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Freitas-Costa NC, Andrade P, Normando P, Salvatte Nunes KS, Raymundo CE, Ribeiro de Castro IR, Maria de Aquino Lacerda E, Farias DR, Kac G. Association of development quotient with nutritional status of vitamins B6, B12, and folate in 6-59-month-old children: Results from the Brazilian National Survey on Child Nutrition (ENANI-2019). Am J Clin Nutr 2023:S0002-9165(23)47384-4. [PMID: 37105522 DOI: 10.1016/j.ajcnut.2023.04.026] [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] [Received: 01/07/2023] [Revised: 03/28/2023] [Accepted: 04/19/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND Vitamins B6, B12, and folate are essential for the formation and maintenance of the human brain, but studies evaluating these vitamins with early childhood development (ECD) in children under five are limited and controversial. OBJECTIVE To evaluate the association between vitamins B6, B12, and folate concentrations/status and ECD. METHODS Data regarding 6,520 children aged 6-59 months (from the Brazilian National Survey on Child Nutrition [ENANI-2019]) were analyzed. ECD was assessed using the Survey of Well-being of Young Children's milestones questionnaire. Vitamin B6 concentration (nmol/L) was classified according to the tertile of the distribution and with the cutoff <20 nmol/L. Folate concentrations >45.3 nmol/L were classified as high, and vitamin B12 <150 pmol/L as deficient. The graded response model was used to estimate developmental age, and the developmental quotient (DQ) was calculated as the developmental age divided by chronological age. Multiple linear regression models were adjusted for confounders. RESULTS The DQ mean (95% confidence interval) for Brazilian children was 0.99 (0.97-1.01). Children aged 6-23 months (1.13 [1.10-1.16]) had a higher DQ mean than those aged 24-35 (0.99 [0.95-1.03]) and 36-59 months (0.89 [0.86-0.92]). Child age was inversely associated with DQ (β=-0.007; p<0.001). An interaction between child age and vitamin B12 deficiency in the DQ (β=-0.005; p<0.001) indicated that, in children aged 36-59 months, the DQ was markedly lower in children with B12 deficiency than in those without B12 deficiency. Vitamin B6 concentrations were directly associated with the DQ (β=0.0004; p=0.031) among children aged 24-59 months in the adjusted model. No association was observed between folate status and DQ. CONCLUSIONS In Brazil, the DQ is lower among older children, and those with vitamin B12 deficiency. Vitamin B6 status was directly associated with the DQ in children aged 24-59 months.
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Affiliation(s)
- Nathalia Cristina Freitas-Costa
- Nutritional Epidemiology Observatory, Institute of Nutrition Josué de Castro, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Pedro Andrade
- Institute of Applied Economic Research, Rio de Janeiro, Brazil
| | - Paula Normando
- Nutritional Epidemiology Observatory, Institute of Nutrition Josué de Castro, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Keronlainy Silva Salvatte Nunes
- Nutritional Epidemiology Observatory, Institute of Nutrition Josué de Castro, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Carlos Eduardo Raymundo
- Institute of Collective Health, School of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Elisa Maria de Aquino Lacerda
- Nutritional Epidemiology Observatory, Institute of Nutrition Josué de Castro, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Dayana Rodrigues Farias
- Nutritional Epidemiology Observatory, Institute of Nutrition Josué de Castro, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Gilberto Kac
- Nutritional Epidemiology Observatory, Institute of Nutrition Josué de Castro, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.
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Valentini NC, de Borba LS, Panceri C, Smith BA, Procianoy RS, Silveira RC. Early Detection of Cognitive, Language, and Motor Delays for Low-Income Preterm Infants: A Brazilian Cohort Longitudinal Study on Infant Neurodevelopment and Maternal Practice. Front Psychol 2021; 12:753551. [PMID: 34777151 PMCID: PMC8581740 DOI: 10.3389/fpsyg.2021.753551] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 09/30/2021] [Indexed: 12/02/2022] Open
Abstract
Aim: This study examined the neurodevelopment trajectories, the prevalence of delays, and the risks and protective factors (adverse outcomes, environment, and maternal factors) associated with cognitive, motor, and language development for preterm infants from 4– to 24-months. Method: We assessed 186 preterm infants (24.7% extremely preterm; 54.8% very preterm; 20.4% moderate/late preterm) from 4– to 24-months using the Bayley Scales of Infant Development – III. Maternal practices and knowledge were assessed using the Daily Activities of Infant Scale and the Knowledge of Infant Development Inventory. Birth risks and adverse outcomes were obtained from infant medical profiles. Results: A high prevalence of delays was found; red flags for delays at 24-months were detected at 4– and 8-months of age. The neurodevelopmental trajectories showed steady scores across time for cognitive composite scores for extremely- and very-preterm infants and for language composite scores for the extremely- and moderate/late-preterm; a similar trend was observed for the motor trajectories of moderate/late preterm. Changes over time were restricted to motor composite scores for extremely- and very-preterm infants and for cognitive composite scores for moderate/late preterm; declines, stabilization, and improvements were observed longitudinally. Positive, strong, and significant correlations were for the neurodevelopment scores at the first year of life and later neurodevelopment at 18 and 24 months. The cognitive, language, and motor composite scores of extremely and very preterm groups were associated with more risk factors (adverse outcomes, environment, and maternal factors). However, for moderate/late preterm infants, only APGAR and maternal practices significantly explained the variance in neurodevelopment. Discussion: Although adverse outcomes were strongly associated with infant neurodevelopment, the environment and the parents’ engagement in play and breastfeeding were protective factors for most preterm infants. Intervention strategies for preterm infants should start at 4– to 8-months of age to prevent unwanted outcomes later in life.
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Affiliation(s)
- Nadia C Valentini
- Escola de Educação Física, Fisioterapia e Dança, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Luana S de Borba
- Escola de Educação Física, Fisioterapia e Dança, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Escola de Fisioterapia, Centro Universitário Ritter dos Reis (UniRitter), Porto Alegre, Brazil
| | - Carolina Panceri
- Escola de Educação Física, Fisioterapia e Dança, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Beth A Smith
- Developmental Neuroscience and Neurogenetics Program, The Saban Research Institute, Division of Research on Children, Youth, and Families, Children's Hospital Los Angeles, Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Renato S Procianoy
- Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,Escola de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Rita C Silveira
- Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,Escola de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
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Oliveira CVRD, Palombo CNT, Toriyama ÁTM, Veríssimo MDLÓR, Castro MCD, Fujimori E. Health inequalities: child development in different social groups. Rev Esc Enferm USP 2019; 53:e03499. [PMID: 31800802 DOI: 10.1590/s1980-220x2018037103499] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Accepted: 01/22/2019] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To analyze child development in different social groups. METHOD A cross-sectional study with children under 3 years old enrolled in basic health units of a municipality in the state of São Paulo, Brazil. Child development was verified by the Ministry of Health's Development Monitoring Form. The Social Class Index was used to classify families into social groups and the predefined hierarchical theoretical model for univariate and multiple logistic regression analysis. RESULTS The sample consisted of 348 children, in which 29% of the children presented the absence of some developmental milestone expected for their age, while social group and age group were associated with child development in the final model. Children from the least socially inserted groups aged 12 months or older were more likely to be missing some developmental milestone. CONCLUSION The proportion of children with the absence of some developmental milestones is high and associated with lower social inclusion. The importance of developmental surveillance by the primary care nursing team is emphasized in order to identify the most vulnerable groups and to implement early interventions which can minimize the negative effects which worsen with age.
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Affiliation(s)
| | | | - Áurea Tamami Minagawa Toriyama
- Universidade de São Paulo, Escola de Enfermagem, Departamento de Enfermagem Materno-infantil e Psiquiátrica, São Paulo, SP, Brasil
| | - Maria de La Ó Ramallo Veríssimo
- Universidade de São Paulo, Escola de Enfermagem, Departamento de Enfermagem Materno-infantil e Psiquiátrica, São Paulo, SP, Brasil
| | - Márcia Caldas de Castro
- Harvard University School of Public Health, Department Global Health and Population, Boston, MA, United States
| | - Elizabeth Fujimori
- Universidade de São Paulo, Escola de Enfermagem, Departamento de Enfermagem em Saúde Coletiva, São Paulo, SP, Brasil
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Hadders-Algra M, Boxum AG, Hielkema T, Hamer EG. Effect of early intervention in infants at very high risk of cerebral palsy: a systematic review. Dev Med Child Neurol 2017; 59:246-258. [PMID: 27925172 DOI: 10.1111/dmcn.13331] [Citation(s) in RCA: 80] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/29/2016] [Indexed: 01/18/2023]
Abstract
AIM First, to systematically review the evidence on the effect of intervention applied during the first postnatal year in infants with or at very high risk of cerebral palsy (CP) on child and family outcome. Second, to assess whether type and dosing of intervention modify the effect of intervention. METHOD Relevant literature was identified by searching the PubMed, Embase, and CINAHL databases. Selection criteria included infants younger than 12 months corrected age with or at very high risk of CP. Methodological quality including risk of bias was scrutinized. RESULTS Thirteen papers met the inclusion criteria. Seven studies with moderate to high methodological quality were analysed in detail; they evaluated neurodevelopmental treatment only (n=2), multisensory stimulation (n=1), developmental stimulation (n=2), and multifaceted interventions consisting of a mix of developmental stimulation, support of parent-infant interaction, and neurodevelopmental treatment (n=2). The heterogeneity precluded conclusions. Yet, two suggestions emerged: (1) dosing may be critical for effectiveness; (2) multifaceted intervention may offer best opportunities for child and family. INTERPRETATION The literature on early intervention in very high-risk infants with sufficient methodological quality is limited, heterogeneous, and provides weak evidence on the effect. More studies are urgently needed. Suggestions for future research are provided.
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Affiliation(s)
- Mijna Hadders-Algra
- University of Groningen, University Medical Center Groningen, Department of Paediatrics, Division of Developmental Neurology, Groningen, the Netherlands
| | - Anke G Boxum
- University of Groningen, University Medical Center Groningen, Department of Paediatrics, Division of Developmental Neurology, Groningen, the Netherlands
| | - Tjitske Hielkema
- University of Groningen, University Medical Center Groningen, Department of Paediatrics, Division of Developmental Neurology, Groningen, the Netherlands.,University of Groningen, University Medical Center Groningen, Department of Rehabilitation Medicine, Center for Rehabilitation, Groningen, the Netherlands
| | - Elisa G Hamer
- University of Groningen, University Medical Center Groningen, Department of Paediatrics, Division of Developmental Neurology, Groningen, the Netherlands.,Radboud University Medical Center, Department of Neurology, Nijmegen, the Netherlands
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