Jolana Rambousková

Health Behaviors, Nutritional Status, and Anthropometric Parameters of Roma and Non-Roma Mothers and Their Infants in the Czech Republic

OBJECTIVE To compare maternal health behaviors, maternal nutritional status, and infant size at birth of Romas and non-Romas in the Czech Republic. DESIGN Maternal interviews and food frequency questionnaire, maternal blood samples, physical measurements of mothers and infants. SETTING Hospital, maternal/child care center; 2-4 days postpartum. PARTICIPANTS 76 Roma mothers and 151 mothers from the majority population. MAIN OUTCOME MEASURES Infant length/weight; maternal height/weight; weight gain during pregnancy; duration of pregnancy; maternal smoking habits; dietary intake; use of food supplements during pregnancy; and maternal blood levels of folate, beta-carotene, retinol, and alpha-tocopherol. ANALYSIS Comparison of ethnic groups by 2-sample Wilcoxon test, chi-square, Fischers exact test, relative risk, and analysis of variance (ANOVA). RESULTS Pregnancy duration was about 1 week shorter in Roma women (P < .001), and their infants had lower birth weight (P < .001) and shorter length (P < .001). Prevalence of smoking was significantly higher among Roma mothers (P < .001). Roma women used food supplements less frequently than non-Roma women (P < .001) and had significantly lower mean blood concentrations of folate (P < .001), beta-carotene (P < .001), retinol (P < .02), and alpha-tocopherol (P < .02). CONCLUSIONS AND IMPLICATIONS The nutritional status of Roma mothers is worse than that of mothers from the majority Czech population. The dietary and smoking habits of pregnant Roma women should be of special concern to family doctors, obstetricians, nutrition educators, and social workers.

Trace elements in the blood of institutionalized elderly in the Czech Republic

Whole blood selenium, copper, zinc and manganese concentrations of 197 institutionalized senior citizens (46 males, 151 females) aged 61-100 years (mean age 83.6 years) were determined using atomic absorption spectrometry and inductively coupled plasma mass spectrometry from two localities in the Czech Republic (Prague and Teplice) from 2009 through 2011. Geometric means (GM) of whole blood selenium (B-Se), copper (B-Cu), zinc (B-Zn) and manganese (B-Mn) levels were 74.0 μg/l, 941.0 μg/l, 5898.0 μg/l and 10.9 μg/l, respectively. Gender-related differences were found with significantly higher B-Cu levels in women and significantly higher B-Zn levels in men. The percentage of seniors with B-Se levels lower than 56 μg/l (which is equivalent to the critical value of 45 μg/l of Se in serum (S-Se)) was 8.6%. A negative correlation between age and B-Se levels was found. B-Zn positively correlated with serum albumin and prealbumin whereas a negative correlation between age and B-Zn was observed. Seniors with diabetes mellitus and atherosclerosis had higher B-Cu and B-Mn levels, respectively, than those without these diagnoses. The elderly from Prague had significantly higher B-Mn concentrations than those from Teplice. We found no evidence of serious essential elements deficiencies or excesses in the seniors who participated in this study.

Blood levels of lead, cadmium, and mercury in the elderly living in institutionalized care in the Czech Republic

BACKGROUND There is limited research examining the chemical load of toxic metals in the elderly. The aim of the present study was two-fold: to determine the body burden of lead, cadmium and mercury in association with age, gender, locality, lifestyle factors and potential health impacts among this population and to compare the values with blood values from the general Czech population aged 18-64 years. METHODS Lead, cadmium and mercury were examined in the blood of institutionalized senior citizens (46 males, 151 females aged 61-100 years) from two localities in the Czech Republic (Prague and Teplice) from 2009 through 2011. Measurements were made using inductively coupled plasma mass spectrometry (Pb, Cd) and a single purpose spectrometer AMA 254 (Hg). RESULTS Geometric means (GM) of whole blood lead (B-Pb), cadmium (B-Cd) and mercury (B-Hg) levels were 25.3μg/l, 0.55μg/l and 0.21μg/l, respectively. No age-related differences were found for B-Pb and B-Cd levels but a negative correlation with age was observed for B-Hg levels (p=0.04). B-Pb levels in men were significantly higher than in women (GM 29.9μg/l vs. 24.1μg/l). B-Cd was significantly higher in women (GM 0.57μg/l) than in men (0.50μg/l) (p=0.007) and in smokers (GM 1.29μg/l) than in nonsmokers (GM 0.53μg/l) (p=<0.001) and in seniors from Prague (GM 0.60μg/l) compared to those from Teplice (GM 0.43μg/l) (p=<0.001). Seniors with a history of chronic kidney disease, stroke and those using psycho-pharmaceuticals had higher B-Pb levels (p=0.008, 0.04 and 0.05, resp.), seniors diagnosed with atherosclerosis had higher B-Cd levels (p=0.002) and seniors using psycho-pharmaceuticals had higher B-Hg levels (p=0.07). B-Hg levels were also positively correlated with blood albumin levels (p=0.015). CONCLUSIONS This study provides data on levels of heavy metals in a group of elderly people. Such information is very scarce. Associations with diseases should be the subject of further investigation.

Nutritional Status Assessment of Institutionalized Elderly in Prague, Czech Republic

Background: There are few studies in the Czech Republic describing and evaluating the nutritional status of institutionalized elderly. Methods: Data were collected from 659 women and 156 men aged 65 years and older and living in retirement homes in and around Prague. Data included: a Mini-Nutritional Assessment (MNA questionnaire), anthropometric measurements and biochemical evaluations. Results: According to the MNA questionnaire, 10.2% of these elderly individuals were malnourished and 39.4% were at risk of malnutrition. More women than men were malnourished (OR = 0.59 and 95% CI 0.42-0.86). Mean BMI values were 25.5 for females and 27.5 for males. MNA was positively correlated mostly with immobility (r = 0.63; p < 0.001), BMI (r = 0.57; p < 0.001) and mid-arm circumference (r = 0.56; p < 0.001). Serum albumin levels were <28 g/l in 1.3% (1.3% of the women and 1.36% of the men) and between 29.0 - 34.0 g/l in 21% (22.5% of the women and 14.4% of the men). Statistically significant differences between groups according to MNA scores were found for albumin, prealbumin, transferrin and creatinine. Prevalence of smoking was significantly higher among males. Conclusion: The study results confirmed that institutionalized elderly, especially women, should be considered a nutritionally vulnerable population group that needs attention.

Trans fatty acids in subcutaneous fat of pregnant women and in human milk in the Czech Republic.

Abstract: Using capillary gas chromatography, we determined total content of trans fatty acids (TFA) and C18:1 trans fatty acids in human milk and subcutaneous fat in 35 healthy Prague women. The average content of TFA in human milk fat was 4.22% (SD = 1.87%) of all fatty acids, and the value of trans C18:1 isomers was 3.63% (SD = 1.81%). The average concentration of total trans fatty acids in subcutaneous fat was 4.41% (SD = 0.79%) and the average content of C18:1 trans isomers was 2.81% (SD = 0.61%).

Iodine saturation of Roma neonates in prague is not at an optimum level.

Aim: The purpose of our study was to determine urinary iodine as an indicator of iodine supplementation in Roma (Gypsy) neonates compared to majority population neonates. Methods: The groups studied were formed by 30 full-term Roma neonates and 151 majority population neonates. Iodine was determined from samples of urine collected on the 4th day after delivery, after alkaline ashing, using the Sandell-Kolthoff method. Results: The median of urinary iodine in Roma neonates was 92.15 µg/l urine and in neonates from majority population mothers it was 109.20 µg/l urine. The mean of urinary iodine in Roma neonates was 114.55 µg/l urine (SD 71.68 µg/l) and in neonates from majority population mothers it was 141.86 µg/l urine (SD 87.42 µg/l). The difference was not statistically significant. Majority population mothers more frequently consumed nutrition supplements containing iodine as well as fish. Conclusions: Compared to older data, supplementation of neonates with iodine is higher. However, it does not reach optimum levels. The urinary iodine median in Roma neonates lies in the mild iodine deficiency band.

Higher Content of C18:1 Trans Fatty Acids in Early Human Milk Fat of Roma Breast-Feeding Women

Aim: The purpose of our study was to determine the content of trans fatty acids in early human breast milk as an indicator of dietary exposure in a sample of Roma breast-feeding women and in a sample of women from the general Czech population. Methods: We collected samples of early human milk from 43 Prague women from the general population and 21 Roma women. After lipid extraction, the fatty acids were converted into methyl esters (FAMEs). Finally, gas chromatography with flame ionization detector (GC-FID) analysis on a CP-Sil 88 column was used to determine C18:1 trans monoenic fatty acid levels and total trans isomers fatty acid levels in human milk. Results: A significantly higher content of C18:1 trans fatty acid isomers was detected in human milk fat from Roma mothers than in women of the general population (2.73 vs. 2.09%, p < 0.05). Both groups monitored did not differ in the representation of total fatty acid trans isomers. Differences in the frequency of consumption of certain TFA sources (butter, fried crisps) were established. Conclusions: The study proved a higher fatty acid trans isomers content in Roma breast-feeding mothers in the Czech Republic, and this is probably related to their bad eating habits.

Prevalence of malnutrition risk among institutionalized elderly from North Bohemia is higher than among those in the Capital City of Prague, Czech Republic

OBJECTIVE The aim of the study is to assess the risk of malnutrition among institutionalized elderly individuals in North Bohemia and compare it to the risk of malnutrition in the capital city of Prague, Czech Republic. In the Czech Republic, very few studies have been conducted with the goal of describing and evaluating the nutritional status of the institutionalized elderly. METHODS In this study, data was collected from 254 elderly individuals (aged ≥ 65) residing in retirement homes in North Bohemia and then compared with similar data for the elderly living in retirement homes in Prague (the data from Prague were previously published in 2013). The data included an Mini-Nutritional Assessment (MNA) test; anthropometric measurements - Body Mass Index (BMI), waist circumference, triceps skinfold thickness; and biochemical parameters - albumin, prealbumin, transferrin, urea, and creatinine. RESULTS Mean BMI values were 27.4 kg/m2 for females and 26.3 kg/m2 for males. According to the MNA questionnaire, 10.4% of all tested elderly were malnourished and 50.8% were at risk of malnutrition; lager proportion of females were found to be malnourished than males. Biochemical indicators supported the MNA results. MNA categories correlated positively with independence (r = 0.56; p < 0.001), mental status (r = 0.54; p < 0.001), mobility (r = 0.46; p < 0.001), calf circumference (r = 0.42; p < 0.001), BMI, and the ability to self-feed (both r = 0.37; p < 0.001). The percentage of institutionalized elderly with malnutrition living in North Bohemia and Prague were about the same; however, the percentage of those at risk of malnutrition was higher in North Bohemia (p = 0.006). CONCLUSION Study results confirmed that the institutionalized elderly face issues that lower their nutritional status and put them at increased risk; clearly these issues need urgent attention.