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Kedir S, Abate KH, Mohammed B, Abafita J, Ademe BW. Impact of weekly iron-folic acid supplementation on nutritional status and parasitic reinfection among school-age children and adolescents in Sub-Saharan Africa: a systematic review and meta-analysis. Front Pediatr 2024; 12:1366540. [PMID: 38952434 PMCID: PMC11215082 DOI: 10.3389/fped.2024.1366540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Accepted: 05/28/2024] [Indexed: 07/03/2024] Open
Abstract
Background Two significant etiological factors contributing to iron deficiency anemia, and undernutrition posing substantial public health challenges in Sub-Saharan Africa, are soil-transmitted helminths and malaria. This study carried out the effect of weekly iron-folic acid supplementation (WIFAS) on the nutrition and general health of school-age children and adolescents in Sub-Saharan Africa, a systematic review and meta-analysis have been conducted. Methods To find pertinent publications for this study, a thorough search was carried out on May 20, 2023, across five databases: Pubmed (MEDLINE), Web of Science, Scopus, Cochrane Library, and Google Scholar. In addition, a search was conducted on August 23, 2023, to capture any new records. The inclusion criteria for the studies were based on school-age children and adolescent populations, randomized controlled trials, and investigations into the effects of WIFAS. The outcomes of interest were measured through anthropometric changes, malaria, and helminthic reinfection. Results A systematic review of 11 articles revealed that WIFAS significantly decreased the risk of schistosomiasis reinfection by 21% among adolescents (risk ratio = 0.79, 95%CI: 0.66, 0.97; heterogeneity I 2 = 0.00%, P = 0.02). However, no significant impact was observed on the risk of malaria reinfection (risk ratio = 1.02, 95%CI: 0.92, 1.13; heterogeneity I 2 = 0.00%, P = 0.67) or A. Lumbricoides reinfection (risk ratio = 0.95, 95%CI: 0.75, 1.19; heterogeneity I 2 = 0.00%, P = 0.65). Moreover, the analysis demonstrated that there is no significant effect of iron-folic acid supplementation in measured height and height for age Z-score (HAZ) of the school-age children (Hedge's g -0.05, 95%CI: -0.3, 0.2; test for heterogeneity I 2 = 0.00%, P = 0.7) and (Hedge's g 0.12, 95%CI: -0.13, 0.37; test for heterogeneity I 2 = 0.00%, P = 0.36) respectively. Conclusion The effectiveness of WIFAS in reducing the risk of schistosomiasis reinfection in adolescents has been demonstrated to be greater than that of a placebo or no intervention. Additionally, the narrative synthesis of iron-folic acid supplementation has emerged as a potential public health intervention for promoting weight change. However, there was no significant association between WIFAS and Ascariasis, trichuriasis, and hookworm. Moreover, the certainty of the evidence for the effects of WIFAS on height and malaria is low and therefore inconclusive. Whereas, the certainty of the evidence for the effectiveness of WIFAS on Schistosomiasis is moderate. Even though the mechanisms need further research WIFAS may be implemented as part of a comprehensive public health strategy to address schistosomiasis in adolescents. Systematic Review Registration https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023397898, PROSPERO (CRD42023397898).
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Affiliation(s)
- Shemsu Kedir
- Department of Nutrition and Dietetics, Institute of Health, Jimma University, Jimma, Ethiopia
- Department of Public Health, College of Medicine and Health Science, Werabe University, Werabe, Ethiopia
| | - Kalkidan Hassen Abate
- Department of Nutrition and Dietetics, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Bekri Mohammed
- Department of Nutrition and Dietetics, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Jemal Abafita
- Department of Economics, Jimma University, Jimma, Ethiopia
| | - Beyene Wondafrash Ademe
- Department of Nutrition and Dietetics, Institute of Health, Jimma University, Jimma, Ethiopia
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Malan L, Zandberg L, Pienaar C, Nienaber A, Havemann-Nel L. Regular moderate physical activity potentially accelerates and strengthens both the pro-inflammatory and pro-resolving lipid mediator response after acute exercise stress. Prostaglandins Leukot Essent Fatty Acids 2024; 202:102642. [PMID: 39216411 DOI: 10.1016/j.plefa.2024.102642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 07/19/2024] [Accepted: 08/22/2024] [Indexed: 09/04/2024]
Abstract
The PUFA-derived lipid mediator response shifts from pro-inflammatory to inflammation resolution over time and may be modified by regular moderate exercise. This pre-post-test study aimed to compare the expression of PTGES2 (COX2) and ALOX15 in leucocytes and the plasma 5- and 15-HETE, 18-HEPE and 17-HDHA responses after unaccustomed resistance exercise between 18-35-year-old male recreational runners (n = 18) and less-active controls (n = 15). One repetition maximum (1RM) was determined for squats, 45° leg presses and leg extensions. Subsequently three sets of 8-10 repetitions were performed at 80 % 1RM and blood collected over 72 hours. PTGES2 and ALOX15 expression changed over time in runners (P = 0.016, P = 0.007) but not controls (P = 0.631, P = 0.539). 5- and 15-HETE changed over time in runners (P < 0.001, P = 0.022), but not controls (P = 0.457, P = 0.985). 18-HEPE changed in runners and controls (P < 0.001, P = 0.024), 17-HDHA changed borderline in runners (P = 0.076). In conclusion, pro-inflammatory and inflammation-resolving lipid mediators may respond sooner and more robust in recreational runners than less-active controls after strenuous resistance exercise.
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Affiliation(s)
- Linda Malan
- Center of Excellence for Nutrition, North-West University, Potchefstroom, South Africa.
| | - Lizelle Zandberg
- Center of Excellence for Nutrition, North-West University, Potchefstroom, South Africa
| | - Cindy Pienaar
- Physical Activity, Sport and Recreation Research Focus Area (PhASRec), Faculty of Health Sciences, North-West University, Potchefstroom, South Africa; Department of Sport Studies, Faculty of Applied Sciences, Durban University of Technology, South Africa
| | - Arista Nienaber
- Center of Excellence for Nutrition, North-West University, Potchefstroom, South Africa
| | - Lize Havemann-Nel
- Center of Excellence for Nutrition, North-West University, Potchefstroom, South Africa
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Elliott SD, Vickers ML, McKeon G, Eriksson L, Malacova E, Scott JG. Iron Supplementation in Management of Neurodevelopmental Disorders: Systematic Review, Meta-Analysis, and Qualitative Synthesis. J Neuropsychiatry Clin Neurosci 2024; 36:178-186. [PMID: 38343311 DOI: 10.1176/appi.neuropsych.20230081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/12/2024]
Abstract
OBJECTIVE The authors sought to explore the role of iron supplementation in the management of neurodevelopmental disorders among children and youths. METHODS A systematic review in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was undertaken. A subset of results was suitable for meta-analysis. The quality of the evidence and strength of the clinical recommendations were assessed by using the Grading of Recommendations, Assessment, Development, and Evaluation method, and critical appraisal was conducted with the Joanna Briggs Institute critical appraisal tools. RESULTS Nine articles met inclusion criteria. These articles included studies of attention-deficit hyperactivity disorder (ADHD) (N=7), autism spectrum disorder (N=1), and Tourette's syndrome (N=1). Three randomized controlled trials evaluating iron supplementation for ADHD hyperactivity symptom severity (124 participants: placebo, N=56; supplement, N=68) met inclusion criteria for a meta-analysis. Effect sizes for the placebo and supplement groups were moderate (Cohen's d=0.76) and large (Cohen's d=1.70), respectively, although these differences were not significant. The impact of iron supplementation on inattentive ADHD symptom severity was examined in two trials (75 participants: placebo, N=31; supplement, N=44). Large, nonsignificant effect sizes were demonstrated for the placebo (Cohen's d=1.66) and supplementation (Cohen's d=3.19) groups. The quality of the evidence and strength of the clinical recommendations were considered very low. CONCLUSIONS Further research is needed to examine the role of iron supplementation in the management of ADHD and neurodevelopmental disorders more generally. Additionally, iron supplementation comes with risks, including death in the case of overdose.
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Affiliation(s)
- Stephen D Elliott
- Metro North Mental Health Service, Herston, Australia (Elliott, Vickers); Faculty of Medicine, University of Glasgow, Glasgow, United Kingdom (Elliott); Faculty of Medicine (Vickers), Child Health Research Center (McKeon, Scott), and Herston Health Sciences Library (Eriksson), University of Queensland, Brisbane, Australia; Faculty of Health, Queensland University of Technology, Brisbane, Australia (Vickers); West Moreton Health Psychology, Park Center for Mental Health, Brisbane, Australia (McKeon); Child and Youth Mental Health Group, Queensland Center for Mental Health Research, Brisbane, Australia (McKeon, Scott); Queensland Institute of Medical Research Berghofer Medical Research Institute, Brisbane, Australia (Malacova, Scott); Child and Youth Mental Health Service, Children's Health Queensland Hospital and Health Service, Brisbane, Australia (Scott)
| | - Mark L Vickers
- Metro North Mental Health Service, Herston, Australia (Elliott, Vickers); Faculty of Medicine, University of Glasgow, Glasgow, United Kingdom (Elliott); Faculty of Medicine (Vickers), Child Health Research Center (McKeon, Scott), and Herston Health Sciences Library (Eriksson), University of Queensland, Brisbane, Australia; Faculty of Health, Queensland University of Technology, Brisbane, Australia (Vickers); West Moreton Health Psychology, Park Center for Mental Health, Brisbane, Australia (McKeon); Child and Youth Mental Health Group, Queensland Center for Mental Health Research, Brisbane, Australia (McKeon, Scott); Queensland Institute of Medical Research Berghofer Medical Research Institute, Brisbane, Australia (Malacova, Scott); Child and Youth Mental Health Service, Children's Health Queensland Hospital and Health Service, Brisbane, Australia (Scott)
| | - Gemma McKeon
- Metro North Mental Health Service, Herston, Australia (Elliott, Vickers); Faculty of Medicine, University of Glasgow, Glasgow, United Kingdom (Elliott); Faculty of Medicine (Vickers), Child Health Research Center (McKeon, Scott), and Herston Health Sciences Library (Eriksson), University of Queensland, Brisbane, Australia; Faculty of Health, Queensland University of Technology, Brisbane, Australia (Vickers); West Moreton Health Psychology, Park Center for Mental Health, Brisbane, Australia (McKeon); Child and Youth Mental Health Group, Queensland Center for Mental Health Research, Brisbane, Australia (McKeon, Scott); Queensland Institute of Medical Research Berghofer Medical Research Institute, Brisbane, Australia (Malacova, Scott); Child and Youth Mental Health Service, Children's Health Queensland Hospital and Health Service, Brisbane, Australia (Scott)
| | - Lars Eriksson
- Metro North Mental Health Service, Herston, Australia (Elliott, Vickers); Faculty of Medicine, University of Glasgow, Glasgow, United Kingdom (Elliott); Faculty of Medicine (Vickers), Child Health Research Center (McKeon, Scott), and Herston Health Sciences Library (Eriksson), University of Queensland, Brisbane, Australia; Faculty of Health, Queensland University of Technology, Brisbane, Australia (Vickers); West Moreton Health Psychology, Park Center for Mental Health, Brisbane, Australia (McKeon); Child and Youth Mental Health Group, Queensland Center for Mental Health Research, Brisbane, Australia (McKeon, Scott); Queensland Institute of Medical Research Berghofer Medical Research Institute, Brisbane, Australia (Malacova, Scott); Child and Youth Mental Health Service, Children's Health Queensland Hospital and Health Service, Brisbane, Australia (Scott)
| | - Eva Malacova
- Metro North Mental Health Service, Herston, Australia (Elliott, Vickers); Faculty of Medicine, University of Glasgow, Glasgow, United Kingdom (Elliott); Faculty of Medicine (Vickers), Child Health Research Center (McKeon, Scott), and Herston Health Sciences Library (Eriksson), University of Queensland, Brisbane, Australia; Faculty of Health, Queensland University of Technology, Brisbane, Australia (Vickers); West Moreton Health Psychology, Park Center for Mental Health, Brisbane, Australia (McKeon); Child and Youth Mental Health Group, Queensland Center for Mental Health Research, Brisbane, Australia (McKeon, Scott); Queensland Institute of Medical Research Berghofer Medical Research Institute, Brisbane, Australia (Malacova, Scott); Child and Youth Mental Health Service, Children's Health Queensland Hospital and Health Service, Brisbane, Australia (Scott)
| | - James G Scott
- Metro North Mental Health Service, Herston, Australia (Elliott, Vickers); Faculty of Medicine, University of Glasgow, Glasgow, United Kingdom (Elliott); Faculty of Medicine (Vickers), Child Health Research Center (McKeon, Scott), and Herston Health Sciences Library (Eriksson), University of Queensland, Brisbane, Australia; Faculty of Health, Queensland University of Technology, Brisbane, Australia (Vickers); West Moreton Health Psychology, Park Center for Mental Health, Brisbane, Australia (McKeon); Child and Youth Mental Health Group, Queensland Center for Mental Health Research, Brisbane, Australia (McKeon, Scott); Queensland Institute of Medical Research Berghofer Medical Research Institute, Brisbane, Australia (Malacova, Scott); Child and Youth Mental Health Service, Children's Health Queensland Hospital and Health Service, Brisbane, Australia (Scott)
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Gutema BT, Levecke B, Sorrie MB, Megersa ND, Zewdie TH, Yesera GE, De Henauw S, Abubakar A, Abbeddou S. Effectiveness of intermittent iron and high-dose vitamin A supplementation on cognitive development of school children in southern Ethiopia: a randomized placebo-controlled trial. Am J Clin Nutr 2024; 119:470-484. [PMID: 37952928 DOI: 10.1016/j.ajcnut.2023.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 11/01/2023] [Accepted: 11/06/2023] [Indexed: 11/14/2023] Open
Abstract
BACKGROUND Iron is an essential mineral whose deficiency results in cognitive alteration, impaired emotional behaviors, and altered myelination and neurotransmission. In animal models, it has been shown that vitamin A (VA) could affect cognition. OBJECTIVES The study aimed to evaluate the effectiveness of intermittent iron and VA supplementation on cognitive development of schoolchildren, and to assess the interaction between these supplementations. METHODS Considering a 2 × 2 factorial design, 504 children were randomly assigned to 1 of the 4 arms: placebo VA and placebo iron supplement; high-dose vitamin VA and placebo iron supplement; iron supplement and placebo VA; and iron and high-dose vitamin VA supplements. Cognitive development was assessed using Raven's Coloured Progressive Matrices, digit span, Tower of London, and visual search tasks. RESULTS The mean [± standard deviation (SD)] age of the enrolled children was 9.6 (±1.6) y. One-fifth of the children had iron deficiency or anemia, whereas 2.9%, 3.9%, and 12.1% of children had low iron stores, iron deficiency anemia, and VA deficiency, respectively. Intermittent iron supplementation did not result in any significant improvement of children's cognitive development and had a negative effect on the performance index of the visual search task compared with placebo (-0.17 SD, 95% confidence interval: -0.32, -0.02). Effects were evident among children with stunting, thinness, or children coming from understimulating home environments. High-dose VA supplementation resulted in a significant improvement of digit span z-score with a mean difference of 0.30 SD (95% confidence interval: 0.14, 0.46) compared with placebo VA. VA had a more beneficial impact for girls, children infected with helminths, and those from food secure households. CONCLUSION In a population where the prevalence of iron deficiency is low, intermittent iron supplementation did not have any or negative effect on the child's cognitive development outcomes. Conversely, VA supplementation improved the child's working memory. TRIAL REGISTRATION NUMBER The study is registered at clinicaltrials.gov as NCT04137354 (https://clinicaltrials.gov/study/NCT04137354).
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Affiliation(s)
- Befikadu Tariku Gutema
- School of Public Health, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia; Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
| | - Bruno Levecke
- Department of Translational Physiology, Infectiology and Public Health, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Muluken Bekele Sorrie
- School of Public Health, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia; Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Nega Degefa Megersa
- School of Nursing, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Tadiwos Hailu Zewdie
- School of Medicine, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Gesila Endashaw Yesera
- School of Nursing, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Stefaan De Henauw
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Amina Abubakar
- Kenya Medical Research Institute (KMRI)-Wellcome Trust Research Programme, Centre for Geographic Medicine Research (Coast), Kenya Medical Research Institute, Kilifi, Kenya
| | - Souheila Abbeddou
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
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Bjørklund G, Semenova Y, Hangan T, Pen JJ, Aaseth J, Peana M. Perspectives on Iron Deficiency as a Cause of Human Disease in Global Public Health. Curr Med Chem 2024; 31:1428-1440. [PMID: 38572614 DOI: 10.2174/0929867330666230324154606] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 11/23/2022] [Accepted: 12/13/2022] [Indexed: 04/05/2024]
Abstract
Iron (Fe) is a necessary trace element in numerous pathways of human metabolism. Therefore, Fe deficiency is capable of causing multiple health problems. Apart from the well-known microcytic anemia, lack of Fe can cause severe psychomotor disorders in children, pregnant women, and adults in general. Iron deficiency is a global health issue, mainly caused by dietary deficiency but aggravated by inflammatory conditions. The challenges related to this deficiency need to be addressed on national and international levels. This review aims to summarize briefly the disease burden caused by Fe deficiency in the context of global public health and aspires to offer some hands-on guidelines.
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Affiliation(s)
- Geir Bjørklund
- Department of Research, Council for Nutritional and Environmental Medicine (CONEM), Mo i Rana, Norway
| | - Yuliya Semenova
- Department of Surgery, Nazarbayev University School of Medicine, Astana, Kazakhstan
| | - Tony Hangan
- Faculty of Medicine, Ovidius University of Constanta, Constanta, Romania
| | - Joeri J Pen
- Department of Nutrition, UZ Brussel, Vrije Universiteit Brussel (VUB), Brussels, Belgium
- Diabetes Clinic, Department of Internal Medicine, UZ Brussel, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Jan Aaseth
- Research Department, Innlandet Hospital, Brumunddal, Norway
- Inland Norway University of Applied Sciences, Elverum, Norway
| | - Massimiliano Peana
- Department of Chemical, Physical, Mathematical and Natural Sciences, University of Sassari, Sassari, Italy
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Kruger HS, Visser M, Malan L, Zandberg L, Wicks M, Ricci C, Faber M. Anthropometric nutritional status of children (0-18 years) in South Africa 1997-2022: a systematic review and meta-analysis. Public Health Nutr 2023; 26:2226-2242. [PMID: 37800336 DOI: 10.1017/s1368980023001994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/07/2023]
Abstract
OBJECTIVE To conduct a comprehensive systematic review and meta-analysis of the available literature on the anthropometric nutritional status of South African infants and children, 0-18 years old and to report on trends of changes in nutritional status over the period 1997-2022. DESIGN Systematic review and meta-analysis. SETTING Review of the available literature on the anthropometric nutritional status of South African infants and children, 0-18 years old, over the period 1997-2022. PARTICIPANTS South African infants and children, 0-18 years old. RESULTS Only quantitative data from ninety-five publications that described the nutritional status in terms of anthropometry were included. Most recent studies applied the WHO 2006 and 2007 definitions for malnutrition among children 0-5 years old and 5-19 years old, respectively. Meta-analysis of all prevalence data shows the highest stunting prevalence of 25·1 % among infants and preschool children, compared to 11·3 % among primary school-age children and 9·6 % among adolescents. Furthermore, the overweight and obesity prevalence was similar among children younger than 6 years and adolescents (19 %), compared to 12·5 % among primary school-age children. In national surveys, adolescent overweight prevalence increased from 16·9 % in 2002 to 23·1 % in 2011. Meta-regression analysis shows a decrease in stunting among children 6-18 years old and an increase in combined overweight and obesity in the 10-19 years age group. CONCLUSION The double burden of malnutrition remains evident in South Africa with stunting and overweight/obesity the most prevalent forms of malnutrition among children.
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Affiliation(s)
- Herculina Salome Kruger
- Centre of Excellence for Nutrition, North-West University, Potchefstroom, 2520South Africa
- Medical Research Council Unit for Hypertension and Cardiovascular Disease, North-West University, South Africa
| | - Marina Visser
- Centre of Excellence for Nutrition, North-West University, Potchefstroom, 2520South Africa
| | - Linda Malan
- Centre of Excellence for Nutrition, North-West University, Potchefstroom, 2520South Africa
| | - Lizelle Zandberg
- Centre of Excellence for Nutrition, North-West University, Potchefstroom, 2520South Africa
| | - Mariaan Wicks
- Centre of Excellence for Nutrition, North-West University, Potchefstroom, 2520South Africa
| | - Cristian Ricci
- Africa Unit for Transdisciplinary Health Research, North-West University, Potchefstroom, South Africa
| | - Mieke Faber
- Centre of Excellence for Nutrition, North-West University, Potchefstroom, 2520South Africa
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa
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Sherzai D, Moness R, Sherzai S, Sherzai A. A Systematic Review of Omega-3 Fatty Acid Consumption and Cognitive Outcomes in Neurodevelopment. Am J Lifestyle Med 2023; 17:649-685. [PMID: 37711355 PMCID: PMC10498982 DOI: 10.1177/15598276221116052] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/16/2023] Open
Abstract
INTRODUCTION This systematic review addresses the effects of n-3 long-chain polyunsaturated fatty acids consumption on human neurodevelopment. It evaluates articles published between 2000 and 2022 investigating the cognitive outcomes during the period of neurodevelopment: from fetal development to adolescence. For the purpose of this review the terms LC PUFA and omega-3 fatty acid will be used interchangeably. METHOD Data were sourced from several major databases including PubMed (MEDLINE), Web of Science, and ProQuest Central. Randomized controlled trials (RCTs), nonrandomized controlled trials, prospective or retrospective cohort studies, and observational studies investigating the effects of omega-3 fatty acid consumption from dietary supplements, multiple-nutrient supplement, or food questionnaire on neurodevelopment were considered. Study population was separated in three developmental phases: (1) in-utero, (2) lactation/infancy, and (3) childhood/adolescence. Each article was evaluated for several key factors such as study type, type/dosage of PUFAs, number of subjects, length of intervention, participant age range, population characteristics, outcome measure (both primary/cognitive and secondary/other), results, conclusion, and confounding variables/limitations. RESULTS A total of 88 articles were included in the review, 69 RCTs and 19 longitudinal or observational studies. The results indicate equivocal effect of intervention, with some short-term benefits observed in the areas of visual attention, working memory, executive function, and communication. Omega-3 supplement might have a short-term positive impact on neurodevelopment in all three phases. Supplementation is recommended throughout life, rather than only during the earliest developmental stage.
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Affiliation(s)
- Dean Sherzai
- Dept of Neurology, Brain Health and Alzheimer's Prevention Program, Loma Linda University, Loma Linda, CA, USA (AS, DS); Oak Ridge High School, El Dorado Hills, CA, USA (RM); California State University, Los Angeles, CA, USA (SS)
| | - Roman Moness
- Dept of Neurology, Brain Health and Alzheimer's Prevention Program, Loma Linda University, Loma Linda, CA, USA (AS, DS); Oak Ridge High School, El Dorado Hills, CA, USA (RM); California State University, Los Angeles, CA, USA (SS)
| | - Sophia Sherzai
- Dept of Neurology, Brain Health and Alzheimer's Prevention Program, Loma Linda University, Loma Linda, CA, USA (AS, DS); Oak Ridge High School, El Dorado Hills, CA, USA (RM); California State University, Los Angeles, CA, USA (SS)
| | - Ayesha Sherzai
- Dept of Neurology, Brain Health and Alzheimer's Prevention Program, Loma Linda University, Loma Linda, CA, USA (AS, DS); Oak Ridge High School, El Dorado Hills, CA, USA (RM); California State University, Los Angeles, CA, USA (SS)
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Gutema BT, Sorrie MB, Megersa ND, Yesera GE, Yeshitila YG, Pauwels NS, De Henauw S, Abbeddou S. Effects of iron supplementation on cognitive development in school-age children: Systematic review and meta-analysis. PLoS One 2023; 18:e0287703. [PMID: 37368919 DOI: 10.1371/journal.pone.0287703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 06/09/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND Iron deficiency is negatively associated with children's cognitive development. Evidence showed that iron supplementation improves cognitive development. Nearly 50% of anemia is caused by iron deficiency. Anemia affects more school-age children, at an age where their brain development continues. The aim of this systematic review and meta-analysis is to review the evidence from published randomized controlled trials to evaluate the effects of iron supplementation on cognitive development and function among school-age children. METHOD Five databases including MEDLINE, EMBASE, Scopus, Web of Science and CENTRAL were used to search for articles on April 20th, 2021. The search was reconducted on October 13th, 2022 to retrieve new records. Studies were eligible if they included school children 6-12 years of age, were randomized controlled trials, and if they tested iron supplementation and measured cognitive development. RESULT Thirteen articles were included in the systematic review. Overall, iron supplementation significantly improved intelligence (standardized mean difference, 95% confidence interval) (SMD 0.46, 95%CI: 0.19, 0.73, P<0.001), attention and concentration (SMD 0.44, 95%CI: 0.07, 0.81, P = 0.02) and memory (SMD 0.44, 95%CI: 0.21, 0.67, P <0.001) of school-age children. There was no significant effect of iron supplementation on school achievement of school-age children (SMD 0.06, 95%CI: -0.15, 0.26, P = 0.56). In a subgroup analysis, iron-supplemented children who were anemic at baseline had had better outcomes of intelligence (SMD 0.79, 95%CI: 0.41, 1.16, P = 0.001) and memory (SMD 0.47, 95%CI: 0.13, 0.81; P = 0.006). CONCLUSION Iron supplementation has a significant positive effect on the intelligence, attention and concentration, and the memory of school-age children but there was no evidence on the effect of iron supplementation on their school achievement.
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Affiliation(s)
- Befikadu Tariku Gutema
- School of Public Health, Arba Minch University, Arba Minch, Ethiopia
- Public Health Nutrition Unit, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | | | | | | | | | - Nele S Pauwels
- Knowledge Centre for Health Ghent, Ghent University Hospital, Ghent, Belgium
| | - Stefaan De Henauw
- Public Health Nutrition Unit, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Souheila Abbeddou
- Public Health Nutrition Unit, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
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Osuna E, Symington EA, Malan L, Ricci C, Zandberg L, Smuts CM, Baumgartner J. Higher n-3 polyunsaturated fatty acid status during early pregnancy is associated with lower risk for depression at 12 months postpartum: The NuPED study. Prostaglandins Leukot Essent Fatty Acids 2023; 190:102528. [PMID: 36716632 DOI: 10.1016/j.plefa.2022.102528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 11/30/2022] [Accepted: 12/23/2022] [Indexed: 01/15/2023]
Abstract
Perinatal depression can negatively affect the health of the mother and her offspring. N-3 polyunsaturated fatty acids (PUFA) may play a role in the aetiology of depression. Therefore, we investigated the association of n-3 PUFA status during early pregnancy with perinatal depression among women living in urban Johannesburg, South Africa. For this prospective analysis, we analysed red blood cell (RBC) total phospholipid fatty acid (FA) composition (% of total FA) of 242 pregnant women at <18 weeks' gestation. We used the Edinburgh Postnatal Depression Scale (EPDS) to identify women at risk for depression (EPDS score ≥9) at <18, 22 and 36 weeks' gestation, and at 6 and 12 months postpartum. RBC EPA status was negatively (β=-0.22, p<0.05), and the AA/EPA ratio positively (β=0.24, p<0.05) associated with EPDS scores at 12 months postpartum. Higher RBC DHA and n-3 index were further associated with lower odds (OR=0.56 [95% CI: 0.32-0.91]; OR=0.63 [95% CI: 0.39-0.94]), while higher n-6/n-3 PUFA and AA/EPA ratios early in pregnancy were associated with higher odds for depression at 12 months postpartum ((OR=2.34 [95% CI: 1.12-4.97]; OR=1.02 [95% CI: 1.00-1.05]). Our results suggest that women with a higher RBC n-3 PUFA status during early pregnancy may be at lower risk for depression at 12 months postpartum.
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Affiliation(s)
- Ester Osuna
- Laboratory of Human Nutrition, Institute of Food, Nutrition and Health, ETH Zurich, Switzerland
| | - Elizabeth A Symington
- Department of Life and Consumer Sciences, University of South Africa, Johannesburg, South Africa
| | - Linda Malan
- Centre of Excellence for Nutrition, North-West University, Potchefstroom, South Africa
| | - Cristian Ricci
- Africa Unit for Transdisciplinary Health Research (AUTHER), North-West University, Potchefstroom, South Africa
| | - Lizelle Zandberg
- Centre of Excellence for Nutrition, North-West University, Potchefstroom, South Africa
| | - Cornelius M Smuts
- Centre of Excellence for Nutrition, North-West University, Potchefstroom, South Africa
| | - Jeannine Baumgartner
- Laboratory of Human Nutrition, Institute of Food, Nutrition and Health, ETH Zurich, Switzerland; Centre of Excellence for Nutrition, North-West University, Potchefstroom, South Africa; Department of Nutritional Sciences, King's College London, London, United Kingdom.
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10
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Chen Z, Yang H, Wang D, Sudfeld CR, Zhao A, Xin Y, Chen JC, Fawzi WW, Xing Y, Li Z. Effect of Oral Iron Supplementation on Cognitive Function among Children and Adolescents in Low- and Middle-Income Countries: A Systematic Review and Meta-Analysis. Nutrients 2022; 14:5332. [PMID: 36558491 PMCID: PMC9783508 DOI: 10.3390/nu14245332] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 12/07/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND There is abundant evidence showing that iron deficiency is closely linked with delayed brain development, worse school performance, and behavioral abnormalities. However, evidence on the impact of iron supplementation among children and adolescents in low- and middle-income countries (LMICs) has been inconsistent. This study aims to examine the effect of oral iron supplementation on cognitive function among children and adolescents in LMICs. METHODS A systematic review and meta-analysis was conducted to examine the impact of iron supplementation on cognitive function (including intelligence, attention, short-term memory, long-term memory, and school performance) among children and adolescents aged 5 to 19. We searched PubMed, Embase, Web of Science, CINAHL, and references of related articles published from the inception of the databases to 1 May 2022. Random-effects pooled standardized mean difference (SMD) with 95% confidence intervals (CIs) were calculated to estimate the effect of iron supplementation on cognitive function. We also investigated the heterogeneity of the effects using subgroup and meta-regression analyses. This review was registered with PROSPERO (CRD42020179064). RESULTS Nine studies with 1196 individual participants from five countries were identified and included. Iron had a positive impact on intelligence test scores among children and adolescents (SMD = 0.47, 95% confidence interval [CI]: 0.10, 0.83). Meta-regression showed that the intelligence test scores improved with increasing the iron supplement dose (odds ratio [CI] = 1.02, 95% CI: 1.00, 1.04). There were no significant effects on attention, short-term memory, long-term memory, or school performance. CONCLUSIONS Oral iron intake can improve the intelligence test scores of children and adolescents in LMICs and should be considered for future nutritional interventions.
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Affiliation(s)
- Zekun Chen
- Vanke School of Public Health, Tsinghua University, Beijing 100084, China
| | - Huanhuan Yang
- Vanke School of Public Health, Tsinghua University, Beijing 100084, China
| | - Dongqing Wang
- Department of Global Health and Population, Department of Nutrition, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA 02115, USA
| | - Christopher R. Sudfeld
- Department of Global Health and Population, Department of Nutrition, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA 02115, USA
| | - Ai Zhao
- Vanke School of Public Health, Tsinghua University, Beijing 100084, China
| | - Yiqian Xin
- Duke Global Health Institute, Duke University, Durham, NC 27705, USA
| | - Jiawen Carmen Chen
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA 90089, USA
| | - Wafaie W. Fawzi
- Department of Global Health and Population, Department of Nutrition, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA 02115, USA
| | - Yan Xing
- Department of Pediatrics, Peking University Third Hospital, Beijing 100191, China
| | - Zhihui Li
- Vanke School of Public Health, Tsinghua University, Beijing 100084, China
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11
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Docosahexaenoic Acid as the Bidirectional Biomarker of Dietary and Metabolic Risk Patterns in Chinese Children: A Comparison with Plasma and Erythrocyte. Nutrients 2022; 14:nu14153095. [PMID: 35956271 PMCID: PMC9370652 DOI: 10.3390/nu14153095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 07/20/2022] [Accepted: 07/26/2022] [Indexed: 11/29/2022] Open
Abstract
Objective: The present study aims to measure docosahexaenoic acid (DHA) in both the plasma and erythrocyte of a child population and compares them with respect to their associations with dietary and metabolic risk patterns. Methods: A cross-sectional study was conducted, and a total of 435 children ages 5−7 years old were recruited. Diet information was collected using a food frequency questionnaire (FFQ). The physical indicators, blood pressure, and glycolipid metabolic indicators were determined. The plasma and erythrocyte DHA were analyzed using a gas chromatography mass spectrometer. Principal component analysis was used to identify dietary and metabolic risk patterns. Multivariate regression analyses were used to investigate the associations of DHA status with dietary and metabolic risk patterns. Results: A significant correlation between plasma and the erythrocyte DHA concentration was found (r = 0.232, p < 0.001). A diversified dietary pattern characterized that a high intake of diversified foods had a positive association with the plasma DHA level (β = 0.145, 95% CI: 0.045~0.244, p = 0.004). Children of obesity risk patterns with a high weight, pelvis breadth, BMI, upper arm circumference, and chest circumference had lower plasma DHA concentrations (OR = 0.873, 95% CI: 0.786~0.969, p = 0.011). Children with higher plasma and erythrocyte DHA concentrations were adhered to blood lipid risk patterns with high CHOL and LDL-C levels. The plasma DHA (OR = 1.271, 95% CI: 1.142~1.415, p < 0.001) had a stronger association with a blood lipid risk pattern than erythrocyte (OR = 1.043, 95% CI: 1.002~1.086, p = 0.040). Conclusions: The diversified dietary pattern had a higher plasma DHA concentration. Lower levels of plasma DHA were positively associated with obesity in children. DHA in plasma appears to be more strongly associated with blood lipid metabolism than erythrocyte. Plasma DHA may be a more sensitive bidirectional biomarker to evaluate the recently comprehensive diet intake and metabolic risk of children.
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12
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Rovio SP, Salo H, Niinikoski H, Lagström H, Salo P, Viikari JSA, Rönnemaa T, Jula A, Raitakari OT, Pahkala K. Dietary Intervention in Infancy and Cognitive Function in Young Adulthood: The Special Turku Coronary Risk Factor Intervention Project. J Pediatr 2022; 246:184-190.e1. [PMID: 35367245 DOI: 10.1016/j.jpeds.2022.03.046] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 03/23/2022] [Accepted: 03/25/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Consumption of saturated fatty acids (SAFAs), polyunsaturated fatty acids (PUFAs), cholesterol, and fiber have been linked with cognitive function in adults. We evaluated these associations from childhood by leveraging data from the Special Turku Coronary Risk Factor Intervention Project (STRIP). STUDY DESIGN STRIP recruited children aged 5 months and randomly assigned them into intervention/control groups. The intervention introduced a heart-healthy diet, characterized mainly by low consumption of SAFAs and cholesterol, through counseling at least biannually between age 7 months and 20 years. Diet was assessed repeatedly using food diaries. Six years after the end of the intervention phase, at age 26 years, the participants were invited to the first postintervention follow-up, which included cognitive testing that covered learning and memory, verbal memory, short-term working memory, reaction time, information processing, and cognitive flexibility and inhibitory control. We studied the associations of the STRIP intervention and the consumptions of SAFAs, PUFAs, cholesterol, and fiber within these cognitive domains. RESULTS Participants in the STRIP intervention group had better cognitive flexibility and inhibitory control and were better able to manage conflicting information and ignore task-irrelevant information (0.18 SD higher in the intervention group, adjusted for sex and socioeconomic status). No associations were observed with the dietary components studied. CONCLUSIONS The infancy-onset STRIP intervention, which promoted a heart-healthy diet, was favorably associated with cognitive flexibility and inhibitory control at age 26 years. No associations were found for the intervention targets studied, indicating that these specific dietary components did not underlie the observed effect of the intervention.
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Affiliation(s)
- Suvi P Rovio
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland; Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland.
| | - Henri Salo
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland; Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland
| | - Harri Niinikoski
- Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland; Department of Pediatrics and Adolescent Medicine, University of Turku and Turku University Hospital, Turku, Finland
| | - Hanna Lagström
- Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland; Department of Public Health, University of Turku and Turku University Hospital, Turku, Finland
| | - Pia Salo
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland; Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland
| | - Jorma S A Viikari
- Department of Medicine, University of Turku, Turku, Finland; Division of Medicine, Turku University Hospital, Turku, Finland
| | - Tapani Rönnemaa
- Department of Medicine, University of Turku, Turku, Finland; Division of Medicine, Turku University Hospital, Turku, Finland
| | - Antti Jula
- Department of Chronic Disease Prevention, Institute for Health and Welfare, Turku, Finland
| | - Olli T Raitakari
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland; Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland; Department of Clinical Physiology and Nuclear Medicine, University of Turku and Turku University Hospital, Turku, Finland
| | - Katja Pahkala
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland; Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland; Paavo Nurmi Center and Unit for Health and Physical Activity, University of Turku, Turku, Finland
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13
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Nampijja M, Mutua AM, Elliott AM, Muriuki JM, Abubakar A, Webb EL, Atkinson SH. Low Hemoglobin Levels Are Associated with Reduced Psychomotor and Language Abilities in Young Ugandan Children. Nutrients 2022; 14:nu14071452. [PMID: 35406065 PMCID: PMC9002834 DOI: 10.3390/nu14071452] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 03/22/2022] [Accepted: 03/28/2022] [Indexed: 12/10/2022] Open
Abstract
Children living in Sub-Saharan Africa are vulnerable to developmental delay, particularly in the critical first five years due to various adverse exposures including disease and nutritional deficiencies. Anemia and iron deficiency (ID) are highly prevalent in pregnant mothers and young children and are implicated in abnormal brain development. However, available evidence on the association between anemia, ID and neurodevelopment in sub-Saharan Africa is limited. Using data from the Entebbe Mother and Baby Study prospective birth cohort, we examined the effect of maternal and child hemoglobin (Hb) levels and child iron status on developmental scores in 933 and 530 pre-school Ugandan children respectively. Associations between Hb levels, iron status and developmental scores were assessed using regression analyses adjusting for potential confounders. Lower maternal and child Hb levels were associated with reduced psychomotor scores at 15 months, while only lower Hb levels in infancy were associated with reduced language scores. We found no evidence that anemia or ID was associated with cognitive or motor scores at five years. This study emphasizes the importance of managing anemia in pregnancy and infancy and highlights the need for further studies on the effects of anemia and ID in children living in Sub-Saharan Africa.
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Affiliation(s)
- Margaret Nampijja
- Maternal and Child Wellbeing (MCW) Unit, African Population and Health Research Center, Nairobi 00100, Kenya;
- Medical Research Council, Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe P.O. Box 49, Uganda;
| | - Agnes M. Mutua
- Kenya Medical Research Institute (KEMRI) Wellcome Trust Research Programme, KEMRI Centre for Geographic Medicine Research-Coast, Kilifi 230-80108, Kenya; (J.M.M.); (A.A.)
- Correspondence: (A.M.M.); (S.H.A.); Tel.: +254-709983677-76 (A.M.M. & S.H.A.)
| | - Alison M. Elliott
- Medical Research Council, Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe P.O. Box 49, Uganda;
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
| | - John Muthii Muriuki
- Kenya Medical Research Institute (KEMRI) Wellcome Trust Research Programme, KEMRI Centre for Geographic Medicine Research-Coast, Kilifi 230-80108, Kenya; (J.M.M.); (A.A.)
| | - Amina Abubakar
- Kenya Medical Research Institute (KEMRI) Wellcome Trust Research Programme, KEMRI Centre for Geographic Medicine Research-Coast, Kilifi 230-80108, Kenya; (J.M.M.); (A.A.)
- Department of Public Health, School of Human and Health Sciences, Pwani University, Kilifi 195-80108, Kenya
- Department of Psychiatry, University of Oxford, Oxford OX3 7JX, UK
- Institute for Human Development, Aga Khan University, Nairobi 30270-00100, Kenya
| | - Emily L. Webb
- MRC International Statistics and Epidemiology Group, Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK;
| | - Sarah H. Atkinson
- Kenya Medical Research Institute (KEMRI) Wellcome Trust Research Programme, KEMRI Centre for Geographic Medicine Research-Coast, Kilifi 230-80108, Kenya; (J.M.M.); (A.A.)
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford OX3 7FZ, UK
- Department of Paediatrics, University of Oxford, Oxford OX3 9DU, UK
- Correspondence: (A.M.M.); (S.H.A.); Tel.: +254-709983677-76 (A.M.M. & S.H.A.)
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14
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Tomlinson M, Skeen S, Melendez-Torres GJ, Hunt X, Desmond C, Morgan B, Murray L, Cooper PJ, Rathod SD, Marlow M, Fearon P. First 1,000 days: enough for mothers but not for children? Long-term outcomes of an early intervention on maternal depressed mood and child cognitive development: follow-up of a randomised controlled trial. J Child Psychol Psychiatry 2022; 63:261-272. [PMID: 34227113 DOI: 10.1111/jcpp.13482] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/26/2021] [Indexed: 01/01/2023]
Abstract
BACKGROUND Child cognitive development is often compromised in contexts of poverty and adversity, and these deficits tend to endure and affect the child across the life course. In the conditions of poverty and violence that characterise many low- and middle-income countries (LMIC), the capacity of parents to provide the kind of care that promotes good child development may be severely compromised, especially where caregivers suffer from depression. One avenue of early intervention focuses on the quality of the early mother-infant relationship. The aim of this study was to examine the long-term impact of an early intervention to improve the mother-infant relationship quality on child cognitive outcomes at 13 years of age. We also estimated the current costs to replicate the intervention. METHOD We re-recruited 333 children from an early childhood maternal-infant attachment intervention, 'Thula Sana', when the children were 13 years old, to assess whether there were impacts of the intervention on child cognitive outcomes, and maternal mood. We used the Kaufman Assessment Battery to assess the child cognitive development and the Patient Health Questionnaire (PHQ-9) and the Self-Reporting Questionnaire (SRQ-20) to assess maternal mental health. RESULTS Effect estimates indicated a pattern of null findings for the impact of the intervention on child cognitive development. However, the intervention had an effect on caregiver psychological distress (PHQ-9, ES = -0.17 [CI: -1.95, 0.05] and SRQ-20, ES = -0.30 [CI: -2.41, -0.19]), but not anxiety. The annual cost per mother-child pair to replicate the Thula Sana intervention in 2019 was estimated at ZAR13,365 ($780). CONCLUSION In a socio-economically deprived peri-urban settlement in South Africa, a home visiting intervention, delivered by community workers to mothers in pregnancy and the first six postpartum months, had no overall effect on child cognitive development at 13 years of age. However, those caregivers who were part of the original intervention showed lasting improvements in depressed mood. Despite the fact that there was no intervention effect on long-term child outcomes, the improvements in maternal mood are important.
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Affiliation(s)
- Mark Tomlinson
- Department of Global Health, Institute for Life Course Health Research, Stellenbosch University, Stellenbosch, South Africa.,School of Nursing and Midwifery, Queens University Belfast, Belfast, Northern Ireland, UK
| | - Sarah Skeen
- Department of Global Health, Institute for Life Course Health Research, Stellenbosch University, Stellenbosch, South Africa
| | - G J Melendez-Torres
- Peninsula Technology Assessment Group, University of Exeter Medical School, Exeter, UK
| | - Xanthe Hunt
- Department of Global Health, Institute for Life Course Health Research, Stellenbosch University, Stellenbosch, South Africa
| | - Chris Desmond
- Priceless, School of Public Health, Wits University, Johannesburg, South Africa
| | - Barak Morgan
- Global Risk Governance Programme, Institute for Safety Governance and Criminology, Law Faculty, University of Cape Town, Cape Town, South Africa
| | - Lynne Murray
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
| | - Peter J Cooper
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
| | - Sujit D Rathod
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Marguerite Marlow
- Department of Global Health, Institute for Life Course Health Research, Stellenbosch University, Stellenbosch, South Africa
| | - Pasco Fearon
- Developmental Neuroscience Unit, University College London, London, UK
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15
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Mutua AM, Mwangi K, Abubakar A, Atkinson SH. Effects of iron intake on neurobehavioural outcomes in African children: a systematic review and meta-analysis of randomised controlled trials. Wellcome Open Res 2021; 6:181. [PMID: 35106382 PMCID: PMC8777511 DOI: 10.12688/wellcomeopenres.16931.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2021] [Indexed: 11/20/2022] Open
Abstract
Background: Iron deficiency and developmental delay are common in African children. While experimental studies indicate an important role of iron in brain development, effects of iron on child development remain unclear. We aimed to evaluate the effects of iron supplementation or fortification on neurobehavioural outcomes in African children and further summarise these effects in children living in non-African countries for comparison. Methods: We searched PubMed, EMBASE, PsycINFO, Scopus and Cochrane Library for studies published up to 22 nd October 2021. We included randomised controlled trials (RCTs) evaluating effects of iron supplementation or fortification on neurobehavioural outcomes in children. Due to heterogeneity in study methods, we analysed all studies qualitatively and in secondary analyses only seven RCTs with 11 arms were meta-analysed. Results: We identified 2231 studies and included 35 studies (n=9988) in the systematic review. Only five studies (n=1294) included African children while 30 (n=8694) included children living in non-African countries. Of the five African studies, two (n=647) reported beneficial effects of iron supplementation on neurobehavioural outcomes in anaemic children, while three (n=647) found no beneficial effects. Of 30 studies in children living in non-African countries, 10 (n=3105) reported beneficial effects of iron supplementation or fortification on neurobehavioural outcomes, seven (n=786) reported beneficial effects only in children who had iron deficiency, iron deficiency anaemia or anaemia while 13 (n=4803) reported no beneficial effects. Conclusions: There are few studies in African children despite the high burden of iron deficiency and developmental delay in this population. Evidence on the effects of iron supplementation on neurobehavioural outcomes remains unclear and there is need for further well-powered studies evaluating these effects in African populations. PROSPERO registration: CRD42018091278 (20/03/2018).
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Affiliation(s)
- Agnes M. Mutua
- Kenya Medical Research Institute (KEMRI), Centre for Geographic Medicine Research-Coast, KEMRI Wellcome Trust Research Programme, Kilifi, 230-80108, Kenya
| | - Kelvinson Mwangi
- Kenya Medical Research Institute (KEMRI), Centre for Geographic Medicine Research-Coast, KEMRI Wellcome Trust Research Programme, Kilifi, 230-80108, Kenya
| | - Amina Abubakar
- Kenya Medical Research Institute (KEMRI), Centre for Geographic Medicine Research-Coast, KEMRI Wellcome Trust Research Programme, Kilifi, 230-80108, Kenya
- Institute for Human Development, Aga Khan University, Nairobi, 30270-00100, Kenya
- Department of Psychiatry, University of Oxford, Oxford, OX3 7JX, UK
- Department of Public Health, School of Human and Health Sciences, Pwani University, Kilifi, 195-80108, Kenya
| | - Sarah H. Atkinson
- Kenya Medical Research Institute (KEMRI), Centre for Geographic Medicine Research-Coast, KEMRI Wellcome Trust Research Programme, Kilifi, 230-80108, Kenya
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, OX3 7FZ, UK
- Department of Paediatrics, University of Oxford, Oxford, OX3 9DU, UK
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16
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Ahern MB, Thilsted SH, Kjellevold M, Overå R, Toppe J, Doura M, Kalaluka E, Wismen B, Vargas M, Franz N. Locally-Procured Fish Is Essential in School Feeding Programmes in Sub-Saharan Africa. Foods 2021; 10:foods10092080. [PMID: 34574190 PMCID: PMC8466277 DOI: 10.3390/foods10092080] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 08/20/2021] [Accepted: 08/20/2021] [Indexed: 11/16/2022] Open
Abstract
Fish make an important contribution to micronutrient intake, long-chained polyunsaturated omega-3 fatty acids (n-3 LC-PUFAS), and animal protein, as well as ensuring food and nutrition security and livelihoods for fishing communities. Micronutrient deficiencies are persistent in sub-Saharan Africa (SSA), contributing to public health issues not only in the first 1000 days but throughout adolescence and into adulthood. School feeding programs (SFPs) and home-grown school feeding programs (HGSF), which source foods from local producers, particularly fisherfolk, offer an entry point for encouraging healthy diets and delivering essential macro- and micronutrients to schoolchildren, which are important for the continued cognitive development of children and adolescents and can contribute to the realization of sustainable development goals (SDGs) 1, 2, 3, 5, and 14. The importance of HGSF for poverty alleviation (SDG1) and zero hunger (SDG 2) have been recognized by the United Nations Hunger Task Force and the African Union Development Agency-New Partnership for African Development (AUDA-NEPAD), which formulated a strategy for HGSF to improve nutrition for the growing youth population across Africa. A scoping review was conducted to understand the lessons learned from SFPs, which included fish and fish products from small-scale producers, identifying the challenges and best practices for the inclusion of fish, opportunities for improvements across the supply chain, and gaps in nutritional requirements for schoolchildren which could be improved through the inclusion of fish. Challenges to the inclusion fish in SFPs include food safety, supply and access to raw materials, organizational capacity, and cost, while good practices include the engagement of various stakeholders in creating and testing fish products, and repurposing fisheries by-products or using underutilized species to ensure cost-effective solutions. This study builds evidence of the inclusion of nutritious fish and fish products in SFPs, highlighting the need to replicate and scale good practices to ensure sustainable, community-centred, and demand-driven solutions for alleviating poverty, malnutrition, and contributing to greater health and wellbeing in adolescence.
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Affiliation(s)
- Molly B. Ahern
- Fisheries and Aquaculture Division, Food and Agriculture Organization of the United Nations (FAO), 00153 Rome, Italy;
- Correspondence:
| | | | | | - Ragnhild Overå
- Department of Geography, University of Bergen, 5007 Bergen, Norway;
| | - Jogeir Toppe
- Sub-Regional Office for Mesoamerica, Food and Agriculture Organization of the United Nations (FAO), Panama City 32408, Panama;
| | - Michele Doura
- School-Based Programmes Unit, World Food Programme, 00148 Rome, Italy; (M.D.); (E.K.)
| | - Edna Kalaluka
- School-Based Programmes Unit, World Food Programme, 00148 Rome, Italy; (M.D.); (E.K.)
| | | | - Melisa Vargas
- Nutrition Division, Food and Agriculture Organization of the United Nations (FAO), 00153 Rome, Italy;
| | - Nicole Franz
- Fisheries and Aquaculture Division, Food and Agriculture Organization of the United Nations (FAO), 00153 Rome, Italy;
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17
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Onifade OM, Pringle KG, Rollo ME, Collins CE, Schumacher T, Rae KM. Dietary intake of Indigenous Australian infants and young children in the Gomeroi gaaynggal cohort. Nutr Diet 2021; 78:386-396. [PMID: 33908693 PMCID: PMC8518589 DOI: 10.1111/1747-0080.12673] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 03/20/2021] [Accepted: 03/25/2021] [Indexed: 01/12/2023]
Abstract
AIM The nutritional quality of foods consumed by infants and young children to complement breastfeeding or formula feeding influences growth and development. The aim of this study was to identify the dietary intake of Indigenous infants and young children in the Gomeroi gaaynggal cohort, and evaluate the nutritional adequacy of their intake compared with Australian recommendations. METHODS Dietary intake was assessed using diet recalls at approximately 9-, 12- and 24-month visits. Nutrient values of foods were obtained from AUSNUT 2011-13 and nutrient intake compared to the Australian Nutrient Reference Values. Foods were categorised into food groups and intakes compared to the Australian Guide to Healthy Eating. RESULTS A total of 206 infants and young children were included in the study. Of these, 95 individual children had dietary data collected between 7.6 and 24.7 months. Infant formula and breastfeeding rates were highest among infants (70% and 20%, respectively). Cow's milk intake was highest among young children (75%). Infants and young children in the cohort met most macro- and micronutrient intake recommendations. Few young children met recommendation for iron (42%), no infant met recommendation for omega-3 fatty acids and almost all exceeded recommendation for sodium. Most young children met daily dairy and fruit recommendations although intake of discretionary foods was high. CONCLUSIONS This study found that diets of Indigenous infants and young children met most key nutrient reference targets. Potential target areas that require dietary optimisation have been identified and will be the focus of community-led strategies in adequate infant nutrition promotion.
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Affiliation(s)
- Oyepeju M. Onifade
- School of Medicine and Public HealthUniversity of NewcastleCallaghanNew South WalesAustralia
- Pregnancy and Research ProgramHunter Medical Research InstituteNewcastleNew South WalesAustralia
| | - Kirsty G. Pringle
- Pregnancy and Research ProgramHunter Medical Research InstituteNewcastleNew South WalesAustralia
- School of Biomedical Science and PharmacyUniversity of NewcastleCallaghanNew South WalesAustralia
| | - Megan E. Rollo
- School of Health SciencesUniversity of NewcastleCallaghanNew South WalesAustralia
- Priority Research Centre for Physical Activity and NutritionUniversity of NewcastleCallaghanNew South WalesAustralia
| | - Clare E. Collins
- School of Health SciencesUniversity of NewcastleCallaghanNew South WalesAustralia
- Priority Research Centre for Physical Activity and NutritionUniversity of NewcastleCallaghanNew South WalesAustralia
| | - Tracy Schumacher
- Priority Research Centre for Physical Activity and NutritionUniversity of NewcastleCallaghanNew South WalesAustralia
- Department of Rural HealthUniversity of NewcastleTamworthNew South WalesAustralia
- Priority Research Centre for Health BehavioursUniversity of NewcastleCallaghanNew South WalesAustralia
| | - Kym M. Rae
- Mater Research InstituteAubigny PlaceBrisbaneQueenslandAustralia
- Faculty of MedicineUniversity of QueenslandHerstonQueenslandAustralia
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Mutua AM, Mwangi K, Abubakar A, Atkinson SH. Effects of iron intake on neurobehavioural outcomes in African children: a systematic review and meta-analysis of randomised controlled trials. Wellcome Open Res 2021; 6:181. [PMID: 35106382 PMCID: PMC8777511 DOI: 10.12688/wellcomeopenres.16931.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2021] [Indexed: 04/06/2024] Open
Abstract
Background: Iron deficiency and developmental delay are common in African children. While experimental studies indicate an important role of iron in brain development, effects of iron on child development remain unclear. We aimed to evaluate the effects of iron supplementation or fortification on neurobehavioural outcomes in African children and further summarise these effects in children living in non-African countries for comparison. Methods: We searched PubMed, EMBASE, PsycINFO, Scopus and Cochrane Library for studies published up to 9 th March 2021. We included randomised controlled trials (RCTs) evaluating effects of iron supplementation or fortification on neurobehavioural outcomes in children. Due to heterogeneity in study methods, we analysed the studies qualitatively and only seven RCTs with 11 arms were meta-analysed. Results: We identified 2155 studies and included 34 studies (n=9808) in the systematic review. Only five studies (n=1294) included African children while 29 (n=8514) included children living in non-African countries. Of the five African studies, two (n=647) reported beneficial effects of iron supplementation on neurobehavioural outcomes in anaemic children while three (n=647) found no beneficial effects. Of 29 studies in children living in non-African countries, nine (n=2925) reported beneficial effects of iron supplementation or fortification on neurobehavioural outcomes, seven (n=786) reported beneficial effects only in children who had iron deficiency, iron deficiency anaemia or anaemia while 13 (n=4803) reported no beneficial effects. Meta-analysis of seven studies (n=775) in non-African countries showed no beneficial effects of iron supplementation on cognitive or motor development in children. Conclusions: There are few studies in African children despite the high burden of iron deficiency and developmental delay in this population. Evidence on the effects of iron supplementation on neurobehavioural outcomes remains unclear and there is need for further well-powered studies evaluating these effects in African populations. PROSPERO registration: CRD42018091278 (20/03/2018).
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Affiliation(s)
- Agnes M. Mutua
- Kenya Medical Research Institute (KEMRI), Centre for Geographic Medicine Research-Coast, KEMRI Wellcome Trust Research Programme, Kilifi, 230-80108, Kenya
| | - Kelvinson Mwangi
- Kenya Medical Research Institute (KEMRI), Centre for Geographic Medicine Research-Coast, KEMRI Wellcome Trust Research Programme, Kilifi, 230-80108, Kenya
| | - Amina Abubakar
- Kenya Medical Research Institute (KEMRI), Centre for Geographic Medicine Research-Coast, KEMRI Wellcome Trust Research Programme, Kilifi, 230-80108, Kenya
- Institute for Human Development, Aga Khan University, Nairobi, 30270-00100, Kenya
- Department of Psychiatry, University of Oxford, Oxford, OX3 7JX, UK
- Department of Public Health, School of Human and Health Sciences, Pwani University, Kilifi, 195-80108, Kenya
| | - Sarah H. Atkinson
- Kenya Medical Research Institute (KEMRI), Centre for Geographic Medicine Research-Coast, KEMRI Wellcome Trust Research Programme, Kilifi, 230-80108, Kenya
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, OX3 7FZ, UK
- Department of Paediatrics, University of Oxford, Oxford, OX3 9DU, UK
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19
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Parasannanavar D, Gaddam I, Bukya T, Ibrahim S A, Reddy K S, Banjara SK, Salvadi BPP, Kumar B N, Rao SF, Geddam JJB, Rajkumar H. Omega-3 polyunsaturated fatty acid intake and plasma fatty acids of school going Indian children - a cross-sectional study. Prostaglandins Leukot Essent Fatty Acids 2021; 170:102294. [PMID: 34052598 DOI: 10.1016/j.plefa.2021.102294] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 03/25/2021] [Accepted: 05/06/2021] [Indexed: 12/18/2022]
Abstract
Long-chain omega-3 polyunsaturated fatty acids (PUFA) such as docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) play an essential role in cognitive and behavioural changes among school going children. This study delineates the dietary omega-3 PUFA [alpha-Linolenic acid (ALA), DHA, and EPA] intake and plasma fatty acids levels among school-going children. This is a cross-sectional study purely observational in nature, wherein 625 apparently healthy boys and girls aged between 7 and 13 years were selected from five different schools of Hyderabad. Dietary information on omega-3 PUFA (ALA, DHA, and EPA) intake was collected using a food frequency questionnaire. Plasma fatty acid concentrations were measured in 34% of sub-sample using standard gas chromatography. The study revealed that the average dietary intakes of omega-3 PUFA, ALA, DHA, and EPA were 55.46, 15.82, 35.59, 4.06 mg/day, respectively. There was a significant difference in mean DHA intake among gender and age group [girls (38.64±1.45 mg/day), boys (31.80±1.38 mg/day) p < 0.001] and [7-10 years (31.75±1.38 mg/day), 11-13 years (38.07±1.40 mg/day) p < 0.01]. The mean plasma DHA and DPA levels of overall subjects were 0.98 nmol% and 0.18nmol% respectively which was comparable among different gender, age and BMI-for age groups. There was a positive correlation between dietary DHA intake and plasma DHA level [ρ=0.376 (p < 0.001)]. The current study demonstrated that the omega-3 PUFA intake in school going children was less and reinforces the importance of increasing the omega-3 PUFA intake through diet and supplements.
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Affiliation(s)
- Devaraj Parasannanavar
- Division of Clinical Epidemiology, ICMR-National Institute of Nutrition, Hyderabad, Telangana, India-500 007. 8074928620.
| | - Indraja Gaddam
- ICMR-National Institute of Nutrition, Hyderabad, Telangana, India-500 007.
| | - Tulja Bukya
- Division of Clinical Epidemiology, ICMR-National Institute of Nutrition, Hyderabad, Telangana, India-500 007. 8074928620.
| | - Ahamed Ibrahim S
- Lipid Chemistry Department, ICMR-National Institute of Nutrition, Hyderabad, Telangana, India-500 007.
| | - Suryam Reddy K
- Lipid Chemistry Department, ICMR-National Institute of Nutrition, Hyderabad, Telangana, India-500 007.
| | - Santosh Kumar Banjara
- Clinical Division, ICMR-National Institute of Nutrition, Hyderabad, Telangana, India-500 007.
| | - Blessy P Priyanka Salvadi
- Division of Clinical Epidemiology, ICMR-National Institute of Nutrition, Hyderabad, Telangana, India-500 007. 8074928620.
| | - Naveen Kumar B
- Division of Clinical Epidemiology, ICMR-National Institute of Nutrition, Hyderabad, Telangana, India-500 007. 8074928620.
| | - Sylvia Fernandez Rao
- Behavioral Science Unit, Extension & Training Division, (ICMR)-National Institute of Nutrition, Hyderabad, Telangana, India-500 007.
| | - J J Babu Geddam
- Division of Clinical Epidemiology, ICMR-National Institute of Nutrition, Hyderabad, Telangana, India-500 007. 8074928620.
| | - Hemalatha Rajkumar
- Scientist 'G' and The Director, ICMR-National Institute of Nutrition, Jamai-Osmania, Tarnaka, Hyderabad, Telangana-500007.
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20
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Nienaber A, Ozturk M, Dolman RC, Zandberg L, Hayford FE, Brombacher F, Blaauw R, Smuts CM, Parihar SP, Malan L. Beneficial effect of long-chain n-3 polyunsaturated fatty acid supplementation on tuberculosis in mice. Prostaglandins Leukot Essent Fatty Acids 2021; 170:102304. [PMID: 34082319 DOI: 10.1016/j.plefa.2021.102304] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 05/03/2021] [Accepted: 05/25/2021] [Indexed: 10/21/2022]
Abstract
Intakes of the omega-3 essential fatty acids (n-3 EFAs) are low in the general adult population, with high n-6/n-3 polyunsaturated fatty acid (PUFA) ratios and the accompanying suboptimal n-3 PUFA status. Eicosapentaenoic (EPA) and docosahexaenoic acid (DHA) have antibacterial and inflammation-resolving effects in tuberculosis (TB). However, whether switching to a diet with optimum n-3 EFA intake after the infection has comparable benefits has not been investigated. We aimed to compare the effects of a diet with sufficient n-3 EFA content in an acceptable n-6/n-3 PUFA ratio for rodents ((n-3)eFAS group) with those on the same diet supplemented with EPA and DHA (EPA/DHA group) in Mycobacterium tuberculosis (Mtb)-infected C3HeB/FeJ mice with a low n-3 PUFA status. Mice were conditioned on an n-3 PUFA-deficient diet with a high n-6/n-3 PUFA ratio for 6 weeks before Mtb infection and randomized to either (n-3)eFAS or EPA/DHA diets 1 week post-infection for 3 weeks. At endpoint, EPA and DHA compositions were higher and arachidonic acid, osbond acid, and total n-6 LCPUFAs lower in all lipid pools measured in the EPA/DHA group (all P < 0.001). Percentage body weight gain was higher (P = 0.017) and lung bacterial load lower (P < 0.001) in the EPA/DHA group. Additionally, the EPA/DHA group had a more pro-resolving lung lipid mediator profile and lower lung in IL-1α and IL-1β concentrations (P = 0.023, P = 0.049). Inverse correlations were found between the lung and peripheral blood mononuclear cell EPA and DHA and selected pro-inflammatory cytokines. These are the first findings that indicate that EPA/DHA supplementation provides benefits superior to a diet with sufficient n-3 EFAs concerning bacterial killing, weight gain and lung inflammation resolution in Mtb-infected mice with a low n-3 PUFA status. Therefore, EPA and DHA may be worth considering as adjunct TB treatment.
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Affiliation(s)
- Arista Nienaber
- Centre of Excellence for Nutrition, North-West University, Potchefstroom, South Africa.
| | - Mumin Ozturk
- International Centre for Genetic Engineering and Biotechnology (ICGEB), Cape Town-Component, University of Cape Town, Cape Town, Western Cape, South Africa; Institute of Infectious Diseases and Molecular Medicine (IDM), Division of Immunology and South African Medical Research Council (SAMRC) Immunology of Infectious Diseases, University of Cape Town, Cape Town, Western Cape, South Africa
| | - Robin C Dolman
- Centre of Excellence for Nutrition, North-West University, Potchefstroom, South Africa
| | - Lizelle Zandberg
- Centre of Excellence for Nutrition, North-West University, Potchefstroom, South Africa
| | - Frank Ea Hayford
- Centre of Excellence for Nutrition, North-West University, Potchefstroom, South Africa; Department of Nutrition and Dietetics, School of biomedical and Allied Health Sciences, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Frank Brombacher
- International Centre for Genetic Engineering and Biotechnology (ICGEB), Cape Town-Component, University of Cape Town, Cape Town, Western Cape, South Africa; Institute of Infectious Diseases and Molecular Medicine (IDM), Division of Immunology and South African Medical Research Council (SAMRC) Immunology of Infectious Diseases, University of Cape Town, Cape Town, Western Cape, South Africa; Welcome Centre for Infectious Diseases Research in Africa (CIDRI-Africa) and Institute of Infectious Diseases and Molecular Medicine (IDM), University of Cape Town, Cape Town, Western Cape, South Africa; Division of Medical Microbiology, Institute of Infectious Diseases and Molecular Medicine (IDM), Department of Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town, Western Cape, South Africa
| | - Renee Blaauw
- Division of Human Nutrition, Stellenbosch University, Tygerberg, Cape Town, Western Cape, South Africa
| | - Cornelius M Smuts
- Centre of Excellence for Nutrition, North-West University, Potchefstroom, South Africa
| | - Suraj P Parihar
- International Centre for Genetic Engineering and Biotechnology (ICGEB), Cape Town-Component, University of Cape Town, Cape Town, Western Cape, South Africa; Institute of Infectious Diseases and Molecular Medicine (IDM), Division of Immunology and South African Medical Research Council (SAMRC) Immunology of Infectious Diseases, University of Cape Town, Cape Town, Western Cape, South Africa; Welcome Centre for Infectious Diseases Research in Africa (CIDRI-Africa) and Institute of Infectious Diseases and Molecular Medicine (IDM), University of Cape Town, Cape Town, Western Cape, South Africa; Division of Medical Microbiology, Institute of Infectious Diseases and Molecular Medicine (IDM), Department of Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town, Western Cape, South Africa
| | - Linda Malan
- Centre of Excellence for Nutrition, North-West University, Potchefstroom, South Africa
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21
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Ogłuszka M, Lipiński P, Starzyński RR. Interaction between iron and omega-3 fatty acids metabolisms: where is the cross-link? Crit Rev Food Sci Nutr 2020; 62:3002-3022. [DOI: 10.1080/10408398.2020.1862047] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Magdalena Ogłuszka
- Department of Genomics, Institute of Genetics and Animal Biotechnology of the Polish Academy of Sciences, Jastrzębiec, Poland
| | - Paweł Lipiński
- Department of Molecular Biology, Institute of Genetics and Animal Biotechnology of the Polish Academy of Sciences, Jastrzębiec, Poland
| | - Rafał Radosław Starzyński
- Department of Molecular Biology, Institute of Genetics and Animal Biotechnology of the Polish Academy of Sciences, Jastrzębiec, Poland
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22
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Nutrient density, but not cost of diet, is associated with anemia and iron deficiency in school-age children in South Africa. Nutrition 2020; 84:111096. [PMID: 33453623 DOI: 10.1016/j.nut.2020.111096] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 11/20/2020] [Accepted: 11/21/2020] [Indexed: 11/23/2022]
Abstract
OBJECTIVES This study aimed to investigate the relationship of nutrient density and diet cost with anemia and iron deficiency (ID) in children. METHODS Dietary intake data of 5- to 12-y-old children (n = 578) from three independent studies in low-income communities were pooled. Nutrient densities were calculated using the Nutrient Rich Foods index and Nutrient Rich Diet index, with higher scores indicating more nutrient-dense foods and diets. Food prices and food intake data were used to calculate ratios of nutrient density to price for foods and diets. Descriptive and correlation analyses examined associations of nutrient density and diet cost with anemia and ID. RESULTS Most children (>50%) consumed starchy staples (100%), vegetables that are not vitamin A rich (63.9%), and legumes (58.1%), with mean NRF9.3 scores ranging from 31.9 to 56.3. Cheese, eggs, organ meat, fish, dark-green leafy vegetables, and vitamin A-rich vegetables and fruits had mean NRF9.3 scores ranging from 112.6 to 184.7, but each was consumed by less than a third of the children. Children with anemia or ID had lower NRD9.3 scores than children without (P < 0.001 and P = 0.039, respectively). Diet cost did not differ according to anemia and iron status, but nutrient-density-to-price ratio was lower in children with anemia than without (P = 0.001). CONCLUSIONS Careful selection of nutrient-dense foods as substitutes for foods with lower nutrient density could make it possible for children to consume a diet richer in specific nutrients and help prevent anemia and ID without affecting diet cost.
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Van Pelt AE, Lipow MI, Scott JC, Lowenthal ED. Interventions for Children with Neurocognitive Impairments in Resource-Limited Settings: A Systematic Review. CHILDREN AND YOUTH SERVICES REVIEW 2020; 118:105393. [PMID: 32968334 PMCID: PMC7505233 DOI: 10.1016/j.childyouth.2020.105393] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Many children and adolescents around the world suffer from neurocognitive deficits due to chronic disorders, such as Human Immunodeficiency Virus (HIV) and malaria. Resource-limited settings exacerbate the risk of negative cognitive outcomes due to high prevalence of associated disorders, poverty, and limited access to interventions. Current literature does not provide consensus regarding the efficacy of interventions to support children with cognitive impairments in low-resource settings. This research aimed to identify and evaluate interventions for youth with neurocognitive deficits in resource-limited settings. A systematic review of peer-reviewed literature was conducted within five databases (PubMed, Web of Science, CINAHL, PsycInfo, and WHO Index Medicus). Cognitive impairment was broadly defined to be inclusive of aspects of intellectual and cognitive functioning (e.g., working memory, attention, executive function). The income status of the country or countries in which each study was located was determined according to World Bank Income Status. Studies conducted in countries classified as low- or middle-income were included. Since low-resource areas exist within high-income countries, the resource availability within study settings in high-income countries was systematically evaluated for inclusion. The search yielded 19 articles that met all inclusion criteria. Interventions included strategies involving caregiver training, computerized and non-computerized cognitive training, physical activity, and nutritional supplementation. Interventions were administered in medical facilities, educational facilities, or the home. The majority of the interventions targeted the domains of memory and attention. Overall, the efficacy of interventions was inconsistent. Further, results indicated that the relationship between cognitive improvement and intervention types was not consistent across cognitive domains. However, when evaluating studies on an individual basis, some strategies demonstrated clinically- and statistically-significant improvement in cognitive function among specific groups of children. The low article yield highlights that few researchers have evaluated pediatric cognitive support interventions in low-resource contexts. This review suggests support strategies that should be considered for future studies as neurocognitive screening capacity improves in resource-limited settings.
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Affiliation(s)
- Amelia E. Van Pelt
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine at the University of Pennsylvania, 423 Guardian Drive, Philadelphia, Pennsylvania, United States 19104-6021
- Department of Pediatrics (Global Health Center), Children’s Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, 3501 Civic Center Blvd, Philadelphia, Pennsylvania, United States 19104
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Colonial Penn Center, 3461 Locust Walk, Philadelphia, Pennsylvania, United States 19104-6218
| | - Matthew I. Lipow
- Department of Pediatrics (Global Health Center), Children’s Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, 3501 Civic Center Blvd, Philadelphia, Pennsylvania, United States 19104
- Drexel University College of Medicine, 2900 Queen Lane, Philadelphia, Pennsylvania, United States 19129
| | - J. Cobb Scott
- Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Richards Building, 5th Floor, 3700 Hamilton Walk, Philadelphia, Pennsylvania, 19104-6085 United States
- VISN4 Mental Illness Research, Education, and Clinical Center at the Philadelphia VA Medical Center, 3900 Woodland Ave, MC116, Philadelphia, PA, 19104, United States
| | - Elizabeth D. Lowenthal
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine at the University of Pennsylvania, 423 Guardian Drive, Philadelphia, Pennsylvania, United States 19104-6021
- Department of Pediatrics (Global Health Center), Children’s Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, 3501 Civic Center Blvd, Philadelphia, Pennsylvania, United States 19104
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van der Wurff IS, Meyer BJ, de Groot RH. Effect of Omega-3 Long Chain Polyunsaturated Fatty Acids (n-3 LCPUFA) Supplementation on Cognition in Children and Adolescents: A Systematic Literature Review with a Focus on n-3 LCPUFA Blood Values and Dose of DHA and EPA. Nutrients 2020; 12:E3115. [PMID: 33053843 PMCID: PMC7599612 DOI: 10.3390/nu12103115] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 10/05/2020] [Accepted: 10/06/2020] [Indexed: 02/06/2023] Open
Abstract
Omega-3 long chain polyunsaturated fatty acids (n-3 LCPUFA) supplementation in the cardiovascular field is effective if a certain Omega-3 index (O3I) is achieved or the daily n-3 LCPUFA dose is high enough. Whether this applies to studies on cognition in children and adolescents is unclear. The aims of the current review were to investigate whether: (1) a certain O3I level and (2) a minimum daily n-3 LCPUFA dose are required to improve cognition in 4-25 year olds. Web of Science and PubMed were searched. Inclusion criteria: placebo controlled randomized controlled trial; participants 4-25 years; supplementation with docosahexaenoic acid (DHA) and/or eicosapentaenoic acid (EPA); assessing cognition; in English and ≥10 participants per treatment arm. Thirty-three studies were included, 21 in typically developing participants, 12 in those with a disorder. A positive effect on cognitive measures was more likely in studies with an increase in O3I to >6%. Half of the studies in typically developing children with daily supplementation dose ≥450 mg DHA + EPA showed improved cognition. For children with a disorder no cut-off value was found. In conclusion, daily supplementation of ≥450 mg DHA + EPA per day and an increase in the O3I to >6% makes it more likely to show efficacy on cognition in children and adolescents.
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Affiliation(s)
- Inge S.M. van der Wurff
- Conditions for Lifelong Learning, Faculty of Educational Sciences, Open University of the Netherlands, 6419 Heerlen, The Netherlands;
| | - Barbara J. Meyer
- School of Medicine, Lipid Research Centre, Molecular Horizons, Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW 2522, Australia;
| | - Renate H.M. de Groot
- Conditions for Lifelong Learning, Faculty of Educational Sciences, Open University of the Netherlands, 6419 Heerlen, The Netherlands;
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, 6200 Maastricht, The Netherlands
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Yang GY, Wu T, Huang SY, Huang BX, Wang HL, Lan QY, Li CL, Zhu HL, Fang AP. No effect of 6-month supplementation with 300 mg/d docosahexaenoic acid on executive functions among healthy school-aged children: a randomized, double-blind, placebo-controlled trial. Eur J Nutr 2020; 60:1985-1997. [PMID: 32979077 DOI: 10.1007/s00394-020-02388-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 09/14/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE Docosahexaenoic acid (DHA) plays an essential role in brain, and its status is dependent on dietary intakes. School-aged children in rural China, who consume diets low in omega-3 polyunsaturated fatty acids, may benefit from DHA supplementation. Therefore, this trial was performed to examine the effect of 6-month DHA supplementation on executive functions (EFs) among healthy school-aged children in rural China. METHODS A randomized, double-blind, placebo-controlled trial was conducted among 106 primary school children aged 7-12 years in rural China. Participants were randomized to receive either 300 mg/d DHA or placebo for 6 months. EFs including working memory and cognitive flexibility were evaluated at baseline, at 3 months and at 6 months, using Digit Span Backwards and Wisconsin card sorting test, respectively. Socio-demographic data were collected at baseline, and erythrocyte membrane fatty acids and serum neurotransmitters were measured at baseline and after 6-month intervention. RESULTS Ninety-four children (88.7%) completed the study according to the protocol. Changes in erythrocyte membrane fatty acids indicated good compliance of the participants. There was no significant intervention effect on serum neurotransmitters. In two-factor ANCOVA, both groups showed a significant improvement in the Digit Span Backwards and the Wisconsin card sorting test from baseline to endpoint. However, no significant intervention effect was found on any EF scores. Linear regression analysis suggested no significant association between changes in erythrocyte DHA level with changes in any EF scores. CONCLUSIONS Supplementation with 300 mg/d DHA for 6 months had no benefit on EFs including working memory and cognitive flexibility among healthy school-aged children. This trial was registered at clinicaltrials.gov as NCT02308930 on December 5, 2014.
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Affiliation(s)
- Guo-Yi Yang
- Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Department of Nutrition, School of Public Health, Sun Yat-Sen University, 74th Zhongshan Er Road, Guangzhou, 510080, China
| | - Ting Wu
- Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Department of Nutrition, School of Public Health, Sun Yat-Sen University, 74th Zhongshan Er Road, Guangzhou, 510080, China
| | - Si-Yu Huang
- Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Department of Nutrition, School of Public Health, Sun Yat-Sen University, 74th Zhongshan Er Road, Guangzhou, 510080, China
| | - Bi-Xia Huang
- Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Department of Nutrition, School of Public Health, Sun Yat-Sen University, 74th Zhongshan Er Road, Guangzhou, 510080, China
| | - Hai-Lin Wang
- Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Department of Nutrition, School of Public Health, Sun Yat-Sen University, 74th Zhongshan Er Road, Guangzhou, 510080, China
| | - Qiu-Ye Lan
- Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Department of Nutrition, School of Public Health, Sun Yat-Sen University, 74th Zhongshan Er Road, Guangzhou, 510080, China
| | - Chun-Lei Li
- Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Department of Nutrition, School of Public Health, Sun Yat-Sen University, 74th Zhongshan Er Road, Guangzhou, 510080, China
| | - Hui-Lian Zhu
- Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Department of Nutrition, School of Public Health, Sun Yat-Sen University, 74th Zhongshan Er Road, Guangzhou, 510080, China.
| | - Ai-Ping Fang
- Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Department of Nutrition, School of Public Health, Sun Yat-Sen University, 74th Zhongshan Er Road, Guangzhou, 510080, China.
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Associations of dietary diversity with anaemia and iron status among 5- to 12-year-old schoolchildren in South Africa. Public Health Nutr 2020; 24:2554-2562. [PMID: 32618231 DOI: 10.1017/s1368980020000543] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVE To examine the associations of dietary diversity with anaemia and iron status among primary school-aged children in South Africa. DESIGN An analysis was conducted with pooled individual data from the baseline surveys from three previously conducted independent intervention studies. Two different dietary diversity scores (DDS) were calculated based on data from 1-day (1-d) and 3-day (3-d) dietary recall periods, respectively. Logistic regression analysis was performed to examine the associations of dietary diversity with anaemia and iron status. SETTING KwaZulu-Natal and North West provinces, South Africa. PARTICIPANTS Children (n 578) 5- to 12-year-old. RESULTS A DDS ≤ 4 was associated with higher odds of being anaemic (1-d P = 0·001; 3-d P = 0·006) and being iron deficient (ID) (3-d P < 0·001). For both recall periods, consumption of 'vegetables and fruits other than vitamin A-rich' and 'animal-source foods (ASF)' was associated with lower odds of being anaemic (both P = 0·002), and 'organ meats' with lower odds of being ID (1-d P = 0·045; 3-d P < 0·001). Consumption of 'meat, chicken and fish' was associated with lower odds of being anaemic (P = 0·045), and 'vegetables and fruits other than vitamin A-rich', 'legumes, nuts and seeds' and 'ASF' with lower odds of being ID for the 3-d recall period only (P = 0·038, P = 0·020 and P = 0·003, respectively). CONCLUSION In order to improve anaemia and iron status among primary school-aged children, dietary diversification, with emphasis on consumption of vegetables, fruits and ASF (including organ meats), should be promoted.
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Teisen MN, Vuholm S, Niclasen J, Aristizabal-Henao JJ, Stark KD, Geertsen SS, Damsgaard CT, Lauritzen L. Effects of oily fish intake on cognitive and socioemotional function in healthy 8-9-year-old children: the FiSK Junior randomized trial. Am J Clin Nutr 2020; 112:74-83. [PMID: 32529206 DOI: 10.1093/ajcn/nqaa050] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 02/24/2020] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Long-chain n-3 PUFAs (n-3 LCPUFAs) accrete in the brain during childhood and affect brain development. Randomized trials in children show inconsistent effects of n-3 LCPUFAs on cognitive and socioemotional function, and few have investigated effects of fish per se. OBJECTIVES We aimed to investigate the effects of oily fish consumption on overall and domain-specific cognitive and socioemotional scores and explore sex differences. METHODS Healthy 8-9-y-old children (n = 199) were randomly allocated to receive ∼300 g/wk oily fish or poultry (control) for 12 ± 2 wk. At baseline and endpoint, we assessed attention, processing speed, executive functions, memory, emotions, and behavior with a large battery of tests and questionnaires and analyzed erythrocyte fatty acid composition. RESULTS One hundred and ninety-seven (99%) children completed the trial. Children in the fish group consumed 375 (25th-75th percentile: 325-426) g/wk oily fish resulting in 2.3 (95% CI: 1.9, 2.6) fatty acid percentage points higher erythrocyte n-3 LCPUFA than in the poultry group. The overall cognitive performance score tended to improve by 0.17 (95% CI: -0.01, 0.35) points in children who received fish compared with poultry, supported by n-3 LCPUFA dose dependency. This was driven mainly by fewer errors [-1.9 (95% CI: -3.4, -0.3)] in an attention task and improved cognitive flexibility measured as faster reaction time [-51 ms (95% CI: -94, -7 ms)] in a complex relative to a simple task ("mixing cost"). The fish intervention furthermore reduced parent-rated Strength and Difficulties Questionnaire total difficulties by -0.89 (95% CI: -1.60, -0.18) points mainly due to a -0.63 (95% CI: -1.11, -0.16) points reduction in internalizing problems that was reflected in tendency to a decrease in the overall socioemotional problems score of -0.13 (95% CI: -0.26, 0.01) points. The overall effects were similar in boys and girls. CONCLUSIONS Oily fish dose-dependently improved cognitive function, especially attention and cognitive flexibility, and reduced socioemotional problems. The results support the importance of n-3 LCPUFAs for optimal brain function and fish intake recommendations in children.The trial was registered at www.clinicaltrials.gov as NCT02809508.
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Affiliation(s)
- Marie N Teisen
- Department of Nutrition, Exercise, and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Stine Vuholm
- Department of Nutrition, Exercise, and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Janni Niclasen
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | | | - Ken D Stark
- Department of Kinesiology, University of Waterloo, Waterloo, Ontario, Canada
| | - Svend S Geertsen
- Department of Nutrition, Exercise, and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Camilla T Damsgaard
- Department of Nutrition, Exercise, and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Lotte Lauritzen
- Department of Nutrition, Exercise, and Sports, University of Copenhagen, Copenhagen, Denmark
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Ojwang AA, Smuts CM, Zec M, Wentzel-Viljoen E, Kruger IM, Kruger HS. Comparison of dietary and plasma phospholipid fatty acids between normal weight and overweight black South Africans according to metabolic health: The PURE study. Prostaglandins Leukot Essent Fatty Acids 2020; 158:102039. [PMID: 31780327 DOI: 10.1016/j.plefa.2019.102039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 11/17/2019] [Accepted: 11/18/2019] [Indexed: 12/29/2022]
Abstract
BACKGROUND Information regarding circulating fatty acids (FA) in association with metabolic health in black Africans is scarce, while the usefulness of circulating FAs as biomarkers of dietary fat intake and predictors for medical conditions is increasing. OBJECTIVE We compared eleven dietary and the levels of 26 plasma phospholipid FAs in metabolically healthy and unhealthy phenotypes in black South African adults. METHODS Adults from the South African arm of the Prospective Urban and Rural Epidemiology study baseline (n = 711) were categorised into four groups, namely normal weight without metabolic syndrome (MetS) (MHNW), normal weight with MetS (MUNW), metabolically healthy overweight/obese (MHO) and metabolically unhealthy overweight/obese (MUO). Dietary and plasma phospholipid FAs were measured by a quantitative food frequency questionnaire and gas chromatography-tandem mass spectrometry, respectively. We compared dietary FAs, plasma phospholipid FAs, and estimated desaturase activity between the metabolic status groups using ANCOVA adjusted for age and energy intake. RESULTS MetS was diagnosed in 35% of the participants. After adjustment for age and total energy intake, in comparison to the MHNW reference group, saturated dietary FAs (C14:0 to C18:0) and alpha-linolenic acid intakes were higher in both overweight/obese groups (MHO and MUO), while linoleic acid intakes were higher in the MUO group only. Plasma levels of most saturated FAs (C18:0 to C22:0) and PUFAs were higher, whereas selected MUFAs, palmitic acid, and estimated desaturase activities were lower in the overweight/obese groups. CONCLUSIONS The overweight groups generally had higher fat intakes than normal-weight groups, but lower plasma levels of palmitic, palmitoleic, oleic, cis-vaccenic and estimated desaturase activities. Therefore, in this population, lower plasma levels of palmitic, palmitoleic, oleic, and cis-vaccenic acids and decreased estimated desaturase activities may be biomarkers of abnormal metabolic health in overweight/obese study participants.
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Affiliation(s)
- A A Ojwang
- Centre of Excellence for Nutrition, North-West University, 2520 Potchefstroom, South Africa; Technical University of Kenya, Kenya.
| | - C M Smuts
- Centre of Excellence for Nutrition, North-West University, 2520 Potchefstroom, South Africa.
| | - M Zec
- Centre of Excellence for Nutrition, North-West University, 2520 Potchefstroom, South Africa; Centre of Excellence in Nutrition and Metabolism, Institute for Medical Research, University of Belgrade, Serbia
| | - E Wentzel-Viljoen
- Centre of Excellence for Nutrition, North-West University, 2520 Potchefstroom, South Africa.
| | - I M Kruger
- Africa Unit for Transdisciplinary Health Research, North-West University, 2520 Potchefstroom, South Africa.
| | - H S Kruger
- Centre of Excellence for Nutrition, North-West University, 2520 Potchefstroom, South Africa; Medical Research Council Extra Mural Unit: Hypertension and CVD, North-West University, 2520 Potchefstroom, South Africa.
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Pertiwi K, Küpers LK, Geleijnse JM, Zock PL, Wanders AJ, Kruger HS, van Zyl T, Kruger IM, Smuts CM. Associations of linoleic acid with markers of glucose metabolism and liver function in South African adults. Lipids Health Dis 2020; 19:138. [PMID: 32546275 PMCID: PMC7296762 DOI: 10.1186/s12944-020-01318-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 06/10/2020] [Indexed: 11/17/2022] Open
Abstract
Background The relation between dietary and circulating linoleic acid (18:2 n-6, LA), glucose metabolism and liver function is not yet clear. Associations of dietary and circulating LA with glucose metabolism and liver function markers were investigated. Methods Cross-sectional analyses in 633 black South Africans (aged > 30 years, 62% female, 51% urban) without type 2 diabetes at baseline of the Prospective Urban Rural Epidemiology study. A cultural-sensitive 145-item food-frequency questionnaire was used to collect dietary data, including LA (percentage of energy; en%). Blood samples were collected to measure circulating LA (% total fatty acids (FA); plasma phospholipids), plasma glucose, glycosylated hemoglobin (HbA1c), serum gamma-glutamyl transferase (GGT), alanine (ALT) and aspartate aminotransferase (AST). Associations per 1 standard deviation (SD) and in tertiles were analyzed using multivariable regression. Results Mean (±SD) dietary and circulating LA was 6.8 (±3.1) en% and 16.0 (±3.5) % total FA, respectively. Dietary and circulating LA were not associated with plasma glucose or HbA1c (β per 1 SD: − 0.005 to 0.010, P > 0.20). Higher dietary LA was generally associated with lower serum liver enzymes levels. One SD higher circulating LA was associated with 22% lower serum GGT (β (95% confidence interval): − 0.25 (− 0.31, − 0.18), P < 0.001), but only ≤9% lower for ALT and AST. Circulating LA and serum GGT associations differed by alcohol use and locality. Conclusion Dietary and circulating LA were inversely associated with markers of impaired liver function, but not with glucose metabolism. Alcohol use may play a role in the association between LA and liver function. Trial registration PURE North-West Province South Africa study described in this manuscript is part of the PURE study. The PURE study is registered in ClinicalTrials.gov (Identifier: NCT03225586; URL).
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Affiliation(s)
- Kamalita Pertiwi
- Division of Human Nutrition and Health, Wageningen University, Wageningen, The Netherlands.
| | - Leanne K Küpers
- Division of Human Nutrition and Health, Wageningen University, Wageningen, The Netherlands
| | - Johanna M Geleijnse
- Division of Human Nutrition and Health, Wageningen University, Wageningen, The Netherlands
| | - Peter L Zock
- Division of Human Nutrition and Health, Wageningen University, Wageningen, The Netherlands.,Unilever R&D, Foods Innovation Centre, Wageningen, the Netherlands
| | - Anne J Wanders
- Unilever R&D, Foods Innovation Centre, Wageningen, the Netherlands
| | - Herculina S Kruger
- Centre of Excellence for Nutrition, Faculty of Health Sciences, North-West University, Potchefstroom, South Africa
| | - Tertia van Zyl
- Centre of Excellence for Nutrition, Faculty of Health Sciences, North-West University, Potchefstroom, South Africa
| | - Iolanthé M Kruger
- Africa Unit for Transdisciplinary Health Research, Faculty of Health Sciences, North-West University, Potchefstroom, South Africa
| | - Cornelius M Smuts
- Centre of Excellence for Nutrition, Faculty of Health Sciences, North-West University, Potchefstroom, South Africa
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Omega-3 and its domain-specific effects on cognitive test performance in youths: A meta-analysis. Neurosci Biobehav Rev 2020; 112:420-436. [DOI: 10.1016/j.neubiorev.2020.02.016] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 02/03/2020] [Accepted: 02/12/2020] [Indexed: 12/20/2022]
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Siziba LP, Chimhashu T, Siro SS, Ngounda JO, Jacobs A, Malan L, Smuts CM, Baumgartner J. Breast milk and erythrocyte fatty acid composition of lactating women residing in a peri‑urban South African township. Prostaglandins Leukot Essent Fatty Acids 2020; 156:102027. [PMID: 31740198 DOI: 10.1016/j.plefa.2019.102027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 10/30/2019] [Accepted: 11/05/2019] [Indexed: 10/25/2022]
Abstract
Data on breast milk fatty acid (FA) composition in South African lactating women in relation to their FA status, as well as on potential compositional changes within feed, are limited. The aim of this study was to assess the FA composition of breast milk sampled at three time points within feed, and to determine associations with red blood cell (RBC) total phospholipid FA levels in lactating South African mothers of 2-4-month-old breastfed infants. FA composition (% total FAs) was analyzed in RBC total phospholipids, and in fore-, mid-feed and hind-milk samples of lactating mothers (n = 100) of Black African descent living in a peri‑urban township. The mean age of the lactating women was 27.8 ± 6.8 years. Geometric mean (95% CI) breast milk SFA, MUFA and PUFA contents were 37.7 (37.3,38.1), 28.5 (27.9, 28.8), and 23.5 (23.2, 24.5)%, respectively. Breast milk DHA and AA contents were 0.25 (0.24, 3.71) and 0.81 (0.79, 0.83)%, respectively, in fore-, mid- and hind-milk combined. Maternal RBC EPA, DHA and AA levels were 0.37 (0.34, 0.40), 3.8 (3.6, 4.0) and 15.4 (14.8, 16.1)%, respectively. Women who reported to consume fish often (n = 3) had significantly higher RBC EPA levels than women who consumed fish sometimes (n = 56), never (n = 14) or rarely (n = 19). Breast milk DHA positively correlated with maternal RBC DHA, while no correlations were found between breast milk AA and maternal RBC AA. Breast milk ALA and DHA contents were significantly higher in mid-feed [ALA= 0.8 (0.2, 0.2), DHA=0.3 (0.2, 0.3)] and hind-milk [ALA=0.8 (0.8, 0.9), DHA=0.3 (0.3, 0.3)] than foremilk [ALA=0.8 (0.7, 0.9), DHA=0.2 (0.2, 0.3)]. In contrast, LA and AA contents remained constant within feed. In this sample of peri‑urban South African lactating mothers, breast milk was low in DHA and high in AA compared to global means. Breast milk DHA was associated with maternal RBC status, while breast milk AA was not. We further showed that breast milk ALA and DHA increased, while LA and AA remained unchanged within feed. This suggests that n-3 PUFA maybe preferentially transferred to breast milk within feed through biomagnification.
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Affiliation(s)
- Linda P Siziba
- Centre of Excellence for Nutrition, North-West University, Private Bag X6001, 2520 Potchefstroom, South Africa.
| | - Tsitsi Chimhashu
- Centre of Excellence for Nutrition, North-West University, Private Bag X6001, 2520 Potchefstroom, South Africa; Division of Human Nutrition, Wageningen University, P.O. Box 8129, 6700 EV Wageningen, Netherlands
| | - Sicelosethu S Siro
- Centre of Excellence for Nutrition, North-West University, Private Bag X6001, 2520 Potchefstroom, South Africa
| | - Jennifer Osei Ngounda
- Department of Nutrition and Dietetics, University of the Free State, Bloemfontein, South Africa
| | - Adriaan Jacobs
- Centre of Excellence for Nutrition, North-West University, Private Bag X6001, 2520 Potchefstroom, South Africa
| | - Linda Malan
- Centre of Excellence for Nutrition, North-West University, Private Bag X6001, 2520 Potchefstroom, South Africa
| | - Cornelius M Smuts
- Centre of Excellence for Nutrition, North-West University, Private Bag X6001, 2520 Potchefstroom, South Africa
| | - Jeannine Baumgartner
- Centre of Excellence for Nutrition, North-West University, Private Bag X6001, 2520 Potchefstroom, South Africa; Laboratory of Human Nutrition, Institute of Food, Nutrition and Health, ETH Zürich, Switzerland
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Fensham M, Steenekamp J, Jacobs A, Hamman J. Artificial membranes in combination with selected natural oils for in vitro drug passive diffusion screening in Ussing type chamber apparatus applied to gastro-retentive systems. Pharm Dev Technol 2019; 25:366-375. [PMID: 31835955 DOI: 10.1080/10837450.2019.1705484] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Mark Fensham
- Centre of Excellence for Pharmaceutical Sciences, North-West University, Potchefstroom, South Africa
| | - Jan Steenekamp
- Centre of Excellence for Pharmaceutical Sciences, North-West University, Potchefstroom, South Africa
| | - Adriaan Jacobs
- Centre of Excellence for Nutrition, North-West University, Potchefstroom, South Africa
| | - Josias Hamman
- Centre of Excellence for Pharmaceutical Sciences, North-West University, Potchefstroom, South Africa
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Rangel-Huerta OD, Gil A. Effect of omega-3 fatty acids on cognition: an updated systematic review of randomized clinical trials. Nutr Rev 2019; 76:1-20. [PMID: 29240924 DOI: 10.1093/nutrit/nux064] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Context The increasing number of studies on the effects of n-3 long-chain polyunsaturated fatty acids (LC-PUFAs) on health, particularly cognition, in the last 5 years reflects the growing interest in this area of research. Objective The aim for this systematic review was to evaluate the scientific evidence published in the last 5 years (2012-2017) on the effects of n-3 LC-PUFA intake on cognition, cognitive development, and cognitive decline to determine whether n-3 LC-PUFAs support cognitive development and prevent cognitive decline. Data Sources The PubMed database was searched. Study Selection The 51 articles included in this systematic review reported on healthy individuals with mild or moderate cognitive impairment and patients with Alzheimer's disease. Risk of bias was assessed using Cochrane methodology. Data Extraction The number of study participants, the type of study, the type and dose of n-3 LC-PUFAs, and the key results are reported here. Results Current evidence indicates that n-3 LC-PUFAs administered during pregnancy or breastfeeding have no effect on the skills or cognitive development of children in later stages of development. Evidence regarding the improvement of cognitive function during childhood and youth or in attention deficit/hyperactivity disorder is inconclusive. Moreover, it is still unclear if n-3 LC-PUFAs can improve cognitive development or prevent cognitive decline in young or older adults.
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Affiliation(s)
- Oscar D Rangel-Huerta
- Department of Biochemistry and Molecular Biology II, Institute of Nutrition and Food Technology, Biomedical Research Centre, University of Granada, Granada, Spain
| | - Angel Gil
- Department of Biochemistry and Molecular Biology II, Institute of Nutrition and Food Technology, Biomedical Research Centre, University of Granada, Granada, Spain.,Centro de Investigación Biomédica en Red de la Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
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Long-Chain Polyunsaturated Fatty Acids Are Associated with Blood Pressure and Hypertension over 10-Years in Black South African Adults Undergoing Nutritional Transition. Foods 2019; 8:foods8090394. [PMID: 31500169 PMCID: PMC6770669 DOI: 10.3390/foods8090394] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 08/30/2019] [Accepted: 09/02/2019] [Indexed: 12/19/2022] Open
Abstract
Nutritional transition in Africa is linked with increased blood pressure (BP). We examined 10-year fatty acid status and longitudinal associations between individual long-chain polyunsaturated fatty acids (PUFA), BP and status of hypertension (≥140/90 mmHg and/or medication use) in black South Africans. We included 300 adults (>30 years) participating in the Prospective Urban Rural Epidemiology study, and analysed data from three consecutive examinations (2005, 2010 and 2015 study years). Fatty acids in plasma phospholipids were analysed by gas chromatography-mass spectrometry. We applied sequential linear mixed models for continuous outcomes and generalized mixed models for the hypertension outcome, in the complete sample and separately in urban and rural subjects. Mean baseline systolic/diastolic BP was 137/89 mmHg. Ten-year hypertension status increased among rural (48.6% to 68.6%, p = 0.001) and tended to decrease among urban subjects (67.5% to 61.9%, p = 0.253). Regardless of urbanisation, n-6 PUFA increased and eicosapentaenoic acid (EPA, C20:5 n-3) decreased over the 10-years. Subjects in the highest tertile of arachidonic acid (C20:4 n-6) had 3.81 mmHg lower systolic (95% confidence interval (CI): −7.07, −0.54) and 3.82 mmHg lower diastolic BP (DBP) (95% CI: −5.70, −1.95) compared to the reference tertile, irrespective of lifestyle and clinical confounders. Similarly, osbond acid (C22:5 n-6) was inversely associated with DBP. Over the 10-years, subjects in the highest EPA tertile presented with +2.92 and +1.94 mmHg higher SBP and DBP, respectively, and with 1.46 higher odds of being hypertensive. In black South African adults, individual plasma n-6 PUFA were inversely associated with BP, whereas EPA was adversely associated with hypertension, supporting implementation of dietary fat quality in national cardiovascular primary prevention strategies.
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Siziba LP, Baumgartner J, Ricci C, Jacobs A, Rothman M, Matsungo TM, Covic N, Faber M, Smuts CM. Associations of plasma total phospholipid fatty acid patterns with feeding practices, growth, and psychomotor development in 6-month-old South African infants. MATERNAL & CHILD NUTRITION 2019; 15:e12763. [PMID: 30489019 PMCID: PMC7199032 DOI: 10.1111/mcn.12763] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 10/14/2018] [Accepted: 11/19/2018] [Indexed: 11/28/2022]
Abstract
The objective of this study was to assess plasma fatty acid (FA) patterns of 6-month-old South African infants and to determine their association with feeding practices, growth, and psychomotor development. Plasma total phospholipid FA composition (% of total FAs) of 6-month-old infants (n = 353) from a peri-urban township was analysed, and principal component and factor analysis were performed to identify plasma FA patterns. Feeding practices, anthropometric measurements, and psychomotor development scores were determined. Four major plasma phospholipid FA patterns were identified: A plant-based C18 FA, a high n-6 long-chain polyunsaturated fatty acids (LCPUFA), a C16:1 and long-chain saturated fatty acid (SFA), and a high n-3 and low n-6 LCPUFA pattern. Formula feeding was associated with higher, whereas breastfeeding was associated with lower scores for the plant-based C18 FA and C16:1 and long-chain SFA patterns. On the other hand, breastfeeding, the consumption of cow's milk, and the consumption of semisolid foods were associated with higher scores, whereas formula feeding was associated with lower scores for the high n-6 LCPUFA pattern. Breastfeeding and the consumption of semisolids were also associated with higher high n-3 and low n-6 LCPUFA pattern scores. The C16:1 and long-chain SFA and high n-3 and low n-6 LCPUFA patterns were positively associated with psychomotor development scores. In 6-month-old South African infants, we identified distinct plasma FA patterns that presumably represent the FA quality of their diet and that are associated with psychomotor development. Our results suggest that breast milk is an important source of n-6 LCPUFAs and formula-fed infants may be at risk of inadequate LCPUFA intake.
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Affiliation(s)
- Linda P. Siziba
- Centre of Excellence for NutritionNorth‐West UniversityPotchefstroomSouth Africa
| | - Jeannine Baumgartner
- Centre of Excellence for NutritionNorth‐West UniversityPotchefstroomSouth Africa
| | - Cristian Ricci
- Centre of Excellence for NutritionNorth‐West UniversityPotchefstroomSouth Africa
| | - Adriaan Jacobs
- Centre of Excellence for NutritionNorth‐West UniversityPotchefstroomSouth Africa
| | - Marinel Rothman
- Centre of Excellence for NutritionNorth‐West UniversityPotchefstroomSouth Africa
| | | | - Namukolo Covic
- Poverty, Health and Nutrition DivisionInternational Food Policy Research InstituteWashingtonDCUSA
| | - Mieke Faber
- Centre of Excellence for NutritionNorth‐West UniversityPotchefstroomSouth Africa
- Non‐Communicable Disease Research UnitSouth African Medical Research CouncilCape TownSouth Africa
| | - Cornelius M. Smuts
- Centre of Excellence for NutritionNorth‐West UniversityPotchefstroomSouth Africa
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Effect of 1 Year Krill Oil Supplementation on Cognitive Achievement of Dutch Adolescents: A Double-Blind Randomized Controlled Trial. Nutrients 2019; 11:nu11061230. [PMID: 31151199 PMCID: PMC6628105 DOI: 10.3390/nu11061230] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 05/24/2019] [Accepted: 05/26/2019] [Indexed: 11/17/2022] Open
Abstract
Long-chain polyunsaturated fatty acids (LCPUFA) are important for brain development and function, maybe especially during adolescence. Observational studies have demonstrated an association between fish consumption (a source of LCPUFA) and cognition in adolescents, but intervention trials are lacking. The goal of the current study was to investigate the effect of one year of krill oil (a source of LCPUFA) supplementation on the cognitive performance of adolescents with a low Omega-3 Index (O3I ≤ 5%). A double-blind, randomized, and placebo-controlled supplementation trial with repeated measurements (baseline (T0), three months (T1), six months (T2), and 12 months (T3)) in adolescents (267 randomized) was executed. Participants were randomized to 400 mg eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) per day in Cohort I or placebo and 800 mg EPA + DHA per day in Cohort II or placebo. O3I was monitored by a finger prick at all time points. At T0, T2, and T3, participants executed a neurocognitive test battery. Covariate corrected mixed models were run with either condition (krill or placebo) or O3I as predictors. Krill oil supplementation led to a small but significant increase in mean O3I, but few participants increased to the intended O3I range (8–11%). There was no significant effect of supplementation on the neurocognitive tests, nor a relationship between O3I and neurocognitive test scores. The increase in O3I was small in most participants, probably due to non-compliance. Possibly the increase in O3I was too small to demonstrate an effect. More research on the influence of LCPUFAs on cognition in adolescents is needed.
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Teisen MN, Niclasen J, Vuholm S, Lundbye-Jensen J, Stark KD, Damsgaard CT, Geertsen SS, Lauritzen L. Exploring correlations between neuropsychological measures and domain-specific consistency in associations with n-3 LCPUFA status in 8-9 year-old boys and girls. PLoS One 2019; 14:e0216696. [PMID: 31116782 PMCID: PMC6530844 DOI: 10.1371/journal.pone.0216696] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 04/25/2019] [Indexed: 01/18/2023] Open
Abstract
Long-chain n-3 polyunsaturated fatty acids (n-3 LCPUFA) have in some studies been associated with cognitive and socioemotional outcomes in children, but results are inconsistent possibly due to the use of different tests and potential gender-specific effects. The objective of this cross-sectional study was to explore overall patterns in neuropsychological scores as well as correlations between scores within specific domains, and to examine potential gender differences and consistency in associations with n-3 LCPUFA status. In 199 Danish 8–9 year-old children, we performed a large battery of tests and questionnaires on attention, processing speed, executive functions, memory, and socioemotional traits, and measured erythrocyte fatty acid composition. Principal component analyses (PCA) showed that most of the variation in both cognitive performance and socioemotional traits was explained by overall performance, followed by speed-accuracy trade off and externalizing vs. internalizing problems, respectively. Boys had higher speed, lower attention and higher externalizing problem scores than girls. Measures of performance within both processing speed and attention domains correlated moderately, whereas no correlations were found for measures of executive functions apart from some weak correlations for impulsivity. Parent-rated scores for both externalizing and internalizing problems correlated strongly, whereas correlations with child-rated scores were weak. Scores within specific domains did not consistently associate with n-3 LCPUFA, except for processing speed measures which all pointed to faster processing with increased n-3 LCPUFA status. Gender differences in the associations were observed for attention and impulsivity. Child- but not parent-rated internalizing and social problems tended to associate directly with n-3 LCPUFA, supported by increased internalizing problems measured by the PCA component. In conclusion, measures of speed and attention seem to represent these domains in general, whereas single measures of more complex cognitive functions should be interpreted with caution. One approach could be to use multiple tests and create multivariate scores to guide interpretations. Furthermore, the results indicate a need to consider both parent- and child-rated socioemotional scores and gender differences in neuropsychological functions e.g. in investigations of n-3 LCPUFA effects.
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Affiliation(s)
- Marie N. Teisen
- Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Copenhagen, Denmark
- * E-mail:
| | - Janni Niclasen
- Steno Diabetes Center Copenhagen, Health Promotion, Diabetes Prevention Research, Copenhagen, Denmark
- Frederikshøj Dagbehandlingsskole, Copenhagen, Denmark
| | - Stine Vuholm
- Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Copenhagen, Denmark
| | - Jesper Lundbye-Jensen
- Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Copenhagen, Denmark
| | - Ken D. Stark
- Department of Kinesiology, Faculty of Applied Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Camilla T. Damsgaard
- Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Copenhagen, Denmark
| | - Svend S. Geertsen
- Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Copenhagen, Denmark
| | - Lotte Lauritzen
- Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Copenhagen, Denmark
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de Lange Z, Kahler B, Smuts CM, Pieters M. Plasma phospholipid fatty acids are associated with altered fibrin clot properties in a population-based setting. Prostaglandins Leukot Essent Fatty Acids 2019; 143:1-7. [PMID: 30975377 DOI: 10.1016/j.plefa.2019.02.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 01/22/2019] [Accepted: 02/06/2019] [Indexed: 10/27/2022]
Abstract
Evidence regarding the relationship of plasma clot properties with fatty acids is contradictory, owing to different experimental protocols employed. The relationship of fibrinogen and plasma fibrin clot properties with plasma phospholipid fatty acids were cross-sectionally investigated in a population-based setting in 900 individuals. Composite saturated fatty acids (driven by stearic acid) and composite n-3 and n-6 polyunsaturated fatty acids (driven by docosahexaenoic and arachidonic acid respectively) were associated with prothrombotic clot properties. Composite monounsaturated fatty acids (driven by oleic acid) were associated with a profibrinolytic clot phenotype. Fibrinogen and BMI partly mediated these relationships. Individual plasma fatty acids from the same composite group had opposing associations with clot properties indicating that associations with composite fatty acid groups is dependent on the relative composition of the comprising fatty acids. The relationship of the plasma phospholipid fatty acid profile with disease should not be interpreted without considering the role of regulatory mechanisms.
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Affiliation(s)
- Z de Lange
- Centre of Excellence for Nutrition, North-West University, Private Bag X6001, Potchefstroom 2520, South Africa.
| | - B Kahler
- Centre of Excellence for Nutrition, North-West University, Private Bag X6001, Potchefstroom 2520, South Africa
| | - C M Smuts
- Centre of Excellence for Nutrition, North-West University, Private Bag X6001, Potchefstroom 2520, South Africa.
| | - M Pieters
- Centre of Excellence for Nutrition, North-West University, Private Bag X6001, Potchefstroom 2520, South Africa.
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Visser M, Van Zyl T, Hanekom SM, Baumgartner J, van der Hoeven M, Taljaard-Krugell C, Smuts CM, Faber M. Nutrient patterns and their relation to anemia and iron status in 5- to 12-y-old children in South Africa. Nutrition 2019; 62:194-200. [PMID: 30925444 DOI: 10.1016/j.nut.2019.01.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 12/27/2018] [Accepted: 01/23/2019] [Indexed: 01/08/2023]
Abstract
OBJECTIVE The aim of this study was to assess nutrient patterns and their relation to anemia and iron status of school children using pooled data from three study populations in South Africa. METHODS Data from 5- to 12-y-old children (N = 578) from three independent studies conducted in two provinces in South Africa were pooled. Data used in the analysis were dietary intake, hemoglobin, and plasma ferritin concentrations. Nutrient patterns were determined using factor analysis. Logistic regression analysis was performed to determine relationships of nutrient patterns with anemia and iron deficiency. RESULTS In the pooled group, 13.8% of the children were anemic and 27.7% were iron deficient (ID). More than half of children did not meet the Estimated Average Requirement for various nutrients, including vitamins A, C, B12, folate, and zinc, although only 17.7% of children had an iron intake below the requirements. Median intakes for vitamins A and C were lower for anemic than non-anemic children (P = 0.03 and 0.02, respectively) and for ID versus non-ID children (P = 0.03 and 0.046, respectively). Four nutrient patterns were identified: plant protein, carbohydrate, iron, and B vitamins; animal protein and saturated fat; vitamins A and B12; and calcium and fiber. The vitamin A and B12 nutrient pattern was associated with lower odds of being anemic (odds ratio, 0.63; 95% confidence interval, 0.49-0.91; P = 0.035). CONCLUSION The present results highlighted the potential role of the combination of dietary vitamin A and B12 in the etiology of nutritional anemia in school-age children in South Africa. Nutrient pattern analysis may improve the understanding of the synergistic role of nutrients related to anemia and may assist in planning intervention strategies.
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Affiliation(s)
- Marina Visser
- Centre of Excellence for Nutrition, North-West University, South Africa.
| | - Tertia Van Zyl
- Centre of Excellence for Nutrition, North-West University, South Africa
| | - Susanna M Hanekom
- Centre of Excellence for Nutrition, North-West University, South Africa
| | | | - Marinka van der Hoeven
- Centre of Excellence for Nutrition, North-West University, South Africa; Infectious Disease and Public Health, Vrije University, The Netherlands
| | | | - Cornelius M Smuts
- Centre of Excellence for Nutrition, North-West University, South Africa
| | - Mieke Faber
- Centre of Excellence for Nutrition, North-West University, South Africa; Non-Communicable Diseases Research Unit, South African Medical Research Council, South Africa
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Donoghue V, Schleicher GK, Spruyt MGL, Malan L, Nel DG, Calder PC, Blaauw R. Four-oil intravenous lipid emulsion effect on plasma fatty acid composition, inflammatory markers and clinical outcomes in acutely ill patients: A randomised control trial (Foil fact). Clin Nutr 2018; 38:2583-2591. [PMID: 30638739 DOI: 10.1016/j.clnu.2018.12.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 12/03/2018] [Accepted: 12/04/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS Data in critically ill patients on the effect of intravenous lipid emulsions (LEs), containing omega-3 polyunsaturated fatty acids (PUFAs), in parenteral nutrition (PN) are scarce and conflicting. This study compared the effects of a four-oil LE (30% soybean oil, 30% medium-chain triglycerides, 25% olive oil and 15% fish oil (FO)) (SMOFlipid®) to those of a 100% soybean oil-based LE in critically ill adult intensive care unit (ICU) patients. METHODS In this double-blind, randomised study, patients (n = 75) predicted to need PN for more than 5 days were randomised to receive either a four-oil LE (Study Group (SG)) or a 100% soybean oil LE (Control Group (CG)). Isocaloric, isonitrogenous PN was administered continuously for 5 days. FO was provided at a dose of 0.09-0.22 g/kg body weight. Measurements included biochemical parameters and sequential organ failure assessment (SOFA) score daily and plasma total phospholipid fatty acids (FAs) and cytokine levels on days 1, 3, 6. Days on mechanical ventilation, length of stay and mortality were also recorded. ANOVA was used to compare response variables between the two groups over the time and Pearson correlation was used to measure relationships between continuous variables. RESULTS 68 patients completed the study (n = 35 SG, n = 33 CG), with male predominance (66% SG, 56% CG). Average age was 60.8 ± 13.9 years (SG) versus 55.7 ± 14.8 (CG) (p = 0.143). The majority were surgical admissions (85% SG versus 91% CG) followed by medical. Plasma phospholipid oleic acid (p = 0.022) and alpha-linolenic acid (p<0.0005) increased in both groups. In the SG, plasma phospholipid EPA and DHA increased (both p<0.001), whereas the omega-6:omega-3 PUFA (n-6:n-3 PUFA) ratio decreased (p < 0.001). Aspartate aminotransferase (AST), alanine aminotransferase (ALT) and bilirubin decreased in both treatment groups. Considering only the change from day 1 to day 6 there was a bigger decrease in AST, ALT and bilirubin levels in the SG. Concentrations of TNF-α decreased from day 1 to day 6 in the SG, whereas they increased in the CG, but the change was not statistically significant (p = 0.112). A significant negative correlation was found between EPA provision on day 3 and the SOFA score (r = -0.4047, p = 0.018). Days on mechanical ventilation (1.24 ± 0.83 days in SG versus 0.88 ± 1.63 days in CG, p = 0.385) and ICU LOS (9.5 ± 7.09 days in SG versus 10.7 ± 7.6 days in CG, p = 0.490) were not different between groups. CONCLUSION PN containing a four-oil LE increased plasma EPA and DHA, decreased n-6:n-3 PUFA ratio, and was safe and well tolerated. The negative relationship between day 3 EPA and SOFA score seems promising, but EPA intake and effects may have been diluted by enteral nutrition which was started in more than half of patients on day 4. There was no significant difference in terms of other biochemical measurements, SOFA score, length of ICU stay and mortality. More research is needed in this patient population, particularly regarding dose, duration and timing of FO and the effects on clinical outcomes.
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Affiliation(s)
- V Donoghue
- Division of Human Nutrition, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa.
| | - G K Schleicher
- Wits Donald Gordon Medical Centre ICU, Parktown, Johannesburg, South Africa
| | - M G L Spruyt
- Critical Care, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa
| | - L Malan
- Centre of Excellence for Nutrition, North-West University, Potchefstroom Campus, South Africa
| | - D G Nel
- Centre for Statistical Consultation, Stellenbosch University, Stellenbosch, South Africa
| | - P C Calder
- Faculty of Medicine, University of Southampton, UK and NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust and University of Southampton, Southampton, UK
| | - R Blaauw
- Division of Human Nutrition, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
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Symington EA, Baumgartner J, Malan L, Zandberg L, Ricci C, Smuts CM. Nutrition during pregnancy and early development (NuPED) in urban South Africa: a study protocol for a prospective cohort. BMC Pregnancy Childbirth 2018; 18:308. [PMID: 30041623 PMCID: PMC6056931 DOI: 10.1186/s12884-018-1943-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Accepted: 07/16/2018] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Adequate nutrition during pregnancy is important to ensure optimal birth outcomes, maternal health and offspring development. However, little is known about the dietary intake and nutritional status of pregnant women residing in urban South Africa. Therefore, the Nutrition during Pregnancy and Early Development (NuPED) cohort study was initiated to assess early nutrition-related exposures predictive of early childhood development in urban South Africa. METHODS The aims of this prospective cohort study are: 1) to assess dietary intake and nutritional status of urban pregnant women in Johannesburg, South Africa, and 2) to determine associations with birth outcomes, measures of maternal health, as well as measures of offspring health and development. Pregnant women (< 18 weeks' gestation) (n = 250) are being recruited from primary healthcare clinics in Johannesburg and are followed-up at a provincial hospital. Participants' dietary intake and nutrient status (focus on micronutrients and fatty acids) are assessed at < 18, 22 and 36 weeks' gestation. Additional assessments during pregnancy include anthropometric and blood pressure measurements, obstetric ultrasound screens, and assessments of food security, maternal fatigue, prenatal depression, allergy, immune function, morbidity and gestational diabetes. At birth, maternal and neonatal health is assessed and an umbilical cord blood sample collected. Maternal and offspring health is followed-up at 6 weeks, as well as at 6, ≈7.5 and 12 months after birth. Follow-up assessments of mothers include anthropometric measures, diet history, nutrient status, blood pressure, breast milk composition, and measures of postnatal depression and fatigue. Follow-up assessments of the offspring include feeding practices, nutrient status, measures of growth, psychomotor, socio-emotional and immune development, morbidity, allergy, as well as analysis of the gut microbiome and the epigenome. DISCUSSION Ensuring adequate nutrition during pregnancy is one of the key actions endorsed by the South African Government to promote optimal early childhood development in an effort to eradicate poverty. The results from this study may serve as a basis for the development of context-specific nutritional interventions which can improve birth outcomes and long-term quality of life of the mother and her offspring.
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Affiliation(s)
- Elizabeth A. Symington
- Centre of Excellence for Nutrition, North-West University, Potchefstroom, South Africa
- Department of Life and Consumer Sciences, University of South Africa, Johannesburg, South Africa
| | - Jeannine Baumgartner
- Centre of Excellence for Nutrition, North-West University, Potchefstroom, South Africa
| | - Linda Malan
- Centre of Excellence for Nutrition, North-West University, Potchefstroom, South Africa
| | - Lizelle Zandberg
- Centre of Excellence for Nutrition, North-West University, Potchefstroom, South Africa
| | - Cristian Ricci
- Centre of Excellence for Nutrition, North-West University, Potchefstroom, South Africa
| | - Cornelius M. Smuts
- Centre of Excellence for Nutrition, North-West University, Potchefstroom, South Africa
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Mitchell JM, Tomlinson M, Bland RM, Houle B, Stein A, Rochat TJ. Confirmatory factor analysis of the Kaufman assessment battery in a sample of primary school-aged children in rural South Africa. SOUTH AFRICAN JOURNAL OF PSYCHOLOGY 2017. [DOI: 10.1177/0081246317741822] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The Kaufman Assessment Battery for Children, Second Edition, measures cognitive processing, includes non-verbal sub-tests, and is increasingly used in low- and middle-income countries. While the Kaufman Assessment Battery for Children, Second Edition, has been validated in the United States, a psychometric evaluation has not been conducted in Southern Africa. This study aims to establish the reliability and validity of the Kaufman Assessment Battery for Children, Second Edition, among a sample of 376 primary school-aged children in rural South Africa (7–11 years). We examined Cronbach’s alpha and conducted a confirmatory factor analysis. The battery showed good reliability (mental processing index [α = .78]), and the originally validated structure of the Kaufman Assessment Battery for Children, Second Edition, was maintained (χ2 = 16.30, p = .432). Mean scores were low on the Planning sub-scale. On the Simultaneous sub-scale, the mean score was higher for the supplementary sub-test Block Counting versus the core sub-test Triangles. With translation and the inclusion of supplementary sub-tests, the Kaufman Assessment Battery for Children, Second Edition, is an appropriate assessment to use in this context (150/150).
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Affiliation(s)
- Joanie M Mitchell
- Africa Health Research Institute, Durban, South Africa
- Department of Psychology, Stellenbosch University, South Africa
| | - Mark Tomlinson
- Department of Psychology, Stellenbosch University, South Africa
| | - Ruth M Bland
- Africa Health Research Institute, Durban, South Africa
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Royal Hospital for Sick Children and Institute of Health and Wellbeing, University of Glasgow, UK
| | - Brian Houle
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- School of Demography, The Australian National University, Australia
- CU Population Center, Institute of Behavioral Science, University of Colorado Boulder, United States
| | - Alan Stein
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Psychiatry, University of Oxford, UK
| | - Tamsen J Rochat
- Africa Health Research Institute, Durban, South Africa
- Department of Psychiatry, University of Oxford, UK
- Human and Social Development, Human Sciences Research Council, South Africa
- MRC/Developmental Pathways to Health Research Unit, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
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Nutrition (Micronutrients) in Child Growth and Development: A Systematic Review on Current Evidence, Recommendations and Opportunities for Further Research. J Dev Behav Pediatr 2017; 38:665-679. [PMID: 28746059 DOI: 10.1097/dbp.0000000000000482] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVE An important aspect of malnutrition is deficiency of different micronutrients during pregnancy or early childhood. We systematically reviewed the role of nutrition in child growth (weight or height gain) and development. METHODS A comprehensive literature search was done on PubMed/Cochrane Library browsing through 38,795 abstracts until December 31, 2016 to select systematic reviews/meta-analyses and individual randomized controlled trials (RCTs) of micronutrient supplementation. RESULTS Micronutrients studied included iron, iodine, folate, zinc, calcium, magnesium, selenium, vitamin D, vitamin A, vitamin B complex, and multiple micronutrients. We summarize evidence with details and results of RCTs, highlight strengths/weaknesses, and critically interpret findings. Effects of breastfeeding-promotion, food-supplementation (complementary and school feeding), conditional-cash-transfers, and integrated nutrition/psychosocial interventions are discussed. CONCLUSION Based on this evidence we make policy and programmatic recommendations for supplementation to mothers and children at high-risk of deficiency.
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Lam LF, Lawlis TR. Feeding the brain – The effects of micronutrient interventions on cognitive performance among school-aged children: A systematic review of randomized controlled trials. Clin Nutr 2017; 36:1007-1014. [DOI: 10.1016/j.clnu.2016.06.013] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 06/01/2016] [Accepted: 06/19/2016] [Indexed: 11/25/2022]
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A Review of Recruitment, Adherence and Drop-Out Rates in Omega-3 Polyunsaturated Fatty Acid Supplementation Trials in Children and Adolescents. Nutrients 2017; 9:nu9050474. [PMID: 28489030 PMCID: PMC5452204 DOI: 10.3390/nu9050474] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 04/26/2017] [Accepted: 05/02/2017] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION The influence of n-3 long-chain polyunsaturated fatty acids (n-3 LCPUFA) supplementation on health outcomes has been studied extensively with randomized controlled trials (RCT). In many research fields, difficulties with recruitment, adherence and high drop-out rates have been reported. However, what is unknown is how common these problems are in n-3 LCPUFA supplementation studies in children and adolescents. Therefore, this paper will review n-3 LCPUFA supplementation studies in children and adolescents with regard to recruitment, adherence and drop-out rates. METHODS The Web of Science, PubMed and Ovid databases were searched for papers reporting on RCT supplementing children and adolescents (2-18 years) with a form of n-3 LCPUFA (or placebo) for at least four weeks. As a proxy for abiding to CONSORT guidelines, we noted whether manuscripts provided a flow-chart and provided dates defining the period of recruitment and follow-up. RESULTS Ninety manuscripts (reporting on 75 studies) met the inclusion criteria. The majority of the studies did not abide by the CONSORT guidelines: 55% did not provide a flow-chart, while 70% did not provide dates. The majority of studies provided minimal details about the recruitment process. Only 25 of the 75 studies reported an adherence rate which was on average 85%. Sixty-five of the 75 studies included drop-out rates which were on average 17%. CONCLUSION Less than half of the included studies abided by the CONSORT guidelines (45% included a flow chart, while 30% reported dates). Problems with recruitment and drop-out seem to be common in n-3 LCPUFA supplementation trials in children and adolescents. However, reporting about recruitment, adherence and dropout rates was very heterogeneous and minimal in the included studies. Some techniques to improve recruitment, adherence and dropout rates were identified from the literature, however these techniques may need to be tailored to n-3 LCPUFA supplementation studies in children and adolescents.
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Hansen SL, Ritterband-Rosenbaum A, Voigt CB, Hellgren LI, Sørensen ADM, Jacobsen C, Greve LZ, Jørgensen KD, Bilde PE, Kiens B, Nielsen JB. Supplementation of docosahexaenoic acid (DHA), vitamin D 3 and uridine in combination with six weeks of cognitive and motor training in prepubescent children: a pilot study. BMC Nutr 2017; 3:37. [PMID: 32153817 PMCID: PMC7050862 DOI: 10.1186/s40795-017-0155-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Accepted: 04/05/2017] [Indexed: 11/10/2022] Open
Abstract
Background Learning and memory have been shown to be influenced by combination of dietary supplements and exercise in animal models, but there is little available evidence from human subjects. The aim of this pilot study was to investigate the effect of combining a motor- and cognitive exercise program with dietary supplementation consisting of 500 mg docosahexaenoic acid (DHA), 10 μg vitamin D3 and 1000 mg uridine (DDU-supplement) in 16 prepubescent children (age 8–11 years). Methods We designed a randomized, placebo-controlled, double-blinded study lasting 6 weeks in which DDU-supplement or placebo was ingested daily. During the intervention period, all children trained approximately 30 min 3 days/week using an internet-based cognitive and motor training program (Mitii). Prior to and post the intervention period dietary record, blood sampling, physical exercise tests and motor and cognitive tests were performed. Results Fourteen of the 16 children completed the intervention and ingested the supplement as required. 6 weeks DDU-supplementation resulted in a significant increase in the blood concentration of vitamin D2+3 and DHA (p = 0.023 and p < 0.001, respectively). Power calculation based on one of the cognitive tasks revealed a proper sample size of 26 children. Conclusion All children showed improved performance in the trained motor- and cognitive tasks, but it was not possible to demonstrate any significant effects on the cognitive tests from the dietary supplementation. However, DDU-supplementation did result in increased blood concentration of DHA and vitamin D2+3. Trial registration Clinical registration ID: NCT02426554 (clinical Trial.gov). January 2015 retrospectively registered.
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Affiliation(s)
- Solvejg L Hansen
- 1Department of Nutrition, Exercise and Sports, Section of Molecular Physiology, August Krogh Building University of Copenhagen, Universitetsparken 13, 2100 Copenhagen Ø, Denmark
| | - Anina Ritterband-Rosenbaum
- 2Center for Neuroscience, Panum Institute, University of Copenhagen, Blegdamsvej 3, 2200 Copenhagen N, Denmark.,The Elsass Institute, Holmegårdsvej 28, 2920 Charlottelund, Denmark
| | - Camilla B Voigt
- 2Center for Neuroscience, Panum Institute, University of Copenhagen, Blegdamsvej 3, 2200 Copenhagen N, Denmark.,The Elsass Institute, Holmegårdsvej 28, 2920 Charlottelund, Denmark
| | - Lars I Hellgren
- 3Center for Biological Sequence Analysis, Department of Systems Biology, Technical University of Denmark, Søltofts Plads, 2800 Kgs. Lyngby, Denmark
| | - Ann-Dorit M Sørensen
- 4National Food Institute, Division of Industrial Food Research, Technical University of Denmark, Søltofts Plads, 2800 Kgs. Lyngby, Denmark
| | - Charlotte Jacobsen
- 4National Food Institute, Division of Industrial Food Research, Technical University of Denmark, Søltofts Plads, 2800 Kgs. Lyngby, Denmark
| | - Line Z Greve
- The Elsass Institute, Holmegårdsvej 28, 2920 Charlottelund, Denmark
| | | | - Peder E Bilde
- The Elsass Institute, Holmegårdsvej 28, 2920 Charlottelund, Denmark
| | - Bente Kiens
- 1Department of Nutrition, Exercise and Sports, Section of Molecular Physiology, August Krogh Building University of Copenhagen, Universitetsparken 13, 2100 Copenhagen Ø, Denmark
| | - Jens B Nielsen
- 2Center for Neuroscience, Panum Institute, University of Copenhagen, Blegdamsvej 3, 2200 Copenhagen N, Denmark
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Saltzman E, Schlossman N, Brown CA, Balan I, Fuss P, Batra P, Braima de Sa A, Shea MK, Pruzensky WM, Bale C, Roberts SB. Nutrition Status of Primary School Students in Two Rural Regions of Guinea-Bissau. Food Nutr Bull 2016; 38:103-114. [PMID: 28027671 DOI: 10.1177/0379572116679071] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The nutrition status of primary schoolchildren in Africa has received relatively little attention in comparison to that of younger children. We surveyed primary school students in Guinea-Bissau, a nation that is among the poorest in the world. OBJECTIVE Anthropometry and prevalence of anemia and vitamin A deficiency were assessed in schoolchildren participating in International Partnership for Human Development's school feeding program in 2 regions of Guinea-Bissau. METHODS A cross-sectional survey of 32 schools in the regions of Cacheu and Oio was conducted in November 2011. Variables included age, gender, weight, height, hemoglobin, and retinol-binding protein concentrations. Z scores for height for age (HAZ), body mass index for age (BAZ), and weight for age were calculated using World Health Organization reference data. RESULTS Anthropometric assessment of 4784 students revealed stunting (HAZ < -2) in 15.5%, thinness (BAZ < -2) in 13.2%, and anemia in 42.0%. Stunting, thinness, and anemia were significantly more common in males, in students from Oio, and in older students. Vitamin A deficiency, detected in 21.5% of the population, was the only assessment that did not demonstrate significant differences between genders or regions. About 61.1% of all children had 1 or more indicators of undernutrition. CONCLUSION There are substantial rates of stunting, thinness, underweight, anemia, and vitamin A deficiency in primary schoolchildren in Guinea-Bissau, even among those participating in a school lunch program and particularly among males and older students. The results suggest the need for evaluating feeding programs and other methods to improve nutrition status in primary school students, especially in older students.
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Affiliation(s)
- Edward Saltzman
- 1 Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA.,2 Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA, USA
| | - Nina Schlossman
- 1 Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA.,3 Global Food and Nutrition Inc., Washington, DC, USA
| | - Carrie A Brown
- 2 Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA, USA
| | - Ionela Balan
- 4 International Partnership for Human Development, Leesburg, VA, USA
| | - Paul Fuss
- 2 Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA, USA
| | - Payal Batra
- 1 Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA.,2 Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA, USA
| | | | - Mary Kyla Shea
- 2 Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA, USA
| | | | - Carlito Bale
- 4 International Partnership for Human Development, Leesburg, VA, USA
| | - Susan B Roberts
- 1 Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA.,2 Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA, USA
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Pusceddu MM, Kelly P, Stanton C, Cryan JF, Dinan TG. N-3 Polyunsaturated Fatty Acids through the Lifespan: Implication for Psychopathology. Int J Neuropsychopharmacol 2016; 19:pyw078. [PMID: 27608809 PMCID: PMC5203760 DOI: 10.1093/ijnp/pyw078] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE The impact of lifetime dietary habits and their role in physical, mental, and social well-being has been the focus of considerable recent research. Omega-3 polyunsaturated fatty acids as a dietary constituent have been under the spotlight for decades. Omega-3 polyunsaturated fatty acids constitute key regulating factors of neurotransmission, neurogenesis, and neuroinflammation and are thereby fundamental for development, functioning, and aging of the CNS. Of note is the fact that these processes are altered in various psychiatric disorders, including attention deficit hyperactivity disorder, depression, and Alzheimer's disease. DESIGN Relevant literature was identified through a search of MEDLINE via PubMed using the following words, "n-3 PUFAs," "EPA," and "DHA" in combination with "stress," "cognition," "ADHD," "anxiety," "depression," "bipolar disorder," "schizophrenia," and "Alzheimer." The principal focus was on the role of omega-3 polyunsaturated fatty acids throughout the lifespan and their implication for psychopathologies. Recommendations for future investigation on the potential clinical value of omega-3 polyunsaturated fatty acids were examined. RESULTS The inconsistent and inconclusive results from randomized clinical trials limits the usage of omega-3 polyunsaturated fatty acids in clinical practice. However, a body of literature demonstrates an inverse correlation between omega-3 polyunsaturated fatty acid levels and quality of life/ psychiatric diseases. Specifically, older healthy adults showing low habitual intake of omega-3 polyunsaturated fatty acids benefit most from consuming them, showing improved age-related cognitive decline. CONCLUSIONS Although further studies are required, there is an exciting and growing body of research suggesting that omega-3 polyunsaturated fatty acids may have a potential clinical value in the prevention and treatment of psychopathologies.
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Affiliation(s)
- Matteo M Pusceddu
- APC Microbiome Institute, University College Cork, Cork, Ireland (Drs Pusceddu, Cryan, and Dinan); Teagasc, Moorepark, Cork, Ireland (Drs Kelly and Stanton); Department of Anatomy and Neuroscience (Dr Cryan), and Department of Psychiatry and Neurobehavioural Science (Dr Dinan), University College Cork, Cork, Ireland
| | - Philip Kelly
- APC Microbiome Institute, University College Cork, Cork, Ireland (Drs Pusceddu, Cryan, and Dinan); Teagasc, Moorepark, Cork, Ireland (Drs Kelly and Stanton); Department of Anatomy and Neuroscience (Dr Cryan), and Department of Psychiatry and Neurobehavioural Science (Dr Dinan), University College Cork, Cork, Ireland
| | - Catherine Stanton
- APC Microbiome Institute, University College Cork, Cork, Ireland (Drs Pusceddu, Cryan, and Dinan); Teagasc, Moorepark, Cork, Ireland (Drs Kelly and Stanton); Department of Anatomy and Neuroscience (Dr Cryan), and Department of Psychiatry and Neurobehavioural Science (Dr Dinan), University College Cork, Cork, Ireland
| | - John F Cryan
- APC Microbiome Institute, University College Cork, Cork, Ireland (Drs Pusceddu, Cryan, and Dinan); Teagasc, Moorepark, Cork, Ireland (Drs Kelly and Stanton); Department of Anatomy and Neuroscience (Dr Cryan), and Department of Psychiatry and Neurobehavioural Science (Dr Dinan), University College Cork, Cork, Ireland
| | - Timothy G Dinan
- APC Microbiome Institute, University College Cork, Cork, Ireland (Drs Pusceddu, Cryan, and Dinan); Teagasc, Moorepark, Cork, Ireland (Drs Kelly and Stanton); Department of Anatomy and Neuroscience (Dr Cryan), and Department of Psychiatry and Neurobehavioural Science (Dr Dinan), University College Cork, Cork, Ireland.
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Bouhouch RR, El-Fadeli S, Andersson M, Aboussad A, Chabaa L, Zeder C, Kippler M, Baumgartner J, Sedki A, Zimmermann MB. Effects of wheat-flour biscuits fortified with iron and EDTA, alone and in combination, on blood lead concentration, iron status, and cognition in children: a double-blind randomized controlled trial. Am J Clin Nutr 2016; 104:1318-1326. [PMID: 27733396 DOI: 10.3945/ajcn.115.129346] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Accepted: 09/08/2016] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Lead is a common neurotoxicant and its absorption may be increased in iron deficiency (ID). Thus, iron fortification to prevent ID in populations is a promising lead mitigation strategy. Two common fortificants are ferrous sulfate (FeSO4) and ferric sodium EDTA (NaFeEDTA). EDTA can chelate iron and lead. OBJECTIVES Our study objective was to determine the effects of iron and EDTA, alone and in combination, on blood lead (BPb) concentration, iron status, and cognition. DESIGN In this 2 × 2 factorial, double-blind placebo-controlled trial, 457 lead-exposed Moroccan children were stratified by school and grade and randomly assigned to consume biscuits (6 d/wk at school) containing 1) ∼8 mg Fe as FeSO4, 2) ∼8 mg Fe as NaFeEDTA that contained ∼41 mg EDTA, 3) ∼41 mg EDTA as sodium EDTA (Na2EDTA), or 4) placebo for 28 wk. The primary outcome was BPb concentration; secondary outcomes were iron status and cognitive outcomes from subtests of the Kaufman Assessment Battery for Children and the Hopkins Verbal Learning Test. These outcomes were measured at baseline and endpoint. All data were analyzed by intention-to-treat. RESULTS The adjusted geometric mean BPb concentration at baseline was 4.3 μg/dL (95% CI: 4.2, 4.3 μg/dL), and at endpoint these values were 3.3 μg/dL (95% CI: 3.1, 3.5 μg/dL) for FeSO4, 2.9 μg/dL (95% CI: 2.7, 3.0 μg/dL) for NaFeEDTA, 3.3 μg/dL (95% CI: 3.1, 3.5 μg/dL) for EDTA, and 3.7 μg/dL (95% CI: 3.5, 3.9 μg/dL) for placebo. We found an effect of iron (P = 0.009) and EDTA (P = 0.012) for reduced BPb concentrations at endpoint, but no iron × EDTA interaction. Iron fortification improved iron status, but there were no positive effects of iron or EDTA on cognitive test scores. CONCLUSIONS Food fortification with iron and EDTA additively reduces BPb concentrations. Our findings suggest that NaFeEDTA should be the iron fortificant of choice in lead-exposed populations. This trial was registered at clinicaltrials.gov as NCT01573013.
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Affiliation(s)
| | | | - Maria Andersson
- Laboratory of Human Nutrition, ETH Zurich, Zurich, Switzerland
| | | | - Laila Chabaa
- Medical University Hospital Mohammed VI University Hospital, Marrakesh, Morocco
| | | | - Maria Kippler
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; and
| | - Jeannine Baumgartner
- Centre of Excellence for Nutrition, North-West University, Potchefstroom, South Africa
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Mashavave G, Kuona P, Tinago W, Stray-Pedersen B, Munjoma M, Musarurwa C. Dried blood spot omega-3 and omega-6 long chain polyunsaturated fatty acid levels in 7-9 year old Zimbabwean children: a cross sectional study. BMC Clin Pathol 2016; 16:14. [PMID: 27499701 PMCID: PMC4974798 DOI: 10.1186/s12907-016-0035-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Accepted: 07/20/2016] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Omega-3 long chain-polyunsaturated fatty acids (LC-PUFAs)-docosahexaenoic acid (DHA), docosapentaenoic acid (DPA) and eicosapentaenoic acid (EPA)- and omega-6 LC-PUFA arachidonic acid (ARA), are essential for optimum physical and mental development in children. Prior to this study, the blood omega-3 LC-PUFA levels were unknown in Zimbabwean children, particularly in those aged 7-9 years, despite the documented benefits of LC-PUFAs. Documentation of the LC-PUFA levels in this age group would help determine whether interventions, such as fortification, are necessary. This study aimed to determine dried whole blood spot omega-3 and omega-6 LC-PUFA levels and LC-PUFA reference intervals among a selected group of Zimbabwean children aged 7-9 years old. METHODS We conducted a cross sectional study from September 2011 to August 2012 on a cohort of peri-urban, Zimbabwean children aged 7-9 years. The children were born to mothers enrolled at late pregnancy into an HIV prevention program between 2002 and 2004. Dried whole blood spots were sampled on butylated hydroxytoluene antioxidant impregnated filter papers and dried. LC-PUFAs were quantified using gas liquid chromatography. Differences in LC-PUFAs between groups were compared using the Kruskal Wallis test and reference intervals determined using non-parametric statistical methods. RESULTS LC-PUFAs levels were determined in 297 Zimbabwean children of whom 170 (57.2 %) were girls. The study determined that LC-PUFAs (wt/wt) ranges were EPA 0.06-0.55 %, DPA 0.38-1.98 %, DHA 1.13-3.52 %, ARA 5.58-14.64 % and ARA: EPA ratio 15.47-1633.33. Sixteen participants had omega-3 LC-PUFAs levels below the determined reference intervals, while 18 had higher omega-6 LC-PUFAs. The study did not show gender differences in omega-3 and omega-6 LC-PUFAs levels (all p > 0.05). EPA was significantly higher in the 8 year age group compared to those aged 7 and 9 years (median; 0.20 vs 0.17 vs 0.18, respectively, p = 0.049). ARA: EPA ratio was significantly higher in the 7 year age group compared to those aged 8 and 9 years (median; 64.38 vs 56.43 vs 55.87 respectively, p = 0.014). CONCLUSIONS In this cohort of children, lower EPA levels and higher ARA: EPA ratios were observed compared to those reported in apparently healthy children elsewhere. The high ARA: EPA ratios might increase the vulnerability of these children to inflammatory pathologies. Identification and incorporation into diet of locally produced foodstuffs rich in omega-3 LC-PUFAs is recommended as well as advocating for dietary supplementation with omega-3 fish oils and algae based oils.
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Affiliation(s)
- Grace Mashavave
- Department of Chemical Pathology, College of Health Sciences, University of Zimbabwe, PO BOX A178, Avondale, Harare, Zimbabwe
| | - Patience Kuona
- Department of Paediatrics and Child Health, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Willard Tinago
- Department of Community Medicine, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Babill Stray-Pedersen
- Division of Women and Children, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Marshall Munjoma
- Department of Obstetrics and Gynaecology, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Cuthbert Musarurwa
- Department of Chemical Pathology, College of Health Sciences, University of Zimbabwe, PO BOX A178, Avondale, Harare, Zimbabwe
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