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Piper JD, Mazhanga C, Mapako G, Mapurisa I, Mashedze T, Munyama E, Mwapaura M, Chidhanguro D, Gerema G, Tavengwa NV, Ntozini R, Langhaug LF, Smuk M, Rochat T, Kaufman A, Kaufman N, Gladstone M, Allen E, Prendergast AJ. Piloting the adaptation of the Kaufman Assessment Battery for Children-2 nd edition (KABC-II) to assess school-age neurodevelopment in rural Zimbabwe. Wellcome Open Res 2024; 7:274. [PMID: 38910935 PMCID: PMC11190652 DOI: 10.12688/wellcomeopenres.17902.2] [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: 05/20/2024] [Indexed: 06/25/2024] Open
Abstract
Background Neurodevelopment assessment tools for low-resource settings are urgently needed. However, most available tools were developed in high-income settings and may lack cross-cultural validity. Methods We piloted and adapted two subtests within the planning domain of the Kaufman Assessment Battery for Children-2nd edition (KABC-II) for use in rural Zimbabwean children aged 7years. After initial assessments of face validity, we created 4 substitutions for the story completion subtest and 7 additions for the pattern reasoning subtest through a co-design process with fieldworkers and child development experts. To assess how successful the changes were, T-tests adjusting for unequal variances were used to compare scores between the original and adapted versions of the same subtest. ANOVA and pairwise analysis was performed to compare the performance of KABC-II subtests across domains. Intraclass correlation coefficient was calculated to explore the variability between domains. Results Initial test scores on the planning domain were significantly lower than the other three domains of learning, sequential memory and simultaneous reasoning (P<0.001) in 50 children (mean age 7.6(SD 0.2) years). Modified subtests were administered to another 20 children (mean age 7.6(SD 0.2) years), who showed story completion scores that were 0.7 marks higher (95% CI 0.0, 1.4; P=0.05) and pattern reasoning scores 1.8 marks higher (95% CI 0.5, 3.2; P=0.01). Overall, the planning domain mean score increased from 8.1 (SD 2.9) to 10.6 (SD 3.4). The intra class correlation coefficient between all four KABC-II domains was initially 0.43 (95% CI 0.13, 0.64) and after modification was 0.69 (95% CI 0.37, 0.87), suggesting an increase in the construct validity. Conclusions The KABC-II planning domain was successfully adapted to improve cross-cultural validity. Construct validity was enhanced, based on increased inter-correlations among scales. The process of co-design to modify tests for new settings may be beneficial for other commonly used neurodevelopmental tools.
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Affiliation(s)
- Joseph D. Piper
- Department of Genomics and Child Health, Queen Mary University of London, London, E1 4AT, UK
- Zvitambo Institute for Maternal and Child Health Research, Mabelreign, Harare, Zimbabwe
| | - Clever Mazhanga
- Zvitambo Institute for Maternal and Child Health Research, Mabelreign, Harare, Zimbabwe
| | - Gloria Mapako
- Zvitambo Institute for Maternal and Child Health Research, Mabelreign, Harare, Zimbabwe
| | - Idah Mapurisa
- Zvitambo Institute for Maternal and Child Health Research, Mabelreign, Harare, Zimbabwe
| | - Tsitsi Mashedze
- Zvitambo Institute for Maternal and Child Health Research, Mabelreign, Harare, Zimbabwe
| | - Eunice Munyama
- Zvitambo Institute for Maternal and Child Health Research, Mabelreign, Harare, Zimbabwe
| | - Marian Mwapaura
- Zvitambo Institute for Maternal and Child Health Research, Mabelreign, Harare, Zimbabwe
| | - Dzivaidzo Chidhanguro
- Zvitambo Institute for Maternal and Child Health Research, Mabelreign, Harare, Zimbabwe
| | - Grace Gerema
- Zvitambo Institute for Maternal and Child Health Research, Mabelreign, Harare, Zimbabwe
| | - Naume V. Tavengwa
- Zvitambo Institute for Maternal and Child Health Research, Mabelreign, Harare, Zimbabwe
| | - Robert Ntozini
- Zvitambo Institute for Maternal and Child Health Research, Mabelreign, Harare, Zimbabwe
| | - Lisa F. Langhaug
- Zvitambo Institute for Maternal and Child Health Research, Mabelreign, Harare, Zimbabwe
| | - Melanie Smuk
- Department of Genomics and Child Health, Queen Mary University of London, London, E1 4AT, UK
| | - Tamsen Rochat
- Department of Psychology, University of the Witwatersrand, Johannesburg, 2000, South Africa
| | - Alan Kaufman
- Department of Medicine, Yale University, New Haven, Connecticut, 06520-8081, USA
| | - Nadeen Kaufman
- Department of Medicine, Yale University, New Haven, Connecticut, 06520-8081, USA
| | - Melissa Gladstone
- Department of Life Course and Medical Sciences, University of Liverpool, Liverpool, L69 7ZX, UK
| | - Elizabeth Allen
- Department of Life Course and Medical Sciences, University of Liverpool, Liverpool, L69 7ZX, UK
| | - Andrew J. Prendergast
- Department of Genomics and Child Health, Queen Mary University of London, London, E1 4AT, UK
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Liu S, Mo C, Lei L, Lv F, Li J, Xu X, Lu P, Wei G, Huang X, Zeng X, Qiu X. Association of ultraprocessed foods consumption and cognitive function among children aged 4-7 years: a cross-sectional data analysis. Front Nutr 2023; 10:1272126. [PMID: 37881777 PMCID: PMC10597700 DOI: 10.3389/fnut.2023.1272126] [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] [Received: 08/04/2023] [Accepted: 09/25/2023] [Indexed: 10/27/2023] Open
Abstract
Background Sugar-sweetened beverage (SSB) consumption has shown associations with cognitive function in preschool children, but effects of other ultraprocessed foods consumption are rarely discussed in China. This study aimed to investigate the relationship between ultraprocessed food consumption and cognitive function among preschool children in China. Methods A total of 325 children aged 4-7 years were included from Guangxi Zhuang Birth Cohort in Guangxi Zhuang Autonomous Region, China. Face-to-face interviews with parents using the Food Frequency Questionnaire (FFQ) was conducted to investigate the status of seven ultraprocessed foods consumption (i.e., chocolate, biscuits, candy, fast-food, ice cream, SSBs, and sweet bakery products). The mandarin-language version of the Wechsler Preschool and Primary Scale of Intelligence (WPPSI, Fourth Edition) was applied to assess the cognitive function of children. Multiple linear and logistic regression models were used to assess the associations between ultraprocessed food consumption and the full-scale intelligence quotient (FSIQ) and different domains and risk of cognitive deficit, respectively. Results We found that frequent consumption of candy (β = -3.34, 95% CI: -5.62∼-1.06; p = 0.004) and sweet bakery products (β = -2.77, 95% CI: -5.58∼0.04; p = 0.054) were significant associated with decreased FSIQ scores in the linear regression models. However, only frequent consumption of candy was statistically significantly associated with an increased risk of cognitive deficit (OR = 2.05, 95% CI: 1.11∼3.79; p = 0.023) in the logistic regression models. For the different domains, we found frequent consumption of candy (β = -3.85, 95% CI: -6.28∼-1.43; p = 0.002) and sweet bakery products (β = -3.48, 95% CI: -6.47∼-0.49; p = 0.023) was also significantly associated with lower Verbal Comprehension Index (VCI). When combining the seven ultraprocessed foods, we found children who frequently consumed more than two kinds of ultraprocessed foods had a significant decrease of VCI scores (β = -2.66; 95% CI: -5.12∼-0.19; p = 0.035) too. Conclusion Our results suggested that frequent consumption of individual (candy and sweet bakery products) and multiple ultraprocessed foods may decrease VCI scores and thereby impact cognitive function in children aged 4-7 years.
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Affiliation(s)
- Shun Liu
- Department of Child and Adolescent Health and Maternal and Child Health, School of Public Health, Guangxi Medical University, Nanning, China
| | - Caimei Mo
- Department of Epidemiology and Health Statistics, School of Public Health, Guangxi Medical University, Nanning, China
| | - Lidi Lei
- Department of Epidemiology and Health Statistics, School of Public Health, Guangxi Medical University, Nanning, China
| | - Fangfang Lv
- Department of Epidemiology and Health Statistics, School of Public Health, Guangxi Medical University, Nanning, China
| | - Jinxiu Li
- Department of Epidemiology and Health Statistics, School of Public Health, Guangxi Medical University, Nanning, China
| | - Xuemei Xu
- Department of Epidemiology and Health Statistics, School of Public Health, Guangxi Medical University, Nanning, China
| | - Peini Lu
- Department of Epidemiology and Health Statistics, School of Public Health, Guangxi Medical University, Nanning, China
| | - Gangjie Wei
- Department of Epidemiology and Health Statistics, School of Public Health, Guangxi Medical University, Nanning, China
| | - Xuanqian Huang
- Department of Epidemiology and Health Statistics, School of Public Health, Guangxi Medical University, Nanning, China
| | - Xiaoyun Zeng
- Department of Epidemiology and Health Statistics, School of Public Health, Guangxi Medical University, Nanning, China
| | - Xiaoqiang Qiu
- Department of Epidemiology and Health Statistics, School of Public Health, Guangxi Medical University, Nanning, China
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Chien YH, Lin CY, Hsu SY, Chen YH, Wu HT, Huang SW, Chen YC. Effects of Nonnutritive Sweeteners on Body Composition Changes during Pubertal Growth. Nutrients 2023; 15:nu15102319. [PMID: 37242202 DOI: 10.3390/nu15102319] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 05/01/2023] [Accepted: 05/10/2023] [Indexed: 05/28/2023] Open
Abstract
The effects of consuming specific types of nonnutritive sweeteners (NNSs) on adiposity changes in children have remained inconsistent. In this study, we aimed to investigate the effects of the intake of different kinds of NNSs on long-term adiposity changes during pubertal growth. Furthermore, we examined the above relationships among different sexes, pubertal stages, and levels of obesity. A total of 1893 6-15-year-old adults were recruited and followed-up every 3 months. The NNS-FFQ (Food Frequency Questionnaire) was conducted and urine samples were collected to investigate the effects of the selected sweeteners, which included acesulfame potassium, aspartame, sucralose, glycyrrhizin, steviol glycosides, and sorbitol. Multivariate linear mixed-effects models were used to examine the relationship between NNS intake and body composition. The consumption of aspartame, sucralose, glycyrrhizin, stevioside, and sorbitol was associated with decreased fat mass and increased fat-free mass. In the highest tertile group, the effects of NNS consumption on fat mass corresponded to values of -1.21 (95% CI: -2.04 to -0.38) for aspartame, -0.62 (95% CI: -1.42 to 0.19) for sucralose, -1.26 (95% CI: -2.05 to -0.47) for glycyrrhizin, -0.90 (95% CI: -2.28 to 0.48) for stevioside, and -0.87 (95% CI: -1.67 to -0.08) for sorbitol, while the effects on fat-free mass corresponded to values of 1.20 (95% CI: 0.36 to -0.38) for aspartame, 0.62 (95% CI: -0.19 to 1.43) for sucralose, 1.27 (95% CI: 0.48 to 2.06) for glycyrrhizin, 0.85 (95% CI: -0.53 to 2.23) for stevioside, and 0.87 (95% CI: 0.08 to 1.67) for sorbitol. Particularly, aspartame and sorbitol revealed a dose-responsiveness effect. The above finding was more prominent among girls than boys. Moreover, fat mass was significantly reduced in normal-weight children who consumed a moderate amount of aspartame and a large amount of glycyrrhizin and sorbitol compared with obese children. In conclusion, the NNS-specific and sex-specific effects of long-term NNS consumption revealed associations of decreasing fat mass and increasing fat-free mass for children undergoing pubertal growth.
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Affiliation(s)
- Yu-Hsin Chien
- Department of Education, Taipei Medical University Hospital, Taipei 110, Taiwan
| | - Chia-Yuan Lin
- Department of Family Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan
- Department of Food Science, National Taiwan Ocean University, Keelung City 202301, Taiwan
| | - Shih-Yuan Hsu
- Department of Family Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan
| | - Yue-Hwa Chen
- School of Nutrition and Health Sciences, College of Nutrition, Taipei Medical University, Taipei 110, Taiwan
| | - Hung-Tsung Wu
- Department of Internal Medicine, School of Medicine, College of Medicine, National Cheng Kung University, Tainan 701, Taiwan
| | - Shiu-Wen Huang
- Graduate Institute of Medical Sciences, College of Medicine, Taipei Medical University, Taipei 110, Taiwan
- Department of Pharmacology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan
- Department of Medical Research, Research Center of Thoracic Medicine and Asthma, Taipei Medical University Hospital, Taipei 110, Taiwan
| | - Yang-Ching Chen
- Department of Family Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan
- School of Nutrition and Health Sciences, College of Nutrition, Taipei Medical University, Taipei 110, Taiwan
- Department of Family Medicine, Taipei Medical University Hospital, Taipei 110, Taiwan
- Graduate Institute of Metabolism and Obesity Sciences, Taipei Medical University, Taipei 110, Taiwan
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Piper J, Mazhanga C, Mapako G, Mapurisa I, Mashedze T, Munyama E, Mwapaura M, Chidhanguro D, Gerema G, Tavengwa N, Ntozini R, Langhaug L, Smuk M, Rochat T, Kaufman A, Kaufman N, Gladstone M, Allen E, Prendergast A. Piloting the adaptation of the Kaufman Assessment Battery for Children—2nd edition (KABC-II) to assess school-age neurodevelopment in rural Zimbabwe. Wellcome Open Res 2022. [DOI: 10.12688/wellcomeopenres.17902.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Background: Neurodevelopment assessment tools for low-resource settings are urgently needed. However, most available tools were developed in high-income settings and may lack cross-cultural validity. Methods: We piloted and adapted two subtests (pattern reasoning and story completion) within the Kaufman Assessment Battery for Children-2nd edition (KABC-II) for use in rural Zimbabwean children aged 7 years old, both within the planning domain. After initial assessments of face validity, we substituted and added items in the test battery through a co-design process with fieldworkers and child development experts. To assess how successful the changes were, T-tests adjusting for unequal variances were used to compare scores between the original and adapted versions of the same subtest. ANOVA and pairwise analysis was performed to compare the performance of KABC-II subtests across domains. Intraclass correlation coefficient was calculated to explore the variability between domains. Results: Initial test scores on the planning domain were significantly lower than the other three domains of learning, sequential memory and simultaneous reasoning (P<0.001) in 50 children. Modified subtests were administered to another 20 children, who showed story completion scores that were 0.7 marks higher (95% CI 0.0, 1.4; P=0.05) and pattern reasoning scores 1.8 marks higher (95% CI 0.5, 3.2; P=0.01). Overall, the planning domain mean score increased from 8.1 (SD 2.9) to 10.6 (SD 3.4). The intra class correlation coefficient between all four KABC-II domains was initially 0.43 (95% CI 0.13, 0.64) and after modification was 0.69 (95% CI 0.37, 0.87), suggesting an increase in the construct validity. Conclusions: The KABC-II planning domain was successfully adapted to improve cross-cultural validity. Construct validity was enhanced, based on increased inter-correlations among scales. This pilot has since been applied to the SHINE follow-up study. The process of co-design to modify tests for new settings may be beneficial for other commonly used neurodevelopmental tools.
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Pan S, Wang X, Lin L, Chen J, Zhan X, Jin C, Ou X, Gu T, Jing J, Cai L. Association of sugar-sweetened beverages with executive function in autistic children. Front Nutr 2022; 9:940841. [PMID: 36082034 PMCID: PMC9447427 DOI: 10.3389/fnut.2022.940841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 07/20/2022] [Indexed: 11/22/2022] Open
Abstract
The association between sugar-sweetened beverages (SSBs) consumption and executive function (EF) among typically developing (TD) children has been investigated in previous studies but with inconsistent results. Furthermore, this relationship has been less investigated among autistic children who perform worse in EF compared with TD children. In this study, we aimed to investigate the association between SSB consumption and EF in autistic children, and whether the association between SSB and EF in autistic children is different from that in TD children. We recruited 106 autistic children and 207 TD children aged 6–12 years in Guangzhou, China. Children’s EF was assessed by using the Chinese version of parent-reported Behavior Rating Inventory of Executive Function, Stroop Color–Word Test, and working memory subscales of the Chinese version of Wechsler Intelligence Scale for children, Fourth edition. Meanwhile, we assessed children’s dietary intake and SSB consumption with a validated Food Frequency Questionnaire. In this study, 70 (66.0%) autistic children consumed SSB and 20 (18.9%) of them consumed more than two servings SSB a week. Among autistic children, over two servings per week SSB consumption was associated with poorer performance in emotional control [β = 7.20, 95% confidence interval (CI): 0.94–13.46] and plan/Organize (β = 6.45, 95% CI: 0.27–12.63). The association between over two servings/week SSB consumption and emotional control among autistic children was significantly different from that among TD children (βASD = 7.20; βTD = −3.09, Z = 2.72, p = 0.006). Results of this study show that SSB consumption was associated with an impairment in some subscales of EF in autistic children. Furthermore, the association between SSB and EF in autistic children might be different from that in TD children.
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Affiliation(s)
- Shuolin Pan
- Department of Maternal and Child Health, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Xin Wang
- Key Laboratory of Brain, Cognition and Education Sciences, Ministry of Education; Institute for Brain Research and Rehabilitation, South China Normal University, Guangzhou, China
| | - Lizi Lin
- Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Jiajie Chen
- Department of Maternal and Child Health, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Xiaoling Zhan
- Department of Maternal and Child Health, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Chengkai Jin
- Department of Maternal and Child Health, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Xiaoxuan Ou
- Department of Maternal and Child Health, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Tingfeng Gu
- Department of Maternal and Child Health, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Jin Jing
- Department of Maternal and Child Health, School of Public Health, Sun Yat-sen University, Guangzhou, China
- Jin Jing,
| | - Li Cai
- Department of Maternal and Child Health, School of Public Health, Sun Yat-sen University, Guangzhou, China
- *Correspondence: Li Cai,
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Beckmann J, Nqweniso S, Ludyga S, du Randt R, Gresse A, Long KZ, Nienaber M, Seelig H, Pühse U, Steinmann P, Utzinger J, Walter C, Gerber M, Lang C. Evaluation of a Physical Activity and Multi-Micronutrient Intervention on Cognitive and Academic Performance in South African Primary Schoolchildren. Nutrients 2022; 14:nu14132609. [PMID: 35807790 PMCID: PMC9268611 DOI: 10.3390/nu14132609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 06/08/2022] [Accepted: 06/20/2022] [Indexed: 11/16/2022] Open
Abstract
Executive functions (EFs) are essential for optimal academic development. Appropriate nutrition and physical activity (PA) have been shown to facilitate optimal cognitive development. Therefore, this study examined whether a 12-week school-based PA and multi-micronutrient supplementation (MMNS) intervention would improve cognitive and academic performance. A cluster-randomized controlled trial (RCT) was conducted. Children from four schools located in a peri-urban area of South Africa were randomly assigned to (i) PA + MMNS, (ii) PA + placebo, (iii) MMNS or (iv) placebo. Information processing and inhibitory control were measured with a computerized Flanker task. End-of-year results provided insight into academic achievement. Anthropometric measures were used to determine nutritional status. Data were analyzed with linear mixed-models, adjusting for baseline scores, school classes and age; 932 children (458 girls (49.1%), Mage (mean age) = 8.42 ± 1.94 years) completed baseline and post-intervention assessments. Cognitive performance improved among all four groups, with no significant group × time effects. For academic achievement, there was no significant interaction effect between the combined intervention group and placebo. We encourage future studies in this neglected area in order to determine the most optimal design of school-based nutrition and PA programs to enhance overall cognitive performance.
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Affiliation(s)
- Johanna Beckmann
- Department of Sport, Exercise and Health, University of Basel, 4052 Basel, Switzerland; (S.L.); (H.S.); (U.P.); (M.G.); (C.L.)
- Correspondence:
| | - Siphesihle Nqweniso
- Department of Human Movement Science, Nelson Mandela University, Gqeberha 6011, South Africa; (S.N.); (R.d.R.); (M.N.); (C.W.)
| | - Sebastian Ludyga
- Department of Sport, Exercise and Health, University of Basel, 4052 Basel, Switzerland; (S.L.); (H.S.); (U.P.); (M.G.); (C.L.)
| | - Rosa du Randt
- Department of Human Movement Science, Nelson Mandela University, Gqeberha 6011, South Africa; (S.N.); (R.d.R.); (M.N.); (C.W.)
| | - Annelie Gresse
- Department of Human Nutrition and Dietetics, Nelson Mandela University, Gqeberha 6031, South Africa;
| | - Kurt Z. Long
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, 4123 Allschwil, Switzerland; (K.Z.L.); (P.S.); (J.U.)
| | - Madeleine Nienaber
- Department of Human Movement Science, Nelson Mandela University, Gqeberha 6011, South Africa; (S.N.); (R.d.R.); (M.N.); (C.W.)
| | - Harald Seelig
- Department of Sport, Exercise and Health, University of Basel, 4052 Basel, Switzerland; (S.L.); (H.S.); (U.P.); (M.G.); (C.L.)
| | - Uwe Pühse
- Department of Sport, Exercise and Health, University of Basel, 4052 Basel, Switzerland; (S.L.); (H.S.); (U.P.); (M.G.); (C.L.)
| | - Peter Steinmann
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, 4123 Allschwil, Switzerland; (K.Z.L.); (P.S.); (J.U.)
| | - Jürg Utzinger
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, 4123 Allschwil, Switzerland; (K.Z.L.); (P.S.); (J.U.)
| | - Cheryl Walter
- Department of Human Movement Science, Nelson Mandela University, Gqeberha 6011, South Africa; (S.N.); (R.d.R.); (M.N.); (C.W.)
| | - Markus Gerber
- Department of Sport, Exercise and Health, University of Basel, 4052 Basel, Switzerland; (S.L.); (H.S.); (U.P.); (M.G.); (C.L.)
| | - Christin Lang
- Department of Sport, Exercise and Health, University of Basel, 4052 Basel, Switzerland; (S.L.); (H.S.); (U.P.); (M.G.); (C.L.)
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García CR, Piernas C, Martínez-Rodríguez A, Hernández-Morante JJ. Effect of glucose and sucrose on cognition in healthy humans: a systematic review and meta-analysis of interventional studies. Nutr Rev 2021; 79:171-187. [PMID: 32585003 DOI: 10.1093/nutrit/nuaa036] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
CONTEXT Evidence suggests that plasma glucose levels may influence cognitive performance, but this has not been systematically reviewed and quantified. OBJECTIVE The aim of this review was to investigate the potential effects of glucose and sucrose, compared with placebo, on cognition in healthy humans. DATA SOURCES The electronic databases PubMed and Web of Science were searched up to December 2019. Reference lists of selected articles were checked manually. STUDY SELECTION Randomized controlled trials or crossover trials that compared glucose or sucrose with placebo for effects on cognition were eligible. DATA EXTRACTION Potentially eligible articles were selected independently by 2 authors. Risk of bias was assessed through the Cochrane Collaboration tool. Standardized mean differences (SMDs) were obtained from random-effects meta-analyses for a subsample of studies that reported the same outcomes. RESULTS Thirty-seven trials were identified, of which 35 investigated the effect of glucose consumption compared with placebo on cognition. Two studies found no effect of glucose on cognition, while the others found mixed results. Only 3 of the 37 studies investigated the effects of sucrose intake, reporting mixed results. Meta-analyses revealed a significantly positive effect of glucose compared with control, but only when a verbal performance test (immediate word recall) was used in parallel-design studies (SMD = 0.61; 95%CI, 0.20-1.02; I2 = 0%). Twenty-four studies were classified as having high risk of bias for the selection procedure. CONCLUSIONS A limited body of evidence shows a beneficial effect of glucose in individuals performing immediate verbal tasks. High-quality trials with standardized cognitive measurements are needed to better establish the effect of glucose or sucrose on cognition. SYSTEMATIC REVIEW REGISTRATION PROSPERO registration number CRD42019122939.
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Affiliation(s)
| | - Carmen Piernas
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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Normand M, Ritz C, Mela D, Raben A. Low-energy sweeteners and body weight: a citation network analysis. BMJ Nutr Prev Health 2021; 4:319-332. [PMID: 34308140 PMCID: PMC8258071 DOI: 10.1136/bmjnph-2020-000210] [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: 11/26/2020] [Revised: 02/12/2021] [Accepted: 02/17/2021] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE Reviews on the relationship of low-energy sweeteners (LES) with body weight (BW) have reached widely differing conclusions. To assess possible citation bias, citation analysis was used to quantify the relevant characteristics of cited articles, and explore citation patterns in relation to review conclusions. DESIGN A systematic search identified reviews published from January 2010 to March 2020. Different characteristics (for example, type of review or research, journal impact factor, conclusions) were extracted from the reviews and cited articles. Logistic regression was used to estimate likelihood of articles with particular characteristics being cited in reviews. A qualitative network analysis linked reviews sub-grouped by conclusions with the types of articles they cited. MAIN OUTCOME MEASURES (OR; 95% CI) for likelihood that articles with particular characteristics were cited as evidence in reviews. RESULTS From 33 reviews identified, 183 different articles were cited (including other reviews). Narrative reviews were 62% less likely to be cited than systematic reviews with meta-analysis (OR 0.38; 0.16 to 0.86; p=0.03). Likelihood of being cited was higher for evidence on children than adults (OR 2.27; 1.59 to 3.25; p<0.0001), and with increased journal impact factor (OR 1.15; 1.00 to 1.31; p=0.04). No other factors were statistically significant in the main analysis, and few factors were significant in subgroup analyses. Network analysis showed that reviews concluding a beneficial relationship of LES with BW cited mainly randomised controlled trials, whereas reviews concluding an adverse relationship cited mainly observational studies. CONCLUSIONS Overall reference to the available evidence across reviews appears largely arbitrary, making citation bias likely. Differences in the conclusions of individual reviews map onto different types of evidence cited. Overall, inconsistent and selective use of the available evidence may account for the diversity of conclusions in reviews on LES and BW. TRIAL REGISTRATION NUMBER Prior to data analysis, the protocol was registered with the Open Science Framework (https://osf.io/9ghws).
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Affiliation(s)
- Mie Normand
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Frederiksberg, Denmark
| | - Christian Ritz
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Frederiksberg, Denmark
| | | | - Anne Raben
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Frederiksberg, Denmark
- Steno Diabetes Center Copenhagen, Copenhagen, Denmark
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Rogers PJ, Appleton KM. The effects of low-calorie sweeteners on energy intake and body weight: a systematic review and meta-analyses of sustained intervention studies. Int J Obes (Lond) 2021; 45:464-478. [PMID: 33168917 DOI: 10.1038/s41366-020-00704-2] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Revised: 10/16/2020] [Accepted: 10/23/2020] [Indexed: 12/16/2022]
Abstract
Previous meta-analyses of intervention studies have come to different conclusions about effects of consumption of low-calorie sweeteners (LCS) on body weight. The present review included 60 articles reporting 88 parallel-groups and cross-over studies ≥1 week in duration that reported either body weight (BW), BMI and/or energy intake (EI) outcomes. Studies were analysed according to whether they compared (1) LCS with sugar, (2) LCS with water or nothing, or (3) LCS capsules with placebo capsules. Results showed an effect in favour of LCS vs sugar for BW (29 parallel-groups studies, 2267 participants: BW change, -1.06 kg, 95% CI -1.50 to -0.62, I2 = 51%), BMI and EI. Effect on BW change increased with 'dose' of sugar replaced by LCS, whereas there were no differences in study outcome as a function of duration of the intervention or participant blinding. Overall, results showed no difference in effects of LCS vs water/nothing for BW (11 parallel-groups studies, 1068 participants: BW change, 0.10 kg, 95% CI -0.87 to 1.07, I2 = 82%), BMI and EI; and inconsistent effects for LCS consumed in capsules (BW change: -0.28 kg, 95% CI -0.80 to 0.25, I2 = 0%; BMI change: 0.20 kg/m2, 95% CI 0.04 to 0.36, I2 = 0%). Occurrence of adverse events was not affected by the consumption of LCS. The studies available did not permit robust analysis of effects by LCS type. In summary, outcomes were not clearly affected when the treatments differed in sweetness, nor when LCS were consumed in capsules without tasting; however, when treatments differed in energy value (LCS vs sugar), there were consistent effects in favour of LCS. The evidence from human intervention studies supports the use of LCS in weight management, constrained primarily by the amount of added sugar that LCS can displace in the diet.
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Affiliation(s)
- Peter J Rogers
- Nutrition and Behaviour Unit, School of Psychological Science, University of Bristol, Bristol, UK.
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust, University of Bristol, Bristol, BS8 1TU, UK.
| | - Katherine M Appleton
- Department of Psychology, Faculty of Science and Technology, Bournemouth University, Poole, BH12 5BB, UK
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10
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López-Meza MS, Otero-Ojeda G, Estrada JA, Esquivel-Hernández FJ, Contreras I. The impact of nutritive and non-nutritive sweeteners on the central nervous system: preliminary study. Nutr Neurosci 2021; 25:1623-1632. [PMID: 33641634 DOI: 10.1080/1028415x.2021.1885239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Human consumption of food and beverages containing added nutritive or non-nutritive sweeteners has increased worldwide. OBJECTIVE The present study evaluated the possible impact of frequent sweetener consumption on human CNS activity and functions through neuropsychological testing and EEG/qEEG analysis. METHODS A sample of 23 women and 16 men, aged 18-35, with a body mass index between 18 and 24.9 kg/m2 was evaluated. Participants underwent a 1-week washout period in which food with added sugars or sweeteners was restricted from their diet. Initial assessment of cognitive functions was performed with a validated neuropsychological test and EEG/qEEG analysis, prior to supplementation. Sucrose, sucralose, or steviol glycosides, in commercially available presentations, were randomly assigned to three experimental groups of 13 participants each. Sweeteners were supplemented in fixed amounts, daily, for six weeks. After supplementation, neurological tests were repeated and the initial and final results were compared. RESULTS The results show no significant changes between final and initial measures in the steviol glycosides group. However, a significant decrease in encoding memory was found in the sucrose group in the final evaluation. Strikingly, the sucralose group showed a significant decrease in overall memory, encoding memory, and executive functions after supplementation. Furthermore, qEEG analysis showed an increase in theta wave absolute and relative power at the final evaluation in the same group. CONCLUSION These data show that frequent consumption of specific sweeteners is accompanied by measurable changes in EEG/qEEG activity and neuropsychological test performance in humans.
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Affiliation(s)
- M Sagrario López-Meza
- Laboratorio de Neuroquímica, Facultad de Medicina, Universidad Autónoma del Estado de México, Toluca, México
| | - Gloria Otero-Ojeda
- Laboratorio de Neurofisiología, Facultad de Medicina, Universidad Autónoma del Estado de México, Toluca, México
| | - José Antonio Estrada
- Laboratorio de Neuroquímica, Facultad de Medicina, Universidad Autónoma del Estado de México, Toluca, México
| | - Francisco José Esquivel-Hernández
- Laboratorio de Neurometría, Unidad de Investigación Interdisciplinaria en Ciencias de la Salud y la Educación (UIICE), Facultad de Estudios Superiores Iztacala, Universidad Nacional Autónoma de México, Tlalnepantla, México
| | - Irazú Contreras
- Laboratorio de Neuroquímica, Facultad de Medicina, Universidad Autónoma del Estado de México, Toluca, México
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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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Effectiveness of school-based nutrition interventions in sub-Saharan Africa: a systematic review. Public Health Nutr 2020; 23:2626-2636. [PMID: 32646534 DOI: 10.1017/s1368980020000506] [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] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To evaluate the effect of school-based nutrition interventions (SBNI) involving schoolchildren and adolescents in sub-Saharan Africa (SSA) on child nutrition status and nutrition-related knowledge, attitudes and behaviour. DESIGN A systematic review on published school nutrition intervention studies of randomised controlled trials, controlled clinical trials, controlled before-and-after studies or quasi-experimental designs with control. Nine electronic bibliographic databases were searched. To be included, interventions had to involve changes to the school's physical and social environments, to the school's nutrition policies, to teaching curriculum to incorporate nutrition education and/or to partnership with parents/community. SETTING Schools in SSA. PARTICIPANTS School-aged children and adolescents, aged 5-19 years. RESULTS Fourteen studies met our inclusion criteria. While there are few existing studies of SBNI in SSA, the evidence shows that food supplementation/fortification is very effective in reducing micronutrient deficiencies and can improve nutrition status. Secondly, school nutrition education can improve nutrition knowledge, but this may not necessarily translate into healthy nutrition behaviour, indicating that nutrition knowledge may have little impact without a facilitating environment. Results regarding anthropometry were inconclusive; however, there is evidence for the effectiveness of SBNI in improving cognitive abilities. CONCLUSIONS There is enough evidence to warrant further trials of SBNI in SSA. Future research should consider investigating the impact of SBNI on anthropometry and nutrition behaviour, focusing on the role of programme intensity and/or duration. To address the high incidence of micronutrient deficiencies in low- and middle-income countries, food supplementation strategies currently available to schoolchildren should be expanded.
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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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14
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Lohner S, Kuellenberg de Gaudry D, Toews I, Ferenci T, Meerpohl JJ. Non-nutritive sweeteners for diabetes mellitus. Cochrane Database Syst Rev 2020; 5:CD012885. [PMID: 32449201 PMCID: PMC7387865 DOI: 10.1002/14651858.cd012885.pub2] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Products sweetened with non-nutritive sweeteners (NNS) are widely available. Many people with type 1 or type 2 diabetes use NNS as a replacement for nutritive sweeteners to control their carbohydrate and energy intake. Health outcomes associated with NNS use in diabetes are unknown. OBJECTIVES To assess the effects of non-nutritive sweeteners in people with diabetes mellitus. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE Ovid, Scopus, the WHO ICTRP, and ClinicalTrials.gov. The date of the last search of all databases (except for Scopus) was May 2019. We last searched Scopus in January 2019. We did not apply any language restrictions. SELECTION CRITERIA We included randomised controlled trials (RCTs) with a duration of four weeks or more comparing any type of NNS with usual diet, no intervention, placebo, water, a different NNS, or a nutritive sweetener in individuals with type 1 or type 2 diabetes. Trials with concomitant behaviour-changing interventions, such as diet, exercise, or both, were eligible for inclusion, given that the concomitant interventions were the same in the intervention and comparator groups. DATA COLLECTION AND ANALYSIS Two review authors independently screened abstracts, full texts, and records retrieved from trials registries, assessed the certainty of the evidence, and extracted data. We used a random-effects model to perform meta-analysis, and calculated effect estimates as risk ratios (RRs) for dichotomous outcomes and mean differences (MDs) for continuous outcomes, using 95% confidence intervals (CIs). We assessed risk of bias using the Cochrane 'Risk of bias' tool and the certainty of evidence using the GRADE approach. MAIN RESULTS We included nine RCTs that randomised a total of 979 people with type 1 or type 2 diabetes. The intervention duration ranged from 4 to 10 months. We judged none of these trials as at low risk of bias for all 'Risk of bias' domains; most of the included trials did not report the method of randomisation. Three trials compared the effects of a dietary supplement containing NNS with sugar: glycosylated haemoglobin A1c (HbA1c) was 0.4% higher in the NNS group (95% CI -0.5 to 1.2; P = 0.44; 3 trials; 72 participants; very low-certainty evidence). The MD in weight change was -0.1 kg (95% CI -2.7 to 2.6; P = 0.96; 3 trials; 72 participants; very low-certainty evidence). None of the trials with sugar as comparator reported on adverse events. Five trials compared NNS with placebo. The MD for HbA1c was 0%, 95% CI -0.1 to 0.1; P = 0.99; 4 trials; 360 participants; very low-certainty evidence. The 95% prediction interval ranged between -0.3% and 0.3%. The comparison of NNS versus placebo showed a MD in body weight of -0.2 kg, 95% CI -1 to 0.6; P = 0.64; 2 trials; 184 participants; very low-certainty evidence. Three trials reported the numbers of participants experiencing at least one non-serious adverse event: 36/113 participants (31.9%) in the NNS group versus 42/118 participants (35.6%) in the placebo group (RR 0.78, 95% CI 0.39 to 1.56; P = 0.48; 3 trials; 231 participants; very low-certainty evidence). One trial compared NNS with a nutritive low-calorie sweetener (tagatose). HbA1c was 0.3% higher in the NNS group (95% CI 0.1 to 0.4; P = 0.01; 1 trial; 354 participants; very low-certainty evidence). This trial did not report body weight data and adverse events. The included trials did not report data on health-related quality of life, diabetes complications, all-cause mortality, or socioeconomic effects. AUTHORS' CONCLUSIONS There is inconclusive evidence of very low certainty regarding the effects of NNS consumption compared with either sugar, placebo, or nutritive low-calorie sweetener consumption on clinically relevant benefit or harm for HbA1c, body weight, and adverse events in people with type 1 or type 2 diabetes. Data on health-related quality of life, diabetes complications, all-cause mortality, and socioeconomic effects are lacking.
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Affiliation(s)
- Szimonetta Lohner
- Cochrane Hungary, Clinical Center of the University of Pécs, Medical School, University of Pécs, Pécs, Hungary
| | - Daniela Kuellenberg de Gaudry
- Institute for Evidence in Medicine (for Cochrane Germany Foundation), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Ingrid Toews
- Institute for Evidence in Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Tamas Ferenci
- Physiological Controls Research Center, Obuda University, Budapest, Hungary
| | - Joerg J Meerpohl
- Institute for Evidence in Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Cochrane France, Centre de Recherche Épidémiologie et Statistique Sorbonne Paris Cité (CRESS), Inserm UMR1153, Paris Descartes University, Paris, France
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15
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Kakleas K, Christodouli F, Karavanaki K. Nonalcoholic fatty liver disease, insulin resistance, and sweeteners: a literature review. Expert Rev Endocrinol Metab 2020; 15:83-93. [PMID: 32212870 DOI: 10.1080/17446651.2020.1740588] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 03/06/2020] [Indexed: 12/21/2022]
Abstract
Introduction: Sweeteners are substances used to replace sugar. They can either be chemically produced (artificial sweeteners) or extracted from plants (natural sweeteners). In the last two decades, there is an increased popularity in their role as sugar substitutes in individuals to promote weight loss or maintain glycemic control. However, despite their favorable effects, there is concern regarding their side effects and especially their influence in the development of nonalcoholic fatty liver disease (NAFLD).Areas covered: A comprehensive literature search was conducted on Medline including systematic reviews, longitudinal controlled studies, and retrospective cohort studies. We present an up-to-date systematic review of the current literature regarding the safety in artificial and natural sweeteners use as a means of weight loss or diabetes control.Expert opinion: Natural sweeteners have not been associated directly with NAFLD, and on the contrary, some, such as stevia, and trehalose, may have a protective effect. Rare sugars and polyols can be used safely and have significant benefits that include anti-oxidant effect and optimal glycemic control. Artificial sweeteners, due to their effect on NAFLD development and insulin resistance, are not indicated in patients with obesity or diabetes. Further studies in human subjects are required to verify the above findings.
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Affiliation(s)
- Konstantinos Kakleas
- Pediatric Department, Leicester Royal Infirmary, University Hospitals Leicester, Leicester, UK
| | - Foteini Christodouli
- Diabetes and Metabolism Clinic, 2nd Department of Pediatrics, National and Kapodistrian University of Athens, "P&A Kyriakou" Children's Hospital, Athens, Greece
| | - Kyriaki Karavanaki
- Diabetes and Metabolism Clinic, 2nd Department of Pediatrics, National and Kapodistrian University of Athens, "P&A Kyriakou" Children's Hospital, Athens, Greece
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16
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Das JK, Salam RA, Mahmood SB, Moin A, Kumar R, Mukhtar K, Lassi ZS, Bhutta ZA. Food fortification with multiple micronutrients: impact on health outcomes in general population. Cochrane Database Syst Rev 2019; 12:CD011400. [PMID: 31849042 PMCID: PMC6917586 DOI: 10.1002/14651858.cd011400.pub2] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND Vitamins and minerals are essential for growth and maintenance of a healthy body, and have a role in the functioning of almost every organ. Multiple interventions have been designed to improve micronutrient deficiency, and food fortification is one of them. OBJECTIVES To assess the impact of food fortification with multiple micronutrients on health outcomes in the general population, including men, women and children. SEARCH METHODS We searched electronic databases up to 29 August 2018, including the Cochrane Central Register of Controlled Trial (CENTRAL), the Cochrane Effective Practice and Organisation of Care (EPOC) Group Specialised Register and Cochrane Public Health Specialised Register; MEDLINE; Embase, and 20 other databases, including clinical trial registries. There were no date or language restrictions. We checked reference lists of included studies and relevant systematic reviews for additional papers to be considered for inclusion. SELECTION CRITERIA We included randomised controlled trials (RCTs), cluster-RCTs, quasi-randomised trials, controlled before-after (CBA) studies and interrupted time series (ITS) studies that assessed the impact of food fortification with multiple micronutrients (MMNs). Primary outcomes included anaemia, micronutrient deficiencies, anthropometric measures, morbidity, all-cause mortality and cause-specific mortality. Secondary outcomes included potential adverse outcomes, serum concentration of specific micronutrients, serum haemoglobin levels and neurodevelopmental and cognitive outcomes. We included food fortification studies from both high-income and low- and middle-income countries (LMICs). DATA COLLECTION AND ANALYSIS Two review authors independently screened, extracted and quality-appraised the data from eligible studies. We carried out statistical analysis using Review Manager 5 software. We used random-effects meta-analysis for combining data, as the characteristics of study participants and interventions differed significantly. We set out the main findings of the review in 'Summary of findings' tables, using the GRADE approach. MAIN RESULTS We identified 127 studies as relevant through title/abstract screening, and included 43 studies (48 papers) with 19,585 participants (17,878 children) in the review. All the included studies except three compared MMN fortification with placebo/no intervention. Two studies compared MMN fortification versus iodised salt and one study compared MMN fortification versus calcium fortification alone. Thirty-six studies targeted children; 20 studies were conducted in LMICs. Food vehicles used included staple foods, such as rice and flour; dairy products, including milk and yogurt; non-dairy beverages; biscuits; spreads; and salt. Fourteen of the studies were fully commercially funded, 13 had partial-commercial funding, 14 had non-commercial funding and two studies did not specify the source of funding. We rated all the evidence as of low to very low quality due to study limitations, imprecision, high heterogeneity and small sample size. When compared with placebo/no intervention, MMN fortification may reduce anaemia by 32% (risk ratio (RR) 0.68, 95% confidence interval (CI) 0.56 to 0.84; 11 studies, 3746 participants; low-quality evidence), iron deficiency anaemia by 72% (RR 0.28, 95% CI 0.19 to 0.39; 6 studies, 2189 participants; low-quality evidence), iron deficiency by 56% (RR 0.44, 95% CI 0.32 to 0.60; 11 studies, 3289 participants; low-quality evidence); vitamin A deficiency by 58% (RR 0.42, 95% CI 0.28 to 0.62; 6 studies, 1482 participants; low-quality evidence), vitamin B2 deficiency by 64% (RR 0.36, 95% CI 0.19 to 0.68; 1 study, 296 participants; low-quality evidence), vitamin B6 deficiency by 91% (RR 0.09, 95% CI 0.02 to 0.38; 2 studies, 301 participants; low-quality evidence), vitamin B12 deficiency by 58% (RR 0.42, 95% CI 0.25 to 0.71; 3 studies, 728 participants; low-quality evidence), weight-for-age z-scores (WAZ) (mean difference (MD) 0.1, 95% CI 0.02 to 0.17; 8 studies, 2889 participants; low-quality evidence) and weight-for-height/length z-score (WHZ/WLZ) (MD 0.1, 95% CI 0.02 to 0.18; 6 studies, 1758 participants; low-quality evidence). We are uncertain about the effect of MMN fortification on zinc deficiency (RR 0.84, 95% CI 0.65 to 1.08; 5 studies, 1490 participants; low-quality evidence) and height/length-for-age z-score (HAZ/LAZ) (MD 0.09, 95% CI 0.01 to 0.18; 8 studies, 2889 participants; low-quality evidence). Most of the studies in this comparison were conducted in children. Subgroup analyses of funding sources (commercial versus non-commercial) and duration of intervention did not demonstrate any difference in effects, although this was a relatively small number of studies and the possible association between commercial funding and increased effect estimates has been demonstrated in the wider health literature. We could not conduct subgroup analysis by food vehicle and funding; since there were too few studies in each subgroup to draw any meaningful conclusions. When we compared MMNs versus iodised salt, we are uncertain about the effect of MMN fortification on anaemia (R 0.86, 95% CI 0.37 to 2.01; 1 study, 88 participants; very low-quality evidence), iron deficiency anaemia (RR 0.40, 95% CI 0.09 to 1.83; 2 studies, 245 participants; very low-quality evidence), iron deficiency (RR 0.98, 95% CI 0.82 to 1.17; 1 study, 88 participants; very low-quality evidence) and vitamin A deficiency (RR 0.19, 95% CI 0.07 to 0.55; 2 studies, 363 participants; very low-quality evidence). Both of the studies were conducted in children. Only one study conducted in children compared MMN fortification versus calcium fortification. None of the primary outcomes were reported in the study. None of the included studies reported on morbidity, adverse events, all-cause or cause-specific mortality. AUTHORS' CONCLUSIONS The evidence from this review suggests that MMN fortification when compared to placebo/no intervention may reduce anaemia, iron deficiency anaemia and micronutrient deficiencies (iron, vitamin A, vitamin B2 and vitamin B6). We are uncertain of the effect of MMN fortification on anthropometric measures (HAZ/LAZ, WAZ and WHZ/WLZ). There are no data to suggest possible adverse effects of MMN fortification, and we could not draw reliable conclusions from various subgroup analyses due to a limited number of studies in each subgroup. We remain cautious about the level of commercial funding in this field, and the possibility that this may be associated with higher effect estimates, although subgroup analysis in this review did not demonstrate any impact of commercial funding. These findings are subject to study limitations, imprecision, high heterogeneity and small sample sizes, and we rated most of the evidence low to very low quality. and hence no concrete conclusions could be drawn from the findings of this review.
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Affiliation(s)
- Jai K Das
- Aga Khan University HospitalDivision of Women and Child HealthStadium RoadPO Box 3500KarachiSindPakistan
| | - Rehana A Salam
- Aga Khan University HospitalDivision of Women and Child HealthStadium RoadPO Box 3500KarachiSindPakistan
- Healthy Mothers, Babies and Children, South Australian Health and Medical Research InstituteAdelaideAustralia
| | - Salman Bin Mahmood
- Aga Khan University HospitalDepartment of PaediatricsKarachiSindhPakistan
| | - Anoosh Moin
- Aga Khan University HospitalDivision of Women and Child HealthStadium RoadPO Box 3500KarachiSindPakistan
| | - Rohail Kumar
- Aga Khan University HospitalDivision of Women and Child HealthStadium RoadPO Box 3500KarachiSindPakistan
| | - Kashif Mukhtar
- Aga Khan University HospitalDivision of Women and Child HealthStadium RoadPO Box 3500KarachiSindPakistan
| | - Zohra S Lassi
- Aga Khan University HospitalDivision of Women and Child HealthStadium RoadPO Box 3500KarachiSindPakistan
- University of AdelaideRobinson Research InstituteAdelaideAustraliaAustralia
| | - Zulfiqar A Bhutta
- The Hospital for Sick ChildrenCentre for Global Child HealthTorontoCanada
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17
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Baker-Smith CM, de Ferranti SD, Cochran WJ. The Use of Nonnutritive Sweeteners in Children. Pediatrics 2019; 144:peds.2019-2765. [PMID: 31659005 DOI: 10.1542/peds.2019-2765] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
The prevalence of nonnutritive sweeteners (NNSs) in the food supply has increased over time. Not only are more children and adolescents consuming NNSs, but they are also consuming a larger quantity of NNSs in the absence of strong scientific evidence to refute or support the safety of these agents. This policy statement from the American Academy of Pediatrics is intended to provide the pediatric provider with a review of (1) previous steps taken for approved use of NNSs, (2) existing data regarding the safety of NNS use in the general pediatric population, (3) what is known regarding the potential benefits and/or adverse effects of NNS use in children and adolescents, (4) identified gaps in existing knowledge and potential areas of future research, and (5) suggested talking points that pediatricians may use when discussing NNS use with families.
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18
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Young J, Conway EM, Rother KI, Sylvetsky AC. Low-calorie sweetener use, weight, and metabolic health among children: A mini-review. Pediatr Obes 2019; 14:e12521. [PMID: 30983091 DOI: 10.1111/ijpo.12521] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 01/23/2019] [Accepted: 02/01/2019] [Indexed: 01/08/2023]
Abstract
A reduction in the consumption of added sugars and sugar-sweetened beverages (SSBs) is a key focus of public health recommendations for a healthy diet among children. One approach to lower added sugar intake is to instead use low-calorie sweeteners (LCSs), which contain no or few calories. Consumption of LCSs is increasing worldwide, with the most marked rise observed among children and adolescents. However, the extent to which LCS consumption is helpful or harmful for weight management is controversial, particularly when LCS consumption begins in childhood. Herein, we summarize the limited existing literature examining effects of paediatric LCS consumption on appetite, energy intake, and body weight. While positive associations between LCS consumption and weight gain are reported in observational analyses, the majority of intervention studies, some of which blinded children to the contents of the drinks, report benefits of LCSs for reducing excessive child weight gain. Several potential mechanisms have been proposed to explain LCS effects on body weight, including LCS-induced promotion of appetite and energy intake. Yet studies assessing effects of beverages with LCSs (LCSBs) compared with SSBs on child appetite report mixed findings. Some demonstrate that children completely compensate for the diluted energy content of LCSBs by eating more solid food calories at subsequent meals compared with children administered SSBs, while others report a reduction in total energy intake with LCSB ingestion. Given the limited studies and resulting uncertainty as to whether LCSs benefit or worsen weight and metabolic health in children is integral that effects of LCS use during childhood continue to be investigated in future prospective studies.
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Affiliation(s)
- Jordan Young
- Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
| | - Ellen M Conway
- Section on Pediatric Diabetes and Metabolism, NIDDK, NIH, Bethesda, MD, USA
| | - Kristina I Rother
- Section on Pediatric Diabetes and Metabolism, NIDDK, NIH, Bethesda, MD, USA
| | - Allison C Sylvetsky
- Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA.,Section on Pediatric Diabetes and Metabolism, NIDDK, NIH, Bethesda, MD, USA.,Sumner M. Redstone Global Center for Prevention and Wellness, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
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von Philipsborn P, Stratil JM, Burns J, Busert LK, Pfadenhauer LM, Polus S, Holzapfel C, Hauner H, Rehfuess E. Environmental interventions to reduce the consumption of sugar-sweetened beverages and their effects on health. Cochrane Database Syst Rev 2019; 6:CD012292. [PMID: 31194900 PMCID: PMC6564085 DOI: 10.1002/14651858.cd012292.pub2] [Citation(s) in RCA: 104] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Frequent consumption of excess amounts of sugar-sweetened beverages (SSB) is a risk factor for obesity, type 2 diabetes, cardiovascular disease and dental caries. Environmental interventions, i.e. interventions that alter the physical or social environment in which individuals make beverage choices, have been advocated as a means to reduce the consumption of SSB. OBJECTIVES To assess the effects of environmental interventions (excluding taxation) on the consumption of sugar-sweetened beverages and sugar-sweetened milk, diet-related anthropometric measures and health outcomes, and on any reported unintended consequences or adverse outcomes. SEARCH METHODS We searched 11 general, specialist and regional databases from inception to 24 January 2018. We also searched trial registers, reference lists and citations, scanned websites of relevant organisations, and contacted study authors. SELECTION CRITERIA We included studies on interventions implemented at an environmental level, reporting effects on direct or indirect measures of SSB intake, diet-related anthropometric measures and health outcomes, or any reported adverse outcome. We included randomised controlled trials (RCTs), non-randomised controlled trials (NRCTs), controlled before-after (CBA) and interrupted-time-series (ITS) studies, implemented in real-world settings with a combined length of intervention and follow-up of at least 12 weeks and at least 20 individuals in each of the intervention and control groups. We excluded studies in which participants were administered SSB as part of clinical trials, and multicomponent interventions which did not report SSB-specific outcome data. We excluded studies on the taxation of SSB, as these are the subject of a separate Cochrane Review. DATA COLLECTION AND ANALYSIS Two review authors independently screened studies for inclusion, extracted data and assessed the risks of bias of included studies. We classified interventions according to the NOURISHING framework, and synthesised results narratively and conducted meta-analyses for two outcomes relating to two intervention types. We assessed our confidence in the certainty of effect estimates with the GRADE framework as very low, low, moderate or high, and presented 'Summary of findings' tables. MAIN RESULTS We identified 14,488 unique records, and assessed 1030 in full text for eligibility. We found 58 studies meeting our inclusion criteria, including 22 RCTs, 3 NRCTs, 14 CBA studies, and 19 ITS studies, with a total of 1,180,096 participants. The median length of follow-up was 10 months. The studies included children, teenagers and adults, and were implemented in a variety of settings, including schools, retailing and food service establishments. We judged most studies to be at high or unclear risk of bias in at least one domain, and most studies used non-randomised designs. The studies examine a broad range of interventions, and we present results for these separately.Labelling interventions (8 studies): We found moderate-certainty evidence that traffic-light labelling is associated with decreasing sales of SSBs, and low-certainty evidence that nutritional rating score labelling is associated with decreasing sales of SSBs. For menu-board calorie labelling reported effects on SSB sales varied.Nutrition standards in public institutions (16 studies): We found low-certainty evidence that reduced availability of SSBs in schools is associated with decreased SSB consumption. We found very low-certainty evidence that improved availability of drinking water in schools and school fruit programmes are associated with decreased SSB consumption. Reported associations between improved availability of drinking water in schools and student body weight varied.Economic tools (7 studies): We found moderate-certainty evidence that price increases on SSBs are associated with decreasing SSB sales. For price discounts on low-calorie beverages reported effects on SSB sales varied.Whole food supply interventions (3 studies): Reported associations between voluntary industry initiatives to improve the whole food supply and SSB sales varied.Retail and food service interventions (7 studies): We found low-certainty evidence that healthier default beverages in children's menus in chain restaurants are associated with decreasing SSB sales, and moderate-certainty evidence that in-store promotion of healthier beverages in supermarkets is associated with decreasing SSB sales. We found very low-certainty evidence that urban planning restrictions on new fast-food restaurants and restrictions on the number of stores selling SSBs in remote communities are associated with decreasing SSB sales. Reported associations between promotion of healthier beverages in vending machines and SSB intake or sales varied.Intersectoral approaches (8 studies): We found moderate-certainty evidence that government food benefit programmes with restrictions on purchasing SSBs are associated with decreased SSB intake. For unrestricted food benefit programmes reported effects varied. We found moderate-certainty evidence that multicomponent community campaigns focused on SSBs are associated with decreasing SSB sales. Reported associations between trade and investment liberalisation and SSB sales varied.Home-based interventions (7 studies): We found moderate-certainty evidence that improved availability of low-calorie beverages in the home environment is associated with decreased SSB intake, and high-certainty evidence that it is associated with decreased body weight among adolescents with overweight or obesity and a high baseline consumption of SSBs.Adverse outcomes reported by studies, which may occur in some circumstances, included negative effects on revenue, compensatory SSB consumption outside school when the availability of SSBs in schools is reduced, reduced milk intake, stakeholder discontent, and increased total energy content of grocery purchases with price discounts on low-calorie beverages, among others. The certainty of evidence on adverse outcomes was low to very low for most outcomes.We analysed interventions targeting sugar-sweetened milk separately, and found low- to moderate-certainty evidence that emoticon labelling and small prizes for the selection of healthier beverages in elementary school cafeterias are associated with decreased consumption of sugar-sweetened milk. We found low-certainty evidence that improved placement of plain milk in school cafeterias is not associated with decreasing sugar-sweetened milk consumption. AUTHORS' CONCLUSIONS The evidence included in this review indicates that effective, scalable interventions addressing SSB consumption at a population level exist. Implementation should be accompanied by high-quality evaluations using appropriate study designs, with a particular focus on the long-term effects of approaches suitable for large-scale implementation.
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Affiliation(s)
- Peter von Philipsborn
- Ludwig‐Maximilians‐University MunichInstitute for Medical Informatics, Biometry and Epidemiology, Pettenkofer School of Public HealthMarchioninistr. 15MunichBavariaGermany81377
| | - Jan M Stratil
- Ludwig‐Maximilians‐University MunichInstitute for Medical Informatics, Biometry and Epidemiology, Pettenkofer School of Public HealthMarchioninistr. 15MunichBavariaGermany81377
| | - Jacob Burns
- Ludwig‐Maximilians‐University MunichInstitute for Medical Informatics, Biometry and Epidemiology, Pettenkofer School of Public HealthMarchioninistr. 15MunichBavariaGermany81377
| | - Laura K Busert
- University College LondonGreat Ormond Street Institute of Child HealthLondonUK
| | - Lisa M Pfadenhauer
- Ludwig‐Maximilians‐University MunichInstitute for Medical Informatics, Biometry and Epidemiology, Pettenkofer School of Public HealthMarchioninistr. 15MunichBavariaGermany81377
| | - Stephanie Polus
- Ludwig‐Maximilians‐University MunichInstitute for Medical Informatics, Biometry and Epidemiology, Pettenkofer School of Public HealthMarchioninistr. 15MunichBavariaGermany81377
| | - Christina Holzapfel
- School of Medicine, Technical University of MunichInstitute of Nutritional Medicine, Else Kroener‐Fresenius Centre for Nutritional MedicineMunichGermany
| | - Hans Hauner
- School of Medicine, Technical University of MunichInstitute of Nutritional Medicine, Else Kroener‐Fresenius Centre for Nutritional MedicineMunichGermany
| | - Eva Rehfuess
- Ludwig‐Maximilians‐University MunichInstitute for Medical Informatics, Biometry and Epidemiology, Pettenkofer School of Public HealthMarchioninistr. 15MunichBavariaGermany81377
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Hombali AS, Solon JA, Venkatesh BT, Nair NS, Peña‐Rosas JP. Fortification of staple foods with vitamin A for vitamin A deficiency. Cochrane Database Syst Rev 2019; 5:CD010068. [PMID: 31074495 PMCID: PMC6509778 DOI: 10.1002/14651858.cd010068.pub2] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Vitamin A deficiency is a significant public health problem in many low- and middle-income countries, especially affecting young children, women of reproductive age, and pregnant women. Fortification of staple foods with vitamin A has been used to increase vitamin A consumption among these groups. OBJECTIVES To assess the effects of fortifying staple foods with vitamin A for reducing vitamin A deficiency and improving health-related outcomes in the general population older than two years of age. SEARCH METHODS We searched the following international databases with no language or date restrictions: Cochrane Central Register of Controlled Trials (CENTRAL; 2018, Issue 6) in the Cochrane Library; MEDLINE and MEDLINE In Process OVID; Embase OVID; CINAHL Ebsco; Web of Science (ISI) SCI, SSCI, CPCI-exp and CPCI-SSH; BIOSIS (ISI); POPLINE; Bibliomap; TRoPHI; ASSIA (Proquest); IBECS; SCIELO; Global Index Medicus - AFRO and EMRO; LILACS; PAHO; WHOLIS; WPRO; IMSEAR; IndMED; and Native Health Research Database. We also searched clinicaltrials.gov and the International Clinical Trials Registry Platform to identify ongoing and unpublished studies. The date of the last search was 19 July 2018. SELECTION CRITERIA We included individually or cluster-randomised controlled trials (RCTs) in this review. The intervention included fortification of staple foods (sugar, edible oils, edible fats, maize flour or corn meal, wheat flour, milk and dairy products, and condiments and seasonings) with vitamin A alone or in combination with other vitamins and minerals. We included the general population older than two years of age (including pregnant and lactating women) from any country. DATA COLLECTION AND ANALYSIS Two authors independently screened and assessed eligibility of studies for inclusion, extracted data from included studies and assessed their risk of bias. We used standard Cochrane methodology to carry out the review. MAIN RESULTS We included 10 randomised controlled trials involving 4455 participants. All the studies were conducted in low- and upper-middle income countries where vitamin A deficiency was a public health issue. One of the included trials did not contribute data to the outcomes of interest.Three trials compared provision of staple foods fortified with vitamin A versus unfortified staple food, five trials compared provision of staple foods fortified with vitamin A plus other micronutrients versus unfortified staple foods, and two trials compared provision of staple foods fortified with vitamin A plus other micronutrients versus no intervention. No studies compared staple foods fortified with vitamin A alone versus no intervention.The duration of interventions ranged from three to nine months. We assessed six studies at high risk of bias overall. Government organisations, non-governmental organisations, the private sector, and academic institutions funded the included studies; funding source does not appear to have distorted the results.Staple food fortified with vitamin A versus unfortified staple food We are uncertain whether fortifying staple foods with vitamin A alone makes little or no difference for serum retinol concentration (mean difference (MD) 0.03 μmol/L, 95% CI -0.06 to 0.12; 3 studies, 1829 participants; I² = 90%, very low-certainty evidence). It is uncertain whether vitamin A alone reduces the risk of subclinical vitamin A deficiency (risk ratio (RR) 0.45, 95% CI 0.19 to 1.05; 2 studies; 993 participants; I² = 33%, very low-certainty evidence). The certainty of the evidence was mainly affected by risk of bias, imprecision and inconsistency.It is uncertain whether vitamin A fortification reduces clinical vitamin A deficiency, defined as night blindness (RR 0.11, 95% CI 0.01 to 1.98; 1 study, 581 participants, very low-certainty evidence). The certainty of the evidence was mainly affected by imprecision, inconsistency, and risk of bias.Staple foods fortified with vitamin A versus no intervention No studies provided data for this comparison.Staple foods fortified with vitamin A plus other micronutrients versus same unfortified staple foods Fortifying staple foods with vitamin A plus other micronutrients may not increase the serum retinol concentration (MD 0.08 μmol/L, 95% CI -0.06 to 0.22; 4 studies; 1009 participants; I² = 95%, low-certainty evidence). The certainty of the evidence was mainly affected by serious inconsistency and risk of bias.In comparison to unfortified staple foods, fortification with vitamin A plus other micronutrients probably reduces the risk of subclinical vitamin A deficiency (RR 0.27, 95% CI 0.16 to 0.49; 3 studies; 923 participants; I² = 0%; moderate-certainty evidence). The certainty of the evidence was mainly affected by serious risk of bias.Staple foods fortified with vitamin A plus other micronutrients versus no interventionFortification of staple foods with vitamin A plus other micronutrients may increase serum retinol concentration (MD 0.22 μmol/L, 95% CI 0.15 to 0.30; 2 studies; 318 participants; I² = 0%; low-certainty evidence). When compared to no intervention, it is uncertain whether the intervention reduces the risk of subclinical vitamin A deficiency (RR 0.71, 95% CI 0.52 to 0.98; 2 studies; 318 participants; I² = 0%; very low-certainty evidence) . The certainty of the evidence was affected mainly by serious imprecision and risk of bias.No trials reported on the outcomes of all-cause morbidity, all-cause mortality, adverse effects, food intake, congenital anomalies (for pregnant women), or breast milk concentration (for lactating women). AUTHORS' CONCLUSIONS Fortifying staple foods with vitamin A alone may make little or no difference to serum retinol concentrations or the risk of subclinical vitamin A deficiency. In comparison with provision of unfortified foods, provision of staple foods fortified with vitamin A plus other micronutrients may not increase serum retinol concentration but probably reduces the risk of subclinical vitamin A deficiency.Compared to no intervention, staple foods fortified with vitamin A plus other micronutrients may increase serum retinol concentration, although it is uncertain whether the intervention reduces the risk of subclinical vitamin A deficiency as the certainty of the evidence has been assessed as very low.It was not possible to estimate the effect of staple food fortification on outcomes such as mortality, morbidity, adverse effects, congenital anomalies, or breast milk vitamin A, as no trials included these outcomes.The type of funding source for the studies did not appear to distort the results from the analysis.
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Affiliation(s)
- Aditi S Hombali
- Institute of Mental HealthDepartment of ResearchBlock 7, Buangkok View, Buangkok Green Medical ParkSingaporeSingapore539747
| | | | - Bhumika T Venkatesh
- Prasanna School of Public Health, Manipal Academy of Higher EducationPublic Health Evidence South Asia (PHESA)ManipalUdupiIndia
| | - N Sreekumaran Nair
- Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER) (Institution of National Importance Under Ministry of Health and Family Welfare, Government of India)Department of Medical Biometrics & Informatics (Biostatistics)4th Floor, Administrative BlockDhanvantri NagarPuducherryIndia605006
| | - Juan Pablo Peña‐Rosas
- World Health OrganizationEvidence and Programme Guidance, Department of Nutrition for Health and Development20 Avenue AppiaGenevaGESwitzerland1211
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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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Toews I, Lohner S, Küllenberg de Gaudry D, Sommer H, Meerpohl JJ. Association between intake of non-sugar sweeteners and health outcomes: systematic review and meta-analyses of randomised and non-randomised controlled trials and observational studies. BMJ 2019; 364:k4718. [PMID: 30602577 PMCID: PMC6313893 DOI: 10.1136/bmj.k4718] [Citation(s) in RCA: 126] [Impact Index Per Article: 25.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/29/2018] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To assess the association between intake of non-sugar sweeteners (NSS) and important health outcomes in generally healthy or overweight/obese adults and children. DESIGN Systematic review following standard Cochrane review methodology. DATA SOURCES Medline (Ovid), Embase, Cochrane CENTRAL, WHO International Clinical Trials Registry Platform, Clinicaltrials.gov, and reference lists of relevant publications. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Studies including generally healthy adults or children with or without overweight or obesity were eligible. Included study designs allowed for a direct comparison of no intake or lower intake of NSS with higher NSS intake. NSSs had to be clearly named, the dose had to be within the acceptable daily intake, and the intervention duration had to be at least seven days. MAIN OUTCOME MEASURES Body weight or body mass index, glycaemic control, oral health, eating behaviour, preference for sweet taste, cancer, cardiovascular disease, kidney disease, mood, behaviour, neurocognition, and adverse effects. RESULTS The search resulted in 13 941 unique records. Of 56 individual studies that provided data for this review, 35 were observational studies. In adults, evidence of very low and low certainty from a limited number of small studies indicated a small beneficial effect of NSSs on body mass index (mean difference -0.6, 95% confidence interval -1.19 to -0.01; two studies, n=174) and fasting blood glucose (-0.16 mmol/L, -0.26 to -0.06; two, n=52). Lower doses of NSSs were associated with lower weight gain (-0.09 kg, -0.13 to -0.05; one, n=17 934) compared with higher doses of NSSs (very low certainty of evidence). For all other outcomes, no differences were detected between the use and non-use of NSSs, or between different doses of NSSs. No evidence of any effect of NSSs was seen on overweight or obese adults or children actively trying to lose weight (very low to moderate certainty). In children, a smaller increase in body mass index z score was observed with NSS intake compared with sugar intake (-0.15, -0.17 to -0.12; two, n=528, moderate certainty of evidence), but no significant differences were observed in body weight (-0.60 kg, -1.33 to 0.14; two, n=467, low certainty of evidence), or between different doses of NSSs (very low to moderate certainty). CONCLUSIONS Most health outcomes did not seem to have differences between the NSS exposed and unexposed groups. Of the few studies identified for each outcome, most had few participants, were of short duration, and their methodological and reporting quality was limited; therefore, confidence in the reported results is limited. Future studies should assess the effects of NSSs with an appropriate intervention duration. Detailed descriptions of interventions, comparators, and outcomes should be included in all reports. SYSTEMATIC REVIEW REGISTRATION Prospero CRD42017047668.
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Affiliation(s)
- Ingrid Toews
- Institute for Evidence in Medicine (for Cochrane Germany Foundation), Medical Centre of the University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacher Straße 153, 79110 Freiburg, Germany
| | - Szimonetta Lohner
- Cochrane Hungary, Clinical Centre of the University of Pécs, Medical School, University of Pécs, Pécs, Hungary
| | - Daniela Küllenberg de Gaudry
- Institute for Evidence in Medicine (for Cochrane Germany Foundation), Medical Centre of the University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacher Straße 153, 79110 Freiburg, Germany
| | - Harriet Sommer
- Institute for Evidence in Medicine (for Cochrane Germany Foundation), Medical Centre of the University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacher Straße 153, 79110 Freiburg, Germany
- Institute for Medical Biometry and Statistics, Medical Centre of the University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Joerg J Meerpohl
- Institute for Evidence in Medicine (for Cochrane Germany Foundation), Medical Centre of the University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacher Straße 153, 79110 Freiburg, Germany
- Centre of Epidemiological and Statistical Research, Sorbonne Paris Cité, Inserm/Université Paris Descartes, Cochrane France, Paris, France
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Davis JN, Asigbee FM, Markowitz AK, Landry MJ, Vandyousefi S, Khazaee E, Ghaddar R, Goran MI. Consumption of artificial sweetened beverages associated with adiposity and increasing HbA1c in Hispanic youth. Clin Obes 2018; 8:236-243. [PMID: 29896938 PMCID: PMC6055860 DOI: 10.1111/cob.12260] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 04/24/2018] [Accepted: 05/08/2018] [Indexed: 12/04/2022]
Abstract
Research examining the impact of artificial sweetened beverages (ASBs) on obesity and metabolic diseases in adolescents is limited. The overall goal is to examine the longitudinal effects of ASBs on changes in adiposity and metabolic parameters in Hispanic adolescents. Longitudinal cohort with 98 Hispanics (12-18 years) who were overweight or had obesity with the following data at baseline and 1-year later: anthropometrics, diet (24-h recalls), body composition (DXA), glucose and insulin dynamics (oral glucose tolerance and frequently sampled intravenous glucose tolerance test) and fasting lipids. Repeated measures analyses of covariance assessed changes over time between control (no ASBs at either visit), ASB initiators (no ASBs at baseline/ASBs at 1-year) and chronic ASB consumers (ASBs at both visits). ASB initiators (n = 14) and chronic ASB consumers (n = 9) compared to control (n = 75) had higher total body fat at baseline and 1-year (P = 0.05 for group effect). Chronic ASB consumers had a 6% increase in haemoglobin A1c, 34% increase in energy intake (kcal d-1 ) and 39% increase in carbohydrate intake (g d-1 ) over time, while control and ASB initiators maintained (P < 0.05 for group-by-time interactions). These results do not support promoting ASBs as a strategy for adiposity loss or to improve metabolic health.
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Affiliation(s)
- J N Davis
- Department of Nutritional Sciences, University of Texas at Austin, Austin, TX, USA
| | - F M Asigbee
- Department of Nutritional Sciences, University of Texas at Austin, Austin, TX, USA
| | - A K Markowitz
- Department of Nutritional Sciences, University of Texas at Austin, Austin, TX, USA
| | - M J Landry
- Department of Nutritional Sciences, University of Texas at Austin, Austin, TX, USA
| | - S Vandyousefi
- Department of Nutritional Sciences, University of Texas at Austin, Austin, TX, USA
| | - E Khazaee
- Department of Nutritional Sciences, University of Texas at Austin, Austin, TX, USA
| | - R Ghaddar
- Department of Nutritional Sciences, University of Texas at Austin, Austin, TX, USA
| | - M I Goran
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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Early-Life Exposure to Non-Nutritive Sweeteners and the Developmental Origins of Childhood Obesity: Global Evidence from Human and Rodent Studies. Nutrients 2018; 10:nu10020194. [PMID: 29439389 PMCID: PMC5852770 DOI: 10.3390/nu10020194] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2018] [Revised: 02/05/2018] [Accepted: 02/07/2018] [Indexed: 12/18/2022] Open
Abstract
Non-nutritive sweeteners (NNS) are increasingly consumed by children and pregnant women around the world, yet their long-term health impact is unclear. Here, we review an emerging body of evidence suggesting that early-life exposure to NNS may adversely affect body composition and cardio-metabolic health. Some observational studies suggest that children consuming NNS are at increased risk for obesity-related outcomes; however, others find no association or provide evidence of confounding. Fewer studies have examined prenatal NNS exposure, with mixed results from different analytical approaches. There is a paucity of RCTs evaluating NNS in children, yielding inconsistent results that can be difficult to interpret due to study design limitations (e.g., choice of comparator, multifaceted interventions). The majority of this research has been conducted in high-income countries. Some rodent studies demonstrate adverse metabolic effects from NNS, but most have used extreme doses that are not relevant to humans, and few have distinguished prenatal from postnatal exposure. Most studies focus on synthetic NNS in beverages, with few examining plant-derived NNS or NNS in foods. Overall, there is limited and inconsistent evidence regarding the impact of early-life NNS exposure on the developmental programming of obesity and cardio-metabolic health. Further research and mechanistic studies are needed to elucidate these effects and inform dietary recommendations for expectant mothers and children worldwide.
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Infant Development at the Age of 6 Months in Relation to Feeding Practices, Iron Status, and Growth in a Peri-Urban Community of South Africa. Nutrients 2018; 10:nu10010073. [PMID: 29329244 PMCID: PMC5793301 DOI: 10.3390/nu10010073] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Revised: 10/30/2017] [Accepted: 10/31/2017] [Indexed: 12/13/2022] Open
Abstract
Background: Evidence on the association between feeding practices, iron deficiency, anaemia, stunting, and impaired psychomotor development during infancy is limited. This study assessed the association between psychomotor development with early feeding practices, growth, iron status, and anaemia. Methods: This was cross-sectional baseline data of a randomised controlled trial which included 6-month-old infants and their mothers or primary caregivers (n = 750) in a peri-urban community in the North West province of South Africa. The Kilifi Developmental Inventory and a parent rating scale were used to assess psychomotor development. Feeding practices and anthropometric measurements were based on the World Health Organisation (WHO) guidelines. Anaemia and iron status were determined by blood sample analysis. Results: Prevalence of anaemia and stunting for the infants were 36.4% and 28.5%, respectively. Multiple regression analysis showed that birth weight was related to combined psychomotor scores (β = −3.427 (−4.603, 1.891), p < 0.001), as well as parent rating scores (β = −0.843 (−1.507, −0.180), p = 0.013). Length-for-age z-scores were associated with combined psychomotor scores (β = −1.419 (−2.466, 0.373), p = 0.008), as well as parent rating scores (β = −0.747 (−1.483, −0.010), p = 0.047). Conclusions: In this setting, with high prevalence of anaemia and stunting, important associations between lower psychomotor development scores and birthweight as well as length-for-age z-scores in 6-month-old infants were found. These findings warrant further investigation to develop a greater understanding of factors influencing the association between child growth and psychomotor development within the first 1000 days of life.
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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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Osei J, Baumgartner J, Rothman M, Matsungo TM, Covic N, Faber M, Smuts CM. Iodine status and associations with feeding practices and psychomotor milestone development in six-month-old South African infants. MATERNAL & CHILD NUTRITION 2017; 13:e12408. [PMID: 28028913 PMCID: PMC6865918 DOI: 10.1111/mcn.12408] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Revised: 11/03/2016] [Accepted: 11/08/2016] [Indexed: 11/28/2022]
Abstract
Iodine is important for normal growth and psychomotor development. While infants below 6 months of age receive iodine from breast milk or fortified infant formula, the introduction of complementary foods poses a serious risk for deteriorating iodine status. This cross-sectional analysis assessed the iodine status of six-month-old South African infants and explored its associations with feeding practices and psychomotor milestone development. Iodine concentrations were measured in infant (n = 386) and maternal (n = 371) urine (urinary iodine concentration [UIC]), and in breast milk (n = 257 [breast milk iodine concentrations]). Feeding practices and psychomotor milestone development were assessed in all infants. The median (25th-75th percentile) UIC in infants was 345 (213-596) μg/L and was significantly lower in stunted (302 [195-504] μg/L) than non-stunted (366 [225-641] μg/L) infants. Only 6.7% of infants were deficient. Maternal UIC (128 [81-216] μg/L; rs = 0.218, p < 0.001) and breast milk iodine concentrations (170 [110-270] μg/kg; rs = 0.447, p < 0.0001) were associated with infant UIC. Most infants (72%) were breastfed and tended to have higher UIC than non-breastfed infants (p = 0.074). Almost all infants (95%) consumed semi-solid or solid foods, with commercial infant cereals (60%) and jarred infant foods (20%) being the most common solid foods first introduced. Infants who reported to consume commercial infant cereals ≥4 days weekly had significantly higher UIC (372 [225-637] μg/L) than those reported to consume commercial infant cereals seldom or never (308 [200-517] μg/L; p = 0.023). No associations between infant UIC and psychomotor developmental scores were observed. Our results suggest that iodine intake in the studied six-month-old infants was adequate. Iodine in breast milk and commercial infant cereals potentially contributed to this adequate intake.
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Affiliation(s)
- Jennifer Osei
- Centre of Excellence for NutritionNorth‐West UniversityPotchefstroomSouth Africa
| | - Jeannine Baumgartner
- Centre of Excellence for NutritionNorth‐West UniversityPotchefstroomSouth Africa
| | - Marinel Rothman
- Centre of Excellence for NutritionNorth‐West UniversityPotchefstroomSouth Africa
| | | | - Namukolo Covic
- Poverty, Health & Nutrition DivisionInternational Food Policy Research InstituteWashingtonDistrict of ColumbiaUSA
| | - Mieke Faber
- 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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28
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Sanou AS, Diallo AH, Holding P, Nankabirwa V, Engebretsen IMS, Ndeezi G, Tumwine JK, Meda N, Tylleskar T, Kashala-Abotnes E. Maternal alcohol consumption during pregnancy and child's cognitive performance at 6-8 years of age in rural Burkina Faso: an observational study. PeerJ 2017; 5:e3507. [PMID: 28674660 PMCID: PMC5494175 DOI: 10.7717/peerj.3507] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 06/06/2017] [Indexed: 01/06/2023] Open
Abstract
Background In Burkina Faso, it is not uncommon for mothers to drink alcohol, even during pregnancy. We aimed to study the association between maternal alcohol consumption during pregnancy and the child’s cognitive performance using the Kaufman Assessment Battery for Children, 2nd edition (KABC-II) and the Children’s Category Test Level 1 (CCT-1) in rural Burkina Faso. Methods We conducted a follow-up study of a community cluster-randomised Exclusive breastfeeding trial, and re-enrolled the children in rural Burkina Faso. A total of 518 children (268 boys and 250 girls) aged 6–8 years were assessed using the KABC-II and the CCT-1. We examined the effect size difference using Cohen’s d and conducted a linear regression analysis to examine the association. Results Self-reported alcohol consumption during pregnancy was 18.5% (96/518). Children whose mothers reported alcohol consumption during pregnancy performed significantly poorly for memory and spatial abilities tests from small effect size difference for ‘Atlantis’ (0.27) and ‘Triangle’ (0.29) to moderate effect size difference for ‘Number recall’ (0.72) compared to children whose mothers did not consume alcohol during pregnancy; the exposed children scored significantly higher errors with a small effect size (0.37) at problem solving (CCT-1) test compared to unexposed children. At unstandardized and standardized multivariable analysis, children whose mothers reported alcohol consumption during pregnancy performed significantly poorer for memory-‘Atlantis’ (p = 0.03) and ‘Number recall’ (p = 0.0001), and spatial ability tests-‘Triangle’ (p = 0.03); they scored significantly higher errors at problem solving CCT-1 test (p = 0.002); all the results were adjusted for age, sex, schooling, stunting, father’s education, mother’s employment and the promotion of exclusive breastfeeding. No statistical association was found for visual abilities-‘Conceptual Thinking’, ‘Face recognition’, ‘Story completion’, and reasoning tests-‘Rover’, ‘Block counting’, and ‘Pattern Reasoning’. Conclusion Maternal alcohol consumption during pregnancy is associated with poorer cognitive performance for memory, spatial ability, and problem solving tests in the offspring in rural Burkina Faso. Futures studies needs to assess in more detail the maternal alcohol consumption patterns in Burkina Faso and possible preventive strategies.
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Affiliation(s)
- Anselme Simeon Sanou
- Centre for International Health (CIH), Department of Global Public Health and Primary Health Care, Faculty of Medicine, University of Bergen, Bergen, Norway.,Department of Public Health, Centre MURAZ Research Institute, Ministry of Health, Bobo-Dioulasso, Burkina Faso
| | - Abdoulaye Hama Diallo
- Department of Public Health, Centre MURAZ Research Institute, Ministry of Health, Bobo-Dioulasso, Burkina Faso.,Department of Public Health, University of Ouagadougou, Ouagadougou, Burkina Faso
| | | | - Victoria Nankabirwa
- Centre for International Health (CIH), Department of Global Public Health and Primary Health Care, Faculty of Medicine, University of Bergen, Bergen, Norway.,Department of Epidemiology & Biostatistics, School of Public Health, Makerere University, Kampala, Uganda.,Centre for Intervention Science in Maternal and Child Health (CISMAC), Department of Global Public Health and Primary Health Care, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Ingunn Marie S Engebretsen
- Centre for International Health (CIH), Department of Global Public Health and Primary Health Care, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Grace Ndeezi
- Department of Paediatrics and Child Health, Makerere University, Kampala, Uganda
| | - James K Tumwine
- Department of Paediatrics and Child Health, Makerere University, Kampala, Uganda
| | - Nicolas Meda
- Department of Public Health, Centre MURAZ Research Institute, Ministry of Health, Bobo-Dioulasso, Burkina Faso.,Department of Public Health, University of Ouagadougou, Ouagadougou, Burkina Faso
| | - Thorkild Tylleskar
- Centre for International Health (CIH), Department of Global Public Health and Primary Health Care, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Esperance Kashala-Abotnes
- Centre for International Health (CIH), Department of Global Public Health and Primary Health Care, Faculty of Medicine, University of Bergen, Bergen, Norway
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29
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Iannotti L, Dulience SJL, Joseph S, Cooley C, Tufte T, Cox K, Eaton J, Delnatus JR, Wolff PB. Fortified Snack Reduced Anemia in Rural School-Aged Children of Haiti: A Cluster-Randomized, Controlled Trial. PLoS One 2016; 11:e0168121. [PMID: 28005920 PMCID: PMC5179061 DOI: 10.1371/journal.pone.0168121] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Accepted: 11/23/2016] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Nutrition in the school-aged child matters for brain development and public policy investments globally. Our group previously conducted a trial in urban schools of Haiti to examine the effects of a fortified peanut butter snack, Vita Mamba, with limited findings for anemia. OBJECTIVE We aimed to test the hypothesis that Vita Mamba, with systematic deworming in both study arms, would significantly reduce anemia among rural, school-aged children. METHODS A cluster, randomized longitudinal study was conducted in two rural communities of the North-East Department of Haiti, 2014-2015. Healthy children ages 3-16 years were enrolled (n = 321) and assigned by school to intervention (Vita Mamba and deworming) and control (deworming). Vita Mamba contains 260 kcal and meets >75% of the Recommended Dietary Allowance for critical micronutrients. Multivariate regression analyses including propensity score matching techniques to correct for potential group imbalance (Kernel-based Matching and Propensity Score Weighting) were applied to examine difference-in-difference intervention effects. RESULTS At baseline, 51% of the children were anemic with no significant differences between study groups. Vita Mamba supplementation showed a consistent, positive effect across regression models on increasing Hb concentration and reducing the odds of anemia compared to the control group after adjusting for child age, vitamin A supplementation, milk consumption, and height-for-age z score. The average treatment effect for the treated in the Propensity Score Weighting models was 0.62±0.27 grams per 100 milliliters (g/dL) for Hb concentration (F = 4.64, P = 0.001), and the odds of anemia were reduced by 88% (Wald χ² = 9.77, P = 0.02). No differences in change in anthropometric markers were evident. CONCLUSIONS School feeding programs that integrate fortified foods with deworming could reduce anemia burden with important implications for learning, health, and well-being. The rural-urban differences in anemia require further study.
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Affiliation(s)
- Lora Iannotti
- Institute for Public Health, Brown School, Washington University in St. Louis, St. Louis, Missouri, United States of America
- * E-mail:
| | - Sherlie Jean-Louis Dulience
- Institute for Public Health, Brown School, Washington University in St. Louis, St. Louis, Missouri, United States of America
| | - Saminetha Joseph
- Institute for Public Health, Brown School, Washington University in St. Louis, St. Louis, Missouri, United States of America
| | - Charmayne Cooley
- Institute for Public Health, Brown School, Washington University in St. Louis, St. Louis, Missouri, United States of America
| | - Teresa Tufte
- Institute for Public Health, Brown School, Washington University in St. Louis, St. Louis, Missouri, United States of America
| | - Katherine Cox
- Institute for Public Health, Brown School, Washington University in St. Louis, St. Louis, Missouri, United States of America
| | - Jacob Eaton
- Institute for Public Health, Brown School, Washington University in St. Louis, St. Louis, Missouri, United States of America
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30
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Fortified Iodine Milk Improves Iodine Status and Cognitive Abilities in Schoolchildren Aged 7-9 Years Living in a Rural Mountainous Area of Morocco. J Nutr Metab 2016; 2016:8468594. [PMID: 27069679 PMCID: PMC4812403 DOI: 10.1155/2016/8468594] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2015] [Accepted: 02/21/2016] [Indexed: 11/18/2022] Open
Abstract
Iodine is required for the production of the thyroid hormones essential for the growth and development of the brain. All forms of iodine deficiency (ID) affect the mental development of the child. Our study aims to assess the impact of ID on the intellectual development of Moroccan schoolchildren and to evaluate the effect of consumption of fortified milk on reducing ID. In a double-blind controlled trial conducted on schoolchildren, children were divided into two groups to receive fortified milk (30% of cover of RDI iodine) or nonfortified milk for 9 months. Urinary iodine was analyzed using the Sandell-Kolthoff reaction, a dynamic cognitive test using Raven's Standard Progressive Matrices to assess learning potential was performed at baseline and end line, and anthropometric assessment was done only at baseline. The study included schoolchildren who were severely iodine deficient. The prevalence of malnutrition was high in both groups; in this study, we found improvements in iodine status and in cognitive abilities among Moroccan schoolchildren. Our study showed that the consumption of fortified milk led to a clear improvement in iodine status and also appeared to have a favorable effect on the cognitive ability of Moroccan schoolchildren in a rural mountainous region.
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31
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Reid AE, Chauhan BF, Rabbani R, Lys J, Copstein L, Mann A, Abou-Setta AM, Fiander M, MacKay DS, McGavock J, Wicklow B, Zarychanski R, Azad MB. Early Exposure to Nonnutritive Sweeteners and Long-term Metabolic Health: A Systematic Review. Pediatrics 2016; 137:e20153603. [PMID: 26917671 DOI: 10.1542/peds.2015-3603] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/14/2015] [Indexed: 11/24/2022] Open
Abstract
CONTEXT Nonnutritive sweetener (NNS) consumption is increasing among children, yet its long-term health impact is unclear, particularly when exposure occurs during early life. OBJECTIVE To synthesize evidence from prospective studies evaluating the association of early-life NNS exposure and long-term metabolic health. DATA SOURCES Medline, Embase, and Cochrane Library (inception to July 2015). STUDY SELECTION We aimed to include randomized controlled trials (RCTs) evaluating NNS-based interventions and prospective cohort studies reporting NNS exposure among pregnant women, infants, or children (<12 years of age), with a minimum study duration of 6 months. DATA EXTRACTION The primary outcome was BMI; secondary outcomes included growth velocity, overweight/obesity, adiposity, and adverse metabolic effects. Study quality and risk of bias were evaluated using validated assessment tools. RESULTS We identified 6 eligible cohort studies and 2 RCTs (n = 15,641 children). Half of the cohorts reported increasing weight gain or fat mass accumulation with increasing NNS intake, and pooled data from 2 cohorts showed a significant correlation with BMI gain (weighted mean correlation 0.023, 95% confidence interval 0.006 to 0.041). RCTs reported contradictory effects on weight change in children receiving NNSs. No eligible studies evaluated prenatal or infant NNS exposure. LIMITATIONS Meta-analysis was limited because of the small number of eligible studies and heterogeneity of populations and outcomes. CONCLUSIONS There is limited and inconsistent evidence of the long-term metabolic effects of NNS exposure during gestation, infancy, and childhood. Further research is needed to inform recommendations for the use of NNSs in this sensitive population.
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Affiliation(s)
| | - Bhupendrasinh F Chauhan
- George & Fay Yee Center for Healthcare Innovation, College of Pharmacy, Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada; and
| | | | - Justin Lys
- George & Fay Yee Center for Healthcare Innovation
| | | | | | | | | | | | - Jonathan McGavock
- Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada; and Pediatrics and Child Health, and Manitoba Developmental Origins of Chronic Diseases in Children Network
| | - Brandy Wicklow
- Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada; and Pediatrics and Child Health, and Manitoba Developmental Origins of Chronic Diseases in Children Network
| | - Ryan Zarychanski
- George & Fay Yee Center for Healthcare Innovation, Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Meghan B Azad
- George & Fay Yee Center for Healthcare Innovation, Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada; and Pediatrics and Child Health, and Manitoba Developmental Origins of Chronic Diseases in Children Network
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Ecological correlations of dietary food intake and mental health disorders. J Epidemiol Glob Health 2016; 7:81-89. [PMID: 28003094 PMCID: PMC6178813 DOI: 10.1016/j.jegh.2016.12.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Revised: 10/03/2016] [Accepted: 12/01/2016] [Indexed: 11/24/2022] Open
Abstract
This paper examines the ecological association of dietary food intake with mental health outcomes on the group level across countries. Published data from the World Mental Health Survey were used to compare lifetime prevalence of four categories of mental health disorders (anxiety disorders, mood disorders, impulse control disorders, and substance use disorders) with a country’s fish/seafood and sugar/sweetener supply quantity using the Spearman rank correlation. Data were compared for 17 countries across the world. Sugar and sweetener supply quantity was significantly and positively associated with anxiety disorders (rho = 0.75, p = 0.001), mood disorders (rho = 0.75, p = 0.001), impulse control disorders (rho = 0.78, p = 0.001), and substance use disorders (rho = 0.68, p = 0.007). Fish and seafood supply quantity had no significant association with any mental health disorders. Mental health disorders represent a significant health problem around the world. Public health measures aimed at improving the quality and availability of a nation’s food supply could have a significant positive impact on mental health. Further randomized studies are needed to further validate the study findings.
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Aaron GJ, Dror DK, Yang Z. Multiple-Micronutrient Fortified Non-Dairy Beverage Interventions Reduce the Risk of Anemia and Iron Deficiency in School-Aged Children in Low-Middle Income Countries: A Systematic Review and Meta-Analysis (i-iv). Nutrients 2015; 7:3847-68. [PMID: 26007336 PMCID: PMC4446783 DOI: 10.3390/nu7053847] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Revised: 04/24/2015] [Accepted: 05/05/2015] [Indexed: 12/27/2022] Open
Abstract
Multiple-micronutrient (MMN) fortification of beverages may be an effective option to deliver micronutrients to vulnerable populations. The aim of the present systematic review and meta-analysis is to evaluate the nutritional impacts of MMN fortified beverages in the context of low-middle income countries. A systematic search of published literature yielded 1022 citations, of which 10 randomized controlled trials (nine in school-aged children and one in pregnant women) met inclusion criteria. Results of school-aged children were included in the meta-analysis. Compared to iso-caloric controls, children who received MMN fortified beverages for 8 weeks to 6 months showed significant improvements in hemoglobin (+2.76 g/L, 95% CI [1.19, 4.33], p = 0.004; 8 studies) and serum ferritin (+15.42 pmol/L, [5.73, 25.12], p = 0.007; 8 studies); and reduced risk of anemia (RR 0.58 [0.29, 0.88], p = 0.005; 6 studies), iron deficiency (RR 0.34 [0.21, 0.55], p = 0.002; 7 studies), and iron deficiency anemia (RR 0.17 [0.06, 0.53], p = 0.02; 3 studies). MMN fortified beverage interventions could have major programmatic implications for reducing the burden of anemia and iron deficiency in school-aged children in low-middle income countries. Additional research is needed to investigate effects on other biochemical outcomes and population subgroups.
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Affiliation(s)
- Grant J Aaron
- Section Sanitary Engineering, Department of Water Management, Faculty of Civil Engineering and Geosciences, Delft University of Technology, Delft 2600 GA, The Netherlands.
| | - Daphna K Dror
- Global Alliance for Improved Nutrition (GAIN), Rue de Vermont 37-39, Geneva CH-1202, Switzerland.
| | - Zhenyu Yang
- United States Department of Agriculture (USDA), Western Human Nutrition Research Center (WHNRC), 430 W. Health Sciences Dr., Davis, CA 95616, USA.
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Faber M, van Jaarsveld PJ, Kunneke E, Kruger HS, Schoeman SE, van Stuijvenberg ME. Vitamin A and anthropometric status of South African preschool children from four areas with known distinct eating patterns. Nutrition 2014; 31:64-71. [PMID: 25441589 DOI: 10.1016/j.nut.2014.04.024] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2014] [Revised: 04/08/2014] [Accepted: 04/24/2014] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The aim of this study was to assess the vitamin A and anthropometric status of South African preschool children from four areas with known distinct eating patterns. METHODS Serum retinol, anthropometric indicators, and dietary intake were determined for randomly selected preschool children from two rural areas, i.e. KwaZulu-Natal (n = 140) and Limpopo (n = 206); an urban area in the Northern Cape (n = 194); and an urban metropolitan area in the Western Cape (n = 207). RESULTS Serum retinol <20 μg/dL was prevalent in 8.2% to 13.6% children. Between 3% (urban-Northern Cape) and 44.2% (rural-Limpopo) children had received a high-dose vitamin A supplement during the preceding 6 mo. Vitamin A derived from fortified bread and/or maize meal ranged from 65 μg retinol activity equivalents (24%-31% of the Estimated Average Requirement) to 160 μg retinol activity equivalents (58%-76% Estimated Average Requirement). Fortified bread and/or maize meal contributed 57% to 59% of total vitamin A intake in rural children, and 28% to 38% in urban children. Across the four areas, stunting in children ranged from 13.9% to 40.9%; and overweight from 1.2% to 15.1%. CONCLUSION Prevalence of vitamin A deficiency was lower than national figures, and did not differ across areas despite differences in socioeconomics, dietary intake, and vitamin A supplementation coverage. Rural children benefited more from the national food fortification program in terms of vitamin A intake. Large variations in anthropometric status highlight the importance of targeting specific nutrition interventions, taking into account the double burden of overnutrition and undernutrition.
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Affiliation(s)
- Mieke Faber
- Nutritional Intervention Research Unit, Medical Research Council, Cape Town, South Africa; Non-communicable Diseases Research Unit, Medical Research Council, Cape Town, South Africa.
| | - Paul J van Jaarsveld
- Nutritional Intervention Research Unit, Medical Research Council, Cape Town, South Africa; Non-communicable Diseases Research Unit, Medical Research Council, Cape Town, South Africa
| | - Ernie Kunneke
- Division Dietetics, University of the Western Cape, Cape Town, South Africa
| | - H Salomé Kruger
- Centre of Excellence for Nutrition, North-West University, Potchefstroom, South Africa
| | - Serina E Schoeman
- Nutritional Intervention Research Unit, Medical Research Council, Cape Town, South Africa
| | - Martha E van Stuijvenberg
- Nutritional Intervention Research Unit, Medical Research Council, Cape Town, South Africa; Non-communicable Diseases Research Unit, Medical Research Council, Cape Town, South Africa
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35
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Abstract
Micronutrient deficiencies, especially those related to iodine and iron, are linked to different cognitive impairments, as well as to potential long-term behavioral changes. Among the cognitive impairments caused by iron deficiency, those referring to attention span, intelligence, and sensory perception functions are mainly cited, as well as those associated with emotions and behavior, often directly related to the presence of iron deficiency anemia. In addition, iron deficiency without anemia may cause cognitive disturbances. At present, the prevalence of iron deficiency and iron deficiency anemia is 2%-6% among European children. Given the importance of iron deficiency relative to proper cognitive development and the alterations that can persist through adulthood as a result of this deficiency, the objective of this study was to review the current state of knowledge about this health problem. The relevance of iron deficiency and iron deficiency anemia, the distinction between the cognitive consequences of iron deficiency and those affecting specifically cognitive development, and the debate about the utility of iron supplements are the most relevant and controversial topics. Despite there being methodological differences among studies, there is some evidence that iron supplementation improves cognitive functions. Nevertheless, this must be confirmed by means of adequate follow-up studies among different groups.
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