Five years of GWAS discovery

The past five years have seen many scientific and biological discoveries made through the experimental design of genome-wide association studies (GWASs). These studies were aimed at detecting variants at genomic loci that are associated with complex traits in the population and, in particular, at detecting associations between common single-nucleotide polymorphisms (SNPs) and common diseases such as heart disease, diabetes, auto-immune diseases, and psychiatric disorders. We start by giving a number of quotes from scientists and journalists about perceived problems with GWASs. We will then briefly give the history of GWASs and focus on the discoveries made through this experimental design, what those discoveries tell us and do not tell us about the genetics and biology of complex traits, and what immediate utility has come out of these studies. Rather than giving an exhaustive review of all reported findings for all diseases and other complex traits, we focus on the results for auto-immune diseases and metabolic diseases. We return to the perceived failure or disappointment about GWASs in the concluding section. © 2012 The American Society of Human Genetics.

Serum vitamin D levels are lower in Australian children and adolescents with type 1 diabetes than in children without diabetes

Vitamin D is synthesised in the skin through the action of UVB radiation (sunlight), and 25-hydroxy vitamin D (25OHD) measured in serum as a marker of vitamin D status. Several studies, mostly conducted in high latitudes, have shown an association between type 1 diabetes mellitus (T1DM) and low serum 25OHD. We conducted a case-control study to determine whether, in a sub-tropical environment with abundant sunlight (latitude 27.5°S), children with T1DM have lower serum vitamin D than children without diabetes. Fifty-six children with T1DM (14 newly diagnosed) and 46 unrelated control children participated in the study. Serum 25OHD, 1,25-dihydroxy vitamin D (1,25(OH)2D) and selected biochemical indices were measured. Vitamin D receptor (VDR) polymorphisms Taq1, Fok1, and Apa1 were genotyped. Fitzpatrick skin classification, self-reported daily hours of outdoor exposure, and mean UV index over the 35d prior to blood collection were recorded. Serum 25OHD was lower in children with T1DM (n=56) than in controls (n=46) [mean (95%CI)=78.7 (71.8-85.6) nmol/L vs. 91.4 (83.5-98.7) nmol/L, p=0.02]. T1DM children had lower self-reported outdoor exposure and mean UV exposure, but no significant difference in distribution of VDR polymorphisms. 25OHD remained lower in children with T1DM after covariate adjustment. Children newly diagnosed with T1DM had lower 1,25(OH)2D [median (IQR)=89 (68-122) pmol/L] than controls [121 (108-159) pmol/L, p=0.03], or children with established diabetes [137 (113-153) pmol/L, p=0.01]. Children with T1DM have lower 25OHD than controls, even in an environment of abundant sunlight. Whether low vitamin D is a risk factor or consequence of T1DM is unknown. © 2012 John Wiley & Sons A/S.

Rintamamiesten muonitus Suomessa sotavuosina 1939-1945

This study analyzes the war-time rations the Finnish soldiers received on the front from 1939 until 1945. The main objective was to determine the contents of the rations and how they affected the soldiers' nutrition and morale. The information concerning food and feeding is mainly based on the official documents found in the Military Archives. Some additional material was from the historical literature, some from memoirs, or from the veterans who personally experienced the front. The documents in the Archives of Military Medicine provided information on the soldiers' deficiencies. During the Winter War, which took place from 30 November 1939 until 13 March 1940, ample food was available. The cold climate caused problems and the fresh food got frozen. However, no severe deficiency cases were reported and the morale was high. By contrast, during the Continuation War, which began in June, 1941 and ended in September, 1944, difficulties were experienced. At the time farming in the country faced serious problems due to the shortage of labour, fuel, etc. Furthermore, importing food was generally not possible. However, importing food mainly from Germany saved the Finns from hunger. In addition, the self activity of the soldiers on the front added somewhat to the food production. But the rations had to be reduced. Their energy values were consequently low, especially for the young men. Food was monotonous and occasionally caused complaints. The main sources of protein, vitamins and minerals were the whole cereal foods. Butter was fortified with vitamin A and vitamin C tablets were also distributed, to compensate for the scant food sources. Only approximately 300 serious deficiency cases required hospital care during the three years time, out of a total of 400 000 soldiers. Feeding the young soldiers during the war (1944 - 1945) in Lapland, which had been destroyed, was problematic but the increased rations also saved them from deficiencies. In spite of the severe difficulties experienced occasionally in feeding the soldiers during the wars, the system worked all the time. The soldiers were fed, the cases of nutritional deficiency and epidemics caused by food were kept very limited and the morale of soldiers remained high.

Effect of vitamin A deprivation on the cholesterol side-chain cleavage enzyme activity of testes and ovaries of rats (Short Communication)

The cholesterol side-chain cleavage enzyme activity is decreased considerably at the mild stage of vitamin A deficiency in rat testes and ovaries and the decrease in activity becomes more pronounced with progress of deficiency. Supplementation of the deficient rats with retinyl acetate, but not retinoic acid, restores the enzyme activity to normal values. The cholesterol side-chain cleavage enzyme of adrenals is not affected by any of the above treatments.

The role of 25-hydroxyvitamin D deficiency in promoting insulin resistance and inflammation in patients with chronic kidney disease: A randomised controlled trial

BACKGROUND Approximately 50% of patients with stage 3 Chronic Kidney Disease are 25-hydroxyvitamin D insufficient, and this prevalence increases with falling glomerular filtration rate. Vitamin D is now recognised as having pleiotropic roles beyond bone and mineral homeostasis, with the vitamin D receptor and metabolising machinery identified in multiple tissues. Worryingly, recent observational data has highlighted an association between hypovitaminosis D and increased cardiovascular mortality, possibly mediated via vitamin D effects on insulin resistance and inflammation. The main hypothesis of this study is that oral Vitamin D supplementation will ameliorate insulin resistance in patients with Chronic Kidney Disease stage 3 when compared to placebo. Secondary hypotheses will test whether this is associated with decreased inflammation and bone/adipocyte-endocrine dysregulation. METHODS/DESIGN This study is a single-centre, double-blinded, randomised, placebo-controlled trial. Inclusion criteria include; estimated glomerular filtration rate 30-59 ml/min/1.73 m(2); aged >or=18 on entry to study; and serum 25-hydroxyvitamin D levels <75 nmol/L. Patients will be randomised 1:1 to receive either oral cholecalciferol 2000IU/day or placebo for 6 months. The primary outcome will be an improvement in insulin sensitivity, measured by hyperinsulinaemic euglycaemic clamp. Secondary outcome measures will include serum parathyroid hormone, cytokines (Interleukin-1beta, Interleukin-6, Tumour Necrosis Factor alpha), adiponectin (total and High Molecular Weight), osteocalcin (carboxylated and under-carboxylated), peripheral blood mononuclear cell Nuclear Factor Kappa-B p65 binding activity, brachial artery reactivity, aortic pulse wave velocity and waveform analysis, and indirect calorimetry. All outcome measures will be performed at baseline and end of study. DISCUSSION To date, no randomised controlled trial has been performed in pre-dialysis CKD patients to study the correlation between vitamin D status with supplementation, insulin resistance and markers of adverse cardiovascular risk. We remain hopeful that cholecalciferol may be a safe intervention, with health benefits beyond those related to bone-mineral homeostasis. TRIAL REGISTRATION Australian and New Zealand Clinical Trials Registry ACTRN12609000246280.

Metabolism of ubiquinone in relation to vitamin a status in the rat

1. 1. Biosynthetic experiments in vitro with slices of livers from normal and vitamin A-deficient rats confirmed that synthesis of ubiquinone did not increase in vitamin A deficiency. 2. 2. During development of deficiency of vitamin A in the rat, there was a definite increase in the synthesis of ubiquinone at the 10-days stage but this reverted to low, initial level by 20 days and after. 3. 3. Vitamin A analogues, 3-dehydroretinal, 5,6-monoepoxyretinal and retinoic acid, which supported growth have restored ubiquinone concentration to the normal levels and relieved the lowering in its catabolism. The biologically inert 5,8-monoepoxyretinal was the least active of the analogues tested. 4. 4. The concentration and synthesis of ubiquinone in the liver decreased under conditions of hypervitaminosis A. 5. 5. The experimental evidence does not support the hypothesis of inverse relationship between vitamin A and ubiquinone synthesis.

Reconhecimento de padrão na biodisponibilidade do ferro utilizando o Algoritmo Fuzzy C-Means

Este trabalho apresenta um método para reconhecimento do padrão na biodisponibilidade do ferro, através da interação com substâncias que auxiliam a absorção como vitamina C e vitamina A e nutrientes inibidores como cálcio, fitato, oxalato, tanino e cafeína. Os dados foram obtidos através de inquérito alimentar, almoço e jantar, em crianças de 2 a 5 anos da única Creche Municipal de Paraty-RJ entre 2007 e 2008. A Análise de Componentes Principais (ACP) foi aplicada na seleção dos nutrientes e utilizou-se o Algoritmo Fuzzy C-Means (FCM) para criar os agrupamentos classificados de acordo com a biodisponibilidade do ferro. Uma análise de sensibilidade foi desenvolvida na tentativa de buscar quantidades limítrofes de cálcio a serem consumidas nas refeições. A ACP mostrou que no almoço os nutrientes que explicavam melhor a variabilidade do modelo foram ferro, vitamina C, fitato e oxalato, enquanto no jantar o cálcio se mostrou eficaz na determinação da variabilidade do modelo devido ao elevado consumo de leite e derivados. Para o almoço, a aplicação do FCM na interação dos nutrientes, notou-se que a ingestão de vitamina C foi determinante na classificação dos grupos. No jantar, a classificação de grupos foi determinada pela quantidade de ferro heme na interação com o cálcio. Na análise de sensibilidade realizada no almoço e no jantar, duas iterações do algoritmo determinaram a interferência total do cálcio na biodisponibilidade do ferro.

The role of small indigenous fish species in food and nutrition security in Bangladesh

In Bangladesh, only 6% of the daily food intake is animal food of which fish accounts for 50%. Rice is the mainstay, making up 60% of the daily food intake. However, many nutrients such as vitamins A and C, iron, calcium, zinc and iodine are not found in rice and have to be obtained from other sources. Small indigenous fish are a vital contribution to the diet of the rural poor in Bangladesh, where more than 30,000 children go blind every year from vitamin A deficiency and 70% of women and children are iron-deficient. Small fish, which are less than 10 cm in length and usually eaten whole with the organs and bones, contain large amount of calcium and possibly iron and zinc. The largest fish promoted in aquaculture do not contribute significantly to calcium intake. Some species also contain large amount of vitamin A. Much of the small indigenous fish (SIS) of Bangladesh are caught in floodplains and natural waterbodies. Small fish are eaten frequently in small amounts and are more equally distributed among family members than big fish of which men get the larger share. Unfortunately, overfishing and the deterioration of natural habitats have resulted in a decline in SIS. When measures are taken to improve food and nutrition security, there should be a focus on production of small fish so that greater quantities are accessible for consumption by the rural poor.

Papel do antioxidante (vitamina C) na modulação da pressão sanguínea em ratos espontaneamente hipertensos (SHR)

A hipertensão essencial humana, bem como a hipertensão desenvolvida em Ratos Espontaneamente Hipertensos (SHR), são caracterizadas pelo desenvolvimento de Pressão Arterial (PA) elevada na medida em que a idade avança, sem identificação da causa primária. Está bem estabelecido que este modelo animal apresenta estresse oxidativo (EOx) concomitante a hipertensão. O mecanismo pelo qual o antioxidante reduz a pressão não está claro, por essa razão, é necessário avaliar o comportamento destas enzimas envolvidas na homeostase da PA. Ratos Wistar-Kyoto (WKY) e SHR machos receberam ácido ascórbico, 200 mg / kg / dia por sonda orogástrica durante cinco semanas. A PA, a Hipertrofia Ventricular Esquerda (HVE), o Sistema Renina-Angiotensina (SRA), o Peptídeo Natriurético Atrial (ANP) e o EOx foram comparados entre os grupos por pletismografia, estereologia, microscopia confocal de varrimento a laser, microscopia eletrônica de transmissão, western blotting e análise do RT-qPCR. Os SHR tratados com ácido ascórbico reduziram a PA e a HVE. Além disso, as enzimas envolvidas na homeostase da PA, a renina e a Enzima Conversora de Angiotensina (ECA) normalizaram-se, bem como os Receptores tipo 1 de Angiotensina II (AT1). A grande quantidade de grânulos de ANP no grupo SHR foi reduzida pelo tratamento com ácido ascórbico. O balanço oxidativo foi restabelecido nos SHR tratados com este antioxidante. O EOx nos SHR eleva os níveis de renina e de PA. Estas espécies reativas de oxigênio podem ser envolvidas no mecanismo de sinalização para aumentar a expressão de ANP nos miócitos atriais. Estes dados também mostram que o tratamento com o antioxidante (vitamin C) reduz o EOx e normaliza a PA ao menos parcialmente pela redução de taxas de renina.

The effect of vitamins C and E on some of growth factors of cultured Acipenser ruthenus

The effect of vitamins C and E on some of growth factors of cultured Acipenser ruthenus was studied in this thesis. For this purpose diets supplemented with a combination of 100 and 400 mg/kg vitamin C, L-ascorbyl-2-polyphosphate and 100 and 400 mg/kg vitamin E, D-alpha-tocopherol,were each fed to sterlet in 2 replications for 15 weeks. Fifteen fish with average weight of 350.92±14.28 gr were distributed to each of 18 tanks after adaptation with experimental diet. After 5 weeks, there were significant differences in RBC, ESR, HCT and differential counting of white blood cells among the treatments (P<0.05), but there was no significant difference in the amount of WBC among the treatments (P>0.05). After 10 weeks, there were significant differences in the amounts of Monocytes, Lymphocytes and Eosinophils (P<0.05), but there was no significant differences in the amount of other hematologic factors (P>0.05). At the end of the experiment (15th week) only WBC, RBC, Monocyte, lymphocyte and neutrophil showed significant differences between the treatments (P<0.05) and other hematologic factors did not show any significant differences between the treatments (P>0.05). The results of biochemical indices analysis showed significant differences (P<0.05) among treatments for all of the parameters for 5th weeks, total protein and glucose for 10th week and only cholesterol for 15th week. The carcass analysis at the end of experiment showed that only the amount of carbohydrate, protein and ash were significantly difference between the treatments (P<0.05). The results of growth parameters at the end of 3th, 9th, 12th and 15th week showed significant differences between the treatments (P<0.05), but at the end of 6th week only GR was significantly different between the treatments (P<0.05). After concerning acute stress test including reduce water volume, cutting the aeration for 30 minutes at the end of experiment, cortisol and glucose significantly increased (P<0.05) compared with prestress period, but the lowest response to the stressor was observed in fish fed by E400 C 400 mg/kg. On the other hand the survival was 100% during the experiment and no mortality was occurred during this period. Results of this study indicate that Vitamins C and E can have remarkable effects on hematological, biochemical and growth indices in different growth periods. So regarding the effects of vitamin C and E on some growth indices, it seems that the diet containing E400 C 100 mg/kg can be considered as the optimum diet in the rearing condition for this weigth range of fish.

Effect of dietary supplementation of vitamins A, D-3, E, and C on yearling rice field eel, Monopterus albus: Serum indices, gonad development, and metabolism of calcium and phosphorus

The objective of this study was to determine the effect of dietary vitamins A, D-3, E, and C on the gonad development, lipid peroxidation, and immune response of yearling rice field eel, Monopterus albus. A 6-wk feeding trial was designed according to an L-16(4(5)) orthogonal design, in which four vitamins, each at four supplementation levels, were arranged. Sixteen diets were mixed with the different vitamin levels and randomly assigned to 16 groups of fish. Increasing dietary vitamin E supplementation level significantly (P <= 0.05) increased the gonadosomatic index and lowered the serum content of malondialdehyde of rice field eel. Increasing dietary vitamin A and C levels also showed similar effect, but the differences were not statistically significant. Serum immunoglobulin M content increased significantly (P <= 0.01) as dietary vitamin C supplementation levels increased. The concentrations of calcium in bones showed significant (P <= 0.05) trend with vitamin D-3 and A supplementation levels, but the bone phosphorus content was not affected by the dietary vitamin levels.

UASB反应器处理维生素C生产废水研究

维生素C生产废水有机物浓度高、成分复杂、排放量大，是一种亟待处理的典型工业废水。本研究分别采用实验室规模和中试规模的升流式厌氧颗粒污泥床反应器（UASB）对该制药工业废水的厌氧生物处理工艺进行了较为深入的研究。同时采用两种不依赖于纯培养的分子生物学手段—变性梯度凝胶电泳（DGGE）和扩增核糖体DNA限制性分析（ARDRA）技术揭示了UASB反应器不同运行阶段污泥中微生物群落多样性组成及变化。此外，首次研究了零价铁（Fe0）在厌氧消化过程中对反应器运行及微生物群落结构的影响。 采用城市污水处理厂厌氧消化池絮状污泥和处理啤酒废水的颗粒污泥混合接种，小试中温（35±1℃）UASB反应器在其运行的第65天启动成功。反应器稳定运行阶段，在进水COD浓度为9000mg/L、水力停留时间为12h、容积负荷为13.6 kgCOD/m3.d条件下，其COD去除率稳定在85~90%之间，沼气产率达到4.5 m3/m3.d，沼气甲烷含量平均为72%。中试UASB反应器的接种污泥为厌氧消化污泥，其启动时间相对较长，为90天。在稳定运行期，反应器的进水COD浓度为8000~10000mg/L，水力停留时间和容积负荷分别保持在12~16h和10.6~14.2 kgCOD/m3.d范围，该阶段反应器的平均COD去除率稳定在85%左右，沼气产率平均为5.2m3/m3.d，沼气中甲烷含量为69%。上述结果表明中温UASB工艺用于维生素C生产废水处理是高效、可行的。 与对照反应器相比，添加Fe0的小试UASB反应器的COD去除率和沼气产量分别提高了6.5%和10.2%。同时，磷酸盐平均去除率为79%，比对照提高了64%，目前尚未见类似研究报道。在中试规模的UASB反应器中补充一定量的Fe0可缩短反应器启动时间，促进颗粒污泥的形成，该结果可能具有重要的应用价值。培养试验进一步表明，Fe0可以作为产甲烷菌还原CO2生成甲烷的电子供体。培养实验还表明，当系统中存在硝酸盐（0.40 mM）和硫酸盐（0.26 mM）时，Fe0促产甲烷过程受到一定程度的抑制。 采用细菌通用引物968F/1401R和341F/907R获得的PCR-DGGE指纹图谱均表明UASB反应器不同运行阶段细菌种群结构变化明显。小试和中试稳定期污泥的微生物多样性均高于各自初始接种污泥。产甲烷菌通用引物340F/519R的PCR-DGGE结果显示，虽然接种污泥中产甲烷菌的丰富度系数略低于稳定期，但总体而言，反应器运行期间产甲烷菌的种群组成相对稳定。 通过构建不同处理和不同运行阶段污泥样品的16S rRNA基因文库并对克隆基因进行限制性内切酶消化、测序分析。结果表明，稳定期两个反应器微生物群落结构相似，但与各自接种污泥差异明显。小试UASB反应器接种污泥中细菌的优势菌群分别为变形菌纲的δ亚纲（28.7%）和β亚纲（17.4%），至稳定运行期则演替为革兰氏阳性低GC菌群（21.9%）和变形菌纲的δ亚纲（14.0%）。中试反应器接种污泥Green non-sulfer bacteria（25.9%）和变形菌纲的δ亚纲（16.4%）类群占优势，而稳定期Green non-sulfer bacteria类群（17.9%）、革兰氏阳性低GC菌群（16.2%）和变形菌纲的δ亚纲（15.4%）为优势菌群。 产甲烷菌的优势克隆为SRJ 230、SRJ 26和SRJ 583，前两者分别与Methanosaeta concilii和未培养的Methanobacteria-like克隆Gran7M4的同源性达到97%和98%，后者与Methanomethylovorans. sp同源性为99%。接种污泥中上述类群占总克隆数量的比例较低。小试、中试接种污泥中产甲烷菌分别占7.8%和3.0%，但稳定运行期，该比例明显增加，分别达到21.9%和18.8%。上述结果表明启动期与稳定期污泥产甲烷菌种群组成相对稳定，但各类群数量明显增加。 添加Fe0的UASB反应器稳定运行期污泥中产甲烷菌比例（31.2%）高于对照反应器（24.2%）, 革兰氏阳性低GC类群、变形菌纲的δ亚纲比例差异不明显，而变形菌纲β亚纲（6.0%）和Green non-sulfer bacteria（9.2%）的比例均分别低于对照反应器（13.1%和17.1%）。该结果表明，添加Fe0使反应器内微生物群落多样性发生了显著变化。 此外，在添加Fe0的UASB反应器中检测到特异性的克隆SRJ 341和SRJ 320，两者分别同磷酸盐去除和铁氧化有关的克隆子Orbal D41和Clone195的序列相似性达95%和96%。这两个类群可能分别与磷酸盐去除及铁促产甲烷作用密切相关。这一结果尚未见报道。

离子注入选育维生素C高产菌

维生素C二步发酵混菌生产中，第一步由单菌发酵将D-山梨醇转化为L-山梨糖，第二步由产酸菌氧化葡萄糖酸杆菌与伴生菌巨大牙孢杆菌混菌发酵将L-山梨糖转化为2-酮基-L-古龙酸（维生素C的前体物）.利用离子注入技术，采用N<'+>离子束为诱变源，诱变维生素C二步混菌发酵中的产酸菌氧化葡萄糖酸杆菌.通过建立的维生素C高产菌筛选方法，以2-酮基-L古龙酸为筛选标记，获得一株维生素C高产菌株D14，其与生产用伴生菌巨大牙孢杆菌组成维生素C新混合菌系ND14，平均醇酸转化率比生产用混菌提高3.3个百分点.维生素C高产菌株D14及维生素C新混合菌系ND14生长特性及发酵特性为：维生素C高产菌株D14生长能力明显增强;维生素C新混合菌系D14于种子培养基中稳定期延长8-12小时，总生物量增加;在发酵过程中ND14生长明显快于CK，菌体总生物量增加.利用均匀设计的方法对新混合菌系ND14发酵培养基进行了优化，其结果为：最适玉米浆浓度为1.6%、最适尿素浓度为1.6%、最适MgSO<,4>浓度为0.03%、最适KH<,2>PO<,4>浓度为0.06%.

Nutrition, growth and body composition in infancy

This thesis is presented in two parts. Data for this research is from the Cork BASELINE (Babies after SCOPE, Evaluating Longitudinal Impact using Neurological and Nutritional Endpoints) Birth Cohort Study (n = 2137). In this prospective birth cohort study, pediatric follow-up with in-person appointments were repeated from the time of birth through to 2, 6 and 12 months, and at 2 years. Body composition was measured by air displacement plethysmography at birth and at 2 months using the PEA POD Infant Body Composition Tracking System. This thesis provides the first extensive report on the study’s 2 year assessment. In part one, the aims were to investigate potential early-life risk factors for childhood overweight and obesity, including rapid growth and body composition in infancy and umbilical cord concentrations of leptin and high molecular weight (HMW) adiponectin. This research is the first to describe rapid growth in early infancy in terms of changes in direct measures of body composition. These are also the first data to examine associations between umbilical cord leptin and HMW adiponectin concentrations and changes in fat and lean mass in early infancy. These data provide additional insight into characterising the growth trajectory in infancy and into the role of perinatal factors in determining infant growth and subsequent overweight/obesity risk. In part two of this thesis, the aims were to quantify vitamin D intake and status at 2 years and to investigate whether 25-hydroxyvitamin D [25(OH)D] concentrations in early pregnancy and in umbilical cord blood are associated with infant growth and body composition. There was a low prevalence of vitamin D deficiency among Irish 2 year olds (n = 742) despite a high prevalence of inadequate intakes and high latitude (51°N). Maternal 25(OH)D concentrations at 15 weeks gestation and cord 25(OH)D concentrations at delivery were not associated with infant growth or adiposity.

Vitamins C and E for prevention of pre-eclampsia in women with type 1 diabetes (DAPIT): a randomised placebo-controlled trial.

Background
Results of several trials of antioxidant use during pregnancy have not shown a reduction in pre-eclampsia, but the eff ect in women with diabetes is unknown. We aimed to assess whether supplementation with vitamins C and E reduced incidence of pre-eclampsia in women with type 1 diabetes.

Methods
We enrolled women from 25 UK antenatal metabolic clinics in a multicentre randomised placebo-controlled trial. Eligibility criteria were type 1 diabetes preceding pregnancy, presentation between 8 weeks’ and 22 weeks’ gestation, singleton pregnancy, and age 16 years or older. Women were randomly allocated in a 1:1 ratio to receive1000 mg vitamin C and 400 IU vitamin E (a-tocopherol) or matched placebo daily until delivery. The randomisation sequence was stratifi ed by centre with balanced blocks of eight patients. All trial personnel and participants were masked to treatment allocation. The primary endpoint was pre-eclampsia, which we defi ned as gestational hypertension with proteinuria. Analysis was by modifi ed intention to treat. This study is registered, ISRCTN27214045.

Findings
Between April, 2003, and June, 2008, 762 women were randomly allocated to treatment groups (379 vitamin supplementation, 383 placebo). The primary endpoint was assessed for 375 women allocated to receive vitamins, and 374 allocated to placebo. Rates of pre-eclampsia did not differ between vitamin (15%, n=57) and placebo (19%, 70)groups (risk ratio 0·81, 95% CI 0·59–1·12). No adverse maternal or neonatal outcomes were reported.

Interpretation
Supplementation with vitamins C and E did not reduce risk of pre-eclampsia in women with type 1 diabetes. However, the possibility that vitamin supplementation might be benefi cial in women with a low antioxidant status at baseline needs further testing.