In this thesis, the role of migraine as a cardiovascular risk factor is investigated in different populations with a varying medical history, including stroke and polycystic ovary syndrome (PCOS).... Show moreIn this thesis, the role of migraine as a cardiovascular risk factor is investigated in different populations with a varying medical history, including stroke and polycystic ovary syndrome (PCOS). We focused primarily on women and sex-specific features, exploring both conventional and novel measures for vascular health. This thesis was written in the context of the CREW consortium. The aim of the CREW consortium, a cooperation of major medical centers in the Netherlands and commissioned by the Dutch Heart Institute, was to study female-specific cardiovascular pathophysiology. The CREW-MIST (Cardiovascular Riskprofile in Women – MIcrovascular STatus) project, which was part of this consortium, focused on migraine in relation to stroke in women. Female-specific factors such as sex hormone- and pregnancy-related disorders were included in our studies and we explored microvascular health through heart- and brain imaging and functional measurements of the vasculature. Show less
Over the past decades increasing efforts have aimed to improve the health of pregnant women around the world. Namibia has made limited progress in reducing severe maternal outcomes. Aims of this... Show moreOver the past decades increasing efforts have aimed to improve the health of pregnant women around the world. Namibia has made limited progress in reducing severe maternal outcomes. Aims of this thesis were to enhance implementation of a national obstetric surveillance system and assess requirements to improve maternal health in Namibia. The findings of chapters 2-7 provided insight into several important drivers of severe maternal outcome. The most important contributor of the high-incidence of severe maternal outcome in Namibia was poor quality of facility-based care and particularly vulnerable women appeared to be at higher risk of severe maternal outcome. Obstetric surveillance played a crucial role in obtaining these insights. Based on these, targeted recommendations could be formulated. The maternity care system needs to be strengthened, to enable health workers to provide universal coverage of good health care to all women in Namibia. It is therefore crucial the next step will follow, which is to act on the proposed recommendations. The insights obtained through obstetric surveillance will contribute to such action, as for any intervention, it is key it addresses a local need in a context-specific manner. Show less
The power of personalized nutrition lies in being able to conduct clinical research on healthy people while capturing metabolic markers sensitive to the impact of environmental and metabolic... Show moreThe power of personalized nutrition lies in being able to conduct clinical research on healthy people while capturing metabolic markers sensitive to the impact of environmental and metabolic stressors (e.g. diet, changing sex hormones and the menstrual cycle). Using clinical biomarkers, metabolomics, and diet interventions with intake analyses, we demonstrated the metabolic impact of vegan and animal diet interventions using fasting plasma analysis after 48 hours and using postprandial plasma analysis after meals and snacks. Sexually dimorphic responses were differentiated using proteomics and pathway analyses in two larger, sex-balanced cohorts. Finally, clinical biomarker and metabolomics analyses identified metabolic subtypes across menstrual cycle phases. Although challenges with integrating –omics technology and nutrition remain, the fundamental information generated from these research studies may provide a foundation for future novel personalized nutrition strategies. Show less
