Karma Pearce

Increased miscarriage of euploid pregnancies in obese women undergoing cryopreserved embryo transfer

Obesity is known to be associated with an increased risk of miscarriage after natural and assisted conception. Although most sporadic miscarriages are caused by genetic abnormalities, it is presently uncertain if genetics is also the underlying mechanism leading to increased pregnancy loss seen in obese women. Karyotyping of the products of conception suggests a reduced rate of fetal aneuploidy in miscarriages from obese compared with lean individuals. Karyotype analysis, however, is prone to false negative results because of inadvertent culture of maternal rather than fetal tissue. Therefore, to better analyse the effect of the genetic status on obesity-related miscarriage, we retrospectively analysed the outcomes 125 consecutive cryopreserved embryo transfer cycles resulting in a pregnancy after screening for genetic normality using comparative genomic hydridization. Lean individuals (body mass index 18.5-24.9 kg/m2) had a significantly lower rate of miscarriages (14.2%) than overweight (29.1%) or obese (41.9%) women (P = 0.001); this relationship remained significant (P = 0.023) even after adjusting for relevant confounders, e.g. maternal age, cause of infertility, number of previous IVF cycles, type of frozen embryo transfer cycle or past obstetric history. These results support a non-genetic cause for obesity-related miscarriage.

A 4-week nutrition and therapeutics course in an undergraduate pharmacy program.

Objective. To determine the effectiveness of an intensive 4-week nutrition course in increasing the knowledge of undergraduate pharmacy students. Design. A Nutrition and Therapeutics elective course was developed that covered the Australian Guide to Healthy Eating, as well as nutrition labeling, food composition, functional foods, diabetes, cardiovascular disease, nutrition and cancer, osteoporosis, nutrient-drug interactions, nutritional supplements, weight management, and infant feeding. The course was taught using lectures, student-focused tutorials featuring evidence-based practice, problem-based learning exercises, case-based scenarios, media examples, video clips from the lay press, and articles from the professional/scientific literature. Assessment. A self-administered, validated questionnaire on dietary recommendations, sources of nutrients, choosing everyday foods, and diet-disease relationship was administered prior to and after completion of the course. Students’ scores in all 4 areas improved significantly; however, their knowledge of the national dietary recommendations, sources of nutrients, and everyday foods high in nutrients was below that of members of the community. Conclusions. Nutritional education courses can increase the nutrition knowledge of undergraduate pharmacy students. The need for pharmacists to advise patients regarding nutritional supplements continues to increase the need for incorporating nutrition courses within curriculum.

Continuous Glucose Monitoring and Cognitive Performance in Type 2 Diabetes

BACKGROUND Type 2 diabetes is associated with reductions in cognitive function that are associated with glycated hemoglobin (HbA1c) levels, but there is no information on whether cognition is related to postmeal glucose spikes. We explored the relationship of cognition to glucose levels measured by a continuous glucose monitoring system (CGMS) both before and after a weight loss diet. SUBJECTS AND METHODS Forty-four white subjects with type 2 diabetes (59.0 ± 6.2 years old; body mass index, 32.8 ± 4.2 kg/m(2); HbA1c, 6.9 ± 1.0%) completed an 8-week energy-restricted (approximately 6-7 MJ, 30% deficit) diet. Cognitive functioning (short-term memory, working memory, speed of processing [inspection time], psychomotor speed, and executive function) was assessed during four practice sessions, baseline, and Week 8. Parallel glucose levels were attained using the CGMS in 27 subjects. Outcomes were assessed by fasting blood glucose (FBG), postprandial peak glucose (G(max)), time spent >12 mmol/L (T > 12), and 24-h area under the glucose curve (AUC(24)). RESULTS Despite a fall in FBG of 0.65 mmol/L after 8 weeks, digits backward results correlated with FBG at both Week 0 and Week 8 (r = -0.43, P < 0.01 and r = -0.32, P < 0.01, respectively). Digits forward results correlated with FBG (r = -0.39, P < 0.01), G(max) (r = -0.46, P < 0.05), and AUC(24) (r = -0.50, P < 0.01) at Week 0 and FBG (r = -0.59, P < 0.001), G(max) (r = 0.37, P = 0.01), AUC(24) (r = -0.41, P < 0.01), and percentage weight loss (r = 0.31, P < 0.01) at Week 8. Cognitive function was not altered by weight loss, gender, baseline lipid levels, or premorbid intelligence levels (National Adult Reading Test). CONCLUSIONS FBG, G(max,) and AUC(24) were related to cognitive function and an energy-restricted diet for 8 weeks did not alter this relationship.

Metabolic endotoxaemia--a potential novel link between ovarian inflammation and impaired progesterone production.

Abstract Introduction: Medical conditions such as obesity and inflammatory bowel disease are associated with impaired luteal function, menstrual disturbance and infertility. It is proposed that the disturbance in gut wall integrity (“leaky gut”) seen in these conditions may result in the passage of bacterial endotoxin (LPS) from the colonic lumen into the circulation that may initiate inflammation in the ovary and subsequently impair hormone production. Methods: Quantify the association between systemic levels of LBP, a marker of endotoxin exposure, and levels of inflammation in the ovary (follicular fluid IL-6), plus steroid hormone production in 45 women undergoing IVF treatment. Results: Endotoxaemia (LBP) were positively correlated with plasma CRP and inflammation within the ovary (follicular fluid IL-6). Furthermore, endotoxaemia was negatively correlated with progesterone production. Conclusion: The observed correlations, together with previously published animal studies linking endotoxin exposure to impaired luteal function, suggest that the translocation of bacterial endotoxin from the gut lumen into the circulation has the potential to interfere with progesterone production and result in luteal deficiency.

Toward a model of sparkling wine purchasing preferences

Purpose This paper aims to provide further insight into factors influencing Australian consumers’ purchasing preferences for sparkling wine, including champagne. Design/methodology/approach Focus groups were conducted and thematic analysis was undertaken to identify factors influencing sparkling wine consumers’ purchasing preferences. Findings Personal taste was found to influence choice of a sparkling wine rather than another type of beverage, and selection of a particular style and brand of sparkling wine. Country or region of origin was found to be important, often linked to the product being champagne. Brand image, reputation and symbolism were found to influence purchase decisions (sometimes linked to consumption occasion), especially for purchases of gifts. Advice, recommendations and expert reviews, and consumption occasion also were found to influence purchase decisions. Price was found to influence style and brand of sparkling wine purchased. A high price was found to be a barrier for some participants, while other participants were found to avoid sparkling wines priced below some particular level. Thematic analysis enabled development of a preliminary model of purchasing preferences. Research limitations/implications Being exploratory in nature, findings cannot be generalised. Further studies are required to confirm the preliminary model and to evaluate the validity and significance of proposed relationships. Practical implications Findings suggest a producer could benefit from marketing a range of sparkling wines to cater to different tastes, occasions and gift purchases. Findings also confirm the importance of marketers pursuing opportunities to obtain and promote favourable expert reviews for their sparkling wines, and of identifying and promoting regional distinctiveness. Originality/value The first comprehensive model of sparkling wine consumers’ purchasing preferences has been developed. Empirical testing would enable refinement and enhance understanding.

Endotoxin initiated inflammation reduces testosterone production in men of reproductive age

Inflammation, both acute and chronic, is associated with testosterone deficiency, raising the possibility of a direct causal link. One potential trigger for inflammation in obese men is the passage of intestinal bacteria into the circulation due to a breakdown in mucosal barrier integrity. Recently, we hypothesized that this endotoxin exposure may cause androgen deficiency in obese men. To test this hypothesis, we analyzed the relationship between serum levels of lipopolysaccharide-binding protein (LBP), an indirect measure of endotoxin exposure, against male reproductive hormones, inflammatory markers (C-reactive protein, IL-1β, IL-6, TNF-α), and adiposity in 75 men. Adiposity was positively correlated with endotoxin exposure (LBP) and inflammation (C-reactive protein, IL-6) and negatively correlated with testosterone. Furthermore, endotoxemia (LBP) was negatively correlated with serum testosterone but positively correlated with IL-6. Multivariate analysis revealed a significant, negative correlation between serum IL-6 and free testosterone. In a second interventional study, low-dose endotoxin challenge in lean men produced a transient inflammatory response that was followed by a decline in serum testosterone, without changes in LH or FSH, providing further evidence that endotoxin-driven inflammation may result in impaired Leydig cell function.

Influence of nutrition on the decline of ovarian reserve and subsequent onset of natural menopause.

Abstract The early loss of ovarian reserve and subsequent menopause has a major impact on fertility potential and increases the risk of cardiovascular disease, osteoporosis, cognitive decline and mortality later in life. While many studies have reported that lifestyle factors such as diet can influence the age of onset of natural menopause, their results are often contradictory. Therefore, the aim of this study was to examine the influence of diet on the onset of natural menopause using a self-reported food frequency questionnaire in a cohort of 1146 pre-menopausal women followed up for an average of 12.5 years. The primary finding was that the age of natural menopause was positively correlated with dietary intake of the micronutrient β-cryptoxanthin (r2 = 0.105, p < 0.001) and fruit (r2 = 0.07, p = 0.01), with these relationships remaining significant even after adjustment for other known co-variants for onset of menopause (parity, BMI, physical activity level, education, smoking, energy and alcohol intake). Kaplan–Meier survival analysis confirmed that both β-cryptoxanthin and fruit intake was associated with a significant delay in the onset of natural menopause. While still acknowledging that further research is required, in the interim we would advocate that a diet containing ∼400 mcg of β-cryptoxanthin per day from fruits (mandarins, oranges and peaches) has significant potential to delay ovarian senescence by 1.3 years.

Evaluation of the use of the Endotoxin Activity Assay (EAA™) to Quantify Non-septic Exposure of Metabolic Endotoxemia

Objective: Endotoxin, also known as lipopolysaccharide (LPS), is a potent immune stimulant. Low levels of endotoxin exposure (metabolic endotoxemia) play a pivotal role in metabolic disorders. However, there is no robust clinical assay to directly quantify metabolic endotoxemia. We aimed to validate the whole blood Endotoxin Activity Assay (EAA™) as a novel, rapid method to quantify low grade metabolic endotoxemia against the well-established lipopolysaccharide binging protein assay (LBP), a robust surrogate marker of endotoxaemia. Methods: 67 women and 47 men aged 21 to 47 years (35.4 ± 5.5 years, 34.5 ± 7.2 years respectively) were assessed for adiposity (BMI, waist circumference and % body fat using bio-impedance), endotoxin levels (LBP, EAA™) and inflammatory status (serum CRP, IL-6, IL-8). Results: There was no direct relationship between EAA™ and LBP measures for quantitating metabolic endotoxemia for either women or men (R=0.146, p=0.284; R=0.283 p=0.09 respectively). In women, the traditional indirect marker of endotoxemia LBP correlated significantly with CRP and IL-6, measures of generalised immune activation and inflammation (R=0.664, p<0.001, R=0.296, p=0.028 respectively), but not with EAA™ assed endotoxemia. Supporting this relationship, LBP correlated with BMI and body fat percentage (R=0.306, p=0.022; R=0.301, p=0.024 respectively). However, the EAA™ only correlated with body fat percentage (R=0.382, p=0.014). In men, LBP was significantly related to CRP and IL-6 (R=0.345, p=0.046; R=0.421, p=0.009 respectively), but no relationship was observed between these inflammatory markers and EAA™ assed metabolic endotoxemia (R=0.206, p=0.243; R=0.280, p=0.093 respectively). There was no relationship between EAA™ or LBP and any of the three measures of adiposity. Conclusion: In conclusion, the existing rapid whole blood EAA™ method of analysis was not suitable to detect low levels of endotoxemia known to be present in the obese state, while the results suggest LBP indirect analysis remains the superior tool for measuring low grade endotoxemia in this population.

Disparity in the micronutrient content of diets high or low in advanced glycation end products (AGEs) does not explain changes in insulin sensitivity

Abstract We have previously shown that an isoenergetic low advanced glycation end products (AGEs) diet matched for macronutrient content improved insulin sensitivity compared to high AGE diet. Here, we evaluated the differences in micronutrient intake of these two dietary patterns and if they could explain differences in insulin sensitivity. Participants consumed the intervention diets each for 2 weeks with 4 weeks of habitual dietary intake (washout) in-between. Dietary analysis revealed that the high AGE diet contained greater levels of retinol equivalents (RE) (478.9 + 151.3 μg/day versus 329.0 + 170.0 μg/day; p < .006), vitamin A (806.3 + 223.5 (μg RE)/day versus 649.1 + 235.8 (μg RE)/day; p < .05) and thiamine (2.3 + 0.6 mg/day versus 1.6 + 0.4 mg/day; p = .014) compared to the low AGE diet. The changes in polyunsaturated fat, retinol, vitamin A and thiamine did not correlate with changes in insulin sensitivity (all p > .1) therefore are unlikely to explain observed changes in insulin sensitivity. (clinicaltrials.gov:NCT00422253).