Vitamins and neural and cognitive developmental outcomes in children

Maternal Folic Acid-Containing Supplement Use in Relation to Offspring Motor Function. A Prospective Study of 503 Mother-Child Dyads

BACKGROUND

The preventive effect of maternal folic acid use on offspring neural tube defects is well-established. However, a putative link between supplement use and other neurodevelopmental outcome is inconsistent. The aim of this study was to examine the association of folic acid-containing supplement use before and during pregnancy with motor function in children aged 3-18 months.

METHOD

The study has a prospective cohort design including 503 mother-infant dyads. Motor function was measured by the Infant Motor Profile (IMP) and Ages and Stages Questionnaire Second Edition (ASQ-2). Associations between exposure and outcome were examined using linear regression analysis with robust standard error estimation.

RESULTS

Offspring total IMP score was not associated with any maternal folic acid-containing supplement use when they were used during pregnancy only (adjusted β = 0.11 95% CI = -1.19, 1.40; p = 0.87) or when they were used both before and during pregnancy (adjusted β = 0.22 95% CI = -0.95, 1.40; p = 0.70). When examining the five domain scores separately, only the IMP domain adaptability showed some association with supplement use during pregnancy (adjusted β = 2.87; 95% CI = 0.08, 5.68; p = 0.04), but the strength of the association was weak. Further, supplement use was not associated with any of the two motor domains of ASQ-2.

CONCLUSION

Although no association between folic acid-containing supplement use and offspring motor function was found, the complexity of this topic and its potential mechanisms, requires further investigation. This research should include robust and accurate measures on maternal nutritional status along with thorough endpoint assessments.

Antenatal determinants of early childhood talking delay and behavioural difficulties

The determinants of talking delay alone or its comorbidity with behavioural difficulties was examined in 5768 two-year-old members of the Growing Up in New Zealand longitudinal study. Using the MacArthur-Bates Communicative Development inventories and the total difficulties score from the preschool Strengths and Difficulties Questionnaire, a composite measure was created so that children were categorised as showing no language or behavioural concerns (72.5%), behavioural only difficulties (6.1%), language only difficulties (18.1%), and comorbid language and behavioural difficulties (3.3%). Analyses revealed that antenatal factors such as maternal perceived stress, inadequate folate intake, vitamin intake, alcohol consumption during the first trimester and maternal smoking all had a significant effect on child outcomes. In particular, low multivitamin intake and perceived stress during pregnancy were associated with coexisting language and behavioural difficulties. These findings support international research in showing that maternal factors during pregnancy are associated with developmental outcomes in the early childhood period, and demonstrate these associations within a NZ context. Interventions which address maternal stress management and health behaviours during pregnancy could be beneficial to offspring development.

Concurrent Micronutrient Deficiencies Are Low and Micronutrient Status Is Not Related to Common Health Indicators in Ghanaian Women Expecting to Become Pregnant

BACKGROUND

Micronutrients are important for reproductive health and pregnancy, but the status of multiple vitamins and minerals is rarely measured in women before pregnancy.

OBJECTIVES

We aimed to assess the status and concurrent deficiencies of micronutrients among women before pregnancy and their relation with common health indicators.

METHODS

This was a cross-sectional study that recruited women who expected to become pregnant within the next 6 mo in Asesewa, Ghana, a semi-urban community. Women self-reported demographics and health history. We measured blood pressure, height, and weight and conducted a blood draw and hemoglobin assessment (n = 98). We measured serum/plasma concentrations of ferritin, iron, total iron binding capacity, zinc, copper, retinol, and 25-hydroxyvitamin D, in addition to markers of inflammation. We used established cutoffs for deficiency and insufficiency/low status for each micronutrient after adjusting ferritin, zinc, and retinol for inflammation. We compared biomarker distributions by common health indicators.

RESULTS

Forty percent of women had overweight/obesity, 33% were anemic, and 23% had elevated blood pressure. Overall, 27% had ≥1 deficiencies, whereas only 4% had 2 deficiencies. Fifty-eight percent of women had ≥1 insufficiencies and 18% had ≥2 insufficiencies. Prevalence of individual deficiencies was 12%, 7%, 7%, 4%, and 0% and prevalence of individual insufficiencies was 18%, 12%, 29%, 13%, and 13% for iron, copper, vitamin A, zinc, and vitamin D, respectively. Iron biomarkers and retinol concentrations differed by anemia status, and copper was higher in those with elevated blood pressure. Micronutrient concentrations were not associated with self-reported medical history (parity or history of anemia, malaria, or night blindness).

CONCLUSIONS

In Asesewa, Ghana, there was a relatively low prevalence of individual micronutrient deficiencies, but the majority of women were insufficient in ≥1 micronutrients. Iron and vitamin A status was lower in those with anemia, but otherwise, micronutrient status did not relate to common health markers.

Effect of maternal high dosages of folic acid supplements on neurocognitive development in children at 4-5 y of age: the prospective birth cohort Infancia y Medio Ambiente (INMA) study

Background: The benefits of the use of folic acid supplements (FASs) during the periconception period to prevent neural tube defects and to ensure normal brain development in offspring are well known. There is concern, however, about the long-term effects of the maternal use of high dosages of FASs that exceed the Tolerable Upper Intake Level (UL) (≥1000 μg/d) on child neurocognitive outcomes.Objective: The objective of the study was to examine the association between the use of high dosages of FASs during pregnancy and child neuropsychological development at ages 4-5 y.Design: The multicenter prospective mother-child cohort study, the Infancia y Medio Ambiente (INMA) Project, was conducted in 4 regions of Spain: Asturias, Sabadell, Gipuzkoa, and Valencia. Pregnant women were recruited between 2003 and 2008. Data on 1682 mother-child pairs were included in the final analyses. The pregnant women completed an interviewer-administered questionnaire that was validated to estimate typical dietary folate intake and the use of FASs at 10-13 and 28-32 wk of gestation. Neuropsychological development scores at 4-5 y of age were estimated with the use of the McCarthy Scales of Children's Abilities. Multiple linear regression and meta-analysis were used to obtain combined-effect estimates.Results: During the periconception period, one-third of the women (n = 502) took FAS dosages ≥1000 μg/d. The use of FAS dosages ≥1000 μg/d in this period was negatively associated with several neuropsychological outcomes scores in children: global verbal (β = -2.49; 95% CI: -4.71, -0.27), verbal memory (β = -3.59; 95% CI: -6.95, -0.23), cognitive function of posterior cortex (β = -2.31; 95% CI: -4.45, -0.18), and cognitive function of left posterior cortex (β = -3.26; 95% CI: -5.51, -1.01).Conclusions: The use of FAS dosages exceeding the UL (≥1000 μg/d) during the periconception period was associated with lower levels of cognitive development in children aged 4-5 y. The use of FAS dosages ≥1000 μg/d during pregnancy should be monitored and prevented as much as possible, unless medically prescribed.

Perinatal nutrition in maternal mental health and child development: Birth of a pregnancy cohort

BACKGROUND

Mental disorders are one of the leading contributors to the global burden of disease. The Alberta Pregnancy Outcomes and Nutrition (APrON) study was initiated in 2008 to better understand perinatal environmental impacts on maternal mental health and child development.

AIMS

This pregnancy cohort was established to investigate the relationship between the maternal environment (e.g. nutritional status), maternal mental health status, birth outcomes, and child development. The purpose of this paper is to describe the creation of this longitudinal cohort, the data collection tools and procedures, and the background characteristics of the participants.

SUBJECTS

Participants were pregnant women age 16 or older, their infants and the biological fathers.

OUTCOME MEASURES

For the women, data were collected during each trimester of pregnancy and at 3, 6, 12, 24, and 36months after the birth of their infant. Maternal measures included diet, stress, current mental and physical health, health history, and lifestyle. In addition, maternal biological samples (DNA, blood, urine, and spot breast milk samples) were banked. Paternal data included current mental and physical health, health history, lifestyle, and banked DNA samples. For infants, DNA and blood were collected as well as information on health, development and feeding behavior.

RESULTS

At the end of recruitment in 2012, the APrON cohort included 2140 women, 2172 infants, and 1417 biological fathers. Descriptive statistics of the cohort, and comparison of women who stayed in the study and those who dropped out are discussed.

CONCLUSION

Findings from the longitudinal cohort may have important implications for health policy and clinical practice.

Prenatal folate, homocysteine and vitamin B12 levels and child brain volumes, cognitive development and psychological functioning: the Generation R Study

Previous studies have suggested that prenatal maternal folate deficiency is associated with reduced prenatal brain growth and psychological problems in offspring. However, little is known about the longer-term impact. The aims of this study were to investigate whether prenatal maternal folate insufficiency, high total homocysteine levels and low vitamin B12 levels are associated with altered brain morphology, cognitive and/or psychological problems in school-aged children. This study was embedded in Generation R, a prospective population-based cohort study. The study sample consisted of 256 Dutch children aged between 6 and 8 years from whom structural brain scans were collected using MRI. The mothers of sixty-two children had insufficient (<8 nmol/l) plasma folate concentrations in early pregnancy. Cognitive development was assessed by the Snijders-Oomen Niet-verbale intelligentietest - Revisie and the NEPSY-II-NL. Psychological problems were assessed at age 6 years using the parent report of the Child Behavior Checklist. Low prenatal folate levels were associated with a smaller total brain volume (B -33·34; 95 % CI -66·7, 0·02; P=050) and predicted poorer performance on the language (B -0·28; 95 % CI -0·52, -0·04; P=0·020) and visuo-spatial domains (B -0·27; 95 % CI -0·50, -0·04; P=0·021). High homocysteine levels (>9·1 µmol/l) predicted poorer performance on the language (B -0·31; 95 % CI -0·56, -0·06; P=0·014) and visuo-spatial domains (B -0·36; 95 % CI -0·60, -0·11; P=0·004). No associations with psychological problems were found. Our findings suggest that folate insufficiency in early pregnancy has a long-lasting, global effect on brain development and is, together with homocysteine levels, associated with poorer cognitive performance.

Motor development related to duration of exclusive breastfeeding, B vitamin status and B12 supplementation in infants with a birth weight between 2000-3000 g, results from a randomized intervention trial

Background

Exclusive breastfeeding for 6 months is assumed to ensure adequate micronutrients for term infants. Our objective was to investigate the effects of prolonged breastfeeding on B vitamin status and neurodevelopment in 80 infants with subnormal birth weights (2000-3000 g) and examine if cobalamin supplementation may benefit motor function in infants who developed biochemical signs of impaired cobalamin function (total homocysteine (tHcy) > 6.5 μmol/L) at 6 months.

Methods

Levels of cobalamin, folate, riboflavin and pyridoxal 5´-phosphate, and the metabolic markers tHcy and methylmalonic acid (MMA), were determined at 6 weeks, 4 and 6 months (n = 80/68/66). Neurodevelopment was assessed with the Alberta Infants Motor Scale (AIMS) and the parental questionnaire Ages and Stages (ASQ) at 6 months.

At 6 months, 32 of 36 infants with tHcy > 6.5 μmol/L were enrolled in a double blind randomized controlled trial to receive 400 μg hydroxycobalamin intramuscularly (n = 16) or sham injection (n = 16). Biochemical status and neurodevelopment were evaluated after one month.

Results

Except for folate, infants who were exclusively breastfed for >1 month had lower B vitamin levels at all assessments and higher tHcy and MMA levels at 4 and 6 months. At 6 months, these infants had lower AIMS scores (p = 0.03) and ASQ gross motor scores (p = 0.01).

Compared to the placebo group, cobalamin treatment resulted in a decrease in plasma tHcy (p < 0.001) and MMA (p = 0.001) levels and a larger increase in AIMS (p = 0.02) and ASQ gross motor scores (p = 0.03).

Conclusions

The findings suggest that prolonged exclusive breastfeeding may not provide sufficient B vitamins for small infants, and that this may have a negative effect on early gross motor development. In infants with mild cobalamin deficiency at 6 months, cobalamin treatment significantly improvement cobalamin status and motor function, suggesting that the observed impairment in motor function associated with long-term exclusive breastfeeding, may be due to cobalamin deficiency.

Clinical trial registration

ClinicalTrials.gov, number NCT01201005

Early-life adversity programs emotional functions and the neuroendocrine stress system: the contribution of nutrition, metabolic hormones and epigenetic mechanisms

Clinical and pre-clinical studies have shown that early-life adversities, such as abuse or neglect, can increase the vulnerability to develop psychopathologies and cognitive decline later in life. Remarkably, the lasting consequences of stress during this sensitive period on the hypothalamic-pituitary-adrenal axis and emotional function closely resemble the long-term effects of early malnutrition and suggest a possible common pathway mediating these effects. During early-life, brain development is affected by both exogenous factors, like nutrition and maternal care as well as by endogenous modulators including stress hormones. These elements, while mostly considered for their independent actions, clearly do not act alone but rather in a synergistic manner. In order to better understand how the programming by early-life stress takes place, it is important to gain further insight into the exact interplay of these key elements, the possible common pathways as well as the underlying molecular mechanisms that mediate their effects. We here review evidence that exposure to both early-life stress and early-life under-/malnutrition similarly lead to life-long alterations on the neuroendocrine stress system and modify emotional functions. We further discuss how the different key elements of the early-life environment interact and affect one another and next suggest a possible role for the early-life adversity induced alterations in metabolic hormones and nutrient availability in shaping later stress responses and emotional function throughout life, possibly via epigenetic mechanisms. Such knowledge will help to develop intervention strategies, which gives the advantage of viewing the synergistic action of a more complete set of changes induced by early-life adversity.

Effects of multivitamin, mineral and herbal supplement on cognition in younger adults and the contribution of B group vitamins

OBJECTIVE

Cognitive benefits of multivitamins have been observed in the elderly, but fewer trials have investigated younger, healthy cohorts. This randomised, double-blind, placebo-controlled study investigated the cognitive effects of 16-week multivitamin supplementation in adults aged 20-49 years.

METHOD

A total of 138 participants aged 20-50 years were randomised and 116 completed the trial. The participants completed a computerised battery of cognitive tasks before and after 16-week supplementation with a multivitamin containing minerals and herbs or placebo. Blood measures of homocysteine, vitamin B6, B12 and folate were collected at both time points.

RESULTS

In men, there was a strong trend (p = 0.01; which did not reach significance when adjusted for multiple comparisons) for the multivitamin to improve performance on the incongruent stroop task, a measure of selective attention and response inhibition. There were no cognitive benefits of multivitamin supplements in women. Multivitamin supplementation substantially increased blood levels of vitamin B6, B12 and folate in both genders and decreased homocysteine in men. In men who received the multivitamin, improved stroop congruent performance was associated with increased vitamin B6 levels.

CONCLUSION

Multivitamin supplementation may be useful for maintaining levels of B vitamins. The effects of multivitamins on speeded attention such as the stroop task in young adults warrant further investigation.

Nutrition and neurodevelopment in children: focus on NUTRIMENTHE project

There is growing evidence that early nutrition affects later cognitive performance. The idea that the diet of mothers, infants, and children could affect later mental performance has major implications for public health practice and policy development and for our understanding of human biology as well as for food product development, economic progress, and future wealth creation. To date, however, much of the evidence is from animal, retrospective studies and short-term nutritional intervention studies in humans. The positive effect of micronutrients on health, especially of pregnant women eating well to maximise their child's cognitive and behavioural outcomes, is commonly acknowledged. The current evidence of an association between gestational nutrition and brain development in healthy children is more credible for folate, n-3 fatty acids, and iron. Recent findings highlight the fact that single-nutrient supplementation is less adequate than supplementation with more complex formulae. However, the optimal content of micronutrient supplementation and whether there is a long-term impact on child's neurodevelopment needs to be investigated further. Moreover, it is also evident that future studies should take into account genetic heterogeneity when evaluating nutritional effects and also nutritional recommendations. The objective of the present review is to provide a background and update on the current knowledge linking nutrition to cognition and behaviour in children, and to show how the large collaborative European Project NUTRIMENTHE is working towards this aim.

The role of nutrition in children's neurocognitive development, from pregnancy through childhood

This review examines the current evidence for a possible connection between nutritional intake (including micronutrients and whole diet) and neurocognitive development in childhood. Earlier studies which have investigated the association between nutrition and cognitive development have focused on individual micronutrients, including omega-3 fatty acids, vitamin B12, folic acid, choline, iron, iodine, and zinc, and single aspects of diet. The research evidence from observational studies suggests that micronutrients may play an important role in the cognitive development of children. However, the results of intervention trials utilizing single micronutrients are inconclusive. More generally, there is evidence that malnutrition can impair cognitive development, whilst breastfeeding appears to be beneficial for cognition. Eating breakfast is also beneficial for cognition. In contrast, there is currently inconclusive evidence regarding the association between obesity and cognition. Since individuals consume combinations of foods, more recently researchers have become interested in the cognitive impact of diet as a composite measure. Only a few studies to date have investigated the associations between dietary patterns and cognitive development. In future research, more well designed intervention trials are needed, with special consideration given to the interactive effects of nutrients.

Maternal and offspring fasting glucose and type 2 diabetes-associated genetic variants and cognitive function at age 8: a Mendelian randomization study in the Avon Longitudinal Study of Parents and Children

Background

In observational epidemiological studies type 2 diabetes (T2D) and both low and high plasma concentrations of fasting glucose have been found to be associated with lower cognitive performance. These associations could be explained by confounding.

Methods

In this study we looked at the association between genetic variants, known to be robustly associated with fasting glucose and T2D risk, in the mother and her offspring to determine whether there is likely to be a causal link between early life exposure to glucose and child’s intelligence quotient (IQ) scores in the Avon Longitudinal Study of Parents and Children (ALSPAC) cohort. We generated a fasting glucose (FGGRS) and a T2D (T2DGRS) genetic risk score and used them in a Mendelian randomization approach.

Results

We found a strong correlation between the FGGRS and fasting glucose plasma measurements that were available for a subset of children, but no association of either the maternal or the offspring FGGRS with child’s IQ was observed. In contrast, the maternal T2DGRS was positively associated with offspring IQ.

Conclusions

Maternal and offspring genetic variants which are associated with glucose levels are not associated with offspring IQ, suggesting that there is unlikely to be a causal link between glucose exposure in utero and IQ in childhood. Further exploration in even larger cohorts is required to exclude the possibility that our null findings were due to a lack of statistical power.