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Background: Dietary supplement use among recreational athletes is common, with the intention of reducing inflammation and improving recovery. We aimed to describe the relationship between omega-3 fatty acid supplement use and inflammation induced by strenuous exercise., Methods: C-reactive protein (CRP) concentrations were measured in 1002 healthy recreational athletes before and 24 h after a 91-km bicycle race. The use of omega-3 fatty acid supplements was reported in 856 out of 1002 recreational athletes, and the association between supplement use and the exercise-induced CRP response was assessed., Results: Two hundred seventy-four subjects reported regular use of omega-3 fatty acid supplements. One hundred seventy-three of these used cod liver oil (CLO). Regular users of omega-3 fatty acid supplements had significantly lower basal and exercise-induced CRP levels as compared to non-users (n = 348, p < 0.001). Compared to non-users, regular users had a 27% (95% confidence interval (CI): 14-40) reduction in Ln CRP response (unadjusted model, p < 0.001) and 16% (95% CI: 5-28, p = 0.006) reduction after adjusting for age, sex, race duration, body mass index, delta creatine kinase, MET hours per week, resting heart rate and higher education. CLO was the primary driver of this response with a 34% (95% CI: 19-49) reduction (unadjusted model, p < 0.001) compared to non-users. Corresponding numbers in the adjusted model were 24% (95% CI: 11-38, p < 0.001)., Conclusion: Basal CRP levels were reduced, and the exercise-induced CRP response was attenuated in healthy recreational cyclists who used omega-3 fatty acid supplements regularly. This effect was only present in regular users of CLO., Trial Registration: NCT02166216 , registered June 18, 2014 - Retrospectively registered.

Background: The role of dietary fish and n-3 polyunsaturated fatty acids (n-PUFAs) in the primary prevention of allergic diseases remains uncertain. The aim of this study was to investigate associations between the consumption of fish and cod liver oil (rich in n-PUFAs) from pregnancy to the first two years of life, and parental reported allergic diseases at six years of age., Methods: We used data from the Prevention of Allergy among Children in Trondheim study and included mother-infant pairs who had submitted questionnaires detailing both maternal or infant diet and allergic disease at six years of age., Results: Eating fish at least once a week at one year of age was associated with a 28-34% reduction in the odds of current eczema, asthma, and wheeze at six years of age. Cod liver oil consumption at least four times per week at one year of age tended to be associated with a lower risk of allergy-related outcomes at six years. We found no consistent associations between allergy-related outcomes and fish or cod liver oil consumption by mothers., Conclusion: The preventive effect of fish consumption is best achieved by increasing dietary fish in the first year of life., Competing Interests: The authors declare no conflict of interest.

Objectives: Emulsified formulations of omega-3 fatty acids may increase plasma concentrations of docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) compared with non-emulsified formulations. The current study evaluated plasma concentrations of DHA + EPA as well as DHA and EPA individually following administration of emulsified vs non-emulsified cod liver oil formulations., Methods: In this randomized, 2-period, crossover study (ClinicalTrials.gov NCT02428699), 47 healthy adults received single doses of an emulsified cod liver oil formulation and a non-emulsified cod liver oil formulation, each containing 10% cod liver oil plus 10% cod oil and closely matched DHA and EPA content. Blood samples were collected for 24 h after dosing to analyze DHA and EPA plasma concentrations using a validated methodology. DHA + EPA, DHA, and EPA pharmacokinetics were compared using an analysis of covariance model. The incremental area under the plasma concentration curve at 24 h (iAUC 0-24 h ) for DHA + EPA was the primary endpoint., Results: DHA + EPA, DHA, and EPA plasma concentrations reached higher levels in plasma following administration of the emulsified vs non-emulsified formulation. The emulsified cod liver oil formulation produced iAUC 0-24 h values for DHA + EPA, DHA, and EPA that were 1.66, 1.78, and 1.64 times higher, respectively, than the non-emulsified formulation; iAUC 0-10 h values were 1.84, 1.96, and 1.79 times higher, respectively (all p < 0.01). Maximum concentrations of DHA + EPA, DHA, and EPA in plasma were significantly higher for the emulsified than the non-emulsified formulation (p < 0.001)., Conclusions: DHA + EPA, DHA, and EPA plasma concentrations were significantly higher for the emulsified cod liver oil supplement vs the reference non-emulsified cod liver oil supplement.

Cod liver oil is a traditional source of vitamin D in Iceland, and regular intake is recommended partly for the sake of bone health. However, the association between lifelong consumption of cod liver oil and bone mineral density (BMD) in old age is unclear. The present study attempted to assess the associations between intake of cod liver oil in adolescence, midlife, and old age, and hip BMD in old age, as well as associations between cod liver oil intake in old age and serum 25-hydroxyvitamin D (25(OH)D) concentration. Participants of the Age, Gene/Environment Susceptibility-Reykjavik Study (age 66-96 years; n 4798), reported retrospectively cod liver oil intake during adolescence and midlife, as well as the one now in old age, using a validated FFQ. BMD of femoral neck and trochanteric region was measured by volumetric quantitative computed tomography, and serum 25(OH)D concentration was measured by means of a direct, competitive chemiluminescence immunoassay. Associations were assessed using linear regression models. No significant association was seen between retrospective cod liver oil intake and hip BMD in old age. Current intake of aged men was also not associated with hip BMD, while aged women with daily intakes had z-scores on average 0.1 higher, compared with those with an intake of < once/week. Although significant, this difference is small, and its clinical relevance is questionable. Intake of aged participants was positively associated with serum 25(OH)D: individuals with intakes of < once/week, one to six time(s)/week and daily intake had concentrations of approximately 40, 50 and 60 nmol/l respectively (P for trend < 0.001).

Background: The research aimed to assess the nutritional value of raw pork meat obtained from pigs on the feed containing different types of used fat., Methods: Meat was obtained from pigs fed in 4 experimental groups, from which groups A and B were given the mixture of rapeseed oil and linseed oil in the ratio of 1:2.5 or 2.3:1:0.2 (lard) as the source of fat. In group C, animals were given the mixture of rapeseed oil (1 part), fish oil (cod-liver oil; 2 parts) and lard (0.5 part), whereas group D obtained the mixture of linseed oil in the same ratio as in group B (2.5 parts), but combined with cod-liver oil (1 part). Meat collected for the research was evaluated and underwent chemical analyses in order to determine its nutritional value. The contents of moisture, protein, fat and ash were determined according to the AOAC methods. The carbohydrate content in various samples was determined by subtracting the sum of moisture, protein, ash and fat content from 100. Energy value (EV) was calculated using Atwater factors. The fatty acids content were analysed in homogenized samples using Folch method. Methyl esters of fatty acids were separated by gas chromatography on GC Trace Ultra THERMO company equipped with a RT 2560 RESTEC capillary column (100 m × 0.25 mm × 0.2 μm) with helium as a carrier gas. Result. The modification of the source of fat in pigs feed did not influence the content of protein and total minerals (ash), whereas it significantly influenced the content of fat and moisture. It has been stated that the use of different fat type in pigs feed, contributed to receiving the meat with modified profile of fatty acids. Higher fatty acids of the n-3 was observed in groups B and D (treated with the mixture of oils with a predominance of linseed oil). The fat from the meat of these groups contain less of n-6 and n-9 fatty acid, which improved the quality indicator of the fat expressed as the ratio of n-6 / n-3. Meat obtained from animals of the groups contained significantly less MUFA, and comparable content UFA and SFA. The meat from all experimental groups the ratio of polyunsaturated fatty acids (PUFA), saturated fatty acids (SFA) remained at a similar level and was 0.5:0.6. Conclusions. The modification of the source of fat in pigs feed did not influence the content of protein and total minerals (ash), whereas it significantly influenced the content of fat and moisture. A different source of fat in pigs feed did not influence the content of fat, saturated fatty acids (SFA) and UFA (unsatur., Results: nd. The research aimed to assess the nutritional value of raw pork meat obtained from pigs on the feed containing different types of used fat. Material and methods. Meat was obtained from pigs fed in 4 experimental groups, from which groups A and B were given the mixture of rapeseed oil and linseed oil in the ratio of 1:2.5 or 2.3:1:0.2 (lard) as the source of fat. In group C, animals were given the mixture of rapeseed oil (1 part), fish oil (cod-liver oil; 2 parts) and lard (0.5 part), whereas group D obtained the mixture of linseed oil in the same ratio as in group B (2.5 parts), but combined with cod-liver oil (1 part). Meat collected for the research was evaluated and underwent chemical analyses in order to determine its nutritional value. The contents of moisture, protein, fat and ash were determined according to the AOAC methods. The carbohydrate content in various samples was determined by subtracting the sum of moisture, protein, ash and fat content from 100. Energy value (EV) was calculated using Atwater factors. The fatty acids content were analysed in homogenized samples using Folch method. Methyl esters of fatty acids were separated by gas chromatography on GC Trace Ultra THERMO company equipped with a RT 2560 RESTEC capillary column (100 m × 0.25 mm × 0.2 μm) with helium as a carrier gas. Result. The modification of the source of fat in pigs feed did not influence the content of protein and total minerals (ash), whereas it significantly influenced the content of fat and moisture. It has been stated that the use of different fat type in pigs feed, contributed to receiving the meat with modified profile of fatty acids. Higher fatty acids of the n-3 was observed in groups B and D (treated with the mixture of oils with a predominance of linseed oil). The fat from the meat of these groups contain less of n-6 and n-9 fatty acid, which improved the quality indicator of the fat expressed as the ratio of n-6 / n-3. Meat obtained from animals of the groups contained significantly less MUFA, and comparable content UFA and SFA. The meat from all experimental groups the ratio of polyunsaturated fatty acids (PUFA), saturated fatty acids (SFA) remained at a similar level and was 0.5:0.6., Conclusions: The modification of the source of fat in pigs feed did not influence the content of protein and total minerals (ash), whereas it significantly influenced the content of fat and moisture. A different source of fat in pigs feed did not influence the content of fat, saturated fatty acids (SFA) and UFA (unsaturated fatty acids) in fat, whereas it significantly influenced the participation of  particular fatty acids belonging to monounsaturated (MUFA) and n-3 and n-6 groups.

Supplement users (SU) make healthy lifestyle choices; on the other hand, SU report more medical conditions. We hypothesised that cod liver oil (CLO) consumers are similar to non-supplement users, since CLO use might originate from historical motives, i.e., rickets prevention, and not health consciousness. CLO consumers were studied in order to identify possible confounders, such as confounding by indication. The European Prospective Investigation into Cancer (EPIC) investigates causes of chronic disease. The participants were 25,639 men and women, aged 40-79 years, recruited from general practices in Norfolk, East-Anglia (UK). Participants completed questionnaires and a health examination between 1993 and 1998. Supplement use was measured using 7-day diet diaries. CLO was the most common supplement used, more prevalent among women and associated with not smoking, higher physical activity level and more favourable eating habits. SU had a higher occurrence of benign growths and bone-related diseases, but CLO was negatively associated with cardiovascular-related conditions. Although the results of SU characteristics in EPIC-Norfolk are comparable with studies worldwide, the CLO group is different from SU in general. Confounding by indication takes place and will need to be taken into account when analysing prospective associations of CLO use with fracture risk and cardiovascular diseases.

Previous studies showed comorbidity of some ocular, enteral, and affective symptoms comprising irritable eye syndrome. Aims of the present study were to learn more about the pathogenic mechanisms of this syndrome and to evaluate benefits of food supplements on these disorders. In in vitro assay, Lactobacillus acidophilus lysate inhibited interleukin (IL)-1β and tumor necrosis factor (TNF)-α generation of lipopolysaccharide (LPS)-stimulated macrophages in dose- and size-dependent manner. For a prospective, open-label phase I/II controlled clinical trial, 40 subjects affected by ocular dysesthesia and hyperesthesia and comorbid enteral and anxiety-depression symptoms were randomly assigned either into the treated group, which received a composition containing probiotic lysate, vitamins A, B, and D and omega 3 fatty acids, or into the control group, which received vitamins and omega 3 fatty acids. For reference, 20 age- and sex-matched healthy subjects were also selected. White blood count (WBC) and lymphocyte and monocyte counts, as well as IL-6 and TNF-α levels, were significantly above the reference levels in both treated and control groups. After 8 weeks, WBC and lymphocyte and monocyte counts, and cytokine levels significantly decreased, and ocular, enteral, and anxiety-depression symptoms significantly improved in the treated group as compared to the control group. This proof-of-concept study suggested that subclinical inflammation may be a common mechanism connecting ocular, enteral, and anxiety/depression symptoms, and supplements affecting dysbiosis may be a new approach to treating this syndrome., (Copyright © 2014. Published by Elsevier Inc.)

Background: The effects of fish consumption and n-3 fatty acids on type 2 diabetes mellitus (T2DM) have recently been debated., Objective: We explored the risk of T2DM in relation to consumption of lean fish, fatty fish, fish products and total fish as well as cod liver oil supplements in a representative sample of Norwegian women., Design: This was a prospective population based cohort study in 33740 women free of T2DM, stroke, angina or heart attack and with detailed information on important co-variates and dietary intake at baseline. Risk ratios and corresponding 95% CI were estimated using Poisson regression with log-person time as offset., Results: Lean fish consumption was inversely associated with T2DM compared to zero intake. Risk ratios and 95% CI for intake of 75 and 100 g lean fish per day were 0.71 (0.51, 0.98) and 0.67 (0.46, 0.98), respectively. There was no effect of intake of fatty fish, fish products, total fish or use of cod liver oil supplements on the risk of T2DM., Conclusion: Lean fish consumption of 75-100 g/d had a beneficial effect on T2DM. It remains unclear whether lean fish in itself has a protective effect on T2DM or that lean fish consumers have a protective life-style that we were not able to take into account in this study. Unfavorable effects of fatty fish consumption or use of cod liver oil supplements on T2DM were not observed.

Vitamin D deficiency occurs worldwide. Winter season and high Body Mass Index (BMI) are associated with low levels of serum 25-hydroxyvitamin D (25(OH)D). We estimated the prevalence of vitamin D deficiency in a Norwegian adult population and examined factors associated with vitamin D deficiency. A cohort of 25, 616 adults (19-55 years) who participated in both the second and third Nord-Trøndelag Health Study (HUNT 2 (1995-1997) and HUNT 3 (2006-2008)) was established in a previous study. A 10% random sample of the cohort population was recruited for serum 25(OH)D measurements (n=2584), which was used for the current cross-sectional study. Vitamin D deficiency was defined as serum 25(OH)D level <50 nmol/L. The overall prevalence of vitamin D deficiency was 40%, but varied by season (winter: 64%; summer: 20%). Winter season (adjusted prevalence ratio (PR): 3.16, 95% CI 2.42 to 4.12) and obesity (BMI ≥30.0 kg/m2) (PR: 1.74, 95% CI 1.45 to 2.10) were strongly associated with prevalent vitamin D deficiency. Current smoking also demonstrated an increased PR (1.41, 95% CI 1.21 to 1.65). Daily intake of cod liver oil (PR: 0.60, 95% CI 0.41 to 0.77), increased physical activity (PR: 0.80, 95% CI 0.68 to 0.95) and more frequent alcohol consumption (PR: 0.76, 95% CI 0.60 to 0.95) were associated with a reduced PR. The prevalence of vitamin D deficiency was high in Norwegian adults. Winter season, high BMI and current smoking were positively associated, and intake of cod liver oil, increased physical activity and more frequent alcohol consumption were inversely associated with vitamin D deficiency.

The immune benefits associated with the optimal intake of dietary fatty acids are widely known. The objective of the present investigation was to elucidate the role of omega-3 polyunsaturated fatty acids (n-3 PUFA) food source on acute pneumonia induced by Klebsiella pneumoniae. Three different n-3 PUFA preparations (cod liver oil, Maxigard, and flaxseed oil) were orally supplemented and infection was induced in different groups of experimental mice. Mice fed olive oil and normal saline served as oil and saline controls, respectively. After 2 weeks of fatty acid feeding, no effect on the establishment of infection was observed when acute pneumonia was induced in animals. On the other hand, 6 weeks of n-3 PUFA administration was found to improve resistance in mice, as reduced lung bacterial load coupled with significant improvement in pathology was seen in infected mice. Alveolar macrophages collected from all 3 groups of mice fed n-3 PUFA exhibited a significant decrease in the level of apoptosis following infection with K. pneumoniae and an enhanced in vitro phagocytic potential for the pathogen. Lower lung levels of nitric oxide, malondialdehyde, and lactate dehydrogenase were associated with a decrease in the severity of tissue damage. There was a significant increase in the lung levels of pro-inflammatory cytokines (tumor necrosis factor alpha (TNF-α) and interleukin-1 beta (IL-1β)). No significant change was observed in the levels of interleukin-10 (IL-10). This study highlights that dietary n-3 PUFA supplementation exerts an overall beneficial effect against acute experimental pneumonia. This mechanism is operative through upregulation of nonspecific and specific immune defenses of the host.

Acne treatment depends on whether patents have a mild, moderate, or severe type of acne. The aim of this study was to compare the using of Isotretinoin (Rokutan) with and without oral vitamin E in treating acne. This study was performed on 60 patients on 0.5 mg/kg/day isotretinoin treatment for 6 months. The first group received 800 IU day(-1) Vit E during treatment and the second group recieved 800 Iu day(-1) cod liver oil capsules. All patients were observed for the complications at 1th, 4th and 6th weeks during treatment. Cheilitis was the most common side effect among these patients (69%). Epistaxis was the second side effect in both groups (22%). Other side effects were xerosis, pruritus, epigastric pain and nail fragility. The frequency and the severity of complications were less common at 4th and 6th weeks of treatment. Isotretinoin is a useful and effective drug in treating severe and treatment-resistance acne lesions.

Vitamin D has been linked with many health outcomes. The aim of this longitudinal study, was to assess predictors of seasonal variation of 25-hydroxy-vitamin D (25(OH)D) (including use of supplements and holidays in sunny destinations) at a northerly latitude in the UK (57°N) in relation to bone health indicators. 365 healthy postmenopausal women (mean age 62.0 y (SD 1.4)) had 25(OH)D measurements by immunoassay, serum C-telopeptide (CTX), estimates of sunlight exposure (badges of polysulphone film), information regarding holidays in sunny destinations, and diet (from food diaries, including use of supplements such as cod liver oil (CLO)) at fixed 3-monthly intervals over 15 months (subject retention 88%) with an additional 25(OH)D assessment in spring 2008. Bone mineral density (BMD) at the lumbar spine (LS) and dual hip was measured in autumn 2006 and spring 2007 (Lunar I-DXA). Deficiency prevalence (25(OH)D<25 nmol/L) was reduced in women who went on holiday to sunny destinations 3 months prior to their visit, compared to women who did not go on holidays [5.4% vs. 24.6% in Spring (p<0.001) and 3.8% vs. 25.6% in Winter (p = 0.001), respectively]. Similarly deficiency was lower amongst those who took CLO supplements compared to women that did not consume these supplements [2.0% vs. 23.7% in Spring (p = 0.001) and 4.5% vs. 24.8% in winter (p = 0.005), respectively]. There was no seasonal variation in CTX; 25(OH)D predicted a small proportion (1.8% variation) of LS BMD in spring 2007 [unstandardized β (SE): 0.039 (0.016), p = 0.017]. Seasonal variation of 25(OH)D had little effect on BMD and no effect on CTX. It appears that small increments in vitamin D (e.g. those that can be achieved by cod liver oil supplements of 5 µg/day) are sufficient to ensure that 25(OH)D is above 25 nmol/L for most people throughout the year. Similarly, holidays in sunny destinations show benefit.

Background: Cod liver oil is an important source of vitamin D, but also contains other fat-soluble components such as vitamin A. Before 1999, the cod liver oil formula in Norway contained a high concentration of vitamin A (1000 µg per 5 ml). High vitamin A status is associated with increased risks of several chronic diseases., Objective: To investigate the association between cod liver oil intake and asthma development., Methods: In the Nord-Trøndelag Health Study, a total of 25 616 Norwegian adults aged 19-55 years were followed up from 1995-1997 to 2006-2008. Current analysis based on 17 528 subjects who were free of asthma and had complete information on cod liver oil intake at baseline. Cod liver oil intake was defined as daily intake ≥ 1 month during the year prior to baseline. Incident asthma was reported as new-onset asthma during the 11-year follow-up., Results: Of the 17 528 subjects, 18% (n=3076) consumed cod liver oil daily for ≥ 1 month over the past year. Cod liver oil intake was significantly associated with incident asthma with an OR of 1.62 (95% CI 1.32 to 1.98) after adjustment for age, sex, daily smoking, physical activity, education, socio-economic status, family history of asthma, and body mass index (BMI). The positive association was consistent across age (< 40/≥ 40 years), sex (men/women), family history of asthma (yes/no) and BMI subgroups (< 25/≥ 25 kg/m(2))., Conclusions: Intake of cod liver oil with high vitamin A content was significantly associated with increased incidence of adult-onset asthma.

Objective: Prevalence of hypertension, which is the most common risk factor for cardiovascular disease in elderly people, increases with age. The aim of the study was to investigate the association between diet and blood pressure in elderly Icelanders, with focus on cod liver oil, and to compare their diet to dietary guidelines., Material and Methods: Diet was assessed using three-day weighed food records and blood pressure was measured after a 12-hour-fast in 236, 65-91 years old, Icelanders living in the capital area of Iceland. 99 men (42%) and 137 women (58%) participated in the study., Results: According to Nordic nutrition recommendations, intake of nutrients was above lower intake levels among the majority of participants. However, 19% were under this level for vitamin-D, 13% for iodine, 17% of men for vitamin-B6, and 26% and 12% of men and women, respectively, for iron. Systolic blood pressure was inversely associated with cod liver oil intake, even when adjusted for age, body mass index, gender, and antihypertensive medications (P=0.01). Intake of long-chain omega-3 fatty acids correlated with blood pressure in a similar way. Other dietary factors were not associated with blood pressure., Conclusion: The results indicate that intake of cod liver oil is associated with lower blood pressure among elderly people and may therefore have beneficial effects on health. A notable proportion of participants was at risk of vitamin D, vitamin B6, iodine, and iron deficiency.

The aim of the present study was to examine the effect of a single high-fat meal with different fat quality on circulating inflammatory markers and gene expression in peripheral blood mononuclear cells (PBMC) to elucidate the role of fat quality on postprandial inflammation. A postprandial study with fourteen healthy females consuming three test meals with different fat quality was performed. Test days were separated by 2 weeks. Fasting and postprandial blood samples at 3 and 6 h after intake were analysed. The test meal consisted of three cakes enriched with coconut fat (43 % energy as saturated fat and 1 % energy as α-linolenic acid (ALA)), linseed oil (14 % energy as ALA and 30 % energy as saturated fat) and cod liver oil (5 % energy as EPA and DHA and 5 % energy as ALA in addition to 31 % energy as saturated fat). In addition, ex vivo PBMC experiments were performed in eight healthy subjects investigating the effects of EPA and ALA on release and gene expression of inflammatory markers. The IL-8 mRNA level was significantly increased after intake of the cod liver oil cake at 6 h compared with fasting level, which was significantly different from the effect observed after the intake of linseed cake. In contrast, no effect was seen on circulating level of IL-8. In addition, ALA and EPA were shown to elicit different effects on the release and mRNA expression levels of inflammatory markers in PBMC cultured ex vivo, with EPA having the most prominent pro-inflammatory potential.

The relationships between vitamin D concentrations, hyperglycemia, and insulin resistance remain uncertain. During 2008 - 2010, an oral glucose tolerance test was performed in 3520 subjects from Tromsø, Norway. Serum 25-hydroxyvitamin D [25(OH)D] was measured in 1193 subjects with normal glucose tolerance, in 304 with isolated impaired fasting glucose, in 254 with isolated impaired glucose tolerance, in 139 with a combination of the two, and in 194 subjects with type 2 diabetes. Serum 25(OH)D did not differ between subjects with isolated impaired fasting glucose or impaired glucose tolerance, but was lower in all groups of deranged glucose metabolism as compared with normal subjects. These differences could not be explained by differences in intakes of vitamin D from cod liver oil or other supplements and remained statistically significant after adjustment for gender, age, body mass index, physical activity score, and month of examination. When the cohort was divided according to serum 25(OH)D quartiles, there was an improvement in all measures of glucose metabolism (fasting and 2-hour plasma glucose, serum insulin, HbA(1c)) and estimates of insulin resistance (QUICKI , HOMA-IR, ISI(0.120)) with increasing serum 25(OH)D quartile. However, interventional studies are needed to prove a causal relationship between vitamin D and glucose metabolism.

Vitamin D is necessary for normal bone growth. Deficiency of vitamin D can lead to rickets in children and osteomalacia in adults. It is difficult to reach the recommended daily dose of vitamin D in children without cod liver oil or other vitamin D supplementation. Several cases of rickets have been diagnosed in Iceland the past few years. Studies suggest a worldwide increase in the prevalence of the disorder. We report on a girl who was diagnosed with rickets at the age of 27 months. She received inadequate amounts of vitamin D supplementation in the form of AD drops and cod liver oil. Because of food allergy she was on a restricted diet which limited her intake of dietary vitamin D. After diagnosis, she received a high-dose vitamin D therapy (Stoss therapy) which corrected the deficiency. Key words: rickets, food allergy, vitamin D.

Objective: Supplements are an important source of micronutrient intake, which, unless taken into account, can misclassify individuals with regard to levels of nutrient exposure. A label-based vitamin and mineral supplements (ViMiS) database was developed to contain manufacturers' information and to enter supplement use by participants in the European Prospective Investigation into Cancer and Nutrition in Norfolk (EPIC-Norfolk). The ViMiS database contains information on all ingredients, broken down into nutrient information in order to be combined with nutrient intake derived from food consumption., Design: Development of the ViMiS database and cross-sectional analysis of supplement use in a population-based study., Setting: Men and women aged 40-79 years from the general population participating in the EPIC-Norfolk study between 1993 and 1997, with data available from 7 d diet diaries (7dDD)., Subjects: A subset of 19 330 participants with available 7dDD and known supplement status., Results: To date, the ViMiS database includes 2066 supplements, which altogether contain 16 586 ingredients, with a median of eleven nutrient/ingredients per supplement. Forty per cent of the cohort took a supplement, of which cod liver oil was the most common (24·5 %)., Conclusions: The ViMiS database provides a flexible tool for estimating total nutrient intake. The high prevalence of supplement use in the general population indicates that supplement use needs to be taken into account when examining the relationship of intake of particular nutrients to health outcomes.

Vitamin D deficiency is pandemic in industrialized countries due to life-style changes. Recent studies suggest that besides bone-metabolism, vitamin D plays a central role in basic cell function like multiplication, differentiation and metabolism. This may explain that low vitamin D levels represent a risk factor for several apparently different diseases such as infective, autoimmune, neurodegenerative and cardiovascular diseases, as well as diabetes, osteoporosis and cancer. Accumulating evidences suggest that an adequate intake of vitamin D may significantly decrease prevalence and clinical outcome of these diseases. Estimated reduction of the economic burden might reach about 10 percent through normalizing vitamin D levels for these diseases. However, high doses of vitamin D monotherapy needs precaution for potential adverse effects and it should be substituted with the recommended doses of vitamin D in combination with synergistic vitamin A and omega 3 fatty acids, such as cod liver oil.

Background: Early life events have been suggested to influence multiple sclerosis (MS) susceptibility, and to potentially modulate its clinical course. We assessed vitamin D-related exposures from childhood to disease onset and their associations with MS progression., Methods: Among veterans in the Multiple Sclerosis Surveillance Registry, 219 reported having the progressive form and met the inclusion criteria. Participants reported their past sun exposure, vitamin D-related intake and age at disability milestones using the Patient-Determined Disease Steps (PDDS). The Cox proportional hazards model was used to examine the association between vitamin D-related exposures and time (years) to disability., Results: Low average sun exposure in the fall/winter before disease onset was associated with an increased risk of progressing to a PDDS score of 8 (hazard ratio, HR: 2.13, 95% confidence interval, CI: 1.20-3.78), whereas use of cod liver oil during childhood and adolescence was associated with a reduced risk (HR: 0.44, 95% CI: 0.20-0.96)., Conclusions: These results suggest that exposure to vitamin D before MS onset might slow disease-related neurodegeneration and thus delay progression to disability among patients with the progressive subtype., (Copyright © 2011 S. Karger AG, Basel.)

Objectives: To assess how postmenopausal women with severe vasomotor symptoms who volunteer for an acupuncture trial (ACUFLASH) differ from the general population (the Norwegian Women and Cancer study, NOWAC); and to describe the use of dietary supplements and medication during trial intervention and follow-up., Methods: Questionnaire data on postmenopausal women regarding demography and use of dietary supplements and medication were compared between the ACUFLASH trial (baseline, 2006-2007, n = 267) and the NOWAC study (2004-2005, n = 331). Additionally, the trial intervention groups, acupuncture and self-care (n = 134) or self-care alone (n = 133), were compared regarding supplements and medication use., Results: The prevalence of dietary supplement use was higher among women with severe vasomotor symptoms (83.9%) than in the population-based sample (74.3%), with particularly extensive use of cod liver oil. The prevalence of medication use was 46.4% in ACUFLASH and 55.0% in NOWAC. Trial participants reported poorer self-reported health, higher education level and tended to be former oral contraceptive users and smokers. At trial baseline, 48.5% of the acupuncture group and 60.3% of the self-care group used dietary supplements (p > 0.05), while 48.5% in the acupuncture group and 45.0% in the self-care group used medication (p > 0.05). Use of supplements for vasomotor symptoms increased significantly in the self-care group at 12 weeks, while it remained unchanged in the acupuncture group. Hormone therapy use increased significantly in both groups after intervention., Conclusion: Postmenopausal women suffering severe vasomotor symptoms used more dietary supplements than the general population. They also had poorer self-reported health, but their medication use was similar to that of the general population. Acupuncture did not influence use of dietary supplements in the randomized intervention.

Cod liver oil contains long-chain omega-3 fatty acids, as well as vitamins D and A. It was a traditional source of vitamin D in the United States and was used to prevent and treat rickets. In our clinical research, we used liquid cod liver oil of adequate purity and acceptable taste for infants and young children, as well as a children's multivitamin/mineral supplement with selenium and other trace metals. In a cluster-randomized study of pediatric visits for upper respiratory illness during the winter and early spring, these nutritional supplements decreased mean visits/subject/month by 36%-58%. Cod liver oil is culturally valued and has been used as a folk remedy by many low-income minorities in the United States. Nutritional supplements cannot be purchased with SNAP benefits (formerly called food stamps). Inclusion of cod liver oil in state Medicaid formularies would make it available to low-income children, whose families may not be able to pay for it out-of-pocket.

This study was carried out to examine the effect of Artemia urmiana nauplii enriched with HUFA, and vitamins C and E on stress tolerance, hematocrit, and biochemical parameters of great sturgeon, Huso huso juveniles. Cod liver oil (EPA 18% and DHA 12%), ascorbyl-6-palmitate and alpha-tocopherol acetate were used as lipid, and vitamin C and E sources, respectively. Beluga juveniles at the stage of first feeding (69.7 +/- 5.9 mg body weight) were randomly divided into five treatments and three tanks were assigned to each diet. All fish groups were fed non-enriched Artemia for the initial 5 days and then fed enriched Artemia for 7 days. Juveniles were fed with Artemia enriched with HUFA + 20% vitamin C (C group); HUFA + 20% vitamin E-enriched Artemia nauplii (E group); HUFA + 20% vitamin C + 20% vitamin E (C and E group); HUFA without vitamins (HUFA) and non-enriched Artemia (control). After the period of enrichment, Juveniles were fed with Daphnia sp. from the 13th to the 40th day. At day 40, the fish were transferred directly from fresh water (0.5 ppt) to brackish water (6 ppt for 4 days and 12 ppt for 2 days) and warm water (from 27 to 33 degrees C) to evaluate juvenile resistance to salinity and thermal shocks. Moreover, all treatments were separately exposed to freshwater in tanks with the same capacity as used for osmotic and thermal tests (as fresh water control). The addition of vitamins C, E, and C + E to HUFA significantly increased fish resistance to 12 ppt salinity and temperature stress tests, whereas survival was not significantly different among challenges at 6 ppt. There was no significant difference in the hematocrit index under stress conditions. Enrichment had significant influence on plasma Na(+) level in the C group on the 4th day at 6 ppt. Na(+) and Ca(2+) concentrations in C, E, and C and E groups on the 1st day at 12 ppt, and Ca(2+) level in E group on the 2nd day at 12 ppt were lower than the other groups. The glucose level in the C and C and E groups was lower than the other treatments on the 1st day at 12 ppt and the 2nd day at 33 degrees C. Regardless of Artemia enrichment, plasma ions (Na(+), K(+), Ca(2+), and Mg(2+)) and glucose concentrations in fish exposed to salinity stress tests were higher than fish in fresh water. Glucose concentration in plasma also increased after 2 days at 33 degrees C. Although most of our results were not significantly different, the use of vitamins C, E, and HUFA in Artemia enrichment can improve Juveniles tolerance under stress conditions, and regardless of enrichment, these data show that beluga juveniles are partly sensitive to high salinity and temperature.

Background: This study aimed to evaluate the impact of a primary prevention intervention program on risk behavior for allergic diseases among children up to 2 years of age. The setting was in ordinary pre- and postnatal primary health care in Trondheim, Norway., Methods: The Prevention of Allergy among Children in Trondheim, Norway (PACT) study invited all pregnant women and parents to children up to 2 years of age in the community to participate in a non-randomized, controlled, multiple life-style intervention study. Interventional topics was increased dietary intake of cod liver oil and oily fish for women during pregnancy and for infants during the first 2 years of life, reduced parental smoking and reduced indoor dampness. A control cohort was established prior to the intervention cohort with "follow up as usual". Questionnaires were completed in pregnancy, 6 weeks after birth and at 1 and 2 years of age. Trends in exposure and behavior are described., Results: Intake of oily fish and cod liver oil increased statistically significantly among women and infants in the intervention cohort compared to the control cohort. There was a low postnatal smoking prevalence in both cohorts, with a trend towards a decreasing smoking prevalence in the control cohort. There was no change in indoor dampness or in behavior related to non- intervened life-style factors., Conclusions: The dietary intervention seemed to be successful. The observed reduced smoking behavior could not be attributed to the intervention program, and the latter had no effect on indoor dampness., Trial Registrations: (Current Controlled Trials registration number: ISRCTN28090297).

Objectives: To study the presentations and treatment outcome of 8 consecutive patients for whom cod liver oil was injected in the subcutaneous area of their penises by a lay person for purpose of augmentation., Methods: Various amounts of cod liver oil were injected in the subcutaneous area of the penis of 8 low socioeconomic class patients by a nonmedical person. They presented by various complications ranging from paraphimosis up to abscess formation and necrosis of penile skin. All the patients underwent emergency initial surgical intervention ranging from dorsal preputial slit to skin debridement. Definitive surgical treatment was carried out using local penile flap and V-Y plasty., Results: The severity of complications was correlated to the amount of oil injected and the time interval between injections and presentation. All the 8 patients were cured after different staged surgical procedures. The postoperative course was uneventful in 6 patients, and 2 patients suffered from wound infection after the secondary treatment. All patients had acceptable cosmetic and functional outcome, and were satisfied regarding the length of the penis. None reported erectile dysfunction., Conclusions: Increased public awareness is indicated to avoid this problem. Early detection and prompt treatment give acceptable anatomic and functional results., (Copyright 2010 Elsevier Inc. All rights reserved.)

A sucrose-rich diet (SRD), compared with a starch diet, induces time-dependent metabolic disorders and insulin resistance with hypertriglyceridemia, similar to type 2 diabetes. In this study, we examined the effect of SRD, after 8 mo, on nuclear receptors peroxisome proliferator-activated receptor-alpha (PPARalpha), and liver X receptor-alpha (LXRalpha), stearoyl-CoA desaturase-1 (SCD-1), and Delta6 and Delta5 desaturases mRNA and activity, hepatic enzymes involved in lipid metabolism, and fatty acid (FA) composition as well as the reversal produced by cod liver oil. SRD induced triglyceride increase in plasma and liver, increasing the anabolic FA synthase, malic enzyme, and glucose-6-phosphate dehydrogenase, but not the prooxidative enzymes FA oxidase and carnitine palmitoyltransferase I, and correspondingly decreased PPARalpha and increased LXRalpha expressions. Results suggest a contribution of both nuclear receptors' interaction on these enzymatic activities. SRD depressed SCD-1 without altering oleic acid proportion and increased Delta6 and Delta5 desaturases and the proportion of n-6 arachidonic acid. Therefore, the data do not support that SRD hypertriglyceridemia is produced by increased SCD-1-dependent oleic acid biosynthesis. The administration of 7% cod liver oil for 2 mo depressed LXRalpha, enhancing PPARalpha in control and SRD-fed rats, reversing the activity of the hepatic enzymes involved in lipid metabolism and therefore the hyperlipidemia produced by the SRD. Fish oil increased n-3 PUFA and depressed n-6 PUFA of liver lipids without altering the 18:1/18:0 ratio, suggesting that its effects were produced mainly by competition of dietary n-6 and n-3 FA and not through desaturase activity modification.

Pegylated liposomal doxorubicin (PLD) is an effective and tolerable agent in the treatment of recurrent and refractory ovarian carcinoma. One of the most common dose-limiting toxicities of PLD is palmar-plantar erythrodysesthesia (PPE). We report a retrospective review of patients who took cod liver oil (CLO) while being treated with PLD at Roswell Park Cancer Institute. None of the patients required dose reduction, treatment interruption or discontinuation secondary to skin toxicity. No patient experienced grade 2 or greater PPE. The mechanism for the development of PLD-induced PPE is unknown. CLO may possibly mitigate it via decreased extravasation of PLD and/or by a blunting of the local inflammatory response. The effects of CLO should be further evaluated in a prospective, randomized trial, and attempts to elucidate the mechanism by which CLO may exert its effects should be pursued.

Background: Very long chain n-3 polyunsaturated fatty acids have modulating effects on inflammatory mechanisms. Seal and fish oils are rich in n-3 polyunsaturated fatty acids, and possibly therefore high doses of nasoduodenally administered seal oil rapidly relieved inflammatory bowel disease (IBD)-associated joint pain in two recent studies. In the present study, we compared the effects of short-term oral administration of seal oil and cod liver oil on IBD-related joint pain, leucotriene B(4) level, serum fatty acid profile and IBD activity., Methods: Thirty-eight patients with IBD-related joint pain were included in the study; 21 had Crohn's disease and 17 ulcerative colitis. Ten milliters of seal oil (n=18) or cod liver oil (n=20) was self-administered orally 3 times a day for 14 days before meals in a double-blind setting., Results: There were no significant differences between the two intervention groups or between Crohn's disease and ulcerative colitis patients. There was a tendency toward improvement in several joint pain parameters after both seal oil and cod liver oil administration. Further, plasma leucotriene B(4) concentration, serum Sigma n-6 to Sigma n-3, and arachidonic acid (20:4n-6) to eicosapentaenoic acid (20:5n-3) ratios were similarly reduced after administration of seal oil and cod liver oil., Conclusion: No significant differences in the two treatment groups were seen; in both groups, the changes in several joint pain parameters, leucotriene B(4) level of plasma, and serum fatty acid profile were putatively favourable.

Objectives: Dose-dependant gastrointestinal and cardiovascular side-effects limit the use of NSAIDs in the management of RA. The n-3 essential fatty acids (EFAs) have previously demonstrated some anti-inflammatory and NSAID-sparing properties. The objective of this study was to determine whether cod liver oil supplementation helps reduce daily NSAID requirement of patients with RA., Methods: Dual-centre, double-blind placebo-controlled randomized study of 9 months' duration. Ninety-seven patients with RA were randomized to take either 10 g of cod liver oil containing 2.2 g of n-3 EFAs or air-filled identical placebo capsules. Documentation of NSAID daily requirement, clinical and laboratory parameters of RA disease activity and safety checks were done at 0, 4, 12, 24 and 36 weeks. At 12 weeks, patients were instructed to gradually reduce, and if possible, stop their NSAID intake. Relative reduction of daily NSAID requirement by >30% after 9 months was the primary outcome measure., Results: Fifty-eight patients (60%) completed the study. Out of 49 patients 19 (39%) in the cod liver oil group and out of 48 patients 5 (10%) in the placebo group were able to reduce their daily NSAID requirement by >30% (P = 0.002, chi-squared test). No differences between the groups were observed in the clinical parameters of RA disease activity or in the side-effects observed., Conclusions: This study suggests that cod liver oil supplements containing n-3 fatty acids can be used as NSAID-sparing agents in RA patients.

Use of cod liver oil, which is rich in vitamins A and D, is traditionally recommended during the fall and winter months as a protective measure against vitamin D deficiency in several countries. It is not known whether childhood cod liver oil intake is related to variations in bone mineral density (BMD) or fractures in adult life. In 2001, a total of 3,052 Norway women aged 50-70 years had forearm BMD measured in a substudy of the population-based Nord-Trøndelag Health Study. Women reporting no childhood cod liver oil intake had statistically significantly higher BMD than those with any ingestion of cod liver oil. The odds ratio for low BMD (>1 standard deviation below age-specific mean) in women reporting cod liver oil intake throughout the year as compared with women with no intake was 2.3 (95% confidence interval: 1.4, 3.9), adjusted for body mass index, smoking, menopausal status, estrogen use, and current milk consumption. There were indications of a negative dose-response effect of childhood cod liver oil intake on bone. Although the vitamin A content of commercial cod liver oil was recently reduced by 75% in Norway, the past high concentration remains a possible explanation for the observed negative association between childhood cod liver oil intake and forearm BMD.

Abnormalities in the metabolism of essential fatty acids and the results of increased oxidative stress have been implicated in cardiovascular disorders observed in diabetes mellitus. This study, therefore, aimed to investigate the effects of cod liver oil (CLO, Lysi Ltd, Iceland), which comprises mainly an antioxidant vitamin A, n:3 polyunsaturated fatty acids (n:3 PUFAs), eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), on cardiovascular abnormalities in streptozotocin (STZ)-diabetic rats. Two days after single STZ (55 mg kg(-1), i.p.) or vehicle injection, diabetes was verified by increased blood glucose, and non-diabetic and diabetic rats were left untreated or treated with CLO (0.5 mL kg(-1) daily, by intragastric probing) for 12 weeks. Plasma glucose, triacylglycerol and cholesterol concentrations were significantly elevated in 12-week untreated-diabetic rats; CLO provided better weight gain, entirely prevented the plasma lipid abnormalities, but partially controlled the glycaemia in diabetic rats. In isolated aorta rings, diabetes resulted in increased phenylephrine-induced vasoconstriction and isoprenaline-induced vasorelaxation, impaired endothelium-dependent vasodilatation and unchanged responsiveness to sodium nitroprusside. CLO treatment completely prevented endothelial deficiency, partly corrected the phenylephrine-induced vasoconstriction and did not affect the responses to isoprenaline and sodium nitroprusside in diabetic aorta. Diabetes also produced a marked decrease in the rate of spontaneously beating right atria and a significant increase in basal contractile force of left ventricular papillary muscle. The responsiveness of right atria to the positive chronotropic effect of isoprenaline was significantly decreased in diabetic rats, and was increased in CLO-treated diabetic rats. The positive chronotropic effect of noradrenaline was markedly increased in diabetic atria, but prevented by CLO treatment. Diabetes also resulted in an increased positive inotropic response of papillary muscle to both noradrenaline and isoprenaline, which were prevented by CLO treatment. CLO treatment also resulted in lower tissue sensitivity (pD(2)) to these agonists in diabetic papillary muscle. Ventricular hydroxyproline content was found to be unchanged among the experimental groups. The ultrastructure of diabetic myocardium displayed various degenerations (i.e. intracellular oedema, myofibrillar fragmentation, condensed pleomorphic mitochondria, thick capillary irregular basement membrane, swollen endothelial cells), which were partially prevented by CLO treatment. We conclude that the supplementation with CLO is effective in preventing cardiovascular disorders observed in experimental diabetes.

Background: A diet rich in fish or cod oil might possibly reduce the risk for asthma and atopic diseases. However, previous studies show conflicting results and no studies have assessed the potential long-term effects of childhood fish intake on adult asthma., Objective: To investigate whether childhood and adult fish and cod oil intake was related to adult asthma., Methods: In a large population-based study, Respiratory Health in Northern Europe (RHINE), 16 187 subjects aged 23-54 years answered a postal questionnaire. The relations of fish and cod oil intake with asthma symptoms and asthma were analysed using multiple logistic and Cox regression analyses, with adjustment for gender, adult hayfever, smoking, age, body mass index, household size, dwelling, parental education and centre, and for maternal smoking and family history of hayfever and asthma in a subsample (n=2459)., Results: Subjects from Iceland and Norway reported much more frequent intake of fish both in childhood and adulthood as compared with subjects from Sweden, Estonia and Denmark. Current fish intake less than weekly in adults was associated with more asthma symptoms, while more frequent fish intake did not appear to decrease the risk further. No dose-response association was found between childhood fish intake and adult asthma, but those who never ate fish in childhood had an increased risk for asthma and earlier asthma onset. Adult consumption of cod oil had a u-shaped association with asthma, with the highest risks in those taking cod oil never and daily., Conclusion: A minimum level of weekly fish intake in adulthood was associated with protection against asthma symptoms in this large North-European multi-centre study. Subjects who never ate fish in childhood were at an increased risk for asthma. Both indicate a possible threshold effect of fish on asthma.

Background: Clinical trials suggest that omega-3 fatty acids improve the outcome of depression. This study aimed to evaluate the association between intake of cod liver oil, rich in omega-3 fatty acids, and high levels of symptoms of depression and anxiety in the general population., Methods: We used data from the "The Hordaland Health Study '97-'99" (HUSK), a population based cross-sectional health survey from Norway including 21,835 subjects aged 40-49 and 70-74 years. Symptoms of depression and anxiety were measured by The Hospital Anxiety and Depression Scale (HADS). We used logistic regression to study associations., Results: Among the participants, 8.9% used cod liver oil daily. A total of 3.6% had high levels of depressive symptoms. The prevalence of such depressive symptoms among the subjects who used cod liver oil daily was 2.5%, as compared to 3.8% in the rest of the population. The users of cod liver oil were significantly less likely to have depressive symptoms than non-users after adjusting for multiple possible confounding factors (odds ratio=0.71, 95% confidence interval 0.52 to 0.97). These factors included age, gender, smoking habits, coffee consumption, alcohol consumption, physical activity, and education. In addition, we found that the prevalence of high levels of depressive symptoms decreased with increasing duration (0-12 months) of cod liver oil use (multivariate adjusted test for trend, P=0.04). We were only able to study this latter association in a subset of the population aged 40-46 years., Limitations: Data are cross sectional., Conclusions: The findings indicate that regular use of cod liver oil is negatively associated with high levels of depressive symptoms in the general population.

Background: A relationship between the latitude related distribution of multiple sclerosis (MS) and exposure to sunlight has long been considered. Higher sun exposure during early life has been associated with decreased risk of MS., Objective: Since Norway is an exception to the latitude gradient of MS prevalence, we tested here whether sunlight exposure or vitamin D-related dietary factors in childhood and adolescence are associated with the risk of MS., Methods: Retrospective recall questionnaire data from 152 MS patients and 402 population controls born at and living at latitudes 66-71 degrees N were analysed by means of conditional logistic regression analysis accounting for the matching variables age, sex, and place of birth., Results: Increased outdoor activities during summer in early life were associated with a decreased risk of MS, most pronounced at ages 16-20 years (odds ratio (OR) 0.55, 95% CI 0.39-0.78, p = 0.001, adjusted for intake of fish and cod-liver oil). A protective effect of supplementation with cod-liver oil was suggested in the subgroup that reported low summer outdoor activities (OR 0.57, 95% CI 0.31-1.05, p = 0.072). Consumption of fish three or more times a week was also associated with reduced risk of MS (OR 0.55, 95% CI 0.33-0.93, p = 0.024)., Conclusion: Summer outdoor activities in childhood and adolescence are associated with a reduced risk of MS even north of the Arctic Circle. Supplemental cod-liver oil may be protective when sun exposure is less, suggesting that both climate and diet may interact to influence MS risk at a population level.

Background: Vitamin D, antiproliferative and proapoptotic in breast cancer cell lines, can reduce the development of mammary tumors in carcinogen-exposed rats. Current evidence in humans is limited with some suggestion that vitamin D-related factors may reduce the risk of breast cancer. We conducted a population-based case-control study to assess the evidence for a relationship between sources of vitamin D and breast cancer risk., Methods: Women with newly diagnosed invasive breast cancer were identified from the Ontario Cancer Registry. Women without breast cancer were identified through randomly selected residential telephone numbers. Telephone interviews were completed for 972 cases and 1,135 controls. Odds ratios (OR) and 95% confidence intervals (CI) for vitamin D-related variables were estimated using unconditional logistic regression with adjustment for potential confounders., Results: Reduced breast cancer risks were associated with increasing sun exposure from ages 10 to 19 (e.g., OR, 0.65; 95% CI, 0.50-0.85 for the highest quartile of outdoor activities versus the lowest; P for trend = 0.0006). Reduced risk was also associated with cod liver oil use (OR, 0.76; 95% CI, 0.62-0.92) and increasing milk consumption (OR, 0.62 95% CI 0.45-0.86 for >or=10 glasses per week versus none; P for trend = 0.0004). There was weaker evidence for associations from ages 20 to 29 and no evidence for ages 45 to 54., Conclusion: We found strong evidence to support the hypothesis that vitamin D could help prevent breast cancer. However, our results suggest that exposure earlier in life, particularly during breast development, maybe most relevant. These results should be confirmed.

This work was undertaken to study the impact of the source of n-3 FA on their incorporation in serum, on blood lipid composition, and on cellular activation. A clinical trial comprising 71 volunteers, divided into five groups, was performed. Three groups were given 400 g smoked salmon (n = 14), cooked salmon (n = 15), or cooked cod (n = 13) per week for 8 wk. A fourth group was given 15 mL/d of cod liver oil (CLO) (n = 15), and a fifth group served as control (n = 14) without supplementation. The serum content of EPA and DHA before and after intervention revealed a higher rise in EPA and DHA in the cooked salmon group (129% rise in EPA and 45% rise in DHA) as compared with CLO (106 and 25%, respectively) despite an intake of EPA and DHA in the CLO group of 3.0 g/d compared with 1.2 g/d in the cooked salmon group. No significant changes were observed in blood lipids, fibrinogen, fibrinolysis, or lipopolysaccharide (LPS)-induced tissue factor (TF) activity, tumor necrosis factor-alpha (TNFalpha), interleukin-8 (IL-8), leukotriene B4 (LTB4), and thromboxane B2 (TxB2) in whole blood. EPA and DHA were negatively correlated with LPS-induced TNFalpha, IL-8, LTB4, TxB2, and TF in whole blood. In conclusion, fish consumption is more effective in increasing serum EPA and DHA than supplementing the diet with fish oil. Since the n-3 FA are predominantly in TAG in fish as well as CLO, it is suggested that the larger uptake from fish than CLO is due to differences in physiochemical structure of the lipids.

Objective: Docosahexaenoic acid (DHA, 22:6 n-3) is considered an essential fatty acid for the fetus and newborn infant, but the optimal level of supply is not known. We studied the effect of supplementing pregnant and lactating women with marine n-3 polyunsaturated fatty acids (PUFAs) as compared to n-6 PUFAs related to maternal and infant lipid levels., Study Design: Five hundred and ninety pregnant women in weeks 17-19 of pregnancy were recruited. They were given either 10 mL cod liver oil (n-3 PUFAs) or corn oil (n-6 PUFAs) daily until three months after delivery, and 341 women took part in the study until giving birth., Results: Maternal supplementation with cod liver oil increased the concentration of DHA in maternal as well as infant plasma and umbilical tissue phospholipids, as compared to corn oil. The maternal plasma triacylglycerol increase during pregnancy was less pronounced in women supplemented with cod liver oil as compared to corn oil. The concentration of high-density lipoprotein (HDL)-cholesterol was unchanged during pregnancy in the cod liver oil group, whereas it decreased in the corn oil group, promoting a greater increase in the ratio of total cholesterol/HDL-cholesterol in the corn oil group., Conclusion: Maternal supplementation with n-3 fatty acids during pregnancy and lactation provides more DHA to the infant and reduces maternal plasma lipid levels compared to supplementation with n-6 fatty acids.

Objective: To investigate whether there is a relationship between maternal intake of cod-liver oil in early and late pregnancy and hypertensive disorders in pregnancy., Design: An observational prospective study., Setting: Free-living conditions in a community with traditional fish and cod-liver oil consumption., Population: Four hundred and eighty-eight low-risk pregnant Icelandic women., Methods: Maternal use of cod-liver oil, foods and other supplements was estimated with a semiquantitative food frequency questionnaire covering food intake together with lifestyle factors for the previous 3 months. Questionnaires were filled out twice, between 11 and 15 weeks of gestation and between 34 and 37 weeks of gestation. Supplements related to hypertensive disorders in pregnancy, i.e. gestational hypertension and pre-eclampsia, were presented, with logistic regression controlling for potential confounding., Main Outcome Measures: Gestational hypertension, pre-eclampsia, cod-liver oil and multivitamins., Results: The odds ratio for developing hypertensive disorders in pregnancy for women consuming liquid cod-liver oil was 4.7 (95% CI 1.8-12.6, P= 0.002), after adjusting for confounding factors. By dividing the amount of n-3 long-chain polyunsaturated fatty acids (n-3 LCPUFA) into centiles, the odds ratio for hypertensive disorders across groups for n-3 LCPUFA suggested a u-shaped curve (P = 0.008). Similar results were found for gestational hypertension alone. Further, the use of multivitamin supplements without vitamins A and D in late pregnancy doubled the odds of hypertensive disorders (OR 2.4, 95% CI 1.0-5.4, P= 0.044)., Conclusions: Consumption of high doses of n-3 LCPUFA in early pregnancy, or other nutrients found in liquid cod-liver oil, may increase the risk of developing hypertensive disorders in pregnancy.

Background/aims: The proportion of polyunsaturated fatty acids (PUFA) in the diet and breast milk of lactating women with traditional fish and cod liver oil consumption was investigated under free-living conditions., Methods: Dietary intake of 77 lactating women was investigated by 24-hour recalls and breast milk samples were taken at the same occasions. Maternal intake data was calculated and fatty acid pattern from breast milk samples analyzed with gas chromatography., Results: Women using cod liver oil (n = 18) had a significantly higher total PUFA intake (14 +/- 10 vs. 9 +/- 7 g/day; 5.0 +/- 3.4 vs. 3.9 +/- 3.0 Energy%; p < 0.05) than women who did not use it (n = 59). In particular, mothers consuming cod liver oil had higher breast milk proportion of docosahexaenoic acid (DHA, 0.54 vs. 0.30%, p < 0.05). They also had higher breast milk proportions of eicosapentaenoic acid (EPA; 0.16 vs.0.07%; p < 0.05) and docosapentaenoic acid (DPA; 0.22 vs. 0.17%; p < 0.05)., Conclusion: The proportion of PUFA in the diet is significantly higher among women consuming cod liver oil. Its use also gives higher proportion of EPA,DPA and DHA in breast milk without decreasing other important fatty acids. As this may have an impact on the health and development of breast-fed infants in later life, regular maternal cod liver oil intake could be relevant for the infant as well as for the nutritional adequacy of the maternal diet., (Copyright 2006 S. Karger AG, Basel.)

Objective: To investigate the possible association between birth outcome and marine food and cod liver oil intake of healthy women in early (prior to 15 weeks of gestation) pregnancy., Design: An observational study., Setting: Free-living conditions in a community with traditional fish and cod liver oil consumption., Population: Four hundred and thirty-five healthy pregnant Icelandic women without antenatal and intrapartum complications., Methods: Dietary intake of the women was estimated with a semi-quantitative food frequency questionnaire (FFQ) covering food intake together with lifestyle factors for the previous three months. Questionnaires were filled out at between 11 and 15 weeks and between 34 and 37 weeks of gestation. The estimated intake of marine food and cod liver oil was compared with birthweight by linear and logistic regression controlling for potential confounding., Main Outcome Measures: Birthweight, cod liver oil intake, lifestyle factors (alcohol, smoking)., Results: Fourteen percent of the study population used liquid cod liver oil in early pregnancy. Regression analysis shows that these women gave birth to heavier babies (P < 0.001), even after adjusting for the length of gestation and other confounding., Conclusions: Maternal intake of liquid cod liver oil early in pregnancy was associated with a higher birthweight. Higher birthweight has been associated with a lower risk of diseases later in life and maternal cod liver oil intake might be one of the means for achieving higher birthweight.

Objective: To assess vitamin D status and the impact of three fish meals consisting of cod liver and fresh cod-liver oil on the plasma level of vitamin D metabolites in an area with high consumption of cod liver and cod-liver oil., Design: Experimental field study., Methods: Thirty-two volunteers from the Skjervøy (70 degrees N) municipality in northern Norway were recruited to consume three traditional mølje meals, consisting of cod, cod liver, fresh cod-liver oil and hard roe, in one week. The liver and fresh cod-liver oil consumed by the participants were weighed and recorded. Blood samples were collected before the first meal, and subsequently 12 h and 4 days after the last meal. The blood samples were analysed for the vitamin D metabolites 25-hydroxyvitamin D (25(OH)D) and 1,25-dihydroxyvitamin D (1,25(OH)2D). All participants answered a semi-quantitative food-frequency questionnaire, which was used to estimate usual daily nutrient intake. The study was carried out in the last part of March 2001., Results: The median daily vitamin D intake estimated from the questionnaire was 9.9 microg. The proportion of subjects with baseline 25(OH)D level below 50 nmol l(-1) was 15.4% and none were below 37.5 nmol l(-1). Only "mølje consumption" and "time spent in daylight" were significantly associated with baseline log 25(OH)D. The mean total intake of vitamin D in the three servings was 272 microg (standard deviation 94 microg), ranging from 142 to 434 microg. Relative to baseline plasma concentration, the mean level of 25(OH)D decreased slightly in both post-consumption samples (P< or =0.03), while 1,25(OH)2D peaked 12 h after the final meal (P=0.03)., Conclusion: Three mølje meals provided, on average, an amount of vitamin D equal to 54 times the recommended daily dose. Subjects with food consumption habits that included frequent mølje meals during the winter sustained satisfactory vitamin D levels in their blood, in spite of the long "vitamin D winter" (i.e. absence of ultraviolet-induced vitamin D production in the skin).

Objective: To assess the use of cod-liver oil supplements among Norwegian women and to examine dietary, lifestyle, demographic, and health factors associated with use of this supplement., Design: Cross-sectional study., Setting and Subjects: The study is based on data from a food frequency questionnaire from 1998 answered by 37,226 women aged 41-55 y, who in 1991/1992 participated in the Norwegian component of the European Prospective Investigation into Cancer and Nutrition (EPIC). The Norwegian EPIC cohort was based on a random nation-wide sample of Norwegian women., Results: Cod-liver oil supplement use was reported by 44.7% of the participating women. Subjects with higher education, high physical activity level, and body mass index (BMI) in the normal range were more likely to use cod-liver oil supplements. Consumption did also increase with increased age as well as with increased reported consumption of fruits, vegetables, fatty fish, lean fish, and vitamin D (excluding the vitamin D contribution from cod-liver oil). Energy intake was higher among cod-liver oil users than nonusers. Whole-year daily users of cod-liver oil were also more likely to take other dietary supplements (OR=2.45, 95% CI: 2.28-2.62). Never smokers were more likely to use cod-liver oil supplements than current smokers., Conclusion: Use of cod-liver oil is associated with several sociodemographic factors, self-reported health issues, and intake of fish, fruit, and vegetables. When assessing the relationship between cod-liver oil use and occurrence of chronic diseases potential confounders need to be considered. Cod-liver oil use seemed not to be matched with vitamin D needs. Thus, emphasis on assessing vitamin D status by measuring levels in blood should be investigated further, in particular, among people living in northern latitudes.