for-gestational-age infants.Thompson JM, Wall C, Becroft DM, Robinson E, Wild CJ, Mitchell EA.Department of Paediatrics, University of Auckland, Private Bag Auckland,New Zealand.Maternal nutritional status before and during pregnancy is important for thegrowth and development of the fetus. The effects of pre-pregnancy nutrition(estimated by maternal size) are well documented. There is little information intoday's Western society on the effect of maternal nutrition during pregnancy onthe fetus. The aim of the study was to describe dietary patterns of a cohort ofmothers during pregnancy (using principal components analysis with a varimaxrotation) and assess the effect of these dietary patterns on the risk ofdelivering a small-for-gestational-age (SGA) baby. The study was a case-controlstudy investigating factors related to SGA. The population was 1714 subjects inAuckland, New Zealand, born between October 1995 and November 1997, about half ofwhom were born SGA ( < or = 10th percentile for sex and gestation). Maternaldietary information was collected using FFQ after delivery for the first and lastmonths of pregnancy. Three dietary patterns (traditional, junk and fusion) weredefined. Factors associated with these dietary patterns when examined inmultivariable analyses included marital status, maternal weight, maternal age andethnicity. In multivariable analysis, mothers who had higher 'traditional' dietscores in early pregnancy were less likely to deliver a SGA infant (OR = 0.86; 95% CI 0.75, 0.99). Maternal diet, particularly in early pregnancy, is importantfor the development of the fetus. Socio-demographic factors tend to besignificantly related to dietary patterns, suggesting that extra resources may benecessary for disadvantaged mothers to ensure good nutrition in pregnancy.24. Eur J Clin Nutr Apr;62(4): Epub 2007 Mar 28.Major dietary patterns in pregnancy and fetal growth.Knudsen VK, Orozova-Bekkevold IM, Mikkelsen TB, Wolff S, Olsen SF.Maternal Nutrition Group, Danish Epidemiology Science Centre, Statens SerumInstitut, Copenhagen, Denmark.OBJECTIVES: To investigate possible associations between maternal diet duringpregnancy and fetal growth.METHOD: Factor analysis was used to explore dietary patterns among pregnantwomen. The association between maternal dietary patterns and fetal growth (interms of small for gestational age, SGA) was investigated by logistic regression.Prospective cohort study, including information on women in Denmark.RESULTS: Two major dietary patterns were defined: the first pattern wascharacterized by red and processed meat, high-fat dairy, and the second patternwas characterized by intake of vegetables, fruits, poultry and fish. Women wereclassified into three classes according to their diet: the first class had highintake of foods of the first dietary pattern, and was classified as 'the Westerndiet', the second class preferred foods of the second pattern and was classifiedas the 'Health Conscious'; and the third one had eaten foods of both patterns,and was classified as the 'Intermediate'. The odds ratio of having a small forgestational-age infant (with a birth weight below the 2.5th percentile forgestational age and gender) was 0.74 (95% CI ) for women in the HealthConscious class compared with women in the Western Diet class. The analyses wereadjusted for parity, maternal smoking, age, height, pre-pregnancy weight andfather's height.CONCLUSIONS: Our results indicated that a diet in pregnancy, based on red andprocessed meat and high-fat diary, was associated with increased risk for SGA.Further studies are warranted to identify specific macro-, or micronutrients thatmay be underlying these associations.PMID: [PubMed - indexed for MEDLINE]
10 Ricerche che suggeriscono vantaggi dell’alimentazione mediterranea o equivalente sulla salute riproduttiva Malformazioni congeniteAlimentazione “occidentale” aumenta il rischio di labio e/o palatoschisi, dell’80%(Olanda-Vujkovic, 2007)Rischio ridotto di spina bifida (Olanda-Vujkovic, 2009; USA-Carmichael, 2012).Alimentazione ricca di donatori di metile (colina, B-Vitamine) (es.: ricca di pesce e crostacei) riduce il rischio di:cardiopatie congenite, del 70% ! (Olanda-Obermann-Borst, 2011)craniosinostosi (USA-Carmichael, 2010), (negativo per integratori con AF)difetti del tubo neurale (USA-Carmichael, 2010)Alimentazione non salutare aumenta rischio di ipospadia del 54% (UK-de Kort, 2011).Alimentazione occidentale (western type), o messicana aumentano il rischio di DTN nei confronti di un’alimentazione prudente rispettivamente del 45% e del 58% (Stati Uniti –Sotres Alvarez, 2013)3: Vujkovic M, Ocke MC, van der Spek PJ, Yazdanpanah N, Steegers EA,Steegers-Theunissen RP. Maternal Western dietary patterns and the risk ofdeveloping a cleft lip with or without a cleft palate. Obstet Gynecol. 2007Aug;110(2 Pt 1): PubMed PMID:Obermann-Borst SA, Vujkovic M, de Vries JH, Wildhagen MF, Looman CW, de Jonge R, Steegers EA, Steegers-Theunissen RP. A maternal dietary pattern characterised by fish and seafood in association with the risk of congenital heart defects in the offspring. BJOG Sep;118(10): doi: /j x. Epub 2011 May 18. PubMed PMID:AbstractOBJECTIVE:To identify maternal dietary patterns related to biomarkers of methylation and to investigate associations between these dietary patterns and the risk of congenital heart defects (CHDs) in the offspring.DESIGN:Case-control study.SETTING:Western part of the Netherlands, Population: One hundred and seventy-nine mothers of children with CHD and 231 mothers of children without a congenital malformation.METHODS:Food intake was obtained by food frequency questionnaires. The reduced rank regression method was used to identify dietary patterns related to the biomarker concentrations of methylation in blood.MAIN OUTCOME MEASURES:Dietary patterns, vitamin B and homocysteine concentrations, biomarkers of methylation (S-adenosylmethionine [SAM] and S-adenosylhomocysteine [SAH]) and the risk of CHD estimated by odds ratios and 95% confidence intervals.RESULTS:The one-carbon-poor dietary pattern, comprising a high intake of snacks, sugar-rich products and beverages, was associated with SAH (β = 0.92, P < 0.001). The one-carbon-rich dietary pattern with high fish and seafood intake was associated with SAM (β = 0.44, P < 0.001) and inversely with SAH (β =-0.08, P < 0.001). Strong adherence to this dietary pattern resulted in higher serum (P <0.05) and red blood cell (P < 0.01) folate and a reduced risk of CHD in offspring: odds ratio, 0.3 (95% confidence interval, ).CONCLUSIONS:The one-carbon-rich dietary pattern, characterised by the high intake of fish and seafood, is associated with a reduced risk of CHD. This finding warrants further investigation in a randomised intervention trial.1. Birth Defects Res A Clin Mol Teratol Dec;88(12): doi:/bdra Epub 2010 Sep 14. Free full textCraniosynostosis and nutrient intake during pregnancy.Carmichael SL, Rasmussen SA, Lammer EJ, Ma C, Shaw GM; National Birth DefectsPrevention Study.California Research Division, March of Dimes Foundation, Oakland, California,USA.OBJECTIVE: To examine the association of craniosynostosis with maternal intake offolic acid-containing supplements and dietary nutrients.METHODS: The study included deliveries from 1997 to 2005 from the National BirthDefects Prevention Study. Nonsyndromic infants with craniosynostosis (n = 815)were compared to nonmalformed, population-based liveborn control infants (n =6789), by estimating adjusted odds ratios (AORs) and 95% confidence intervals(CIs) from logistic regression models that included mother's age, parity,race-ethnicity, education, body mass index, smoking, alcohol, fertilitytreatments, plurality, and study center. We compared quartiles of intake andspecified nutrients as continuous.RESULTS: Intake of folic acid-containing supplements was not associated withcraniosynostosis (AORs were close to 1). Analyses of dietary nutrients wererestricted to mothers who took supplements during the first trimester (i.e., mostwomen). Based on continuous specifications of nutrients, sagittal synostosis riskwas significantly lower among women with higher intake of riboflavin and vitaminsB₆, E, and C; metopic synostosis risk was significantly higher among women withhigher intakes of choline and vitamin B₁₂; and coronal synostosis risk wassignificantly lower among women with higher intake of methionine and vitamin C.As examples, AORs for sagittal synostosis among women with intakes of vitamin B₆and riboflavin in the highest versus lowest quartiles were 0.4 (95% CI, )and 0.5 (95% CI, ), respectively.CONCLUSION: This analysis suggests that dietary intake of certain nutrients maybe associated with craniosynostosis, and results may vary by suture type.1. Birth Defects Res A Clin Mol Teratol Aug;88(8): Free full textPericonceptional nutrient intakes and risks of neural tube defects in California.Carmichael SL, Yang W, Shaw GM.California Research Division, March of Dimes Foundation, Oakland, California, USA.BACKGROUND: This study investigated the association of neural tube defects (NTDs)with maternal periconceptional intake of folic acid-containing supplements anddietary nutrients, including folate, among deliveries that occurred after folicacid fortification in selected California counties.METHODS: The population-based case-control study included fetuses and live borninfants with spina bifida (189) or anencephaly (141) and 625 nonmalformed, liveborn controls delivered from 1999 to Mothers reported supplement use duringtelephone interviews, which included a 107-item food frequency questionnaire. Fordietary nutrients, intakes <25th, 25th to <75th (reference), and > or =75thpercentile were compared, based on control distributions.RESULTS: After adjustment for potential confounders, any versus no supplementintake resulted in ORs of 0.8 (95% CI, ) for anencephaly and 0.8 (95% CI,) for spina bifida. After stratification by maternal intake of vitaminsupplements, most factors in the glycemic pathway were not associated with eitherNTD, with the exception of low levels of fructose and glucose that weresignificantly associated with anencephaly. Some nutrients that contribute toone-carbon metabolism showed lowered risks (folate, riboflavin, vitamins B(6) andB(12)); others did not (choline, methionine, zinc). Antioxidant nutrients tendedto be associated with lowered risks (vitamins C, E, A, beta-carotene, lutein).CONCLUSIONS: Mothers' intake of vitamin supplements was modestly if at allassociated with a lowered risk of NTDs. Dietary intake of several nutrientscontributing to one-carbon metabolism and oxidative stress were associated withreduced NTD risk.7. Paediatr Perinat Epidemiol May;25(3): doi: /j x. Epub 2011 Mar 21. Relationship between maternal dietary patterns and hypospadias. de Kort CA, Nieuwenhuijsen MJ, Mendez MA.Little is known about the role of maternal nutrition in the development ofhypospadias, which is the most common urogenital congenital anomaly. This studyinvestigated the relationship between maternal nutrition and the risk ofhypospadias, particularly focusing on maternal food patterns. We compared 471hypospadias cases with 490 controls in the United Kingdom. A questionnaireincluding information on life style, occupation, usual maternal diet and dietarysupplements was administered using telephone interviews. Cases and controls werecompared for individual food item intake and food patterns derived by clusteranalysis. Multivariable logistic regression analysis adjusted for income,maternal age, low birthweight, smoking and folic acid supplement use was used toassess the relationship between maternal nutrition and hypospadias. Three foodpatterns were created with the labels 'health conscious', 'mixed' and 'non-healthconscious'. 'Non-health conscious' subjects (low frequency of consumption ofyoghurt, cheese, eggs, fruit and vegetables, fish, beans and pulses, olive oiland organic food) had a higher risk of hypospadias (odds ratio 1.54; 95%confidence interval 1.06, 2.26) compared with 'health conscious' subjects (highfrequency of consumption of fresh fruit and vegetables, dried fruit, fresh orfrozen fish, beans, pulses, soya products, olive oil and organic food), afteradjustment for potential confounders. Intakes of individual foods were notstrongly associated with hypospadias. We could not exclude the possibility ofresidual confounding, and this needs to be further investigated. We found anassociation between food pattern and hypospadias, with those with less healthconscious food patterns having a higher risk. Further study is needed to confirmthis association.1. Obstet Gynecol Aug;110(2 Pt 1):Maternal Western dietary patterns and the risk of developing a cleft lip with orwithout a cleft palate.Vujkovic M, Ocke MC, van der Spek PJ, Yazdanpanah N, Steegers EA,Steegers-Theunissen RP.Departments of Obstetrics and Gynecology/Division of Obstetrics and PrenatalMedicine, Erasmus MC, University Medical Center, 3000 CA Rotterdam, theNetherlands.OBJECTIVE: To identify maternal dietary patterns in association with a cleft lipor cleft palate or both in the offspring.METHODS: In a case-control study of 203 mothers of a child with a cleft lip orcleft palate and 178 mothers with non-malformed offspring, maternal nutritionalintakes were assessed 14 months after the birth of the index child to estimatethe preconception intake. We measured serum and red blood cell folate, serumvitamin B12, whole blood vitamin B6, and total plasma homocysteine as biomarkers.Dietary patterns were analyzed by factor analysis. Univariate and multivariateanalyses were performed and odds ratios with 95% confidence intervals calculated.RESULTS: Two major dietary patterns were identified. The Western dietary pattern,eg, high in meat, pizza, legumes, and potatoes, and low in fruits, was associatedwith a higher risk of a cleft lip or cleft palate (odds ratio 1.9; 95% confidenceinterval ). This risk remained significant after adjustment for potentialconfounders of maternal education and smoking at the time of the study, andpericonception use of folic acid or multivitamins. This dietary pattern wasassociated with lower red blood cell folate (P=.02), vitamin B6 (P=.001), vitaminB12 (P=.02), and higher homocysteine (P=.05) concentrations. The use of thePrudent pattern, eg, high intakes of fish, garlic, nuts, vegetables, increasedvitamin B12 (P<.001) and serum folate (P=.05) levels, was not associated withcleft lip or cleft palate risk compared with the Western diet.CONCLUSION: The use of the maternal Western diet increases the risk of offspringwith a cleft lip or cleft palate approximately two fold. Therefore, dietary andlifestyle profiles should be included in preconception screening programs.LEVEL OF EVIDENCE: II.PMID: [PubMed - indexed for MEDLINE]
11 Depressione post-partum Ricerche che suggeriscono vantaggi dell’alimentazione mediterranea o equivalente sulla salute riproduttiva Depressione postpartum, wheezing, tumoriDepressione post-partumL’alimentazione salutare diminuisce il rischio di depressione post-partum del 50% (Grecia-Chatzi, 2011).L’alimentazione salutare non protegge dalla depressione post-partum (Giappone-Kanzaki, 2011).Wheezing – asmaL’alimentazione mediterranea riduce il rischio di asma, OR: e di wheezing OR: 0.64 (Messico-de Battle, 2008); wheezing OR: 0.22 (Spagna-Chatzi, 2008) e (Irlanda-Fitzsimon, 2007).L’alimentazione “occidentale” riduce il rischio di wheezing, OR: 0.59 (Giappone-Miyake, 2011).Nessuna associazione tra wheezing e tre pattern alimentari analizzati (USA-Lange, 2010; UK-Shaheen, 2009)Alimentazione ricca di frutta e verdura diminuisce il rischio di tumori infantili nei maschi, OR: (USA-Musselman, 2011).6. Public Health Nutr Sep;14(9): Epub 2011 Apr 11. Dietary patterns during pregnancy and the risk of postpartum depression: the mother-child 'Rhea' cohort in Crete, Greece. Chatzi L, Melaki V, Sarri K, Apostolaki I, Roumeliotaki T, Georgiou V, Vassilaki M, Koutis A, Bitsios P, Kogevinas M.OBJECTIVE: To identify and describe dietary patterns in a cohort of pregnantwomen, and investigate whether dietary patterns during pregnancy are related topostpartum depression (PPD).DESIGN: The study uses data from the prospective mother-child cohort 'Rhea'study. Pregnant women completed an FFQ in mid-pregnancy and the EdinburgPostpartum Depression Scale (EPDS) at 8-10 weeks postpartum. Dietary patternsduring pregnancy ('health conscious', 'Western') were identified using principalcomponent analysis. Associations between dietary patterns categorized in tertilesand PPD symptoms were investigated by multivariable regression models afteradjusting for confounders.SETTING: Heraklion, Crete, Greece,SUBJECTS: A total of 529 women, participating in the 'Rhea' cohort.RESULTS: High adherence to a 'health conscious' diet, characterized byvegetables, fruit, pulses, nuts, dairy products, fish and olive oil, wasassociated with lower EPDS scores (highest v. lowest tertile: β-coefficient =-1·75, P = 0·02). Women in the second (relative risk (RR) = 0·52, 95 % CI 0·30,0·92) or third tertile (RR = 0·51, 95 % CI 0·25, 1·05) of the 'health conscious'dietary pattern were about 50 % less likely to have high levels of PPD symptoms(EPDS ≥ 13) compared with those in the lowest tertile.CONCLUSIONS: This is the first prospective study showing that a healthy dietduring pregnancy is associated with reduced risk for PPD. Additional longitudinalstudies and trials are needed to confirm these findings.8. Br J Nutr Apr;105(8): Epub 2010 Dec 13.Dietary patterns during pregnancy and the risk of postpartum depression in Japan:the Osaka Maternal and Child Health Study.Okubo H, Miyake Y, Sasaki S, Tanaka K, Murakami K, Hirota Y; Osaka Maternal andChild Health Study Group.Collaborators: Kanzaki H, Kitada M, Horikoshi Y, Ishiko O, Nakai Y, Nishio J,Yamamasu S, Yasuda J, Kawai S, Yanagihara K, Wakuda K, Kawashima T, Narimoto K,Iwasa Y, Orino K, Tsunetoh I, Yoshida J, Iito J, Kaneko T, Kamiya T, KuribayashiH, Taniguchi T, Takemura H, Morimoto Y, Matsunaga I, Oda H, Ohya Y.Department of Social and Preventive Epidemiology, Graduate School of Medicine,The University of Tokyo, Hongo 7-3-1, Bunkyo-ku, Tokyo , Japan.Although several nutrients and foods are suggested to be preventive againstpostpartum depression, all previous studies have primarily focused on singlenutrients or foods. In contrast, studies on dietary patterns, namely themeasurement of overall diet by considering the cumulative effects of nutrient,may provide new insights into the influence of diet on postpartum depression. Weprospectively examined the association between dietary patterns during pregnancyand the risk of postpartum depression among 865 Japanese women. Diet was assessedwith a validated, self-administered diet history questionnaire. Dietary patternsfrom thirty-three predefined food groups (energy-adjusted food (g/d)) wereextracted by factor analysis. Postpartum depression was defined as present whenthe subjects had an Edinburgh Postnatal Depression Scale score of ≥ 9 at 2-9months postpartum. A total of 121 women (14·0 %) were classified as havingpostpartum depression. Three dietary patterns were identified: 'Healthy','Western' and 'Japanese' patterns. After adjustment for potential confounders,neither the 'Healthy' nor the 'Japanese' pattern was related to the risk ofpostpartum depression. Compared with the first quartile of the 'Western' pattern,only the second quartile was independently related to a decreased risk ofpostpartum depression (multivariate OR 0·52, 95 % CI 0·30, 0·93), although noevident exposure-response associations were observed (P for trend = 0·36). Thepresent study failed to substantiate clear associations between dietary patternsand the risk of postpartum depression. Further studies with more accuratemeasurements are warranted to confirm the relationship between dietary patternsand the risk of postpartum depression.5. Pediatr Allergy Immunol Nov;22(7): doi: /j x. Epub 2011 May 4. Maternal dietary patterns during pregnancy and risk of wheeze and eczema in Japanese infants aged months: the Osaka Maternal and Child Health Study. Miyake Y, Okubo H, Sasaki S, Tanaka K, Hirota Y.BACKGROUND: Maternal diet during pregnancy might influence the development ofchildhood allergic disorders. Aims: This prospective study examined therelationship between maternal dietary patterns during pregnancy and the risk ofwheeze and eczema in the offspring aged months.MATERIALS & METHODS: Subjects were 763 mother-child pairs. Data on maternalintake during pregnancy were assessed with a diet history questionnaire. Dietarypatterns were derived from factor analysis of 33 predefined food groups. Symptomsof wheeze and eczema were based on criteria of the International Study of Asthmaand Allergies in Childhood. Adjustment was made for maternal age, gestation,residential municipality, family income, maternal and paternal education,maternal and paternal history of allergic disorders, changes in maternal diet inpregnancy, season at baseline, maternal smoking during pregnancy, baby's oldersiblings, sex, birth weight, age at the third survey, household smoking, andbreastfeeding duration.RESULTS: Three dietary patterns were identified: 'healthy', characterized by highintake of green and yellow vegetables, seaweed, mushrooms, white vegetables,pulses, potatoes, fish, sea products, fruit, and shellfish; 'Western',characterized by high intake of vegetable oil, salt-containing seasonings, beefand pork, processed meat, eggs, chicken, and white vegetables; and 'Japanese',characterized by high intake of rice, miso soup, sea products, and fish. Therewas a tendency for an inverse exposure-response relationship between the maternalWestern pattern during pregnancy and the risk of childhood wheeze by crudeanalysis. After adjustment for the confounding factors under study, the inverserelationship was strengthened: the adjusted OR between extreme quartiles was 0.59(95% CI: , p for trend = 0.02). No such inverse association was observedfor childhood eczema. Neither the maternal healthy pattern nor the Japanesepattern during pregnancy was related to childhood wheeze or eczema.CONCLUSION: The maternal Western pattern during pregnancy may be preventiveagainst wheeze in the offspring.19. Thorax Jun;63(6): Epub 2008 Jan 15.Mediterranean diet in pregnancy is protective for wheeze and atopy in childhood.Chatzi L, Torrent M, Romieu I, Garcia-Esteban R, Ferrer C, Vioque J, Kogevinas M,Sunyer J.Department of Social Medicine, Faculty of Medicine, University of Crete, PO Box2208, Heraklion, 71003, Crete, Greece.Comment inThorax Jun;63(6):483-5.INTRODUCTION: Dietary intake of specific nutrients or food groups duringpregnancy could play a role in the risk of asthma and atopy in offspring, butspecific dietary patterns have not been implicated. The authors evaluated theimpact of maternal (during pregnancy) and child adherence to a Mediterranean dieton asthma and atopy in childhood.METHODS: Women presenting for antenatal care at all general practices in Menorca,a Mediterranean island in Spain, over a 12 month period starting in mid-1997 wererecruited. 460 children were included in the analysis after 6.5 years offollow-up. Maternal dietary intake during pregnancy and children's dietary intakeat age 6.5 years were assessed by food frequency questionnaires, and adherence toa Mediterranean diet was evaluated by a priori defined scores. During follow-up,parents completed questionnaires on the child's respiratory and allergicsymptoms. Children underwent skin prick tests with six common aeroallergens.RESULTS: The prevalence rates of persistent wheeze, atopic wheeze and atopy atage 6.5 years were 13.2%, 5.8% and 17.0%, respectively. One-third (36.1%) ofmothers had a low quality Mediterranean diet during pregnancy according to theMediterranean Diet Score, while the rest had a high score. A high MediterraneanDiet Score during pregnancy (at two levels, using "low" score as the reference)was found to be protective for persistent wheeze (OR 0.22; 95% CI 0.08 to 0.58),atopic wheeze (OR 0.30; 95% CI 0.10 to 0.90) and atopy (OR 0.55; 95% CI 0.31 to0.97) at age 6.5 years after adjusting for potential confounders. Childhoodadherence to a Mediterranean diet was negatively associated with persistentwheeze and atopy although the associations did not reach statisticalsignificance.CONCLUSION: These results support a protective effect of a high level ofadherence to a Mediterranean diet during pregnancy against asthma-like symptomsand atopy in childhood.PMID: [PubMed - indexed for MEDLINE]22. Ir Med J Sep;100(8):supplMothers' dietary patterns during pregnancy and risk of asthma symptoms inchildren at 3 years.Fitzsimon N, Fallon U, O'Mahony D, Loftus BG, Bury G, Murphy AW, Kelleher CC;Lifeways Cross Generation Cohort Study Steering Group.UCD School of Public Health and Population Science.There is increasing evidence that dietary factors in early life play a role inthe aetiology of childhood asthma. Our objective in this analysis was to assesswhether maternal dietary patterns during pregnancy, as measured by a validatedfood frequency questionnaire, influenced general practitioner diagnosis of asthmaby the age of 3 years in the Life-ways cohort of children. General Practicefollow-up records were available for 631 of 1001 singleton children, twins havingbeen excluded (63% follow-up rate). Overall 10.4% of children had diagnosedasthma, a prevalence rate comparable with other studies. In logistic regressionmodels, based on quartiles of intake, which adjusted for maternal lifestyle andsocio-economic circumstances, relatively higher maternal fruit and vegetableintake and oily fish consumption were associated with lower risk of childrendeveloping asthma, whilst those with relatively higher spreadable fat intake hada higher risk of asthma. These findings warrant further investigation as theyimply an important role for maternal diet in childhood asthma, though theconfounding effect of other social and lifestyle factors should be assessed asthe children get older.PMID: [PubMed - indexed for MEDLINE]11. J Allergy Clin Immunol Aug;126(2):250-5, 255.e1-4. Epub 2010 Jun 26.Maternal dietary pattern during pregnancy is not associated with recurrent wheezein children.Lange NE, Rifas-Shiman SL, Camargo CA Jr, Gold DR, Gillman MW, Litonjua AA.Channing Laboratory, Brigham and Women's Hospital and Harvard Medical School,Boston, MA 02115, USA.BACKGROUND: The rise in asthma prevalence over the last few decades may be aresult of changes in prenatal or early-life environment, including maternal dietduring pregnancy. Previous studies have found associations between individualfoods or nutrients consumed during pregnancy and asthma or wheeze in children,but these may be confounded by overall dietary pattern.OBJECTIVE: To determine whether overall maternal dietary pattern during pregnancyis associated with recurrent wheeze in children.METHODS: A total of 1376 mother-infant pairs from Project Viva, a longitudinalprebirth cohort, who had responses for food frequency questionnaires in the firstand second trimester and outcome data at 3 years of age were included.Multivariable logistic regression was used to look at associations betweendietary pattern and the primary outcome of recurrent wheeze at 3 years. Overalldietary pattern was examined by using Mediterranean diet score, Alternate HealthyEating Index modified for pregnancy (AHEI-P), and principal components analysisto look at Western and Prudent diets.RESULTS: None of these dietary patterns was associated with the primary outcomeof recurrent wheeze in children in either the crude or the multivariable model(multivariable model, odds ratio per 1-point increase in Mediterranean diet, 0.98[95% CI, ]; AHEI-P, 1.07 [ ]; Prudent, 1.02 [ ];Western, 0.98 [ ]).CONCLUSION: Overall dietary pattern during pregnancy is not associated withrecurrent wheeze in this cohort. Maternal intake of individual nutrients may bemore important determinants of offspring wheeze-associated illness than isdietary pattern.Copyright 2010 American Academy of Allergy, Asthma & Immunology. Published byMosby, Inc. All rights reserved.PMCID: PMCPMID: [PubMed - indexed for MEDLINE]16. Thorax May;64(5): Epub 2009 Feb 12.Dietary patterns in pregnancy and respiratory and atopic outcomes in childhood.Shaheen SO, Northstone K, Newson RB, Emmett PM, Sherriff A, Henderson AJ.National Heart and Lung Institute, Imperial College London, UK.BACKGROUND: Studies of the relation between maternal diet in pregnancy andrespiratory and atopic outcomes in the offspring have focused on the effects ofindividual nutrients and foods rather than dietary patterns. A study wasundertaken to determine whether dietary patterns in pregnancy are related tochildhood asthma and related outcomes.METHODS: In a population-based birth cohort, the Avon Longitudinal Study ofParents and Children (ALSPAC), dietary patterns in pregnancy previouslyidentified using principal components analysis ("health conscious","traditional", "processed", "vegetarian" and "confectionery") were related toearly wheezing phenotypes and eczema; wheezing, hay fever, eczema,doctor-diagnosed asthma, atopy and total IgE at 7 years; lung function andbronchial responsiveness at 8-9 years. In regression models, confounders werecontrolled for using propensity scores.RESULTS: Univariately, the "health conscious" pattern was positively associatedwith eczema, total IgE, forced expiratory volume in 1 s and forced expiratoryflow and negatively associated with early wheezing and asthma (unadjusted oddsratios per standard deviation increase in pattern score for early persistentwheeze and asthma: 0.78 (95% CI 0.70 to 0.87), p = 7.3x10(-6), N = 8886 and 0.90(95% CI 0.84 to 0.97), p = 0.007, N = 7625, respectively). The "processed"pattern was positively associated with early wheezing and negatively associatedwith atopy and forced vital capacity. On controlling for confounders, the effectswere substantially attenuated and became non-significant (adjusted odds ratiosfor the associations of the "health conscious" pattern with early persistentwheeze and asthma: 1.00 (0.86 to 1.16), p = 0.99 and 0.95 (0.86 to 1.04), p =0.27, respectively).CONCLUSIONS: In this cohort, dietary patterns in pregnancy did not predict asthmaand related outcomes in the offspring after controlling for confounders.PMID: [PubMed - indexed for MEDLINE]17. Allergy Oct;63(10):Mediterranean diet is associated with reduced asthma and rhinitis in Mexicanchildren.de Batlle J, Garcia-Aymerich J, Barraza-Villarreal A, Antó JM, Romieu I.Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain.BACKGROUND: Diet during pregnancy and childhood has been suggested to play animportant role in children's asthma risk. We assessed whether the adherence to aMediterranean dietary pattern, for children in the last 12 months and theirmothers during pregnancy, was associated with both childhood asthma and allergicrhinitis.METHODS: A cross-sectional study was conducted in 2004 using a random sample of1476 children (6- to 7-year old) from the Mexicali region, Mexico. Dietary dataof children's intake in the last 12 months and their mothers' intake duringpregnancy was collected, through a parental food frequency questionnaire. AMediterranean diet score was computed [Trichopoulou et al., N Engl J Med 348(2003), 2599]. Data on seven asthma and rhinitis-related outcomes were obtainedfrom the International Study of Asthma and Allergies in Childhood questionnaire.RESULTS: Adherence to a Mediterranean dietary pattern was inversely associatedwith asthma ever (OR = 0.60, 95% CI = ), wheezing ever (0.64,), rhinitis ever (0.41, ), sneezing ever (0.79, ),current sneezing (0.71, ) and current itchy-watery eyes (0.63,). No associations were found using the mothers' pregnancy diet score,except for current sneezing (0.71, ).CONCLUSIONS: Our findings suggest a protective effect of following a healthydietary pattern on asthma and allergic rhinitis in Mexican children.PMID: [PubMed - indexed for MEDLINE]9. Am J Epidemiol Feb 1;173(3): Epub 2010 Nov 23. Maternal dietary patterns during early pregnancy and the odds of childhood germ cell tumors: A Children's Oncology Group study. Musselman JR, Jurek AM, Johnson KJ, Linabery AM, Robison LL, Shu XO, Ross JA University of Minnesota, Minneapolis, USA.,Maternal diet during pregnancy may be associated with cancer in offspring. Intakeof individual foods, as well as dietary patterns, can be used when examiningthese relations. Here, the authors examined associations between maternal dietaryintake patterns and pediatric germ cell tumors (GCTs) using principal componentsanalysis and logistic regression. Mothers of 222 GCT cases aged less than 15years who were diagnosed at a Children's Oncology Group institution between 1993and 2001 and those of 336 frequency-matched controls completed aself-administered food frequency questionnaire of diet during early pregnancy.Four dietary patterns were identified: "Western," "fruits and vegetables,""protein," and "healthful." With adjustment for birth weight, parity, and vitaminuse, the fruits and vegetables pattern was significantly associated with a lowerodds for GCTs (odds ratio (OR) = 0.83, 95% confidence interval (CI): 0.69, 0.99;2 sided). Upon stratification, the fruits and vegetables pattern wassignificantly associated with a lower odds in males (OR = 0.66, 95% CI: 0.47,0.92) but not females (OR = 0.91, 95% CI: 0.72, 1.14). A quantitative assessmentof assumed nondifferential reporting error indicated no notable deviations fromunadjusted odds ratio estimates. Results of this exploratory analysis suggestthat maternal prenatal dietary patterns could be considered in future studies ofGCTs in offspringICBD – Agrigento – Sciacca -- Novembre 21-22, | 11
12 ConclusioneLa lista dei vantaggi dell’alimentazione mediterranea, anche per la procreazione è molto ampia.L’alimentazione mediterranea ha innumerevoli vantaggi, che non sono legati ad una specifica vitamina o oligoelemento, ma al loro equilibrio complessivo.L’importante è dapprima convincere se stessi e adottare per primi le sane abitudini alimentari e poi trasmetterle agli altri.ICBD – Agrigento – Sciacca -- Novembre 21-22, | 12
13 Domande Pierpaolo Mastroiacovo firstname.lastname@example.org Professore di Pediatria Direttore ICBD – Alessandra Lisi International Centre on Birth Defects and Prematurity;Centro Collaborativo OMS, Roma