Browsing by Author "Brough L"

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    A Mixed-Methods Study of Factors Influencing Access to and Use of Micronutrient Powders in Rwanda
    (Johns Hopkins Center for Communication Programs, 2021-06-30) Dusingizimana T; Weber JL; Ramilan T; Iversen PO; Brough L
    The World Health Organization recommends point-of-use fortification with multiple micronutrients powder (MNP) for foods consumed by children aged 6-23 months in populations where anemia prevalence among children under 2 years or under 5 years of age is 20% or higher. In Rwanda, anemia affects 37% of children under 5 years. The MNP program was implemented to address anemia, but research on factors affecting the implementation of the MNP program is limited. We conducted a mixed-methods study to examine the factors influencing access to and use of MNP among mothers (N=379) in Rutsiro district, northwest Rwanda. Inductive content analysis was used for qualitative data. Logistic regression analysis was used to determine factors associated with the use of MNP. Qualitative results indicated that the unavailability of MNP supplies and distribution issues were major barriers to accessing MNP. Factors influencing the use of MNP included mothers' perceptions of side effects and health benefits of MNP, as well as inappropriate complementary feeding practices. Mothers of older children (aged 12-23 months) were more likely to use MNP than those of younger children (aged 6-11 months) (adjusted odds ratio [aOR]=3.63, P<.001). Mothers whose children participated in the supplementary food program were nearly 3 times more likely to use MNP than those whose children had never participated in the program (aOR=2.84, P=.001). Increasing household hunger score was significantly associated with lower odds of using MNP (aOR=0.80, P=.038). Mechanisms to monitor MNP supply and program implementation need to be strengthened to ensure mothers have access to the product. MNP program implementers should address gaps in complementary feeding practices and ensure mothers have access to adequate complementary foods. L'Organisation Mondiale de la Santé recommande l'enrichissement de l'alimentation à domicile (enrichissement sur le point d'utilisation) à l'aide des poudres de micronutriments multiples (PMN) pour les aliments consommés par les enfants âgés de 6 à 23 mois dans les populations où la prévalence de l'anémie chez les enfants de moins de 2 ans ou 5 ans est de 20% ou plus. Au Rwanda, l'anémie touche 37% des enfants de moins de 5 ans et le programme de PMN a été mis en œuvre pour lutter contre l'anémie. Cependant, la recherche sur les facteurs qui affectent la mise en œuvre du programme de PMN est limitée. Nous avons mené une étude par méthodes mixtes pour examiner les facteurs qui influencent l'accès des mères (n=379) à la PMN et son utilisation dans le district de Rutsiro, au nord-ouest du Rwanda. L'analyse du contenu inductif a été utilisée pour les données qualitatives. Pour déterminer les facteurs associés à l'utilisation des PMN, une régression logistique a été utilisée. Les résultats qualitatifs ont indiqué que l'indisponibilité des approvisionnements en PMN et les problèmes de distribution constituaient des obstacles majeurs à l'accès à la PMN. Les facteurs qui influencent l'utilisation des PMN comprenaient les perceptions, chez les mères, des effets secondaires et des avantages des PMN pour la santé, ainsi que des pratiques d'alimentation complémentaire inappropriées. Les mères d'enfants plus âgés (12 à 23 mois) étaient plus susceptibles d'utiliser la PMN que celles d'enfants plus jeunes (6 à 11 mois) (odds ratio ajusté [ORA]=3,63, P<0,001). Les mères des enfants qui avaient participé au programme d'alimentation complémentaire étaient près de 3 fois plus susceptibles d'utiliser la PMN que celles des enfants qui n'avaient jamais participé au programme (ORA=2,84, P=0,001). L'augmentation du score de faim dans les ménages était significativement associée à des chances plus faibles d'utiliser la PMN (ORA=0,80, P=0,038). Les mécanismes de suivi de l'approvisionnement en PMN et de la mise en œuvre du programme doivent être renforcés pour s'assurer que les mères ont accès au produit. Les responsables de la mise en œuvre du programme de PMN devraient combler les lacunes au niveau des pratiques d'alimentation complémentaire et veiller à ce que les mères aient accès à des aliments complémentaires adéquats.
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    Carbohydrate composition, viscosity, solubility, and sensory acceptance of sweetpotato- and maise-based complementary foods
    (Food and Nutrition Research, 2013) Amagloh FK; Mutukumira AN; Brough L; Weber JL; Hardacre A; Coad J
    Background: Cereal-based complementary foods from non-malted ingredients form a relatively high viscous porridge. Therefore, excessive dilution, usually with water, is required to reduce the viscosity to be appropriate for infant feeding. The dilution invariably leads to energy and nutrient thinning, that is, the reduction of energy and nutrient densities. Carbohydrate is the major constituent of food that significantly influences viscosity when heated in water. Objectives: To compare the sweetpotato-based complementary foods (extrusion-cooked ComFa, roller-dried ComFa, and oven-toasted ComFa) and enriched Weanimix (maize-based formulation) regarding their 1) carbohydrate composition, 2) viscosity and water solubility index (WSI), and 3) sensory acceptance evaluated by sub-Sahara African women as model caregivers. Methods: The level of simple sugars/carbohydrates was analysed by spectrophotometry, total dietary fibre by enzymatic-gravimetric method, and total carbohydrate and starch levels estimated by calculation. A Rapid ViscoTM Analyser was used to measure viscosity. WSI was determined gravimetrically. A consumer sensory evaluation was used to evaluate the product acceptance of the roller-dried ComFa, oven-toasted ComFa, and enriched Weanimix. Results: The sweetpotato-based complementary foods were, on average, significantly higher in maltose, sucrose, free glucose and fructose, and total dietary fibre, but they were markedly lower in starch content compared with the levels in the enriched Weanimix. Consequently, the sweetpotato-based complementary foods had relatively low apparent viscosity, and high WSI, than that of enriched Weanimix. The scores of sensory liking given by the caregivers were highest for the roller-dried ComFa, followed by the oven-toasted ComFa, and, finally, the enriched Weanimix. Conclusion: The sweetpotato-based formulations have significant advantages as complementary food due to the high level of endogenous sugars and low starch content that reduce the viscosity, increase the solubility, impart desirable sensory characteristics, and potentially avoid excessive energy and nutrient thinning.
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    Concentration of 12 Oligosaccharides in the Milk of New Zealand Breastfeeding Women
    (MDPI (Basel, Switzerland), 2023-03-23) Jia LL; Brough L; Weber JL; Smith C; Mackay S; Jalili-Moghaddam S; Gibbs M
    Human milk oligosaccharides (HMOs) are the third most abundant component in breast milk. HMOs benefit infant gut health, modulate immune responses, and promote brain development. The profile and concentration of HMOs vary considerably among breastfeeding women, and are reported to be associated with genetic, maternal, and environmental factors as well as feeding practices. One reason for the diversity in HMO concentration is the secretor gene, which determines the presence of an enzyme responsible for the synthesis of 2′-FL and LNFP-I. To date, there is no report about HMO concentration or profile in the New Zealand population. Our objective was to investigate 12 HMO concentrations in a small sample of New Zealand women. Sixty-eight breastfeeding mothers (mean age 32 years, 77% Caucasian) of singleton infants (median age [Q1, Q3] 108 [70, 166] days) were included, with 65% exclusively breastfeeding and 54% who had two or more children. Concentrations of 12 HMOs were measured by UHPLC with fluorescence detection. Overall, 68% of mothers were secretors, which was defined by the presence of 2′-FL in the milk. HMO profiles varied widely; total HMO concentration varied 4.2-fold between women; and individual HMOs varied from 4.8-fold to >100-fold. The median of total HMO concentration (Q1, Q3) of the secretors and non-secretors were 6774.9 (6395.4, 8245.6) mg/L and 7128.0 (6093.1, 7880.1) mg/L respectively. Significant differences in concentration of 2′-FL, 3-FL, A-Tet, LNFP-I, LNFP-II, LNFPV, and LNnT between secretors and non-secretors were found by Mann–Whitney tests. However, there was no significant difference in concentrations of LNFP-III, LNnFP, 3′-SL, 6′-SL, LNT, or total HMOs between the secretors and the non-secretors. HMO concentrations vary broadly between breastfeeding women. A longitudinal cohort of a larger sample size is required to fully investigate HMO profiles at different lactation stages of New Zealand women and to further explore the influence of maternal and environmental factors on HMO concentration.
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    Dietary Patterns and Nutrient Intake in Pregnancy and Lactation
    (MDPI (Basel, Switzerland), 2025-05) Rees G; Brough L; Brough L; Rees G
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    Do Micronutrient and Omega-3 Fatty Acid Supplements Affect Human Maternal Immunity during Pregnancy? A Scoping Review
    (MDPI (Basel, Switzerland), 2022-01-15) Rees G; Brough L; Orsatti GM; Lodge A; Walker S; Pérez-Cano FJ
    Maternal dietary micronutrients and omega-3 fatty acids support development of the fetal and neonatal immune system. Whether supplementation is similarly beneficial for the mother during gestation has received limited attention. A scoping review of human trials was conducted looking for evidence of biochemical, genomic, and clinical effects of supplementation on the maternal immune system. The authors explored the literature on PubMed, Cochrane Library, and Web of Science databases from 2010 to the present day using PRISMA-ScR methodology. Full-length human trials in English were searched for using general terms and vitamin A, B12, C, D, and E; choline; iodine; iron; selenium; zinc; and docosahexaenoic/eicosapentaenoic acid. Of 1391 unique articles, 36 were eligible for inclusion. Diverse biochemical and epigenomic effects of supplementation were identified that may influence innate and adaptive immunity. Possible clinical benefits were encountered in malaria, HIV infections, anemia, Type 1 diabetes mellitus, and preventing preterm delivery. Only limited publications were identified that directly explored maternal immunity in pregnancy and the effects of micronutrients. None provided a holistic perspective. It is concluded that supplementation may influence biochemical aspects of the maternal immune response and some clinical outcomes, but the evidence from this review is not sufficient to justify changes to current guidelines.
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    Effect of Iodine Nutrition During Pregnancy and Lactation on Child Cognitive Outcomes: A Review
    (MDPI (Basel, Switzerland), 2025-06-16) Ma ZF; Brough L; Marconi AM
    Iodine deficiency remains one of the most serious global public health challenges, recognised as the leading cause of preventable brain damage worldwide. It is widely accepted as the primary aetiological factor underlying iodine deficiency disorders (IDD). Inadequate maternal iodine intake reduces thyroxine synthesis, impairing foetal brain development and leading to long-term deficits in cognitive function across childhood and adulthood. However, emerging evidence also suggests that excessive iodine intake may disrupt thyroid function, particularly in individuals with underlying thyroid autoimmunity, potentially leading to adverse neurodevelopmental outcomes. In this state-of-the-art review, we examine the effects of iodine nutrition during pregnancy and lactation on child cognitive outcomes. We provide an overview of the recent global iodine status, critically appraise the current evidence linking both iodine deficiency and excess to neurodevelopmental outcomes, and offer expert interpretation of the key findings. We further highlight areas of uncertainty, introduce emerging evidence from contemporary studies, and propose directions for future research to inform and optimise public health policies and clinical practice. Our findings highlight a U-shaped association, whereby both insufficient and excessive iodine exposure during pregnancy and lactation may impair optimal brain development in the offspring.
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    Food Group Consumption and Nutrient Intake by Breastfeeding Women: Comparison to Current Dietary Guidelines and Nutrient Recommendations.
    (MDPI (Basel, Switzerland), 2025-01-21) Jin Y; Coad J; Brough L; Billeaud C; Asher O
    BACKGROUND/OBJECTIVES: Optimal nutrition is essential for the health of breastfeeding women and their infants. This study aimed to assess food and nutrient intake and alignment with nutrition guidelines for breastfeeding women living in New Zealand. METHODS: Seventy-six breastfeeding women were enrolled in the longitudinal Mother and Infant Nutrition Investigation study and completed a weighed four-day diet diary including supplement use at three months postpartum. The number of servings consumed for each food group were calculated based on the 2020 Eating and Activity Guidelines for New Zealand Adults. Nutrient intakes were compared to the nutrient reference values for Australia and New Zealand. RESULTS: Overall, the percentages of women who met the recommended number of servings for fruits, vegetables, grain foods, meats and milk/milk products were 25%, 0%, 5%, 34%, and 13%, respectively. None of women met the current recommendations for all food groups. Many participants had intakes below the estimated average requirement or adequate intake and were at risk of nutrient inadequacy for vitamin E (55%), vitamin D (53%), manganese (61%), and selenium (55%). CONCLUSIONS: Breastfeeding women had a low alignment with the current dietary guidelines and were at risk of an inadequate intake of vitamin E, D, manganese, and selenium. Research to investigate the barriers and enablers of healthy food choices is needed.
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    Gymnema lactiferum: A Review of Its Traditional Applications, Phytochemical Constituents, and Biological Properties
    (Wiley Periodicals LLC, 2024-10-16) Weerasinghe DMKP; Brough L; Everett DW; Rashidinejad A
    Humanity has a longstanding reliance on natural plants for medicinal purposes, and Gymnema lactiferum (G. lactiferum) has emerged as a medicinal plant with deep-rooted traditional usage. Throughout history, this plant has been an integral part of traditional medical systems, demonstrating diverse therapeutic effects. Notably, among these effects is its ability to decrease blood glucose concentration in diabetic patients, impart cooling effects, serve as an anabolic and rehydrating agent, stimulate spermiogenesis, and exhibit wormicidal properties. Furthermore, G. lactiferum has been used in treating conditions such as hemorrhoids cancers, anorexia, and as a cardiac stimulant. The primary objective of this review is to comprehensively gather and critically assess research findings regarding the medicinal properties of G. lactiferum, specifically emphasizing the bioactive compounds responsible for these properties. Previous studies have documented the presence of various phytochemicals in G. lactiferum, which are associated with some biological activities, including antioxidative, anti-hyperglycemic, cholesterol-regulating, and anti-inflammatory properties. Additionally, this review explores potential future applications for this plant. Beyond its medicinal significance, extracts derived from G. lactiferum demonstrate promise for future nutritional applications. This review highlights the potential use of G. lactiferum as an herbal medicine by critically assessing research on its medicinal value.
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    Iodine
    (Elsevier Inc. on behalf of American Society for Nutrition, 2024-01-30) Brough L; Skeaff S
    The micronutrient iodine is essential for thyroid function. Iodine is a constituent of the thyroid hormones, thyroxine (tetraiodothyronine, T4), and triiodothyronine (T3) that control metabolism, growth, and development [2].
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    Iodine and selenium intakes and status and thyroid function in midlife women with low bread intakes in New Zealand
    (John Wiley and Sons Australia, Ltd on behalf of Dietitians Australia, 2025-06-18) Berger J; Finlayson J; Von Hurst PR; Brough L
    Aims: Iodine and selenium are important nutrients for thyroid function; however, the New Zealand food supply is generally low in both minerals. Bread can be a good source of these minerals; although the popularity of lower carbohydrate diets means some people avoid bread. This study aimed to investigate the effect of low bread intakes on iodine and selenium intakes and status, and thyroid function in mid-life women in New Zealand. Methods: Self-selecting women (n = 46), aged 40–63 years, with a mean daily intake of 1.6 ± 1.5 slices of fortified commercial bread, were recruited into a cross-sectional study in Auckland, New Zealand. Assessment of iodine and selenium intake was via a 3-day diet diary. Iodine and selenium concentrations were measured in 24-h urine samples and selenium concentrations in plasma using inductively coupled plasma mass spectrometry. Thyroid hormones including triiodothyronine and thyroxine were also determined. Results: Median urinary iodine concentration was 49 (35, 78; 25, 75 centile) μg/L indicating iodine deficiency. Of plasma samples measured, 32% had selenium concentrations below 110 μg/L, suggesting inadequacy. Data suggested at least 40% of participants had low intakes of both nutrients. Only two participants had impaired thyroid function; however, plasma selenium concentrations predicted the ratio of triiodothyronine to thyroxine (p = 0.038). Conclusions: A high prevalence of inadequate selenium and iodine intake was observed in women with low bread intakes. Those with low bread intakes need to ensure they consume alternative sources such as dairy, fish and seafood, eggs, meat, other grains, and nuts.
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    Maternal plasma selenium and the occurrence of infection symptoms among women at six and twelve months postpartum
    (MDPI (Basel, Switzerland), 2023-04-03) Jin Y; Coad J; Brough L; Smith C; Mackay S; Jalili-Moghaddan S
    Selenium is essential for human health because it produces selenoproteins, which have antioxidant and anti-inflammatory roles. Recently published data have suggested high selenium status (high hair selenium concentration) improved outcomes in patients with COVID-19 infections. Our objective was to investigate the occurrence of infectious symptoms and selenium status among postpartum women. This is a secondary analysis of data collected in the Mother and Infant Nutrition Investigation—an observational, longitudinal cohort study spanning the first postpartum year of mother and infant pairs (n = 87) in Palmerston North, New Zealand. Plasma selenium was measured in women at six months postpartum (6MPP), and the validated Carr Infection Symptom Checklist (CISC) measured the type and frequency of infection symptoms experienced at 6MPP and twelve months postpartum (12MPP). The checklist contains 30 symptoms of infection; each symptom is scored from 0 (no symptoms) to 4 (severe symptoms), thus the possible total score ranges from zero to 120. The data were expressed as the median (q25, q75). The median maternal plasma selenium was 105.8 (95.6, 115.3) µg/L, with 41% of women meeting the criteria for the maximum expression of selenoprotein P (>110 µg/L). The median CISC scores were 12 (8, 18) at 6MPP and 13 (8, 21) at 12MPP, which were weakly correlated (r = 0.363, p = 0.002). Plasma selenium levels among women with a low CISC score ≤ 15 (n = 56) at 6MPP were significantly higher (110.05 µg/L) than those women with a high score of symptoms of infection (score > 15, n = 23) at 102.18 µg/L (p = 0.048, Mann–Whitney U test). Further research is warranted to investigate whether higher plasma selenium levels contribute to a lower rate of maternal infection during the postpartum period. The association between wider selenium biomarkers and maternal immune function should be determined by examining inflammatory markers or immunoglobulin concentrations
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    Portable X-ray fluorescence of zinc and selenium with nail clippings – visit 3 of the Mother and Infant Nutrition Investigation (MINI)
    (Elsevier B.V., 2025-10) Fleming DEB; Scott AR; Ouellette JA; Kim JS; Lefsay A; Jin Y; Coad J; Brough L
    Introduction: Recent advances in portable X-ray fluorescence (XRF) have opened up the possibility of a rapid and cost-effective method for measuring elemental content in nail clippings. Two elements of particular interest for intake assessment through nail clipping measurement are zinc and selenium. The New Zealand-based Mother and Infant Nutrition Investigation (MINI) provides an ideal testing ground for the application of portable XRF in the measurement of zinc and selenium. Two aspects requiring further study with portable XRF are the optimal time of measurement and the optimal approach to energy spectrum analysis. Methods: A subset of nail clippings from 20 mother-infant pairings were initially selected for analysis over three separate MINI study visits. This paper considers measurements from visit 3 (12 months postpartum). For portable XRF, a mono-energetic X-ray beam was used to excite characteristic X-rays from zinc and selenium. Individual XRF measurements were made for 60 s (real time). In each case, analysis of the elemental signal was performed in four different ways: (1) automated system output concentration; (2) element signal to total signal ratio; (3) element signal to Compton scatter signal; (4) element signal to coherent scatter signal. XRF results were compared against zinc and selenium concentrations obtained from a “gold standard” method of inductively coupled plasma mass spectrometry (ICP-MS). Results: ICP-MS results from the visit 3 nail clippings determined a mean zinc concentration of 104 µg/g and a mean selenium concentration of 0.606 µg/g. Analysis of XRF energy spectra from 60 s measurements showed that zinc was clearly detected in all cases. The selenium signal was more challenging, but was also detected from all spectra. For both zinc and selenium, correlations between XRF results and ICP-MS concentrations were highly significant (p < 0.01) in all cases, with the zinc results more strongly correlated than selenium. Of the four approaches to XRF signal analysis, the three approaches involving an external software package provided superior results relative to the automated system output. Correlations of XRF results with ICP-MS concentrations were similar between these three approaches. Conclusion: ICP-MS concentrations for both zinc and selenium were found to be lower from visit 3 relative to results from visit 1 and visit 2. This may indicate overall dietary changes postpartum. Correlations of XRF results with ICP-MS concentrations suggest that a relatively short 60 s measurement time is adequate for a reliable zinc assessment, but not for selenium. Although correlations of XRF results with ICP-MS concentrations were similar between three different methods of spectra analysis, practical considerations may favor use of the element signal to total signal approach.
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    Portable X-ray fluorescence of zinc and selenium with nail clippings-Mother and Infant Nutrition Investigation (MINI).
    (PLOS, 2024-10-23) Fleming DEB; Madani N; Kaiser MG; Kim JS; Keltie E; Drage N; Jin Y; Coad J; Brough L; Specht A
    Zinc and selenium are essential minerals for human nutrition. Reliable biomarkers of zinc status and selenium status in humans are therefore important. This work investigates a novel portable X-ray fluorescence (XRF) method with the ability to rapidly assess zinc and selenium in nail clippings. This approach used a mono-energetic X-ray beam to excite characteristic X-rays from the clippings. Nail clippings were obtained from the Mother and Infant Nutrition Investigation (MINI), a study designed to assess nutrition in a population of women and their breastfed children in New Zealand. Twenty mother-infant pairings were selected to provide nail clippings at two time points (visit 1 at 3 months postpartum; visit 2 at 6 months postpartum). Nail clippings from each mother-infant pairing were divided into three groupings of clippings prior to analysis: those obtained from a big toe of the mother, those from the other toes of the mother, and those from the toes and fingers of the infant. Clippings were prepared and mounted prior to XRF measurement, providing four distinct fragments from each clipping grouping. These fragments were assessed by XRF using a measurement time of either 300 s (visit 1) or 180 s (visit 2). XRF results were determined through both an automated system output and an analysis of the X-ray energy spectrum. Following this assessment of zinc and selenium with the non-destructive XRF method, clippings were measured for zinc and selenium concentration using a "gold standard" technique of inductively coupled plasma mass spectrometry (ICP-MS). Mean ICP-MS concentrations ranged from 122 μg/g to 127 μg/g for zinc, and from 0.646 μg/g to 0.659 μg/g for selenium. Precision, assessed by a relative standard deviation of measurement, was superior for ICP-MS relative to XRF. For both zinc and selenium, XRF results were compared with ICP-MS concentrations. Linear equations of best fit were determined for each comparison between XRF and ICP-MS results. Coefficients of determination (r2) were stronger for zinc (from 0.74 to 0.95) than selenium (from 0.53 to 0.70). A decrease in XRF measurement time from 300 s to 180 s did not appear to adversely affect the correlation between XRF and ICP-MS results. Using the mono-energetic portable XRF method, the correlation of XRF zinc results with ICP-MS zinc concentrations was improved over previous findings, and selenium measurement was reported for the first time. The method may prove useful for future applications to trace element analysis using nail clippings as a biomarker.
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    Predictors for achieving adequate antenatal care visits during pregnancy: a cross-sectional study in rural Northwest Rwanda
    (BioMed Central Ltd, 2023-01-26) Dusingizimana T; Ramilan T; Weber JL; Iversen PO; Mugabowindekwe M; Ahishakiye J; Brough L
    BACKGROUND: Inadequate antenatal care (ANC) in low-income countries has been identified as a risk factor for poor pregnancy outcome. While many countries, including Rwanda, have near universal ANC coverage, a significant proportion of pregnant women do not achieve the recommended regimen of four ANC visits. The present study aimed to explore the factors associated with achieving the recommendation, with an emphasis on the distance from household to health facilities. METHODS: A geo-referenced cross-sectional study was conducted in Rutsiro district, Western province of Rwanda with 360 randomly selected women. Multiple logistic regression analysis including adjusted odd ratio (aOR) were performed to identify factors associated with achieving the recommended four ANC visits. RESULTS: The majority (65.3%) of women had less than four ANC visits during pregnancy. We found a significant and negative association between distance from household to health facility and achieving the recommended four ANC visits. As the distance increased by 1 km, the odds of achieving the four ANC visits decreased by 19% (aOR = 0.81, P = 0.024). The odds of achieving the recommended four ANC visits were nearly two times higher among mothers with secondary education compared with mothers with primary education or less (aOR = 1.90, P = 0.038). In addition, mothers who responded that their household members always seek health care when necessary had 1.7 times higher odds of achieving four ANC visits compared with those who responded as unable to seek health care (aOR = 1.7, P = 0.041). Furthermore, mothers from poor households had 2.1 times lower odds of achieving four ANC visits than mothers from slightly better-off households (aOR = 2.1, P = 0.028). CONCLUSIONS: Findings from the present study suggest that, in Rutsiro district, travel distance to health facility, coupled with socio-economic constraints, including low education and poverty can make it difficult for pregnant women to achieve the recommended ANC regimen. Innovative strategies are needed to decrease distance by bringing ANC services closer to pregnant women and to enhance ANC seeking behaviour. Interventions should also focus on supporting women to attain at least secondary education level as well as to improve the household socioeconomic status of pregnant women, with a particular focus on women from poor households.
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    Saccharomyces cerevisiae Yeast-Based Supplement and Breast Milk Supply: A Randomised Placebo-Controlled Trial
    (John Wiley and Sons Ltd, 2025-09-11) Jia L; Brough L; Weber JL
    Saccharomyces cerevisiae yeast-based supplements (SCYS) are frequently used as galactagogues with limited evidence of their efficacy. This study investigates the effect of SCYS on human milk oligosaccharide (HMO) concentration and indicators of milk supply. Sixty-eight breastfeeding women with a healthy singleton infant aged 1–7 months were randomly assigned to consume a SCYS product (5 g/day) or placebo for 4 weeks. The primary outcome was the change in the total HMO concentration. The secondary outcomes included participants' perceptions of milk supply, intervention effectiveness, postnatal distress, infant feeding patterns, infant anthropometry, and adverse effects. Intention-to-treat analysis was performed. Multivariable linear regression analysis showed no significant effect of SCYS on individual or total HMO concentrations. However, 65% of women in the SCYS group, compared to 35% in the placebo group, perceived an increase in milk production (p < 0.05). No significant differences were found for other secondary outcomes. However, mothers in the SCYS group had a small but significant improvement in perception of their milk quantity and quality (p < 0.05). SCYS use was also associated with significantly lower formula use at 6 months postpartum (4% vs. 27%, p < 0.05). While SCYS does not impact HMO concentration, it may improve women's perceptions of milk supply. A larger randomised controlled trial is needed to assess its potential effects on actual milk production and composition and address issues of perceived insufficient milk. Trial Registration: This trial was registered at the Australian New Zealand Clinical Trials Registry (trial registration number: ACTRN12619000704190).
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    Saccharomyces cerevisiae Yeast-Based Supplementation as a Galactagogue in Breastfeeding Women? A Review of Evidence from Animal and Human Studies
    (MDPI (Basel, Switzerland), 2021-03) Jia LL; Brough L; Weber JL; Demmelmair H
    Perceived insufficient milk production (PIM) adversely affects breastfeeding duration. Women sometimes use galactagogues with the intent to increase breast milk production and support lactation. Saccharomyces cerevisiae yeast-based supplement (SCYS) is an inactive form of Saccharomyces cerevisiae yeast (SCY) either obtained from the fermentation process or grown on molasses. Anecdotal evidence suggests SCYS is a galactagogue. SCYS is promoted on the internet as a galactagogue in various forms and doses. Dietary supplementation with SCYS during gestation and lactation significantly increases milk yield in ruminants. No human study has evaluated efficacy of SCYS as a galactagogue. SCYS is rich in B vitamins, beta-glucan, mannan oligosaccharides and bioavailable chromium; these may impact breast milk production or composition, thus may alleviate PIM. The safety of taking SCYS during lactation is not well studied. Studies have reported contamination of SCYS with ochratoxin A (OTA) as well as minor side effects from SCYS. Studies are needed to evaluate the efficacy of SCYS on breast milk production and composition and to assess the safety of taking SCYS during lactation in humans.
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    Supplement Use during Pregnancy in Aotearoa, New Zealand
    (MDPI (Basel, Switzerland), 2023-03-06) Funnell C; Coad J; Brough L; Smith C; Mackay S; Jalili-Moghaddam S; Gibbs M
    Iodine is an essential micronutrient required for thyroid function, and is essential during pregnancy for growth and development. Manatū Hauora (MoH) recommends an iodine supplement of 150 µg/day during pregnancy and breastfeeding. To reduce the risk of brain and spinal cord birth defects, the MoH also recommends a folic acid (FA) supplement of 800 µg/day preconception (four weeks) and during the first trimester of pregnancy. A self-administered Qualtrics XM survey was designed for pregnant women between 20–23 weeks of gestation and advertised on Facebook between March 2021–June 2021 throughout Aotearoa. The aim of the survey was to ascertain supplement usage during pregnancy, with a particular focus on iodine and FA. In total, one hundred and sixty pregnant women completed the online survey. A total of 50% were of New Zealand/European ethnicity, 11% were Māori, and 3.2% of a Pacific Island ethnicity. Furthermore, 43% were educated to university level, and 80% were in either voluntary and/or paid employment. In addition, 66% consumed iodine-only supplements (Neurotab; 150 µg/day), 44% consumed FA-only supplements (800 µg/day), and 34% consumed multiple-micronutrient (MN) supplements containing iodine and FA, predominately Elevit or Blackmore pregnancy supplements. Concerningly, 11% of participants took no supplements, and only 45% of the FA supplement users reported taking the FA prior to conception. Furthermore, 13% took both folic and an MN supplement, putting them at risk of an intake over the upper level of intake (1000 mg/day). Additionally, 18% of the participants consumed both an iodine-only and an MN supplement. Only 37% of those using an iodine supplement planned to stop taking it when breastfeeding ceased, suggesting that many were not aware of the recommendation for continuation of use. Despite the high educational status, many did not adhere to the supplement use recommendations. Public health strategies are required to ensure that women of childbearing age are aware of these recommendations for supplement use pre-, during, and post-pregnancy.
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    The Relationship between Nutrient Patterns and Bone Mineral Density in Postmenopausal Women
    (MDPI (Basel, Switzerland), 3/06/2019) Ilesanmi-Oyelere BL; Brough L; Coad J; Roy N; Kruger MC
    In women, the menopausal transition is characterized by acid-base imbalance, estrogen deficiency and rapid bone loss. Research into nutritional factors that influence bone health is therefore necessary. In this study, the relationship between nutrient patterns and nutrients important for bone health with bone mineral density (BMD) was explored. In this cross-sectional analysis, 101 participants aged between 54 and 81 years were eligible. Body composition and BMD analyses were performed using dual-energy X-ray absorptiometry (DXA). Nutrient data were extracted from a 3-day diet diary (3-DDD) using Foodworks 9 and metabolic equivalent (MET-minutes) was calculated from a self-reported New Zealand physical activity questionnaire (NZPAQ). Significant positive correlations were found between intakes of calcium (p = 0.003, r = 0.294), protein (p = 0.013, r = 0.246), riboflavin (p = 0.020, r = 0.232), niacin equivalent (p = 0.010, r = 0.256) and spine BMD. A nutrient pattern high in riboflavin, phosphorus and calcium was significantly positively correlated with spine (p < 0.05, r = 0.197) and femoral neck BMD (p < 0.05, r = 0.213), while the nutrient pattern high in vitamin E, α-tocopherol, β-carotene and omega 6 fatty acids was negatively correlated with hip (p < 0.05, r = -0.215) and trochanter BMD (p < 0.05, r = -0.251). These findings support the hypothesis that a nutrient pattern high in the intake of vitamin E, α-tocopherol and omega 6 fatty acids appears to be detrimental for bone health in postmenopausal women.