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Fan L, Wang X, Szeto IMY, Liu B, Sinclair AJ, Li D. Dietary intake of different ratios of ARA/DHA in early stages and its impact on infant development. Food Funct 2024; 15:3259-3273. [PMID: 38469864 DOI: 10.1039/d3fo04629j] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/13/2024]
Abstract
Long-chain polyunsaturated fatty acids (LC-PUFAs), arachidonic acid (ARA, 20:4n-6) and docosahexaenoic acid (DHA, 22:6n-3) are essential in the development of infants. ARA and DHA from breast milk or infant formula are the main sources of access for infants to meet their physiological and metabolic needs. The ratio of ARA to DHA in breast milk varies among regions and different lactation stages. Different ratios of ARA and DHA mainly from algal oil, animal fat, fish oil, and microbial oil, are added to infant formula in different regions and infant age ranges. Supplementing with appropriate ratios of ARA and DHA during infancy promotes brain, neural, visual, and other development aspects. In this review, we first introduced the current intake status of ARA and DHA in different locations, lactation stages, and age ranges in breast milk and infant formula. Finally, we discussed the effect of different ratios of ARA and DHA on infant development. This review provided a comprehensive research basis for the nutritional research of infants who consume different ratios of ARA and DHA.
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Affiliation(s)
- Lijiao Fan
- Institute of Nutrition & Health, School of Public Health, Qingdao University, Qingdao 266071, China.
| | - Xincen Wang
- Institute of Nutrition & Health, School of Public Health, Qingdao University, Qingdao 266071, China.
| | | | - Biao Liu
- National Center of Technology Innovation for Dairy, Hohhot 010110, China
| | - Andrew J Sinclair
- Department of Nutrition, Dietetics and Food, School of Clinical Sciences, Monash University, Notting Hill, VIC 3168, Australia
- Faculty of Health, Deakin University, Burwood, VIC 3152, Australia
| | - Duo Li
- Institute of Nutrition & Health, School of Public Health, Qingdao University, Qingdao 266071, China.
- Department of Nutrition, Dietetics and Food, School of Clinical Sciences, Monash University, Notting Hill, VIC 3168, Australia
- Department of Food Science and Nutrition, Zhejiang University, Hangzhou 310058, China
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2
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Urlacher SS. The energetics of childhood: Current knowledge and insights into human variation, evolution, and health. AMERICAN JOURNAL OF BIOLOGICAL ANTHROPOLOGY 2023. [PMID: 36866969 DOI: 10.1002/ajpa.24719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 12/22/2022] [Accepted: 02/10/2023] [Indexed: 03/04/2023]
Abstract
How organisms capture and ultimately use metabolic energy-a limiting resource of life-has profound implications for understanding evolutionary legacies and current patterns of phenotypic variation, adaptation, and health. Energetics research among humans has a rich history in biological anthropology and beyond. The energetics of childhood, however, remains relatively underexplored. This shortcoming is notable given the accepted importance of childhood in the evolution of the unique human life history pattern as well as the known sensitivity of childhood development to local environments and lived experiences. In this review, I have three objectives: (1) To overview current knowledge regarding how children acquire and use energy, highlighting work among diverse human populations and pointing to recent advances and remaining areas of uncertainty; (2) To discuss key applications of this knowledge for understanding human variation, evolution, and health; (3) To recommend future avenues for research. A growing body of evidence supports a model of trade-offs and constraint in childhood energy expenditure. This model, combined with advancements on topics such as the energetics of immune activity, the brain, and the gut, provides insights into the evolution of extended human subadulthood and the nature of variation in childhood development, lifetime phenotype, and health.
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Affiliation(s)
- Samuel S Urlacher
- Department of Anthropology, Baylor University, Waco, Texas, USA
- Child and Brain Development Program, CIFAR, Toronto, Canada
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3
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Suratri MAL, Putro G, Rachmat B, Nurhayati, Ristrini, Pracoyo NE, Yulianto A, Suryatma A, Samsudin M, Raharni. Risk Factors for Stunting among Children under Five Years in the Province of East Nusa Tenggara (NTT), Indonesia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1640. [PMID: 36674391 PMCID: PMC9865789 DOI: 10.3390/ijerph20021640] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 01/10/2023] [Accepted: 01/13/2023] [Indexed: 06/17/2023]
Abstract
In East Nusa Tenggara Province, Indonesia, 42.6% of children under five had stunted growth in 2018, which affects both individual and communal levels. The first step in creating effective interventions is identifying the risk factors for stunting. This study aims to pinpoint the stunting risk factors in East Nusa Tenggara Province, Indonesia, by incorporating secondary data from the 2018 Indonesia Basic Health Research (RISKESDAS). This study implemented a cross-sectional design by utilizing the data of individuals who were successfully visited during the survey. Initial data screening in East Nusa Tenggara Province based on the criteria for children aged 0−59 months and stunting showed as many as 1643. Multivariate logistic regression analysis was performed to evaluate the relationship between children’s characteristics and stunting. There was a significant relationship between age group variables for younger children (aged 12−23, 24−35, and 36−47 months), mothers with low education, and children living in rural areas with the incidence of stunting in children (p-value < 0.05). The dominant factors that caused stunting in this study were the children’s age of 24−35 months (OR = 2.08, 95% CI: 1.12−3.86), mothers with low education (OR = 1.57, 95% CI: 1.18−2.08), and children living in rural areas (OR = 1.39, 95% CI: 1.01−1.91). The highest prevalence of stunting was in the group of children aged 12−23 months (45.2%). To prevent child stunting, the government must intervene for mothers with low education and those living in rural areas. Intervention includes intensive socialization about improving nutritional status during pregnancy and practicing complementary feeding and breastfeeding habits until the child is 24 months old.
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Affiliation(s)
| | - Gurendro Putro
- Center for Public Health and Nutrition Research, Health Research Organization, National Research and Innovation Agency, Jakarta 10340, Indonesia
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4
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Hernández-Ruiz Á, Madrigal C, Soto-Méndez MJ, Gil Á. Challenges and perspectives of the double burden of malnutrition in Latin America. CLINICA E INVESTIGACION EN ARTERIOSCLEROSIS : PUBLICACION OFICIAL DE LA SOCIEDAD ESPANOLA DE ARTERIOSCLEROSIS 2022; 34 Suppl 1:S3-S16. [PMID: 35153111 DOI: 10.1016/j.arteri.2021.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 11/22/2021] [Indexed: 06/14/2023]
Abstract
Nutrition is a key factor in the development of non-communicable chronic diseases (NCCDs), especially cardiovascular diseases (CVD) and their risk factors. The "double burden of malnutrition" (DBM) is the coexistence of undernutrition and overnutrition in the same population across the life-course. In Latin America, the transition from a predominantly underweight to an overweight and obese population has increased more rapidly than in other regions in the world. Undernutrition and the micronutrient deficiencies particularly iron, zinc, and vitamins A and D, present high heterogeneity in Latin American countries, and are currently considered important public health problems. In this region, NCCDs account for 50% of the disability-adjusted life-years, led by CVD. The most prevalent cardiovascular risk factors are overweight, obesity, hypertension, dyslipidemia and type 2 diabetes mellitus. Because of the cost of treatment and the potential years of life lost due to premature death, CVD is known to affect the poorest segments of the population, affecting communities, and governments. More than 80% of CVD deaths occur in low- and middle-income countries. The persistence of damage in some cells due to undernutrition may explain certain findings regarding the increase in NCCD. These aspects together with epigenetic changes have highlighted the importance of a lifelong approach to nutritional policy development. Reducing DBM requires major societal interventions in public health and nutrition to achieve holistic change that can be sustained over the long term and spread throughout the global food system. The implementation of effective state policies of double impact actions should influence both sides of the burden and be considered an urgent priority, considering country-specific inequalities and socio-demographic differences in the Latin American region, using diverse and multidisciplinary strategies.
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Affiliation(s)
- Ángela Hernández-Ruiz
- Iberoamerican Nutrition Foundation (FINUT), Av. Del Conocimiento 12, 3.ª pta., Armilla 18016, Granada, Spain
| | - Casandra Madrigal
- Iberoamerican Nutrition Foundation (FINUT), Av. Del Conocimiento 12, 3.ª pta., Armilla 18016, Granada, Spain; Department of Nutrition and Food Science, Faculty of Pharmacy, University of Granada, Granada, Spain
| | - María José Soto-Méndez
- Iberoamerican Nutrition Foundation (FINUT), Av. Del Conocimiento 12, 3.ª pta., Armilla 18016, Granada, Spain
| | - Ángel Gil
- Iberoamerican Nutrition Foundation (FINUT), Av. Del Conocimiento 12, 3.ª pta., Armilla 18016, Granada, Spain; Department of Biochemistry and Molecular Biology II University of Granada, University of Granada, Granada, Spain; Institute of Nutrition and Food Technology "José Mataix," Biomedical Research Center, University of Granada, Granada, Spain; Biosanitary Research Institute IBS.GRANADA, Granada University Hospital Complex, Granada, Spain; CIBEROBN (Physiopathology of Obesity and Nutrition), Instituto de Salud Carlos III, Madrid, Spain.
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5
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de Goffau MC, Jallow AT, Sanyang C, Prentice AM, Meagher N, Price DJ, Revill PA, Parkhill J, Pereira DIA, Wagner J. Gut microbiomes from Gambian infants reveal the development of a non-industrialized Prevotella-based trophic network. Nat Microbiol 2022; 7:132-144. [PMID: 34972822 PMCID: PMC8727306 DOI: 10.1038/s41564-021-01023-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 11/11/2021] [Indexed: 02/07/2023]
Abstract
Distinct bacterial trophic networks exist in the gut microbiota of individuals in industrialized and non-industrialized countries. In particular, non-industrialized gut microbiomes tend to be enriched with Prevotella species. To study the development of these Prevotella-rich compositions, we investigated the gut microbiota of children aged between 7 and 37 months living in rural Gambia (616 children, 1,389 stool samples, stratified by 3-month age groups). These infants, who typically eat a high-fibre, low-protein diet, were part of a double-blind, randomized iron intervention trial (NCT02941081) and here we report the secondary outcome. We found that child age was the largest discriminating factor between samples and that anthropometric indices (collection time points, season, geographic collection site, and iron supplementation) did not significantly influence the gut microbiome. Prevotella copri, Faecalibacterium prausnitzii and Prevotella stercorea were, on average, the most abundant species in these 1,389 samples (35%, 11% and 7%, respectively). Distinct bacterial trophic network clusters were identified, centred around either P. stercorea or F. prausnitzii and were found to develop steadily with age, whereas P. copri, independently of other species, rapidly became dominant after weaning. This dataset, set within a critical gut microbial developmental time frame, provides insights into the development of Prevotella-rich gut microbiomes, which are typically understudied and are underrepresented in western populations.
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Affiliation(s)
- Marcus C de Goffau
- Parasites and Microbes, Wellcome Sanger Institute, Cambridge, UK
- Department of Vascular Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Amadou T Jallow
- Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia
| | - Chilel Sanyang
- Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia
| | - Andrew M Prentice
- Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia
| | - Niamh Meagher
- Department of Infectious Diseases at the Doherty Institute for Infection & Immunity, The University of Melbourne and Royal Melbourne Hospital, Melbourne, VIC, Australia
- Centre for Epidemiology & Biostatistics, Melbourne School of Population & Global Health, The University of Melbourne, Melbourne, Australia
| | - David J Price
- Department of Infectious Diseases at the Doherty Institute for Infection & Immunity, The University of Melbourne and Royal Melbourne Hospital, Melbourne, VIC, Australia
- Centre for Epidemiology & Biostatistics, Melbourne School of Population & Global Health, The University of Melbourne, Melbourne, Australia
| | - Peter A Revill
- Victorian Infectious Disease Reference Laboratory, the Peter Doherty Institute for Infection and Immunity, The University of Melbourne and Royal Melbourne Hospital, Melbourne, Australia
| | - Julian Parkhill
- Department of Veterinary Medicine, University of Cambridge, Cambridge, UK
| | - Dora I A Pereira
- Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia
- Department of Pathology, University of Cambridge, Cambridge, UK
| | - Josef Wagner
- Parasites and Microbes, Wellcome Sanger Institute, Cambridge, UK.
- Victorian Infectious Disease Reference Laboratory, the Peter Doherty Institute for Infection and Immunity, The University of Melbourne and Royal Melbourne Hospital, Melbourne, Australia.
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6
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Arini HRB, Hadju V, Thomas P, Ferguson M. Nutrient and Food Intake of Indonesian Children Under 5 Years of Age: A Systematic Review. Asia Pac J Public Health 2021; 34:25-35. [PMID: 34636257 DOI: 10.1177/10105395211041001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The Indonesian Government's targets to reduce the prevalence of child malnutrition are unlikely to be met based on current progress. Adequate dietary intake is key to meeting these targets. This systematic review aimed to provide a comprehensive overview of the nutrient and food intake of Indonesian children under 5 years of age. Peer-reviewed and gray literature published between 2007 and 2019 were collected. Of 1500 records, 38 articles met the study inclusion criteria and a narrative analysis was conducted. Children under 5 years were reported to have ranging energy and macronutrient intakes, some with adequate protein intake. Micronutrient deficiencies, particularly iron, zinc, calcium, and vitamin C, were reported. Animal-source foods, fruits, and vegetables were consumed by children, but frequency and/or volume of consumption was low, and it is among the probable causes of micronutrient deficiency among children under 5 years. The absence of reporting micronutrient intake in the national survey limited evidence to inform nutrition-related policies. The implementation of a national micronutrient survey will be beneficial in informing policy and practice aimed at reducing the prevalence of child malnutrition in line with national targets, through improvement in dietary intake.
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Affiliation(s)
- Hesti Retno Budi Arini
- The University of Queensland, Brisbane, Queensland, Australia.,Research Institute of Socio-Economic Development, Surabaya, East Java, Indonesia
| | - Veni Hadju
- Hasanuddin University, Makassar, South Sulawesi, Indonesia
| | - Preetha Thomas
- The University of Queensland, Brisbane, Queensland, Australia
| | - Megan Ferguson
- The University of Queensland, Brisbane, Queensland, Australia.,Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
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7
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Monnard C, Fleith M. Total Fat and Fatty Acid Intake among 1-7-Year-Old Children from 33 Countries: Comparison with International Recommendations. Nutrients 2021; 13:3547. [PMID: 34684548 PMCID: PMC8537778 DOI: 10.3390/nu13103547] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 09/30/2021] [Accepted: 10/02/2021] [Indexed: 12/27/2022] Open
Abstract
This work reviews available data on dietary intakes of total fat, saturated fatty acids (SFA) and individual polyunsaturated fatty acids (PUFA) in children in different countries worldwide and for the first time, compares them with recent international recommendations. Studies published before June 2021 reporting total fat, total SFA and individual PUFA intakes in children aged 1-7 y were included. Observed intakes were evaluated against FAO/WHO and EFSA recommendations. 65 studies from 33 countries were included. Fat intake was too low in 88% of studies in young children (1-3 y). SFA intake was >10%E in 69-73% of children, especially in Europe. Linoleic acid intake was <3%E in 24% of studies in 1-2 y olds and within FAO/WHO recommendations among all other ages. Alpha-linolenic acid intake was <0.5%E in almost half of studies. Docosahexaenoic acid (DHA) or eicosapentaenoic acid + DHA intakes were below recommendations in most studies. In summary, while total fat intake was too low among younger children, SFA intake was above, especially in Europe and n-3 PUFA intake, especially DHA, were below recommendations for all ages. Intake of n-3 PUFA, especially DHA, is generally suboptimal. More data, particularly from developing countries, are required to refine these findings and guide implementation of adapted nutrition policies.
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Affiliation(s)
- Cathriona Monnard
- Nestlé Institute of Health Sciences, Nestlé Research, Société des Produits Nestlé S.A., 1015 Lausanne, Switzerland;
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8
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Shahunja KM, Sévin DC, Kendall L, Ahmed T, Hossain MI, Mahfuz M, Zhu X, Singh K, Singh S, Crowther JM, Gibson RA, Darmstadt GL. Effect of topical applications of sunflower seed oil on systemic fatty acid levels in under-two children under rehabilitation for severe acute malnutrition in Bangladesh: a randomized controlled trial. Nutr J 2021; 20:51. [PMID: 34092255 PMCID: PMC8183055 DOI: 10.1186/s12937-021-00707-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 05/18/2021] [Indexed: 11/30/2022] Open
Abstract
Background Children with severe acute malnutrition (SAM) have inadequate levels of fatty acids (FAs) and limited capacity for enteral nutritional rehabilitation. We hypothesized that topical high-linoleate sunflower seed oil (SSO) would be effective adjunctive treatment for children with SAM. Methods This study tested a prespecified secondary endpoint of a randomized, controlled, unblinded clinical trial with 212 children with SAM aged 2 to 24 months in two strata (2 to < 6 months, 6 to 24 months in a 1:2 ratio) at Dhaka Hospital of icddr,b, Bangladesh between January 2016 and December 2017. All children received standard-of-care management of SAM. Children randomized to the emollient group also received whole-body applications of 3 g/kg SSO three times daily for 10 days. We applied difference-in-difference analysis and unsupervised clustering analysis using t-distributed stochastic neighbor embedding (t-SNE) to visualize changes in FA levels in blood from day 0 to day 10 of children with SAM treated with emollient compared to no-emollient. Results Emollient therapy led to systematically higher increases in 26 of 29 FAs over time compared to the control. These effects were driven primarily by changes in younger subjects (27 of 29 FAs). Several FAs, especially those most abundant in SSO showed high-magnitude but non-significant incremental increases from day 0 to day 10 in the emollient group vs. the no-emollient group; for linoleic acid, a 237 μg/mL increase was attributable to enteral feeding and an incremental 98 μg/mL increase (41%) was due to emollient therapy. Behenic acid (22:0), gamma-linolenic acid (18:3n6), and eicosapentaenoic acid (20:5n3) were significantly increased in the younger age stratum; minimal changes were seen in the older children. Conclusions SSO therapy for SAM augmented the impact of enteral feeding in increasing levels of several FAs in young children. Further research is warranted into optimizing this novel approach for nutritional rehabilitation of children with SAM, especially those < 6 months. Trial registration ClinicalTrials.gov: NCT02616289. Supplementary Information The online version contains supplementary material available at 10.1186/s12937-021-00707-3.
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Affiliation(s)
- K M Shahunja
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Daniel C Sévin
- Cellzome GmbH, GlaxoSmithKline R&D, Meyerhofstrasse 1, 69117, Heidelberg, Germany
| | - Lindsay Kendall
- GlaxoSmithKline R&D, Gunnels Wood Road, Stevenage, Hertfordshire, UK
| | - Tahmeed Ahmed
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Md Iqbal Hossain
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Mustafa Mahfuz
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Xinyi Zhu
- GlaxoSmithKline R&D, Gunnels Wood Road, Stevenage, Hertfordshire, UK
| | - Krishan Singh
- GlaxoSmithKline R&D, Gunnels Wood Road, Stevenage, Hertfordshire, UK
| | - Sunita Singh
- GlaxoSmithKline R&D, Gunnels Wood Road, Stevenage, Hertfordshire, UK
| | | | - Rachel A Gibson
- GlaxoSmithKline R&D, Gunnels Wood Road, Stevenage, Hertfordshire, UK
| | - Gary L Darmstadt
- Department of Pediatrics, Stanford University School of Medicine, 1701 Page Mill Road, Room 121, Palo Alto, Stanford, CA, 94304, USA.
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Urlacher SS, Snodgrass JJ, Dugas LR, Madimenos FC, Sugiyama LS, Liebert MA, Joyce CJ, Terán E, Pontzer H. Childhood Daily Energy Expenditure Does Not Decrease with Market Integration and Is Not Related to Adiposity in Amazonia. J Nutr 2021; 151:695-704. [PMID: 33454748 DOI: 10.1093/jn/nxaa361] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 09/25/2020] [Accepted: 10/19/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Childhood overweight and obesity (OW/OB) is increasingly centered in low- and middle-income countries (LMICs) as rural populations experience market integration and lifeway change. Most explanatory studies have relied on imprecise estimates of children's energy expenditure, restricting understanding of the relative effects of changes in diet and energy expenditure on the development of OW/OB in transitioning contexts. OBJECTIVES This study used gold-standard measurements of children's energy expenditure to investigate the changes that underlie OW/OB and the nutrition/epidemiologic transition. METHODS Cross-sectional data were collected from "rural" (n = 43) Shuar forager-horticulturalist children and their "peri-urban" (n = 34) Shuar counterparts (age 4-12 y) in Amazonian Ecuador. Doubly labeled water measurements of total energy expenditure (TEE; kcal/d), respirometry measurements of resting energy expenditure (REE; kcal/d), and measures of diet, physical activity, immune activity, and market integration were analyzed primarily using regression models. RESULTS Peri-urban children had higher body fat percentage (+8.1%, P < 0.001), greater consumption of market-acquired foods (multiple P < 0.001), lower concentrations of immune activity biomarkers (multiple P < 0.05), and lower REE (-108 kcal/d, P = 0.002) than rural children. Despite these differences, peri-urban children's TEE was indistinguishable from that of rural children (P = 0.499). Moreover, although sample-wide IgG concentrations and household incomes predicted REE (both P < 0.05), no examined household, immune activity, or physical activity measures were related to children's overall TEE (all P > 0.09). Diet and energy expenditure associations with adiposity demonstrate that only reported consumption of market-acquired "protein" and "carbohydrate" foods predicted children's body fat levels (multiple P < 0.05). CONCLUSIONS Despite underlying patterns in REE, Shuar children's TEE is not reliably related to market integration and-unlike dietary measures-does not predict adiposity. These findings suggest a leading role of changing dietary intake in transitions to OW/OB in LMICs.
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Affiliation(s)
- Samuel S Urlacher
- Department of Anthropology, Baylor University, Waco, TX, USA.,Child and Brain Development Program, CIFAR, Toronto, Ontario, Canada
| | - J Josh Snodgrass
- Department of Anthropology, University of Oregon, Eugene, OR, USA.,Center for Global Health, University of Oregon, Eugene, OR, USA
| | - Lara R Dugas
- Department of Public Health Sciences, Loyola University Chicago, Chicago, IL, USA
| | | | | | - Melissa A Liebert
- Department of Anthropology, Northern Arizona University, Flagstaff, AZ, USA
| | - Cara J Joyce
- Department of Public Health Sciences, Loyola University Chicago, Chicago, IL, USA
| | - Enrique Terán
- College of Health Sciences, Universidad San Francisco de Quito, Quito, Ecuador
| | - Herman Pontzer
- Department of Evolutionary Anthropology, Duke University, Durham, NC, USA.,Duke Global Health Institute, Duke University, Durham, NC, USA
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10
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Lutter CK, Grummer-Strawn L, Rogers L. Complementary feeding of infants and young children 6 to 23 months of age. Nutr Rev 2021; 79:825-846. [PMID: 33684940 DOI: 10.1093/nutrit/nuaa143] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Complementary feeding, when foods are introduced to complement a milk-based diet, generally occurs between 6 and 23 months of age. It is a critical period for both physical and cognitive development. During this period, the growth rate of the brain is one of the fastest during the life span and, consequently, the timing, dose, and duration of exposure to specific nutrients can result in both positive and negative effects. Complementary feeding is more than ensuring an adequate intake of nutrients; it also is about avoiding excess intakes of calories, salt, sugars, and unhealthy fats. Meals are cultural and social events where young children observe, imitate, learn about foods to like or dislike, and form lifelong eating habits and practices. Meals are also when a child learns to touch foods and connect food tastes to how foods look and feel. Ideally, complementary feeding is responsive and promotes child autonomy, but it can also be used to manage behavior problems or overly indulge a child, resulting in long-term consequences for nutrition and health. Therefore, in addition to what a child is fed, attention to how a child is fed is also important. In this review, 12 topics relevant for updating global guidance on complementary feeding were identified: age of introduction of complementary foods; continued breastfeeding; responsive feeding; safe preparation and storage of complementary foods; food textures, flavors, and acceptance; energy and meal and snack frequency; fats, protein, and carbohydrates; dietary diversity; milks other than breast milk; fluid needs; unhealthy foods and beverages; and use of vitamin and mineral supplements or supplementary foods.
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Affiliation(s)
- Chessa K Lutter
- Division of Food Security and Agriculture, RTI International, Washington, DC, USA
| | | | - Lisa Rogers
- Department of Nutrition and Food Safety, World Health Organization, Geneva, Switzerland
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11
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Countering impaired glucose homeostasis during catch-up growth with essential polyunsaturated fatty acids: is there a major role for improved insulin sensitivity? Nutr Diabetes 2021; 11:4. [PMID: 33414371 PMCID: PMC7791023 DOI: 10.1038/s41387-020-00143-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 07/23/2020] [Accepted: 07/27/2020] [Indexed: 11/08/2022] Open
Abstract
Background/Objectives Catch-up growth, an important risk factor for later obesity and type 2 diabetes, is often characterized by a high rate of fat deposition associated with hyperinsulinemia and glucose intolerance. We tested here the hypothesis that refeeding on a high-fat diet rich in essential polyunsaturated fatty acids (ePUFA) improves glucose homeostasis primarily by enhancing insulin sensitivity in skeletal muscles and adipose tissues. Methods Rats were caloric restricted for 2 weeks followed by 1–2 weeks of isocaloric refeeding on either a low-fat (LF) diet, a high-fat (HF) diet based on animal fat and high in saturated and monounsaturated fatty acids (HF SMFA diet), or a HF diet based on vegetable oils (1:1 mixture of safflower and linseed oils) and rich in the essential fatty acids linoleic and α-linolenic acids (HF ePUFA diet). In addition to measuring body composition and a test of glucose tolerance, insulin sensitivity was assessed during hyperinsulinemic-euglycemic clamps at the whole-body level and in individual skeletal muscles and adipose tissue depots. Results Compared to animals refed the LF diet, those refed the HF-SMFA diet showed a higher rate of fat deposition, higher plasma insulin and glucose responses during the test of glucose tolerance, and markedly lower insulin-stimulated glucose utilization at the whole body level (by a-third to a-half) and in adipose tissue depots (by 2–5 folds) during insulin clamps. While refeeding on the ePUFA diet prevented the increases in fat mass and in plasma insulin and glucose, the results of insulin clamps revealed that insulin-stimulated glucose utilization was not increased in skeletal muscles and only marginally higher in adipose tissues and at the whole-body level. Conclusions These results suggest only a minor role for enhanced insulin sensitivity in the mechanisms by which diets high in ePUFA improves glucose homeostasis during catch-up growth.
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12
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Argaw A, Huybregts L, Wondafrash M, Kolsteren P, Belachew T, Worku BN, Abessa TG, Bouckaert KP. Neither n-3 Long-Chain PUFA Supplementation of Mothers through Lactation nor of Offspring in a Complementary Food Affects Child Overall or Social-Emotional Development: A 2 × 2 Factorial Randomized Controlled Trial in Rural Ethiopia. J Nutr 2019; 149:505-512. [PMID: 30544211 DOI: 10.1093/jn/nxy202] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 06/25/2018] [Accepted: 08/01/2018] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The n-3 (ω-3) long-chain polyunsaturated fatty acid (LC-PUFA) docosahexaenoic acid (DHA) is essential for optimal brain development. There is a lack of evidence on the effect of postnatal n-3 LC-PUFA supplementation on child development in low-income countries. OBJECTIVE We evaluated the efficacy of fish-oil supplementation through lactation or complementary food supplementation on the development of children aged 6-24 mo in rural Ethiopia. METHODS We conducted a double-blind randomized controlled trial of n-3 LC-PUFA supplementation for 12 mo using fish-oil capsules [maternal intervention: 215 mg DHA + 285 mg eicosapentaenoic acid (EPA)] or a fish-oil-enriched complementary food supplement (child intervention: 169 mg DHA + 331 mg EPA). In total, 360 pairs of mothers and infants aged 6-12 mo were randomly assigned to 4 arms: maternal intervention and child control, child intervention and maternal control, maternal and child intervention, and maternal and child control. Primary outcomes were overall developmental performance with the use of a culturally adapted Denver II test that assesses personal-social, language, fine-motor, and gross-motor domains and social-emotional developmental performance using the Ages and Stages Questionnaire: Social Emotional at baseline and at 6 and 12 mo. We used mixed-effects models to estimate intervention effects on developmental performance over time (intervention × time interaction). RESULTS The evolution in overall and social-emotional developmental performance over time did not differ across study arms (intervention × time: F = 1.09, P = 0.35, and F = 0.61, P = 0.61, respectively). Effects did not change after adjustment for child age, birth order, and nutritional status; maternal age and education; wealth; family size; and breastfeeding frequency. Children's developmental performance significantly decreased during study follow-up (β: -0.03 SDs/mo; 95% CI: -0.04, -0.01 SD/mo; P < 0.01). CONCLUSIONS n-3 LC-PUFA supplementation does not affect overall or social-emotional development of children aged 6-24 mo in a low-income setting. Follow-up of the cohort is recommended to determine whether there are long-term effects of the intervention. This trial was registered at clinicaltrials.gov as NCT01817634.
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Affiliation(s)
- Alemayehu Argaw
- Department of Population and Family Health, Institute of Health, Jimma University, Jimma, Ethiopia.,Department of Food Technology, Safety, and Health, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium
| | - Lieven Huybregts
- Poverty, Health, and Nutrition Division, International Food Policy Research Institute, Washington, DC
| | - Mekitie Wondafrash
- Department of Population and Family Health, Institute of Health, Jimma University, Jimma, Ethiopia.,Department of Food Technology, Safety, and Health, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium
| | - Patrick Kolsteren
- Department of Food Technology, Safety, and Health, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium
| | - Tefera Belachew
- Department of Population and Family Health, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Berhanu N Worku
- Department of Psychology, Jimma University, Jimma, Ethiopia.,Rehabilitation Research Center (REVAL), Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Teklu G Abessa
- Special Needs and Inclusive Education, College of Education and Behavioral Sciences, Jimma University, Jimma, Ethiopia.,Rehabilitation Research Center (REVAL), Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Kimberley P Bouckaert
- Department of Food Technology, Safety, and Health, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium
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13
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França FCO, Andrade IS, Lopes Silva MV, Lordêlo MS, Costa RG, Menezes-Filho JA. School meals' centesimal and mineral composition and their nutritional value for Brazilian children. J Trace Elem Med Biol 2018; 48:97-104. [PMID: 29773201 DOI: 10.1016/j.jtemb.2018.03.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 03/12/2018] [Accepted: 03/13/2018] [Indexed: 12/27/2022]
Abstract
The assessment of meals served under the Brazilian National School Meal Program (PNAE) is an important tool to verify its adequacy to the proposed parameters and the nutritional needs of school-aged children. The aim of this study was to evaluate the centesimal and mineral composition of the meals offered by the program and adequacy to the nutritional recommendations in three municipalities of the state of Bahia, Brazil. Centesimal composition of meals was determined according to the reference guidelines and mineral composition was analyzed by atomic absorption spectrometry. Non-parametric analysis of variance was used to test the differences of the medians among the municipalities and Student-t test to compare the means between the two sampling periods. There were inadequacies in the carbohydrate, lipid and protein contents, and none of the municipalities reached the recommendation of 20%. Mineral concentration, especially Fe, Se, Cu and K were much lower than expected. Sodium levels were three-folds higher than the recommended, being worrisome due to higher risk of elevated blood pressure. There were inadequacies with regard to the PNAE guidelines, and there is a need to reevaluate the meals that are being offered to better meet childreńs needs and to form healthy habits from childhood.
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Affiliation(s)
- Fabiana C O França
- Laboratory of Toxicology, College of Pharmacy, Federal University of Bahia, Av. Barão Jeremoabo, s/n, Ondina, 40170-115, Salvador, Bahia, Brazil.
| | - Iziane S Andrade
- School of Nutrition, Federal University of Bahia, Av. Araújo Pinho, n° 32, Canela, 40110-150, Salvador, Bahia, Brazil.
| | - Mariangela V Lopes Silva
- Department of Life Sciences, State University of Bahia, R. Silveira Martins, 2555, Cabula, 41200-470, Salvador, Bahia, Brazil.
| | - Maurício S Lordêlo
- Department of Exact Science and Statistics, State University of Feira de Santana, Av. Transnordestina, s/n, Novo Horizonte, 44036-900, Feira de Santana, Bahia, Brazil.
| | - Renata G Costa
- Laboratory of Toxicology, College of Pharmacy, Federal University of Bahia, Av. Barão Jeremoabo, s/n, Ondina, 40170-115, Salvador, Bahia, Brazil.
| | - José A Menezes-Filho
- Laboratory of Toxicology, College of Pharmacy, Federal University of Bahia, Av. Barão Jeremoabo, s/n, Ondina, 40170-115, Salvador, Bahia, Brazil.
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14
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Lim SX, Toh JY, van Lee L, Han WM, Shek LPC, Tan KH, Yap F, Godfrey KM, Chong YS, Chong MFF. Food Sources of Energy and Macronutrient Intakes among Infants from 6 to 12 Months of Age: The Growing Up in Singapore Towards Healthy Outcomes (GUSTO) Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:E488. [PMID: 29534442 PMCID: PMC5877033 DOI: 10.3390/ijerph15030488] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 02/26/2018] [Accepted: 03/05/2018] [Indexed: 12/22/2022]
Abstract
Adequate nutrition during complementary feeding is important for the growth, development and well-being of children. We aim to examine the energy and macronutrient intake composition and their main food sources in a mother-offspring cohort study in Singapore. The diets of infants were assessed by 24 h dietary recalls or food diaries collected from mothers when their offspring were 6 (n = 760), 9 (n = 893) and 12 (n = 907) months of age. Food sources of energy and macronutrients were determined using the population proportion methodology. Energy intakes per day (kcal; mean (standard deviation, SD)) of these infants were 640 (158) at 6 months, 675 (173) at 9 months, and 761 (208) at 12 months. Infant formula, breastmilk and infant cereals were the top three food sources of energy and macronutrient intakes in infants through the period 6 to 12 months. Other main energy and carbohydrate sources at 9 and 12 months of age were rice porridge, infant biscuits and fresh fruits, while fish, red meat and eggs were the other main protein and total fat sources. Breast-fed and mixed-fed infants had a more varied diet as compared to formula-fed infants. Formula-fed infants had consistently higher protein and lower total fat consumption compared to those who were breastfed. An understanding of these main food sources during complementary feeding can inform local dietary recommendations and policies.
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Affiliation(s)
- Shan-Xuan Lim
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore 117609, Singapore.
- Food Science and Technology Programme, Department of Chemistry, National University of Singapore, Singapore 117543, Singapore.
| | - Jia-Ying Toh
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore 117609, Singapore.
| | - Linde van Lee
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore 117609, Singapore.
| | - Wee-Meng Han
- Department of Nutrition and Dietetics, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore 229899, Singapore.
| | - Lynette Pei-Chi Shek
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore 117609, Singapore.
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, Singapore 119228, Singapore.
- Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, 5 Lower Kent Ridge Road, Singapore 119074, Singapore.
| | - Kok-Hian Tan
- Department of Maternal Fetal Medicine, KK Women's and Children's Hospital, Singapore 229899, Singapore.
- Duke-NUS Medical School, Singapore 169857, Singapore.
| | - Fabian Yap
- Duke-NUS Medical School, Singapore 169857, Singapore.
- Department of Paediatrics, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore 229899, Singapore.
- Lee Kong Chian School of Medicine, Nanyang Technological University, Experimental Medicine Building, Nanyang Drive, Singapore 636921, Singapore.
| | - Keith M Godfrey
- MRC Lifecourse Epidemiology Unit & NIHR Southampton Biomedical Research Centre, University of Southampton & University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK.
| | - Yap-Seng Chong
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore 117609, Singapore.
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, Singapore 119228, Singapore.
| | - Mary Foong-Fong Chong
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore 117609, Singapore.
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, Singapore 117549, Singapore.
- Clinical Nutrition Research Centre, Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Centre for Translational Medicine, Medical Drive #07-02, MD 6 Building, Yong Loo Lin School of Medicine, Singapore 117599, Singapore.
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15
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Forsyth S, Calder PC, Zotor F, Amuna P, Meyer B, Holub B. Dietary Docosahexaenoic Acid and Arachidonic Acid in Early Life: What Is the Best Evidence for Policymakers? ANNALS OF NUTRITION & METABOLISM 2018; 72:210-222. [PMID: 29518776 PMCID: PMC6067655 DOI: 10.1159/000487271] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Accepted: 01/28/2018] [Indexed: 01/01/2023]
Abstract
BACKGROUND A wealth of information on the functional roles of docosahexaenoic acid (DHA) and arachidonic acid (ARA) from cellular, animal, and human studies is available. Yet, there remains a lack of cohesion in policymaking for recommended dietary intakes of DHA and ARA in early life. This is predominantly driven by inconsistent findings from a relatively small number of randomised clinical trials (RCTs), which vary in design, methodology, and outcome measures, all of which were conducted in high-income countries. It is proposed that this selective evidence base may not fully represent the biological importance of DHA and ARA during early and later life and the aim of this paper is to consider a more inclusive and pragmatic approach to evidence assessment of DHA and ARA requirements in infants and young children, which will allow policymaking to reflect the marked diversity of need worldwide. SUMMARY Data from clinical RCTs is considered in the context of the extensive evidence from experimental, animal and human observational studies. Although the RCT data shows evidence of beneficial effects on visual function and in specific cognitive domains, early methodological approaches do not reflect current thinking and this undermines the strength of evidence. An outline of a framework for an inclusive and pragmatic approach to policy development on dietary DHA and ARA in early life is described. CONCLUSION High-quality RCTs that will determine long-term health outcomes in appropriate real-world settings need to be undertaken. In the meantime, a collective pragmatic approach to evidence assessment, may allow public health policymakers to make comprehensive reasoned judgements on the merits, costs, and expediency of dietary DHA and ARA interventions.
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Affiliation(s)
| | - Philip C. Calder
- Human Development and Health Academic Unit, Faculty of Medicine, University of Southampton, Southampton General Hospital, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust and University of Southampton, Southampton, UK
| | - Francis Zotor
- Department of Family and Community Health, School of Public Health, University of Health and Allied Sciences, Hohoe, Ghana
| | - Paul Amuna
- Research Section, Department of Clinical Affairs, Primary Health Care Corporation, Doha, Qatar
| | - Barbara Meyer
- Lipid Research Centre, School of Medicine, Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, New South Wales, Australia
| | - Bruce Holub
- Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, Ontario, Canada
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16
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Argaw A, Wondafrash M, Bouckaert KP, Kolsteren P, Lachat C, Belachew T, De Meulenaer B, Huybregts L. Effects of n-3 long-chain PUFA supplementation to lactating mothers and their breastfed children on child growth and morbidity: a 2 × 2 factorial randomized controlled trial in rural Ethiopia. Am J Clin Nutr 2018; 107:454-464. [PMID: 29566189 DOI: 10.1093/ajcn/nqx057] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 12/01/2017] [Indexed: 11/14/2022] Open
Abstract
Background Recurrent infections and inflammation contribute to growth faltering in low-income countries. n-3 (ω-3) Long-chain polyunsaturated fatty-acids (LC-PUFAs) may improve immune maturation, resistance to infections, and growth in young children who are at risk. Objective We evaluated the independent and combined effects of fish oil (500 mg n-3 LC-PUFAs/d) supplementation to lactating mothers and their breastfed children, aged 6-24 mo, on child morbidity, systemic inflammation, and growth in southwest Ethiopia. Design A 4-arm double-blind randomized controlled trial was conducted by enrolling 360 mother-infant pairs with infants 6-12 mo old. Study arms were both the lactating mother and child receiving fish oil intervention (MCI), only the lactating mother receiving fish oil intervention and child receiving placebo control (MI), only the child receiving intervention and mother receiving placebo control (CI), and both mother and child receiving a placebo supplement or control (C). The primary study outcome was linear growth using monthly changes in length-for-age z score. Anthropometric measurements were taken monthly, and hemoglobin, C-reactive protein, and blood LC-PUFAs were measured at baseline and after 6 and 12 mo of follow-up. Weekly morbidity surveillance was conducted throughout the study. Results Fish-oil supplementation significantly increased blood n-3 LC-PUFA concentration (P < 0.01) and decreased the arachidonic acid:(docosahexaenoic acid + eicosapentaenoic acid) ratio (P < 0.001) in all intervention arms. No significant intervention effect was found on linear growth, morbidity, or systemic inflammation. Compared to the control group, a small positive effect on monthly changes in weight-for-length z scores was found in the CI arm (effect size: 0.022/mo; 95% CI: 0.005, 0.039/mo; P = 0.012) and the MCI arm (effect size: 0.018/mo; 95% CI: 0.001, 0.034/mo; P = 0.041). Conclusions n-3 LC-PUFA supplementation of lactating mothers and children did not affect child linear growth and morbidity in a low-income setting. n-3 LC-PUFA supplementation given directly to children modestly increased relative weight gain. This trial was registered at clinicaltrials.gov as NCT01817634.
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Affiliation(s)
- Alemayehu Argaw
- Department of Population and Family Health, Institute of Health, Jimma University, Jimma, Ethiopia.,Department of Food Safety and Food Quality, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium
| | - Mekitie Wondafrash
- Department of Population and Family Health, Institute of Health, Jimma University, Jimma, Ethiopia.,Department of Food Safety and Food Quality, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium
| | - Kimberley P Bouckaert
- Department of Food Safety and Food Quality, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium
| | - Patrick Kolsteren
- Department of Food Safety and Food Quality, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium
| | - Carl Lachat
- Department of Food Safety and Food Quality, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium
| | - Tefera Belachew
- Department of Population and Family Health, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Bruno De Meulenaer
- Department of Food Safety and Food Quality, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium
| | - Lieven Huybregts
- Poverty, Health and Nutrition Division, International Food Policy Research Institute, Washington, DC
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17
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Qasim A, Turcotte M, de Souza RJ, Samaan MC, Champredon D, Dushoff J, Speakman JR, Meyre D. On the origin of obesity: identifying the biological, environmental and cultural drivers of genetic risk among human populations. Obes Rev 2018; 19:121-149. [PMID: 29144594 DOI: 10.1111/obr.12625] [Citation(s) in RCA: 125] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 08/28/2017] [Accepted: 09/08/2017] [Indexed: 12/12/2022]
Abstract
Genetic predisposition to obesity presents a paradox: how do genetic variants with a detrimental impact on human health persist through evolutionary time? Numerous hypotheses, such as the thrifty genotype hypothesis, attempt to explain this phenomenon yet fail to provide a justification for the modern obesity epidemic. In this critical review, we appraise existing theories explaining the evolutionary origins of obesity and explore novel biological and sociocultural agents of evolutionary change to help explain the modern-day distribution of obesity-predisposing variants. Genetic drift, acting as a form of 'blind justice,' may randomly affect allele frequencies across generations while gene pleiotropy and adaptations to diverse environments may explain the rise and subsequent selection of obesity risk alleles. As an adaptive response, epigenetic regulation of gene expression may impact the manifestation of genetic predisposition to obesity. Finally, exposure to malnutrition and disease epidemics in the wake of oppressive social systems, culturally mediated notions of attractiveness and desirability, and diverse mating systems may play a role in shaping the human genome. As an important first step towards the identification of important drivers of obesity gene evolution, this review may inform empirical research focused on testing evolutionary theories by way of population genetics and mathematical modelling.
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Affiliation(s)
- A Qasim
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - M Turcotte
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - R J de Souza
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - M C Samaan
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.,Department of Pediatrics, McMaster University, Hamilton, ON, Canada.,Division of Pediatric Endocrinology, McMaster Children's Hospital, Hamilton, ON, Canada
| | - D Champredon
- Department of Biology, McMaster University, Hamilton, ON, Canada.,Agent-Based Modelling Laboratory, York University, Toronto, ON, Canada
| | - J Dushoff
- Department of Biology, McMaster University, Hamilton, ON, Canada
| | - J R Speakman
- Institute of Biological and Environmental Sciences, University of Aberdeen, Aberdeen, UK.,State Key Laboratory of Molecular Developmental Biology, Institute of Genetics and Developmental Biology, Chinese Academy of Sciences, Beijing, China
| | - D Meyre
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.,Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON, Canada
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18
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Masters WA, Nene MD, Bell W. Nutrient composition of premixed and packaged complementary foods for sale in low- and middle-income countries: Lack of standards threatens infant growth. MATERNAL & CHILD NUTRITION 2017; 13:e12421. [PMID: 28008727 PMCID: PMC6865969 DOI: 10.1111/mcn.12421] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 10/22/2016] [Accepted: 11/18/2016] [Indexed: 01/17/2023]
Abstract
Premixed flours for infant porridge are increasingly produced and sold in developing countries to complement continued breastfeeding. Such complementary food (CF) products have known efficacy against malnutrition in children from 6 to 24 months of age, but ingredient ratios and production processes may vary. This study provides the first systematic measurement of their actual nutrient composition. We purchased samples of 108 premixed CF products in 22 low- and middle-income countries, and commissioned blind laboratory measurement of each product's macronutrients and micronutrients. We compared measured contents to nutrient claims on their packaging and to CF standards from the Codex Alimentarius, the Super Cereal Plus product used in nutrition assistance programs, and the Lutter and Dewey (2003) recommendations, as well as our own modeled nutrient requirements for a healthy breastfed child. Actual densities are significantly different from nutrient claims for protein (p = .013) and fat (p = .000). Only 15% of samples met two of the three benchmarks for fat, 32% met the most stringent protein standard, while only 22% met them for iron, and 21% for zinc. The median healthy child consuming breast milk plus enough of these solid foods to meet energy needs would experience deficits of zinc at 6 months, iron at 6 and 9 months, and dietary fat from 12 months of age. In summary, premixed CF products can provide adequate nutrient density but usually do not, revealing the need and opportunity for independent monitoring and quality assurance to help grain millers making premixed foods maintain uniform ingredient ratios and production practices.
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Affiliation(s)
- William A. Masters
- Friedman School of Nutrition Science and PolicyTufts UniversityBostonMassachusettsUSA
| | - Marc D. Nene
- Friedman School of Nutrition Science and PolicyTufts UniversityBostonMassachusettsUSA
| | - Winnie Bell
- Friedman School of Nutrition Science and PolicyTufts UniversityBostonMassachusettsUSA
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19
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Correlates of whole-blood polyunsaturated fatty acids among young children with moderate acute malnutrition. Nutr J 2017; 16:44. [PMID: 28705254 PMCID: PMC5508879 DOI: 10.1186/s12937-017-0264-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 06/25/2017] [Indexed: 01/18/2023] Open
Abstract
Background Severe acute malnutrition (SAM) has been associated with low polyunsaturated fatty acid (PUFA) status. However, investigations regarding PUFA status and correlates in children with moderate acute malnutrition (MAM) from low-income countries are scarce. The aim of this study was to describe whole-blood PUFA levels in children with moderate acute malnutrition (MAM) and to identify correlates of PUFAs. Methods We conducted a cross-sectional study using baseline data from a prospective nutritional intervention trial among 1609 children with MAM aged 6–23 months in Burkina Faso,West Africa. Whole-blood PUFAs were measured by gas chromatography and expressed as percent of total whole-blood fatty acids (FA%). Potential correlates of PUFAs including infection, inflammation, hemoglobin, anthropometry (difference between children diagnosed as having MAM based on low mid-upper-arm-circumference (MUAC) only, low MUAC and weight-for-height z-score (WHZ), or low WHZ only) and diet were assessed by linear regression adjusted for age and sex. Results Children with MAM had low concentrations of whole-blood PUFAs, particularly n-3 PUFAs. Moreover, children diagnosed with MAM based only on low MUAC had 0.32 (95% confidence interval (CI), 0.14; 0.50) and 0.40 (95% CI, 0.16; 0.63) FA% lower arachidonic acid (AA) than those recruited based on both low WHZ as well as low MUAC and those recruited with low WHZ only, respectively. Infection and inflammation were associated with low levels of all long-chain (LC)-PUFAs, while hemoglobin was positively associated with whole-blood LC-PUFAs. Conclusion While PUFA deficiency was not a general problem, overall whole-blood PUFA concentrations, especially of n-3 PUFAs, were low. Infection, inflammation, hemoglobin, anthropometry and diet were correlates of PUFAs concentrations in children with MAM. Trial registration The trial is registered at http://www.isrctn.com (ISRCTN42569496).
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20
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Crescenzo R, Mazzoli A, Cancelliere R, Bianco F, Giacco A, Liverini G, Dulloo AG, Iossa S. Polyunsaturated Fatty Acids Stimulate De novo Lipogenesis and Improve Glucose Homeostasis during Refeeding with High Fat Diet. Front Physiol 2017; 8:178. [PMID: 28386235 PMCID: PMC5362646 DOI: 10.3389/fphys.2017.00178] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 03/08/2017] [Indexed: 12/28/2022] Open
Abstract
Aims: The recovery of body weight after a period of caloric restriction is accompanied by an enhanced efficiency of fat deposition and hyperinsulinemia—which are exacerbated by isocaloric refeeding on a high fat diet rich in saturated and monounsaturated fatty acids (SFA-MUFA), and poor in polyunsaturated fatty acids (PUFA), and associated with a blunting of de novo lipogenesis in adipose tissue and liver. As high fat diets rich in PUFA have been shown to limit the excess fat deposition and improve glucose homeostasis, we investigated here the extent to which de novo lipogenesis in liver and adipose tissues (white and brown), as well as hepatic oxidative stress, are influenced by refeeding on diets rich in PUFA. Design: In rats calorically restricted for 14 days and refed for 14 days on isocaloric amounts of a high fat diet rich in lard (i.e., high SFA-MUFA) or in safflower and linseed oils (rich in PUFA), we investigated energy balance, body composition, glycemic profile, and the regulation of fatty acid synthase (rate-limiting enzyme of de novo lipogenesis) in liver, white and brown adipose tissue. We also evaluated oxidative stress in liver and skeletal muscle and markers of hepatic inflammation. Results: Rats refed the PUFA diet gained less lipids and more proteins compared to rats refed SFA-MUFA diet and showed lower amount of visceral and epididymal white adipose tissue, but increased depots of interscapular brown adipose tissue, with higher expression of the uncoupling protein 1. A significant increase in non-protein respiratory quotient and carbohydrate utilization was found in rats refed PUFA diet. Rats refed PUFA diet showed improved glucose homeostasis, as well as lower triglycerides and cholesterol levels. Fatty acid synthase activity was significantly higher in liver, white and brown adipose tissue, while lipid peroxidation and the degree of inflammation in the liver were significantly lower, in rats refed PUFA diet. Conclusions: When considering the composition of high fat diets for nutritional rehabilitation, the inclusion of PUFA could be useful for improving protein deposition and maintaining glucose homeostasis, while limiting lipid storage in adipose tissue and oxidative stress and inflammation in the liver.
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Affiliation(s)
| | - Arianna Mazzoli
- Department of Biology, University of Naples Federico II Naples, Italy
| | - Rosa Cancelliere
- Department of Biology, University of Naples Federico II Naples, Italy
| | - Francesca Bianco
- Department of Biology, University of Naples Federico II Naples, Italy
| | - Antonia Giacco
- Department of Biology, University of Naples Federico II Naples, Italy
| | - Giovanna Liverini
- Department of Biology, University of Naples Federico II Naples, Italy
| | - Abdul G Dulloo
- Division of Physiology, Department of Medicine, University of Fribourg Fribourg, Switzerland
| | - Susanna Iossa
- Department of Biology, University of Naples Federico II Naples, Italy
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21
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Forsyth S, Gautier S, Salem Jr. N. Dietary Intakes of Arachidonic Acid and Docosahexaenoic Acid in Early Life - With a Special Focus on Complementary Feeding in Developing Countries. ANNALS OF NUTRITION & METABOLISM 2017; 70:217-227. [PMID: 28301845 PMCID: PMC5475235 DOI: 10.1159/000463396] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Accepted: 02/13/2017] [Indexed: 12/18/2022]
Abstract
BACKGROUND In developing countries, dietary intakes of arachidonic acid (ARA) and docosahexaenoic acid (DHA) in early life are lower than current recommended levels. This review specifically focusses on the contribution that complementary feeding makes to ARA and DHA intakes in medium- to low-income countries. The aims of the review are (1) to determine the availability of ARA and DHA food sources in developing countries, (2) to estimate the contribution of complementary feeding to dietary intakes of ARA and DHA in infants aged 6-36 months, and (3) to relate the dietary ARA and DHA intake data to key socioeconomic and health indicators. SUMMARY The primary dietary data was collected by the Food and Agriculture Organisation (FAO) using Food Balance Sheets, and fatty acid composition was based on the Australian food composition tables. There is evidence of wide variation in per capita dietary intake for both DHA and ARA food sources, with low intakes of meat and seafood products being highly prevalent in most low-income countries. In children aged 6-36 months, the supply of ARA and DHA from the longer duration of breastfeeding in low-income countries is counterbalanced by the exceptionally low provision of ARA and DHA from complementary foods. The lowest tertile for ARA intake is associated with higher percentages of childhood stunting, birth rate, infant mortality, and longer duration of breast feeding. Key Message: In developing countries, intakes of DHA and ARA from complementary foods are low, and public health organisations need to adopt pragmatic strategies that will ensure that there is a nutritional safety net for the most vulnerable infants.
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Affiliation(s)
- Stewart Forsyth
- School of Medicine, University of Dundee, West Ferry, Dundee, UK
- DSM Nutritional Products, Columbia, MD, USA
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Abstract
Although the literature on the contribution of DHA and arachidonic acid (ARA) to fundamental metabolic functions in brain, immune and cardiovascular systems is extensive, there is a lack of consensus on the need for explicit recommendations on dietary intake for both DHA and ARA during the early years of life. This review takes a public health perspective with the objective of ensuring that recommendations protect the most vulnerable children worldwide. Most studies on the effects of DHA and ARA in early life have been undertaken in high-income countries and this is reflected in policy recommendations. Although breast milk is considered the gold standard and always contains DHA and ARA, there are proposals that infant formulas, especially follow-on formulas, do not need to be supplemented with these fatty acids. Complementary foods frequently have low concentrations of ARA and DHA and this is most significant in low-income countries where availability is also limited. Recent evidence shows that in developing countries, intakes of DHA and ARA during the age period 6–36 months are low and this relates to low national income. It is concluded that a continuum of DHA and ARA intake needs to be maintained during early life, a critical period of infant growth and development. For both infant and follow-on formulas, DHA and ARA should be mandatory at levels that are equivalent to breast milk. An optional recommendation may be limited to countries that can demonstrate evidence of adequate intakes of DHA and ARA during early life.
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Lampl M, Mummert A, Schoen M. Promoting Healthy Growth or Feeding Obesity? The Need for Evidence-Based Oversight of Infant Nutritional Supplement Claims. Healthcare (Basel) 2016; 4:E84. [PMID: 27845744 PMCID: PMC5198126 DOI: 10.3390/healthcare4040084] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 10/10/2016] [Accepted: 10/27/2016] [Indexed: 12/28/2022] Open
Abstract
The Developmental Origins of Health and Disease (DOHaD) model recognizes growth in infancy and childhood as a fundamental determinant of lifespan health. Evidence of long-term health risks among small neonates who subsequently grow rapidly poses a challenge for interventions aiming to support healthy growth, not merely drive weight gain. Defining healthy growth beyond "getting bigger" is essential as infant and young child feeding industries expand. Liquid-based nutritional supplements, originally formulated for undernourished children, are increasingly marketed for and consumed by children generally. Clarifying the nature of the evidentiary base on which structure/function claims promoting "healthy growth" are constructed is important to curb invalid generalizations. Evidence points to changing social beliefs and cultural practices surrounding supplementary feeding, raising specific concerns about the long-term health consequences of an associated altered feeding culture, including reduced dietary variety and weight gain. Reassessing the evidence for and relevance of dietary supplements' "promoting healthy growth" claims for otherwise healthy children is both needed in a time of global obesity and an opportunity to refine intervention approaches among small children for whom rapid subsequent growth in early life augments risk for chronic disease. Scientific and health care partnerships are needed to consider current governmental oversight shortfalls in protecting vulnerable populations from overconsumption. This is important because we may be doing more harm than good.
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Affiliation(s)
- Michelle Lampl
- Center for the Study of Human Health, Emory University, Atlanta, GA 30322, USA.
- Department of Anthropology, Emory University, Atlanta, GA 30322, USA.
| | - Amanda Mummert
- Department of Anthropology, Emory University, Atlanta, GA 30322, USA.
| | - Meriah Schoen
- Center for the Study of Human Health, Emory University, Atlanta, GA 30322, USA.
- Department of Nutrition, Georgia State University, Atlanta, GA 30302, USA.
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Ford R, Faber M, Kunneke E, Smuts CM. Dietary fat intake and red blood cell fatty acid composition of children and women from three different geographical areas in South Africa. Prostaglandins Leukot Essent Fatty Acids 2016; 109:13-21. [PMID: 27269709 DOI: 10.1016/j.plefa.2016.04.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Revised: 04/10/2016] [Accepted: 04/11/2016] [Indexed: 01/04/2023]
Abstract
Dietary fat intake, particularly the type of fat, is reflected in the red blood cell (RBC) fatty acid (FA) profile and is vital in growth, development and health maintenance. The FA profile (%wt/wt) of RBC membrane phospholipids (as determined by gas chromatography) and dietary intake (as determined by 24h recall) was assessed in 2-6y old South African children and their caregivers randomly selected from three communities, i.e. an urban Northern Cape community (urban-NC; n=104), an urban coastal Western Cape community (urban-WC; n=93) and a rural Limpopo Province community (rural-LP; n=102). Mean RBC FA values across groups were compared using ANOVA and Bonferroni post-hoc test while controlling for age and gender (children); median dietary intake values were compared using a Kruskal-Wallis test. Dietary intakes for total fat, saturated FAs and polyunsaturated FAs were higher in the two urban areas compared to the rural area. Total fat intake in rural-LP, and omega-3 FA dietary intake in all three areas were lower than the South African adopted guidelines. Dietary SFA intake in both urban areas was higher than recommended by South African guidelines; this was reflected in the RBC membrane FA profile. Rural-LP children had the lowest intake of omega-3 and omega-6 FAs yet presented with the highest RBC docosahexaenoic acid (DHA) profile and highest arachidonic acid percentage. Although differences observed in dietary fat intake between the two urban and the rural area were reflected in the RBC membrane total phospholipid FA profile, the lowest total fat and α-linolenic acid (ALA) intake by rural children that presented with the highest RBC DHA profile warrants further investigation.
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Affiliation(s)
- Rosalyn Ford
- Centre of Excellence for Nutrition, Faculty of Health Sciences, North-West University, Private Bag X6001, Potchefstrom 2520, South Africa
| | - Mieke Faber
- Non-Communicable Diseases Research Unit, South African Medical Research Council, PO Box 19070, Tygerberg 7505, South Africa
| | - Ernesta Kunneke
- Department of Dietetics and Nutrition, University of the Western Cape, South Africa
| | - Cornelius M Smuts
- Centre of Excellence for Nutrition, Faculty of Health Sciences, North-West University, Private Bag X6001, Potchefstrom 2520, South Africa.
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Hadley KB, Ryan AS, Forsyth S, Gautier S, Salem N. The Essentiality of Arachidonic Acid in Infant Development. Nutrients 2016; 8:216. [PMID: 27077882 PMCID: PMC4848685 DOI: 10.3390/nu8040216] [Citation(s) in RCA: 220] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Revised: 04/01/2016] [Accepted: 04/05/2016] [Indexed: 01/16/2023] Open
Abstract
Arachidonic acid (ARA, 20:4n-6) is an n-6 polyunsaturated 20-carbon fatty acid formed by the biosynthesis from linoleic acid (LA, 18:2n-6). This review considers the essential role that ARA plays in infant development. ARA is always present in human milk at a relatively fixed level and is accumulated in tissues throughout the body where it serves several important functions. Without the provision of preformed ARA in human milk or infant formula the growing infant cannot maintain ARA levels from synthetic pathways alone that are sufficient to meet metabolic demand. During late infancy and early childhood the amount of dietary ARA provided by solid foods is low. ARA serves as a precursor to leukotrienes, prostaglandins, and thromboxanes, collectively known as eicosanoids which are important for immunity and immune response. There is strong evidence based on animal and human studies that ARA is critical for infant growth, brain development, and health. These studies also demonstrate the importance of balancing the amounts of ARA and DHA as too much DHA may suppress the benefits provided by ARA. Both ARA and DHA have been added to infant formulas and follow-on formulas for more than two decades. The amounts and ratios of ARA and DHA needed in infant formula are discussed based on an in depth review of the available scientific evidence.
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Affiliation(s)
- Kevin B Hadley
- DSM Nutritional Products, 6480 Dobbin Road, Columbia, MD 21045, USA.
| | - Alan S Ryan
- Clinical Research Consulting, 9809 Halston Manor, Boynton Beach, FL 33473, USA.
| | - Stewart Forsyth
- School of Medicine, Dentistry & Nursing, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK.
| | - Sheila Gautier
- DSM Nutritional Products, 6480 Dobbin Road, Columbia, MD 21045, USA.
| | - Norman Salem
- DSM Nutritional Products, 6480 Dobbin Road, Columbia, MD 21045, USA.
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Kostecka M. Fatty acid composition of diets of early school-age children and its health implications. Pak J Med Sci 2016; 31:1467-71. [PMID: 26870117 PMCID: PMC4744302 DOI: 10.12669/pjms.316.7614] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Objective: The main objective of this study was to determine the amount and type of fat consumed by early school-age children per day. Dietary fat intake as a percentage of the total calorie intake was also estimated. Methods: The study was conducted in Lublin, the largest city in south-east Poland, between January 2014 and April 2014, on 702 randomly selected children, i.e. 3% of the total population of early school-age children in the research area. The parents were asked to provide information about the type and amount of food consumed by their children daily. A standard food frequency questionnaire was used. Results: Dietary levels of saturated fat were elevated in the analyzed populations and were the source of 13.33% of daily calorie intake. In the studied population, the ratio of saturated to monounsaturated and polyunsaturated fatty acids was determined at 3.25: 2.95: 1. Dietary intake of α-linolenic acid (ALA) reached 1.057 ± 0.55 g (0.63% of daily calorie intake) on average, and dietary intake of linoleic acid (LA) was determined at 3.86 ± 2.51 g (2.31% of daily calorie intake). Conclusions: The average total calorie intake of children aged 6-11 years was 1445.66 calories per day. Average fat intake was 29.64 % of the total calorie intake. The highest intake of SFAs was found in the youngest age group of 6- to 8-year-olds. The type of food consumed by children affected the amount and type of dietary fat in all age groups.
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Affiliation(s)
- Małgorzata Kostecka
- Małgorzata Kostecka, University of Life Sciences in Lublin, Faculty of Food Science and Biotechnology, Ul. Akademicka 15, 20-950 Lublin, Poland
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Mangani C, Maleta K, Phuka J, Cheung YB, Thakwalakwa C, Dewey K, Manary M, Puumalainen T, Ashorn P. Effect of complementary feeding with lipid-based nutrient supplements and corn-soy blend on the incidence of stunting and linear growth among 6- to 18-month-old infants and children in rural Malawi. MATERNAL & CHILD NUTRITION 2015; 11 Suppl 4:132-43. [PMID: 23795976 PMCID: PMC6860208 DOI: 10.1111/mcn.12068] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Low nutritional value of complementary foods is associated with high incidence of childhood growth stunting in low-income countries. This study was done to test a hypothesis that dietary complementation with lipid-based nutrient supplements (LNS) promotes linear growth and reduces the incidence of severe stunting among at-risk infants. A total of 840 6-month-old healthy infants in rural Malawi were enrolled to a randomised assessor-blinded trial. The participants received 12-month supplementation with nothing, milk-LNS, soy-LNS, or corn-soy blend (CSB). Supplements provided micronutrients and approximately 280 kcal energy per day. Outcomes were incidence of severe and very severe stunting [length-for-age z-score, (LAZ) < -3.00 and <-3.50, respectively], and change in LAZ. The incidence of severe stunting was 11.8%, 8.2%, 9.1% and 15.5% (P = 0.098) and that of very severe stunting 7.4%, 2.9%, 8.0% and 6.4% (P = 0.138) in control, milk-LNS, soy-LNS and CSB groups, respectively. Between 9 and 12 months of age, the mean change in LAZ was -0.15, -0.02, -0.12 and -0.18 (P = 0.045) for control, milk-LNS, soy-LNS and CSB groups, respectively. There was no significant between-group difference in linear growth during other age-intervals. Although participants who received milk-LNS had the lowest incidence of severe and very severe stunting, the differences between the groups were smaller than expected. Thus, the results do not provide conclusive evidence on a causal association between the LNS supplementation and the lower incidence of stunting. Exploratory analyses suggest that provision of milk-LNS, but not soy-LNS promotes linear growth among at-risk infants mainly between 9 and 12 months of age.
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Affiliation(s)
- Charles Mangani
- College of Medicine, University of MalawiBlantyreMalawi
- University of Tampere, School of MedicineTampereFinland
| | | | - John Phuka
- College of Medicine, University of MalawiBlantyreMalawi
| | - Yin Bun Cheung
- University of Tampere, School of MedicineTampereFinland
- Duke‐NUS Graduate Medical School, National University of SingaporeSingaporeSingapore
| | - Chrissie Thakwalakwa
- College of Medicine, University of MalawiBlantyreMalawi
- University of Tampere, School of MedicineTampereFinland
| | | | - Mark Manary
- Washington University School of MedicineSt. LouisMissouriUSA
| | | | - Per Ashorn
- University of Tampere, School of MedicineTampereFinland
- Department of Paediatrics, Tampere University HospitalTampereFinland
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Nurhasan M, Roos N, Aristizabal Henao JJ, Chamnan C, Stark KD, Lauritzen L. Effect of storage temperature in a Cambodian field setting on the fatty acid composition in whole blood. Prostaglandins Leukot Essent Fatty Acids 2015; 96:57-61. [PMID: 25753812 DOI: 10.1016/j.plefa.2015.02.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Revised: 01/14/2015] [Accepted: 02/05/2015] [Indexed: 10/24/2022]
Abstract
Fatty acid analysis requires standardized collection and storage of samples, which can be a challenge under field conditions. This study describes the effect of storage temperature on fatty acid composition in two sets of whole blood samples collected from 66 children in a rural area in Cambodia. The samples were stored with butylated hydroxytoluene at -20 °C and -80 °C and the latter required extra transfers due to storage facility limitation. Fatty acid composition was analyzed by high-throughput gas-chromatography and evaluated by paired t-tests and Bland-Altman plots. Total amounts of fat in -20 °C and -80 °C samples did not differ, but there was relatively more highly unsaturated fatty acids (15.8 ± 2.7 vs. 14.4 ± 2.5%, p < 0.001) and a lower n-6/n-3 ratio (6.4 ± 1.4 vs. 6.9 ± 1.4, p < 0.001) in the -20 °C samples. Our results indicate that the importance of storage temperature should be evaluated in the context of storage facility availability and risk of temperature fluctuations during transport.
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Affiliation(s)
- M Nurhasan
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Denmark
| | - N Roos
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Denmark
| | | | - C Chamnan
- Department of Fisheries Post-harvest Technologies and Quality Control, Ministry of Agriculture, Forestry and Fisheries, Kingdom of Cambodia
| | - K D Stark
- Department of Kinesiology, University of Waterloo, Canada
| | - L Lauritzen
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Denmark.
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Jones KDJ, Ali R, Khasira MA, Odera D, West AL, Koster G, Akomo P, Talbert AWA, Goss VM, Ngari M, Thitiri J, Ndoro S, Knight MAG, Omollo K, Ndungu A, Mulongo MM, Bahwere P, Fegan G, Warner JO, Postle AD, Collins S, Calder PC, Berkley JA. Ready-to-use therapeutic food with elevated n-3 polyunsaturated fatty acid content, with or without fish oil, to treat severe acute malnutrition: a randomized controlled trial. BMC Med 2015; 13:93. [PMID: 25902844 PMCID: PMC4407555 DOI: 10.1186/s12916-015-0315-6] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Accepted: 03/09/2015] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Ready-to-use therapeutic foods (RUTF) are lipid-based pastes widely used in the treatment of acute malnutrition. Current specifications for RUTF permit a high n-6 polyunsaturated fatty acid (PUFA) content and low n-3 PUFA, with no stipulated requirements for preformed long-chain n-3 PUFA. The objective of this study was to develop an RUTF with elevated short-chain n-3 PUFA and measure its impact, with and without fish oil supplementation, on children's PUFA status during treatment of severe acute malnutrition. METHODS This randomized controlled trial in children with severe acute malnutrition in rural Kenya included 60 children aged 6 to 50 months who were randomized to receive i) RUTF with standard composition; ii) RUTF with elevated short chain n-3 PUFA; or iii) RUTF with elevated short chain n-3 PUFA plus fish oil capsules. Participants were followed-up for 3 months. The primary outcome was erythrocyte PUFA composition. RESULTS Erythrocyte docosahexaenoic acid (DHA) content declined from baseline in the two arms not receiving fish oil. Erythrocyte long-chain n-3 PUFA content following treatment was significantly higher for participants in the arm receiving fish oil than for those in the arms receiving RUTF with elevated short chain n-3 PUFA or standard RUTF alone: 3 months after enrollment, DHA content was 6.3% (interquartile range 6.0-7.3), 4.5% (3.9-4.9), and 3.9% (2.4-5.7) of total erythrocyte fatty acids (P <0.001), respectively, while eicosapentaenoic acid (EPA) content was 2.0% (1.5-2.6), 0.7% (0.6-0.8), and 0.4% (0.3-0.5) (P <0.001). RUTF with elevated short chain n-3 PUFA and fish oil capsules were acceptable to participants and carers, and there were no significant differences in safety outcomes. CONCLUSIONS PUFA requirements of children with SAM are not met by current formulations of RUTF, or by an RUTF with elevated short-chain n-3 PUFA without additional preformed long-chain n-3 PUFA. Clinical and growth implications of revised formulations need to be addressed in large clinical trials. TRIAL REGISTRATION Clinicaltrials.gov NCT01593969. Registered 4 May 2012.
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Affiliation(s)
- Kelsey D J Jones
- KEMRI-Wellcome Trust Research Programme, Kilifi, 230-80108, Kenya.
- Centre for Global Health Research and Section of Paediatrics, Imperial College, Norfolk Place, London, W2 1PG, UK.
| | - Rehema Ali
- KEMRI-Wellcome Trust Research Programme, Kilifi, 230-80108, Kenya.
| | | | - Dennis Odera
- KEMRI-Wellcome Trust Research Programme, Kilifi, 230-80108, Kenya.
| | - Annette L West
- Faculty of Medicine, University of Southampton, Southampton General Hosptial, Tremona Road, Southampton, SO16 6YD, UK.
| | - Grielof Koster
- Faculty of Medicine, University of Southampton, Southampton General Hosptial, Tremona Road, Southampton, SO16 6YD, UK.
| | - Peter Akomo
- Valid Nutrition, Cuibín Farm, Derry Duff, Bantry, Co., Cork, Republic of Ireland.
| | | | - Victoria M Goss
- Southampton National Institute of Health Research Respiratory Biomedical Research Unit, Southampton General Hosptial, Tremona Road, Southampton, SO16 6YD, UK.
| | - Moses Ngari
- KEMRI-Wellcome Trust Research Programme, Kilifi, 230-80108, Kenya.
| | | | - Said Ndoro
- Kilifi County Hospital, Ministry of Health, Kilifi, 230-80108, Kenya.
| | - Miguel A Garcia Knight
- KEMRI-Wellcome Trust Research Programme, Kilifi, 230-80108, Kenya.
- Nuffield Department of Clinical Medicine, Centre for Tropical Medicine & Global Health, University of Oxford, Old Road Campus, Roosevelt Drive, Oxford, OX3 7FZ, UK.
| | - Kenneth Omollo
- KEMRI-Wellcome Trust Research Programme, Kilifi, 230-80108, Kenya.
| | - Anne Ndungu
- KEMRI-Wellcome Trust Research Programme, Kilifi, 230-80108, Kenya.
| | - Musa M Mulongo
- KEMRI-Wellcome Trust Research Programme, Kilifi, 230-80108, Kenya.
| | - Paluku Bahwere
- Valid International, 35 Leopold Street, Oxford, OX4 1TW, UK.
| | - Greg Fegan
- KEMRI-Wellcome Trust Research Programme, Kilifi, 230-80108, Kenya.
- Nuffield Department of Clinical Medicine, Centre for Tropical Medicine & Global Health, University of Oxford, Old Road Campus, Roosevelt Drive, Oxford, OX3 7FZ, UK.
| | - John O Warner
- Centre for Global Health Research and Section of Paediatrics, Imperial College, Norfolk Place, London, W2 1PG, UK.
| | - Anthony D Postle
- Faculty of Medicine, University of Southampton, Southampton General Hosptial, Tremona Road, Southampton, SO16 6YD, UK.
| | - Steve Collins
- Valid Nutrition, Cuibín Farm, Derry Duff, Bantry, Co., Cork, Republic of Ireland.
- Valid International, 35 Leopold Street, Oxford, OX4 1TW, UK.
| | - Philip C Calder
- Faculty of Medicine, University of Southampton, Southampton General Hosptial, Tremona Road, Southampton, SO16 6YD, UK.
- National Institute of Health Southampton Biomedical Research Centre, Southampton General Hosptial, Tremona Road, Southampton, SO16 6YD, UK.
| | - James A Berkley
- KEMRI-Wellcome Trust Research Programme, Kilifi, 230-80108, Kenya.
- Nuffield Department of Clinical Medicine, Centre for Tropical Medicine & Global Health, University of Oxford, Old Road Campus, Roosevelt Drive, Oxford, OX3 7FZ, UK.
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Silva DE, Nóbrega L, Valente A, Dias C, Almeida F, Cruz JL, Neves E, Afonso C, Guerra A. Aleitamento materno e caracterização dos hábitos alimentares na primeira infância: experiência de São Tomé e Príncipe. REVISTA BRASILEIRA DE SAÚDE MATERNO INFANTIL 2014. [DOI: 10.1590/s1519-38292014000300008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Objetivos: avaliação da amamentação, da diversificação e frequência alimentar, em crianças de São Tomé e Príncipe (STP). Métodos: trata-se de uma amostra constituída por 1285 crianças. O protocolo incluiu a prevalência do aleitamento materno exclusivo (AME) e Total (AMT), início da diversificação alimentar (DA) e um questionário de frequência alimentar. O tratamento estatístico foi efetuado no SPSS®. Os resultados foram apresentados de acordo com o total da amostra. Resultados: 45,5% são do sexo feminino e a média de idades 26±18 meses. 46,6% fez AME até aos 6 meses (média 5±2). A média de AMT foi 12±7 meses e o início da DA aos 6±3 meses (mediana=6), sendo as farinhas e a canja de peixe os primeiros alimentos oferecidos. 42% das crianças são incluídas na dieta familiar aos 7±3 meses (mediana=6). Elevada porcentagem de crianças nunca ingere: leite de vaca (74%) ou iogurte (40%), contrariamente ao elevado consumo de óleo alimentar (34%) e açúcar (33%). A idade média de iniciação da cerveja é aos 18±12 meses e vinho de palma 13±10 meses. Conclusões: observa-se uma elevada prevalência de AME e uma precoce introdução da DA. Embora existam recursos alimentares disponíveis, não há informação/ formação adequada para elaborar um plano alimentar saudável durante a infância.
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Affiliation(s)
- Diana e Silva
- Unidade de Nutrição/Hospital Pediátrico Integrado/Centro Hospitalar São João. Faculdade Ciências Nutrição e Alimentação. Universidade Porto. Alameda Professor Hernâni Monteiro. 4200-455. Porto, Portugal. E-mail: , Portugal
| | - Laura Nóbrega
- Unidade de Nutrição/Hospital Pediátrico Integrado/Centro Hospitalar São João. Faculdade Ciências Nutrição e Alimentação. Universidade Porto. Alameda Professor Hernâni Monteiro. 4200-455. Porto, Portugal. E-mail: , Portugal
| | - Ana Valente
- Unidade de Nutrição/Hospital Pediátrico Integrado/Centro Hospitalar São João. Faculdade Ciências Nutrição e Alimentação. Universidade Porto. Alameda Professor Hernâni Monteiro. 4200-455. Porto, Portugal. E-mail: , Portugal
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Dewey KG. The challenge of meeting nutrient needs of infants and young children during the period of complementary feeding: an evolutionary perspective. J Nutr 2013; 143:2050-4. [PMID: 24132575 PMCID: PMC3827643 DOI: 10.3945/jn.113.182527] [Citation(s) in RCA: 170] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Revised: 08/20/2013] [Accepted: 09/26/2013] [Indexed: 11/14/2022] Open
Abstract
Breast-fed infants and young children need complementary foods with a very high nutrient density (particularly for iron and zinc), especially at ages 6-12 mo. However, in low-income countries, their diet is usually dominated by cereal-based porridges with low nutrient density and poor mineral bioavailability. Complementary feeding diets typically fall short in iron and zinc and sometimes in other nutrients. These gaps in nutritional adequacy of infant diets have likely been a characteristic of human diets since the agricultural revolution ~10,000 y ago. Estimates of nutrient intakes before then, based on hypothetical diets of preagricultural humans, suggest that infants had much higher intakes of key nutrients than is true today and would have been able to meet their nutrient needs from the combination of breast milk and premasticated foods provided by their mothers. Strategies for achieving adequate nutrition for infants and young children in modern times must address the challenge of meeting nutrient needs from largely cereal-based diets.
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Affiliation(s)
- Kathryn G. Dewey
- Department of Nutrition, Program in International and Community Nutrition, University of California, Davis, Davis, CA
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Abstract
Beginning with a historical summary of investigative work into protein-energy malnutrition, now termed 'severe acute malnutrition', this review ends by summarizing recent initiatives to tackle the global problem of malnutrition, specifically Scaling-Up Nutrition (SUN). In early years, macronutrient deficiency or imbalance was considered the principal cause of complex metabolic disturbances, including kwashiorkor, whereas, now, micronutrient deficiency infections, including HIV, and a background of deprivation are implicated. Different approaches to management are reviewed. The rehabilitation of individual children by protocolised-phased feeding has largely given way to community-based therapeutic feeding. Despite sporadic successes, the overall impact on morbidity and mortality has been so disappointing that the global community now plans a new initiative, viz. SUN. Its focus on the critical window of 1000 days (from conception to 2 years) is similar to the earlier focus on early childhood vulnerability which inspired the under-5 clinics and their integration into maternal and child health programmes. 'Targeted' interventions, recently more prominent than integrated community-based primary care, often undertaken by NGOs, have been effective, although sometimes imperfectly accountable. Will SUN, aiming for a broad approach, and the participation of recipient communities finally succeed in integrating nutrition into child health?
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van der Merwe LF, Moore SE, Fulford AJ, Halliday KE, Drammeh S, Young S, Prentice AM. Long-chain PUFA supplementation in rural African infants: a randomized controlled trial of effects on gut integrity, growth, and cognitive development. Am J Clin Nutr 2013; 97:45-57. [PMID: 23221579 PMCID: PMC3522138 DOI: 10.3945/ajcn.112.042267] [Citation(s) in RCA: 81] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Intestinal damage and malabsorption caused by chronic environmental enteropathy are associated with growth faltering seen in infants in less-developed countries. Evidence has suggested that supplementary omega-3 (n-3) long-chain PUFAs (LC-PUFAs) might ameliorate this damage by reducing gastrointestinal inflammation. LC-PUFA supplementation may also benefit cognitive development. OBJECTIVE We tested whether early n-3 LC-PUFA supplementation improves infant intestinal integrity, growth, and cognitive function. DESIGN A randomized, double-blind, controlled trial [200 mg DHA and 300 mg EPA or 2 mL olive oil/d for 6 mo] was conducted in a population of 172 rural Gambian infants aged 3-9 mo. The primary endpoints were anthropometric measures and gut integrity [assessed by using urinary lactulose:mannitol ratios (LMRs)]. Plasma fatty acid status, intestinal mucosal inflammation (fecal calprotectin), daily morbidity, and cognitive development (2-step means-end test and an attention assessment) were secondary endpoints. RESULTS PUFA supplementation resulted in a significant increase in plasma n-3 LC-PUFA concentrations (P < 0.001 for both DHA and EPA) and midupper arm circumference (MUAC) (effect size: 0.31 z scores; 95% CI: 0.06, 0.56; P = 0.017) at 9 mo of age. At 12 mo, MUAC remained greater in the intervention group, and we observed significant increases in skinfold thicknesses (P ≤ 0.022 for all). No other significant differences between treatment groups were detected for growth or LMRs at 9 mo or for secondary outcomes. CONCLUSIONS Fish-oil supplementation successfully increased plasma n-3 fatty acid status. However, in young, breastfed Gambian infants, the intervention failed to improve linear growth, intestinal integrity, morbidity, or selected measures of cognitive development. The trial was registered at www.isrctn.org as ISRCTN66645725.
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Affiliation(s)
- Liandré F van der Merwe
- Medical Research Council International Nutrition Group, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Niinikoski H, Ruottinen S. Is carbohydrate intake in the first years of life related to future risk of NCDs? Nutr Metab Cardiovasc Dis 2012; 22:770-774. [PMID: 22789807 DOI: 10.1016/j.numecd.2012.05.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2011] [Revised: 04/21/2012] [Accepted: 05/09/2012] [Indexed: 11/25/2022]
Abstract
UNLABELLED Studies on children's carbohydrate intake, especially fibre intake, and its associations with later health are rare. The current recommendations for fibre intake in children are based on average assumptions and data extrapolated from intakes in adults. Generally, increase in whole-grain consumption and decrease in sucrose intake are considered healthy. Due to fibre's high bulk volume however, excessive dietary fibre has been feared to decrease energy density have effects on growth, at least in developing countries and in children consuming very restricted diets. Furthermore, it has been speculated that if fats are reduced from the diet, it may become high in sucrose. In STRIP study, which is a long-term, randomized controlled trial designed to decrease the exposure of children to known risk factors of atherosclerosis, carbohydrate intakes have been investigated in detail in children aged 13 months to 9 years. The intervention was successful in decreasing saturated fat intake and cholesterol concentrations throughout childhood and adolescence. The study results also show that a higher than average fibre intake does not displace energy or disturb growth in children and that children with high fibre intake have better dietary quality than those with low fibre intake. Dietary fibre intake associated with lower serum total cholesterol concentrations whereas increases in total carbohydrate, sucrose and fructose intakes associated with increases in serum triglyceride concentrations. In conclusion, from the point of view of CHD risk factor prevention, efforts aiming at increasing the fibre intake while restricting that of refined sugar seem justified in the child population in developed countries. CLINICAL TRIAL REGISTRATION INFORMATION NCT00223600.
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Affiliation(s)
- H Niinikoski
- Turku University Hospital, Department of Pediatrics, Kiinamyllynkatu 4-8, 20520 Turku, Finland.
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Jarjou LMA, Goldberg GR, Coward WA, Prentice A. Calcium intake of rural Gambian infants: a quantitative study of the relative contributions of breast milk and complementary foods at 3 and 12 months of age. Eur J Clin Nutr 2012; 66:673-7. [PMID: 22333875 PMCID: PMC3389617 DOI: 10.1038/ejcn.2012.7] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2011] [Revised: 10/31/2011] [Accepted: 11/01/2011] [Indexed: 11/08/2022]
Abstract
BACKGROUND/OBJECTIVES There is a paucity of information from developing countries on total calcium intake during infancy, and potential consequences for growth and bone development. DESIGN Observational longitudinal study of rural Gambian infants (13 males and 17 females) at 3 and 12 months of age. SUBJECTS/METHODS Breast-milk intake and calcium concentration, weighed dietary intake, anthropometry, midshaft radius bone mineral content (BMC) and bone width (BW). RESULTS At 3 and 12 months (mean ± s.d.) calcium intake from breast milk was 179 ± 53 and 117 ± 38, and from other foods 12 ± 38 and 73 ± 105 mg/day. There was no difference in total calcium intake; 94% and 62% of calcium came from breast milk. At 3 and 12 months, weight s.d.-scores were -0.441 ± 1.07 and -1.967 ± 1.06; length s.d.-scores were -0.511 ± 1.04 and -1.469 ± 1.13. Breast-milk calcium intake positively predicted weight (P = 0.0002, P ≤ 0.0001) and length (P = 0.056, P = 0.001). These relationships were not independent of breast-milk intake, which positively predicted weight (P ≤ 0.002) and length (P = 0.06, P = 0.004). At 3, but not 12 months, weight and length correlated with total calcium intake. There were no relationships between total calcium intake and breast-milk intake with BW or BMC. CONCLUSION The combination of low calcium intake from breast milk and complementary foods resulted in a low total calcium intake close to the estimated biological requirement for bone mineral accretion. Relationships between calcium intake and growth were largely accounted for by breast-milk intake, suggesting that low calcium intake per se was not the limiting factor in the poor growth. These findings have potential implications for deriving calcium requirements in developing countries.
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Huffman SL, Harika RK, Eilander A, Osendarp SJM. Essential fats: how do they affect growth and development of infants and young children in developing countries? A literature review. MATERNAL & CHILD NUTRITION 2011; 7 Suppl 3:44-65. [PMID: 21929635 PMCID: PMC6860654 DOI: 10.1111/j.1740-8709.2011.00356.x] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Omega-3 and omega-6 fatty acids, particularly docosahexaenoic acid (DHA), are known to play an essential role in the development of the brain and retina. Intakes in pregnancy and early life affect growth and cognitive performance later in childhood. However, total fat intake, alpha-linolenic acid (ALA) and DHA intakes are often low among pregnant and lactating women, infants and young children in developing countries. As breast milk is one of the best sources of ALA and DHA, breastfed infants are less likely to be at risk of insufficient intakes than those not breastfed. Enhancing intake of ALA through plant food products (soy beans and oil, canola oil, and foods containing these products such as lipid-based nutrient supplements) has been shown to be feasible. However, because of the low conversion rates of ALA to DHA, it may be more efficient to increase DHA status through increasing fish consumption or DHA fortification, but these approaches may be more costly. In addition, breastfeeding up to 2 years and beyond is recommended to ensure an adequate essential fat intake in early life. Data from developing countries have shown that a higher omega-3 fatty acid intake or supplementation during pregnancy may result in small improvements in birthweight, length and gestational age based on two randomized controlled trials and one cross-sectional study. More rigorous randomized controlled trials are needed to confirm this effect. Limited data from developing countries suggest that ALA or DHA supplementation during lactation and in infants may be beneficial for growth and development of young children 6-24 months of age in these settings. These benefits are more pronounced in undernourished children. However, there is no evidence for improvements in growth following omega-3 fatty acid supplementation in children >2 years of age.
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Affiliation(s)
- Sandra L Huffman
- Department of Nutrition and Program in International and Community Nutrition, University of California Davis, Davis, California 95616, USA.
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Wilson WM, Bulkan J, Piperata BA, Hicks K, Ehlers P. Nutritional status of Makushi Amerindian children and adolescents of Guyana. Ann Hum Biol 2011; 38:615-29. [PMID: 21675938 DOI: 10.3109/03014460.2011.588248] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Amazonian Indians are in the midst of a rapid cultural transition. The developments affecting Amazonian Indians present an opportunity to address important public health problems through public and private initiatives, but to do so it is imperative to begin with information on the health status of these peoples and the underlying factors affecting it. However, relatively few such data are available for this vast region. AIM This study describes the nutritional status of Makushi Amerindians of Guyana and considers several variables which might help to explain it. SUBJECTS AND METHODS Data for 792 Makushi, 0-20 years of age from 11 villages are considered. Outcome variables considered are anthropometric markers of growth and nutritional status; specifically height-for-age, weight-for-height and body-mass index. Predictor variables explored are age, sex, relative isolation, number of siblings, season of birth, diet and morbidity. Fisher's exact test, chi-square, Pearson's correlation and multiple regression were used to assess possible relationships between these variables. RESULTS Relative to other Amazonian Indians, the Makushi have a lower rate of linear-growth faltering and a higher rate of linear-growth faltering relative to non-Amerindian Guyanese. Males, older cohorts, those living in isolated villages or born in the wet season showed higher rates of growth faltering. CONCLUSION Makushi nutritional status may be explained by sex, age, relative isolation, family size, season of birth, dietary intake and infectious disease.
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Affiliation(s)
- Warren M Wilson
- Department of Archaeology, University of Calgary, Calgary, AB, Canada.
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Briend A, Dewey KG, Reinhart GA. Fatty acid status in early life in low-income countries--overview of the situation, policy and research priorities. MATERNAL AND CHILD NUTRITION 2011; 7 Suppl 2:141-8. [PMID: 21366873 DOI: 10.1111/j.1740-8709.2011.00305.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Fat intake may be low in low-income countries and little information is available on its composition in terms of (n-3) and (n-6) fatty acids (FA). As a result, long chain poly-unsaturated fatty acid (LCPUFA) status is a concern, especially in settings where fish intake is low and/or common sources of fat have a low alpha-linolenic acid (ALA) and high linoleic acid (LA) content. High LA levels, as found for instance in sunflower, safflower, corn, peanut and soy oils, may inhibit the conversion of ALA into its LC-PUFA derivatives. Other factors that affect LA and ALA conversion into LC-PUFA, including genetic factors, are little known and should also be investigated in different populations. Different interventions that could feasibly improve LC-PUFA status in low-income countries should be tested and their effects on functional outcomes assessed, preferably starting from pregnancy. Identifying affordable sources of ALA or LC-PUFA that could be made locally available and easily introduced in the diet early in life is also a priority.
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Affiliation(s)
- André Briend
- Department of International Health, University of Tampere Medical School, Tampere Kalevantie 4, Finland.
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Michaelsen KF, Dewey KG, Perez-Exposito AB, Nurhasan M, Lauritzen L, Roos N. Food sources and intake of n-6 and n-3 fatty acids in low-income countries with emphasis on infants, young children (6-24 months), and pregnant and lactating women. MATERNAL AND CHILD NUTRITION 2011; 7 Suppl 2:124-40. [PMID: 21366872 DOI: 10.1111/j.1740-8709.2011.00302.x] [Citation(s) in RCA: 96] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
With increasing interest in the potential effects of n-6 and n-3 fatty acids in early life, there is a need for data on the dietary intake of polyunsaturated fatty acids (PUFA) in low-income countries. This review compiles information on the content in breast milk and in foods that are important in the diets of low-income countries from the few studies available. We also estimate the availability of fat and fatty acids in 13 low-income and middle-income countries based on national food balance sheets from the United Nations' Food and Agriculture Organization Statistical Database (FOASTAT). Breast milk docosahexaenoic acid content is very low in populations living mainly on a plant-based diet, but higher in fish-eating countries. Per capita supply of fat and n-3 fatty acids increases markedly with increasing gross domestic product (GDP). In most of the 13 countries, 70-80% of the supply of PUFA comes from cereals and vegetable oils, some of which have very low α-linolenic acid (ALA) content. The total n-3 fatty acid supply is below or close to the lower end of the recommended intake range [0.4%E (percentage of energy supply)] for infants and young children, and below the minimum recommended level (0.5%E) for pregnant and lactating women in the nine countries with the lowest GDP. Fish is important as a source of long-chain n-3 fatty acids, but intake is low in many countries. The supply of n-3 fatty acids can be increased by using vegetable oils with higher ALA content (e.g. soybean or rapeseed oil) and by increasing fish production (e.g. through fish farming).
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Affiliation(s)
- Kim F Michaelsen
- Department of Human Nutrition, University of Copenhagen, Rolighedsvej 30, Copenhagen, Denmark.
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Prentice AM, van der Merwe L. Impact of fatty acid status on immune function of children in low-income countries. MATERNAL & CHILD NUTRITION 2011; 7 Suppl 2:89-98. [PMID: 21366869 PMCID: PMC6860810 DOI: 10.1111/j.1740-8709.2011.00313.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
In vitro and animal studies point to numerous mechanisms by which fatty acids, especially long-chain polyunsaturated fatty acids (LCPUFA), can modulate the innate and adaptive arms of the immune system. These data strongly suggest that improving the fatty acid supply of young children in low-income countries might have immune benefits. Unfortunately, there have been virtually no studies of fatty acid/immune interactions in such settings. Clinical trial registers list over 150 randomized controlled trials (RCTs) involving PUFAs, only one in a low-income setting (the Gambia). We summarize those results here. There was evidence for improved growth and nutritional status, but the primary end point of chronic environmental enteropathy showed no benefit, possibly because the infants were still substantially breastfed. In high-income settings, there have been RCTs with fatty acids (usually LCPUFAs) in relation to 18 disease end points, for some of which there have been numerous trials (asthma, inflammatory bowel disease and rheumatoid arthritis). For these diseases, the evidence is judged reasonable for risk reduction for childhood asthma (but not in adults), as yielding possible benefit in Crohn's disease (insufficient evidence in ulcerative colitis) and for convincing evidence for rheumatoid arthritis at sufficient dose levels, though formal meta-analyses are not yet available. This analysis suggests that fatty acid interventions could yield immune benefits in children in poor settings, especially in non-breastfed children and in relation to inflammatory conditions such as persistent enteropathy. Benefits might include improved responses to enteric vaccines, which frequently perform poorly in low-income settings, and these questions merit randomized trials.
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Affiliation(s)
- Andrew M Prentice
- MRC International Nutrition Group, London School of Hygiene and Tropical Medicine, London, UK.
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Yakes EA, Arsenault JE, Islam MM, Ahmed T, German JB, Drake C, Hossain MB, Lewis BL, Rahman AS, Jamil KM, Brown KH. Dietary intake of polyunsaturated fatty acids among breast-feeding and non-breast-feeding 24- to 48-month-old children in Bangladesh. J Pediatr Gastroenterol Nutr 2011; 52:351-9. [PMID: 21336160 PMCID: PMC3079426 DOI: 10.1097/mpg.0b013e3182042bc8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVE The aim of the study was to assess the adequacy of polyunsaturated fatty acid intake by rural Bangladeshi children 24 to 48 months old in relation to their breast-feeding status. MATERIALS AND METHODS Multistage sampling was used to select a representative sample of children 24 to 48 months of age from 2 rural districts in Bangladesh (n = 479). Two nonconsecutive 24-hour periods of dietary data were collected via 12-hour daytime in-home observations and recall. Breast milk intake was estimated using test weighing. The National Cancer Institute (NCI) method for episodically consumed foods was used to estimate distributions of usual food and nutrient intakes. RESULTS Based on the estimated intake distributions, >95% of the children had usual fat intakes <30% of total energy. Among 24- to 35-month-old (younger) and 36- to 48-month-old (older) children, respectively, 4% and 16% of breast-feeding children and 31% and 41% of non-breast-feeding children were estimated to consume <10% of total energy from fat. An estimated 80% of all of the children consumed <4% of total energy as linoleic acid, and 99% consumed <1% of energy as α-linolenic acid. Younger breast-feeding children had higher estimated average docosahexaenoic acid (DHA) intakes (0.04 g DHA/day) than their non-breast-feeding counterparts (0.01 g DHA/day; P = 0.0005). Both breast-feeding and non-breast-feeding older children had estimated mean DHA intakes of 0.02 g/day (P = 0.74). CONCLUSIONS Rural Bangladeshi children 24 to 48 months old, and especially those who have discontinued breast-feeding, may benefit from increased fat consumption.
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Intakes and breast-milk concentrations of essential fatty acids are low among Bangladeshi women with 24–48-month-old children. Br J Nutr 2011; 105:1660-70. [DOI: 10.1017/s0007114510004964] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Maternal fat intake and adipose reserves are major sources of PUFA during lactation. The present study examined the cross-sectional relationship between prolonged breast-feeding and maternal BMI, assessed adequacy of fat intake among lactating and non-lactating mothers of children 24–48 months of age and determined breast-milk fatty acid composition. Multi-stage sampling was used to select a representative sample of mothers from two rural districts in Bangladesh (n474). Dietary data were collected during two non-consecutive 24 h periods via 12 h in-home daytime observations and recall. The National Cancer Institute method for episodically consumed foods was used to estimate usual intake distributions. Breast milk samples were collected from ninety-eight women, and breast-milk fatty acid methyl esters were quantified using GC. Approximately 42 % of lactatingv.26 % of non-lactating mothers were underweight (BMI < 18·5 kg/m2;P = 0·0003). The maternal diet was low in total fat (approximately 8 % of mean total energy) and food sources of PUFA, including oil and animal source foods, resulting in a low estimated mean total consumption of PUFA (5·1 g/d). Almost all women were estimated to consume less than the recommended intake levels for total fat, total PUFA, α-linolenic acid (ALA) and DHA. Median breast-milk linoleic acid (8·5 % weight) and ALA (0·2 %) concentrations were among the lowest reported in the literature, in contrast with arachidonic acid (0·5 %) and DHA (0·3 %) concentrations, which were mid-range. Bangladeshi women in general, and especially those who practise prolonged breast-feeding, may benefit from increased consumption of food sources of PUFA.
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Berti PR, Jones AD, Cruz Y, Larrea S, Borja R, Sherwood S. Assessment and characterization of the diet of an isolated population in the Bolivian Andes. Am J Hum Biol 2011; 22:741-9. [PMID: 20721984 DOI: 10.1002/ajhb.21075] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES The goal of this research is to characterize the composition and nutrient adequacy of the diets in the northern region of the Department of Potosí, Bolivia. Communities in this semiarid, mountainous region are isolated and impoverished having the highest rates of child malnutrition and under-five mortality in the Americas. METHODS A total of 2,222 twenty-four-hour dietary recalls were conducted in 30 communities during May and November 2006 and May and November 2007. Food composition data were compiled from diverse published sources and integrated with the recall data to estimate intakes of energy, protein, fat, carbohydrates, and seven micronutrients. Diets were characterized in terms of food sources, seasonality, and nutrient adequacy. RESULTS The diet relies heavily on the potato and other tubers (54% of dietary energy) and grains (30% of dietary energy). Although crop production is seasonal, off-season consumption of chuño helps to minimize seasonal fluctuations in dietary energy intake. Despite relative monotony, intakes of iron, vitamin C, most B vitamins, and vitamin A in adults are probably adequate; riboflavin, calcium, and vitamin A intakes in children are low. Nevertheless, extremely low dietary fat intakes (approximately 3-9% of dietary energy from fat) likely prevent adequate absorption of fat-soluble vitamins as well as lead to deficiencies of essential fatty acids. CONCLUSIONS Dietary inadequacies, especially of fats, may explain much of the poor health observed in northern Potosí. An improved diet may be possible through increasing production and intake of local fat-rich food sources such as small animals.
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Dietary modulation of body composition and insulin sensitivity during catch-up growth in rats: effects of oils rich in n-6 or n-3 PUFA. Br J Nutr 2011; 105:1750-63. [PMID: 21281526 DOI: 10.1017/s0007114510005659] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The present study investigates whether excessive fat accumulation and hyperinsulinaemia during catch-up growth on high-fat diets are altered by n-6 and n-3 PUFA derived from oils rich in either linoleic acid (LA), α-linolenic acid (ALA), arachidonic acid (AA) or DHA. It has been shown that, compared with food-restricted rats refed a high-fat (lard) diet low in PUFA, those refed isoenergetically on diets enriched in LA or ALA, independently of the n-6:n-3 ratio, show improved insulin sensitivity, lower fat mass and higher lean mass, the magnitude of which is related to the proportion of total PUFA precursors (LA+ALA) consumed. These relationships are best fitted by quadratic regression models (r2>0·8, P < 0·001), with threshold values for an impact on body composition corresponding to PUFA precursors contributing 25-30 % of energy intake. Isoenergetic refeeding on high-fat diets enriched in AA or DHA also led to improved body composition, with increases in lean mass as predicted by the quadratic model for PUFA precursors, but decreases in fat mass, which are disproportionately greater than predicted values; insulin sensitivity, however, was not improved. These findings pertaining to the impact of dietary intake of PUFA precursors (LA and ALA) and their elongated-desaturated products (AA and DHA), on body composition and insulin sensitivity, provide important insights into the search for diets aimed at counteracting the pathophysiological consequences of catch-up growth. In particular, diets enriched in essential fatty acids (LA and/or ALA) markedly improve insulin sensitivity and composition of weight regained, independently of the n-6:n-3 fatty acid ratio.
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Oriá RB, Patrick PD, Oriá MOB, Lorntz B, Thompson MR, Azevedo OGR, Lobo RNB, Pinkerton RF, Guerrant RL, Lima AAM. ApoE polymorphisms and diarrheal outcomes in Brazilian shanty town children. Braz J Med Biol Res 2010; 43:249-56. [PMID: 20401432 DOI: 10.1590/s0100-879x2010007500003] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2009] [Accepted: 01/21/2010] [Indexed: 11/22/2022] Open
Abstract
A series of studies have shown that the heavy burdens of diarrheal diseases in the first 2 formative years of life in children living in urban shanty towns have negative effects on physical and cognitive development lasting into later childhood. We have shown that APOE4 is relatively common in shanty town children living in Brazil (13.4%) and suggest that APOE4 has a protective role in cognitive development as well as weight-for-height in children with heavy burdens of diarrhea in early childhood (64/123; 52%), despite being a marker for cognitive decline with Alzheimer's and cardiovascular diseases later in life. APOE2 frequency was higher among children with heaviest diarrhea burdens during the first 2 years of life, as detected by PCR using the restriction fragment length polymorphism method, raising the possibility that ApoE-cholesterol balance might be critical for growth and cognitive development under the stress of heavy diarrhea burdens and when an enriched fat diet is insufficient. These findings provide a potential explanation for the survival advantage in evolution of genes, which might raise cholesterol levels during heavy stress of diarrhea burdens and malnutrition early in life.
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Affiliation(s)
- R B Oriá
- Departamento de Morfologia, Universidade Federal do Ceará
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Abstract
Epidemiological data provide strong evidence for a relationship between undernutrition and life-threatening infection in infants and children. However, the mechanisms that underlie this relationship are poorly understood. Through foetal life, infancy and childhood, the immune system undergoes a process of functional maturation. The adequacy of this process is dependent on environmental factors, and there is accumulating evidence of the impact of pre- and post-natal nutrition in this regard. This review outlines the impact of nutrition during foetal and infant development on the capacity to mount immune responses to infection. It provides an overview of the epidemiologic evidence for such a role and discusses the possible mechanisms involved.
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Affiliation(s)
- Kelsey D J Jones
- Department of Paediatrics, Imperial College, and Imperial College Healthcare NHS Trust, London, UK.
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Michaelsen KF, Hoppe C, Roos N, Kaestel P, Stougaard M, Lauritzen L, Mølgaard C, Girma T, Friis H. Choice of foods and ingredients for moderately malnourished children 6 months to 5 years of age. Food Nutr Bull 2010; 30:S343-404. [PMID: 19998864 DOI: 10.1177/15648265090303s303] [Citation(s) in RCA: 150] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
There is consensus on how to treat severe malnutrition, but there is no agreement on the most cost-effective way to treat infants and young children with moderate malnutrition who consume cereal-dominated diets. The aim of this review is to give an overview of the nutritional qualities of relevant foods and ingredients in relation to the nutritional needs of children with moderate malnutrition and to identify research needs. The following general aspects are covered: energy density, macronutrient content and quality, minerals and vitamins, bioactive substances, antinutritional factors, and food processing. The nutritional values of the main food groups--cereals, legumes, pulses, roots, vegetables, fruits, and animal foods--are discussed. The special beneficial qualities of animal-source foods, which contain high levels of minerals important for growth, high-quality protein, and no antinutrients or fibers, are emphasized. In cereal-dominated diets, the plant foods should be processed to reduce the contents of antinutrients and fibers. Provision of a high fat content to increase energy density is emphasized; however, the content of micronutrients should also be increased to maintain nutrient density. The source of fat should be selected to supply optimal amounts of polyunsaturated fatty acids (PUFAs), especially n-3 fatty acids. Among multiple research needs, the following are highlighted: to identify the minimum quantity of animal foods needed to support acceptable child growth and development, to examine the nutritional gains of reducing contents of antinutrients and fibers in cereal- and legume-based diets, and to examine the role of fat quality, especially PUFA content and ratios, in children with moderate malnutrition.
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Affiliation(s)
- Kim F Michaelsen
- Department of Human Nutrition, University of Copenhagen, Rolighedsvej 30, DK-1958 Frederiksberg C, Denmark.
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Premji ZG, Abdulla S, Ogutu B, Ndong A, Falade CO, Sagara I, Mulure N, Nwaiwu O, Kokwaro G. The content of African diets is adequate to achieve optimal efficacy with fixed-dose artemether-lumefantrine: a review of the evidence. Malar J 2008; 7:244. [PMID: 19032767 PMCID: PMC2611997 DOI: 10.1186/1475-2875-7-244] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2008] [Accepted: 11/25/2008] [Indexed: 11/10/2022] Open
Abstract
A fixed-dose combination of artemether-lumefantrine (AL, Coartem(R)) has shown high efficacy, good tolerability and cost-effectiveness in adults and children with uncomplicated malaria caused by Plasmodium falciparum. Lumefantrine bioavailability is enhanced by food, particularly fat.As the fat content of sub-Saharan African meals is approximately a third that of Western countries, it raises the question of whether fat consumption by African patients is sufficient for good efficacy. Data from healthy volunteers have indicated that drinking 36 mL soya milk (containing only 1.2 g of fat) results in 90% of the lumefantrine absorption obtained with 500 mL milk (16 g fat). African diets are typically based on a carbohydrate staple (starchy root vegetables, fruit [plantain] or cereals) supplemented by soups, relishes and sauces derived from vegetables, pulses, nuts or fish. The most important sources of dietary fat in African countries are oil crops (e.g. peanuts, soya beans) and cooking oils as red palm, peanut, coconut and sesame oils. Total fat intake in the majority of subSaharan countries is estimated to be in the range 30-60 g/person/day across the whole population (average 43 g/person/day). Breast-feeding of infants up to two years of age is standard, with one study estimating a fat intake of 15-30 g fat/day from breast milk up to the age of 18 months. Weaning foods typically contain low levels of fat, and the transition from breast milk to complete weaning is associated with a marked reduction in dietary fat. Nevertheless, fat intake >10 g/day has been reported in young children post-weaning. A randomized trial in Uganda reported no difference in the efficacy of AL between patients receiving supervised meals with a fixed fat content (~23 g fat) or taking AL unsupervised, suggesting that fat intake at home was sufficient for optimal efficacy. Moreover, randomized trials in African children aged 5-59 months have shown similar high cure rates to those observed in older populations, indicating that food consumption is adequate post-weaning. In conclusion, it appears that only a very small amount of dietary fat is necessary to ensure optimal efficacy with AL and that the fat content of standard meals or breast milk in sub-Saharan Africa is adequate.
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Affiliation(s)
- Zulfiqarali G Premji
- Department of Parasitology/Medical Entomology, School of Public Health and Social Sciences, Muhimbili University College of Health Sciences, Dar-es-Salaam, Tanzania.
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