1
|
Smolińska K, Szopa A, Sobczyński J, Serefko A, Dobrowolski P. Nutritional Quality Implications: Exploring the Impact of a Fatty Acid-Rich Diet on Central Nervous System Development. Nutrients 2024; 16:1093. [PMID: 38613126 PMCID: PMC11013435 DOI: 10.3390/nu16071093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 04/05/2024] [Accepted: 04/07/2024] [Indexed: 04/14/2024] Open
Abstract
Given the comprehensive examination of the role of fatty acid-rich diets in central nervous system development in children, this study bridges significant gaps in the understanding of dietary effects on neurodevelopment. It delves into the essential functions of fatty acids in neurodevelopment, including their contributions to neuronal membrane formation, neuroinflammatory modulation, neurogenesis, and synaptic plasticity. Despite the acknowledged importance of these nutrients, this review reveals a lack of comprehensive synthesis in current research, particularly regarding the broader spectrum of fatty acids and their optimal levels throughout childhood. By consolidating the existing knowledge and highlighting critical research gaps, such as the effects of fatty acid metabolism on neurodevelopmental disorders and the need for age-specific dietary guidelines, this study sets a foundation for future studies. This underscores the potential of nutritional strategies to significantly influence neurodevelopmental trajectories, advocating an enriched academic and clinical understanding that can inform dietary recommendations and interventions aimed at optimizing neurological health from infancy.
Collapse
Affiliation(s)
- Katarzyna Smolińska
- Chronic Wounds Laboratory, Medical University of Lublin, Chodźki St. 7, 20-093 Lublin, Poland;
| | - Aleksandra Szopa
- Department of Clinical Pharmacy and Pharmaceutical Care, Medical University of Lublin, Chodźki St. 1, 20-093 Lublin, Poland; (A.S.); (J.S.); (A.S.)
| | - Jan Sobczyński
- Department of Clinical Pharmacy and Pharmaceutical Care, Medical University of Lublin, Chodźki St. 1, 20-093 Lublin, Poland; (A.S.); (J.S.); (A.S.)
| | - Anna Serefko
- Department of Clinical Pharmacy and Pharmaceutical Care, Medical University of Lublin, Chodźki St. 1, 20-093 Lublin, Poland; (A.S.); (J.S.); (A.S.)
| | - Piotr Dobrowolski
- Department of Functional Anatomy and Cytobiology, Maria Curie Sklodowska University, Akademicka St. 19, 20-033 Lublin, Poland
| |
Collapse
|
2
|
Mwita FC, PrayGod G, Sanga E, Setebe T, Joseph G, Kunzi H, Webster J, Gladstone M, Searle R, Ahmed M, Hokororo A, Filteau S, Friis H, Briend A, Olsen MF. Developmental and Nutritional Changes in Children with Severe Acute Malnutrition Provided with n-3 Fatty Acids Improved Ready-to-Use Therapeutic Food and Psychosocial Support: A Pilot Study in Tanzania. Nutrients 2024; 16:692. [PMID: 38474820 PMCID: PMC10934689 DOI: 10.3390/nu16050692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 02/08/2024] [Accepted: 02/23/2024] [Indexed: 03/14/2024] Open
Abstract
Children with severe acute malnutrition (SAM) are at high risk of impaired development. Contributing causes include the inadequate intake of specific nutrients such as polyunsaturated fatty acids (PUFAs) and a lack of adequate stimulation. We conducted a pilot study assessing developmental and nutritional changes in children with SAM provided with a modified ready-to-use therapeutic food and context-specific psychosocial intervention in Mwanza, Tanzania. We recruited 82 children with SAM (6-36 months) and 88 sex- and age-matched non-malnourished children. We measured child development, using the Malawi Development Assessment Tool (MDAT), measures of family and maternal care for children, and whole-blood PUFA levels. At baseline, the mean total MDAT z-score of children with SAM was lower than non-malnourished children; -2.37 (95% confidence interval: -2.92; -1.82), as were their total n-3 fatty acids, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) levels. After 8 weeks of intervention, MDAT z-scores improved in all domains, especially fine motor, among children with SAM. Total n-3 and EPA levels increased, total n-6 fatty acids decreased, and DHA remained unchanged. Family and maternal care also improved. The suggested benefits of the combined interventions on the developmental and nutritional status of children with SAM will be tested in a future trial.
Collapse
Affiliation(s)
- Fredrick Cyprian Mwita
- Mwanza Research Centre, National Institute for Medical Research, Mwanza P.O. Box 1462, Tanzania; (F.C.M.); (E.S.); (T.S.); (G.J.); (H.K.)
| | - George PrayGod
- Mwanza Research Centre, National Institute for Medical Research, Mwanza P.O. Box 1462, Tanzania; (F.C.M.); (E.S.); (T.S.); (G.J.); (H.K.)
| | - Erica Sanga
- Mwanza Research Centre, National Institute for Medical Research, Mwanza P.O. Box 1462, Tanzania; (F.C.M.); (E.S.); (T.S.); (G.J.); (H.K.)
| | - Theresia Setebe
- Mwanza Research Centre, National Institute for Medical Research, Mwanza P.O. Box 1462, Tanzania; (F.C.M.); (E.S.); (T.S.); (G.J.); (H.K.)
| | - Gaudensia Joseph
- Mwanza Research Centre, National Institute for Medical Research, Mwanza P.O. Box 1462, Tanzania; (F.C.M.); (E.S.); (T.S.); (G.J.); (H.K.)
| | - Happyness Kunzi
- Mwanza Research Centre, National Institute for Medical Research, Mwanza P.O. Box 1462, Tanzania; (F.C.M.); (E.S.); (T.S.); (G.J.); (H.K.)
| | - Jayne Webster
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK;
| | - Melissa Gladstone
- Department of Women and Children’s Health, University of Liverpool, Alder Hey Children’s Hospital, Liverpool L12 2AP, UK; (M.G.); (R.S.)
| | - Rebecca Searle
- Department of Women and Children’s Health, University of Liverpool, Alder Hey Children’s Hospital, Liverpool L12 2AP, UK; (M.G.); (R.S.)
| | - Maimuna Ahmed
- Department of Paediatrics, Bugando Medical Centre, Mwanza P.O. Box 1370, Tanzania; (M.A.); (A.H.)
| | - Adolfine Hokororo
- Department of Paediatrics, Bugando Medical Centre, Mwanza P.O. Box 1370, Tanzania; (M.A.); (A.H.)
| | - Suzanne Filteau
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK;
| | - Henrik Friis
- Department of Nutrition, Exercise and Sports, University of Copenhagen, 2200 Copenhagen, Denmark; (H.F.); (A.B.); (M.F.O.)
| | - André Briend
- Department of Nutrition, Exercise and Sports, University of Copenhagen, 2200 Copenhagen, Denmark; (H.F.); (A.B.); (M.F.O.)
- Tampere Centre for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University and Tampere University Hospital, Tampere University, Arvo Ylpön Katu 34, 33100 Tampere, Finland
| | - Mette Frahm Olsen
- Department of Nutrition, Exercise and Sports, University of Copenhagen, 2200 Copenhagen, Denmark; (H.F.); (A.B.); (M.F.O.)
- Department of Infectious Diseases, Rigshospitalet, 2100 Copenhagen, Denmark
| |
Collapse
|
3
|
Nienaber A, Conradie C, Manda G, Chimera-Khombe B, Nel E, Milanzi EB, Dolman-Macleod RC, Lombard MJ. Effect of fatty acid profiles in varying recipes of ready-to-use therapeutic foods on neurodevelopmental and clinical outcomes of children (6-59 months) with severe wasting: a systematic review. Nutr Rev 2023:nuad151. [PMID: 38134960 DOI: 10.1093/nutrit/nuad151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2023] Open
Abstract
CONTEXT In 2020, 13.6 million children under 5 years suffered from severe acute malnutrition (SAM)/wasting. Standard ready-to-use therapeutic foods (RUTFs) improve polyunsaturated fatty acid (PUFA) status but contain suboptimal amounts of omega-3 (n-3) PUFAs with unbalanced n-6-to-n-3 PUFA ratios. OBJECTIVES The aim was to compare the effects of RUTFs with different essential fatty acid contents on PUFA status, neurodevelopmental, and clinical outcomes (mortality, comorbidities, and recovery) of children with severe wasting. DATA SOURCES Twelve databases, trial repositories, and article references with no publication limitations. DATA EXTRACTION Ten studies from randomized, quasi, and cluster-randomized controlled trials providing RUTFs as home treatment to children 6-59 months with SAM/wasting were included. DATA ANALYSIS Plasma phospholipid eicosapentaenoic acid content was higher in children receiving RUTF with altered essential fatty acid contents compared with standard RUTF (0.20 [0.15-0.25], P < 0.00001). Docosahexaenoic acid (DHA) status only improved in children receiving RUTF with added fish oil (0.33 [0.15-0.50], P = 0.0003). The Malawi Developmental Assessment tool (MDAT) global development and problem-solving assessment scores were higher in global assessment and gross motor domains in children receiving added fish oil compared with standard formulation (0.19 [0.0-0.38] and 0.29 [0.03-0.55], respectively). Children receiving high-oleic-acid RUTF (lowering the n-6:n-3 PUFA ratio of the RUTF) with or without fish oil had significantly higher scores in social domains compared with those receiving the standard formulation (0.16 [0.00-0.31] and 0.24 [0.09-0.40]). Significantly higher mortality risk was found in children receiving a standard formulation compared with RUTF with a lower n-6:n-3 PUFA ratio (0.79 [0.67-0.94], P = 0.008). CONCLUSION Although lowering n-6:n-3 PUFA ratios did not increase plasma DHA, it improved specific neurodevelopmental scores and mortality due to lower linoleic acid (high-oleic-acid peanuts), higher alpha-linolenic acid (altered oil), or both. Additional preformed n-3 long-chain PUFAs (fish oil) with RUTF improved the children's DHA status, neurodevelopmental outcomes, and weight-for-height z score. More research is needed regarding cost, availability, stability, acceptability, and the appropriate amount of n-3 long-chain PUFAs required in RUTFs for the best clinical outcomes. SYSTEMATIC REVIEW REGISTRATION PROSPERO registration no. CRD42022303694.
Collapse
Affiliation(s)
- Arista Nienaber
- Centre of Excellence for Nutrition (CEN), North-West University, Potchefstroom Campus, Potchefstroom, South Africa
| | - Cornelia Conradie
- Centre of Excellence for Nutrition (CEN), North-West University, Potchefstroom Campus, Potchefstroom, South Africa
| | - Geoffrey Manda
- Global Health Institute, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | | | - Ettienne Nel
- Department of Paediatrics and Child Health, University Stellenbosch, Bellville, Cape Town, South Africa
| | - Edith B Milanzi
- Medical Research Council Clinical Trials, University College London, London, United Kingdom
| | - Robin C Dolman-Macleod
- Centre of Excellence for Nutrition (CEN), North-West University, Potchefstroom Campus, Potchefstroom, South Africa
| | - Martani J Lombard
- Centre of Excellence for Nutrition (CEN), North-West University, Potchefstroom Campus, Potchefstroom, South Africa
| |
Collapse
|
4
|
Hendrixson DT, Stephenson KB. To survive, yet not thrive: long-term outcomes of childhood survivors of severe acute malnutrition. Am J Clin Nutr 2023; 118:839-840. [PMID: 37923495 DOI: 10.1016/j.ajcnut.2023.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 08/17/2023] [Indexed: 11/07/2023] Open
Affiliation(s)
- D Taylor Hendrixson
- Department of Pediatrics, University of Washington, Seattle, WA, United States.
| | - Kevin B Stephenson
- Department of Medicine, Washington University in St. Louis, St. Louis, MO, United States
| |
Collapse
|
5
|
Mbabazi J, Pesu H, Mutumba R, McCray G, Michaelsen KF, Ritz C, Filteau S, Briend A, Mupere E, Grenov B, Friis H, Olsen MF. Effect of Milk Protein and Whey Permeate in Large-Quantity Lipid-Based Nutrient Supplement on Early Child Development among Children with Stunting: A Randomized 2 × 2 Factorial Trial in Uganda. Nutrients 2023; 15:2659. [PMID: 37375563 DOI: 10.3390/nu15122659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 05/31/2023] [Accepted: 06/01/2023] [Indexed: 06/29/2023] Open
Abstract
Stunting affects 22% children globally, putting them at risk of adverse outcomes including delayed development. We investigated the effect of milk protein (MP) vs. soy and whey permeate (WP) vs. maltodextrin in large-quantity, lipid-based nutrient supplement (LNS), and LNS itself vs. no supplementation, on child development and head circumference among stunted children aged 1-5 years. We conducted a randomized, double-blind, community-based 2 × 2 factorial trial in Uganda (ISRCTN1309319). We randomized 600 children to one of four LNS formulations (~535 kcal/d), with or without MP (n = 299 vs. n = 301) or WP (n = 301 vs. n = 299), for 12 weeks or to no supplementation (n = 150). Child development was assessed using the Malawi Development Assessment Tool. Data were analyzed using linear mixed-effects models. Children had a median [interquartile range] age of 30 [23; 41] months and mean ± standard deviation height-for-age z-score of -3.02 ± 0.74. There were no interactions between MP and WP for any of the outcomes. There was no effect of either MP or WP on any developmental domain. Although LNS itself had no impact on development, it resulted in 0.07 (95%CI: 0.004; 0.14) cm higher head circumference. Neither dairy in LNS, nor LNS in itself, had an effect on development among already stunted children.
Collapse
Affiliation(s)
- Joseph Mbabazi
- Department of Nutrition, Exercise and Sports, University of Copenhagen, 1958 Frederiksberg C, Denmark
- Department of Paediatrics and Child Health, Makerere University, Kampala P.O. Box 7072, Uganda
| | - Hannah Pesu
- Department of Nutrition, Exercise and Sports, University of Copenhagen, 1958 Frederiksberg C, Denmark
| | - Rolland Mutumba
- Department of Nutrition, Exercise and Sports, University of Copenhagen, 1958 Frederiksberg C, Denmark
- Department of Paediatrics and Child Health, Makerere University, Kampala P.O. Box 7072, Uganda
| | - Gareth McCray
- School of Medicine, Keele University, Keele ST5 5BG, UK
| | - Kim F Michaelsen
- Department of Nutrition, Exercise and Sports, University of Copenhagen, 1958 Frederiksberg C, Denmark
| | - Christian Ritz
- The National Institute of Public Health, University of Southern Denmark, 5230 Odense, Denmark
| | - Suzanne Filteau
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
| | - André Briend
- Department of Nutrition, Exercise and Sports, University of Copenhagen, 1958 Frederiksberg C, Denmark
- Tampere Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere University Hospital, 33520 Tampere, Finland
| | - Ezekiel Mupere
- Department of Paediatrics and Child Health, Makerere University, Kampala P.O. Box 7072, Uganda
| | - Benedikte Grenov
- Department of Nutrition, Exercise and Sports, University of Copenhagen, 1958 Frederiksberg C, Denmark
| | - Henrik Friis
- Department of Nutrition, Exercise and Sports, University of Copenhagen, 1958 Frederiksberg C, Denmark
| | - Mette Frahm Olsen
- Department of Nutrition, Exercise and Sports, University of Copenhagen, 1958 Frederiksberg C, Denmark
- Department of Infectious Diseases, Rigshospitalet, 2100 Copenhagen, Denmark
| |
Collapse
|
6
|
Diaz JN, Iannotti LL, Louis Dulience SJ, Vie S, Jiang X, Grigura V, Boncy J, Pierre FJM, Kuhlmann FM. Prevalence of diarrheagenic Escherichia coli and impact on child health in Cap-Haitien, Haiti. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001863. [PMID: 37145992 PMCID: PMC10162540 DOI: 10.1371/journal.pgph.0001863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 04/06/2023] [Indexed: 05/07/2023]
Abstract
BACKGROUND Diarrheagenic Escherichia coli (DEC) are common pathogens infecting children during their growth and development. Determining the epidemiology and the impact of DEC on child anthropometric measures informs prioritization of prevention efforts. These relationships were evaluated in a novel setting, Cap-Haitien, Haiti. METHODS We performed pre-specified secondary analysis of a case-control study of community-dwelling children, 6-36 months of age, enrolled 96 cases with diarrhea and 99 asymptomatic controls. Assessments were performed at enrollment and one month later at follow-up. Established endpoint PCR methodologies targeted DEC gDNA isolated from fecal swabs. The association between DEC and anthropometric z-scores at enrollment was determined using multivariate linear regression. Lastly, we assessed the association between specific biomarkers, choline and docosahexaenoic acid (DHA) and diarrheal burden. RESULTS Enterotoxigenic Escherichia coli (ETEC) was identified in 21.9% of cases vs. 16.1% of controls with heat-stable producing ETEC significantly associated with symptomatic disease. Enteroaggregative E. coli (EAEC) was found in 30.2% of cases vs. 27.3% of controls, and typical enteropathogenic E. coli in 6.3% vs. 4.0% of cases and controls, respectively. Multivariate linear regression, controlled for case or control status, demonstrated ETEC and EAEC were significantly associated with reduced weight-age z-score (WAZ) and height-age z-score (HAZ) after adjusting for confounders. An interaction between ETEC and EAEC was observed. Choline and DHA were not associated with diarrheal burden. CONCLUSIONS DEC are prevalent in north Haitian children. ETEC, EAEC, household environment, and diet are associated with unfavorable anthropometric measures, with possible synergistic interactions between ETEC and EAEC. Further studies with longer follow up may quantify the contribution of individual pathogens to adverse health outcomes.
Collapse
Affiliation(s)
- Jenna N. Diaz
- Department of Pediatrics, Washington University School of Medicine in St. Louis, St. Louis, Missouri, United States of America
| | - Lora L. Iannotti
- Brown School, Institute for Public Health, Washington University in St. Louis, St. Louis, Missouri, United States of America
| | - Sherlie Jean Louis Dulience
- Brown School, Institute for Public Health, Washington University in St. Louis, St. Louis, Missouri, United States of America
| | - Sydney Vie
- Brown School, Institute for Public Health, Washington University in St. Louis, St. Louis, Missouri, United States of America
| | - Xuntian Jiang
- Department of Medicine, Diabetic Cardiovascular Disease Center, Washington University School of Medicine in St. Louis, St. Louis, Missouri, United States of America
| | - Vadim Grigura
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine in St. Louis, St. Louis, Missouri, United States of America
| | - Jacques Boncy
- Laboratoire National de Santé Publique, Ministère de la Santé Publique et de la Population, Port-au-Prince, Haiti
| | - Francesca J. Marhône Pierre
- Unité de Coordination du Programme National d’Alimentation et de Nutrition, Ministère de la Santé Publique et de la Population, Port-au-Prince, Haiti
| | - F. Matthew Kuhlmann
- Laboratoire National de Santé Publique, Ministère de la Santé Publique et de la Population, Port-au-Prince, Haiti
| |
Collapse
|
7
|
Cardino VN, Goeden T, Yakah W, Ezeamama AE, Fenton JI. New Perspectives on the Associations between Blood Fatty Acids, Growth Parameters, and Cognitive Development in Global Child Populations. Nutrients 2023; 15:nu15081933. [PMID: 37111152 PMCID: PMC10143140 DOI: 10.3390/nu15081933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 04/11/2023] [Accepted: 04/15/2023] [Indexed: 04/29/2023] Open
Abstract
Malnutrition is prevalent in low-middle-income countries (LMICs), but it is usually clinically diagnosed through abnormal anthropometric parameters characteristic of protein energy malnutrition (PEM). In doing so, other contributors or byproducts of malnutrition, notably essential fatty acid deficiency (EFAD), are overlooked. Previous research performed mainly in high-income countries (HICs) shows that deficiencies in essential fatty acids (EFAs) and their n-3 and n-6 polyunsaturated fatty acid (PUFA) byproducts (also known as highly unsaturated fatty acids or HUFAs) lead to both abnormal linear growth and impaired cognitive development. These adverse developmental outcomes remain an important public health issue in LMICs. To identify EFAD before severe malnutrition develops, clinicians should perform blood fatty acid panels to measure levels of fatty acids associated with EFAD, notably Mead acid and HUFAs. This review demonstrates the importance of measuring endogenous fatty acid levels for measuring fatty acid intake in various child populations in LMICs. Featured topics include a comparison of fatty acid levels between global child populations, the relationships between growth and cognition and PUFAs and the possible mechanisms driving these relationships, and the potential importance of EFAD and HUFA scores as biomarkers of overall health and normal development.
Collapse
Affiliation(s)
- Vanessa N Cardino
- Department of Food Science and Human Nutrition, Michigan State University, East Lansing, MI 48824, USA
| | - Travis Goeden
- Department of Food Science and Human Nutrition, Michigan State University, East Lansing, MI 48824, USA
| | - William Yakah
- Department of Pediatrics, Columbia University Medical Center, New York, NY 10032, USA
| | - Amara E Ezeamama
- Department of Psychiatry, Michigan State University, East Lansing, MI 48824, USA
| | - Jenifer I Fenton
- Department of Food Science and Human Nutrition, Michigan State University, East Lansing, MI 48824, USA
| |
Collapse
|
8
|
James G, Stephenson K, Callaghan-Gillespie M, Kamara MT, Park HG, Brenna JT, Manary MJ. Docosahexaenoic Acid Stability in Ready-to-Use Therapeutic Food. Foods 2023; 12:foods12020308. [PMID: 36673399 PMCID: PMC9858440 DOI: 10.3390/foods12020308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 01/04/2023] [Accepted: 01/06/2023] [Indexed: 01/11/2023] Open
Abstract
Ready-to-use therapeutic food (RUTF) is used to treat young children diagnosed with severe acute malnutrition. RUTF with low and balanced linoleic and alpha-linolenic acid, plus omega-3 docosahexaenoic acid (DHA), supports long-term cognitive recovery. DHA is prone to degradation due to peroxidation, possibly exacerbated by the iron inherently in RUTF. Our goals were to prepare benchtop and manufacturing scale of RUTF formulations that include DHA and measure its retention. Twenty-seven RUTF formulas with base ingredients, including oats, high oleic or commodity peanuts, and encapsulated or oil-based DHA at various levels were prepared at benchtop scale, followed by seven months of climate-controlled storage. These pilot samples had similar relative DHA retention. At the manufacturing scale, DHA was added at one of two stages in the process, either at the initial or the final mixing stage. Samples taken at preliminary or later steps show that less than 20% of DHA added at the early stages disappeared prior to packaging for any recipe tested. Overall, our data indicate that most DHA included in RUTF is retained in the final product and that DHA is best retained when added at the latest manufacturing stage.
Collapse
Affiliation(s)
- Genevieve James
- Dell Pediatric Research Institute, The University of Texas at Austin, Austin, TX 78723, USA
| | - Kevin Stephenson
- Department of Medicine, Washington University, St. Louis, MO 63110, USA
| | | | | | - Hui Gyu Park
- Dell Pediatric Research Institute, The University of Texas at Austin, Austin, TX 78723, USA
| | - J. Thomas Brenna
- Dell Pediatric Research Institute, The University of Texas at Austin, Austin, TX 78723, USA
| | - Mark J. Manary
- Department of Pediatrics, Washington University, St. Louis, MO 63110, USA
- Project Peanut Butter, Freetown 47235, Sierra Leone
- Children’s Nutrition Research Center, USDA-Agricultural Research Service, Houston, TX 77030, USA
- Correspondence: ; Tel.: +1-(314)-454-2178
| |
Collapse
|
9
|
Kirolos A, Goyheneix M, Kalmus Eliasz M, Chisala M, Lissauer S, Gladstone M, Kerac M. Neurodevelopmental, cognitive, behavioural and mental health impairments following childhood malnutrition: a systematic review. BMJ Glob Health 2022; 7:e009330. [PMID: 35793839 PMCID: PMC9260807 DOI: 10.1136/bmjgh-2022-009330] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 06/11/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Severe childhood malnutrition impairs growth and development short-term, but current understanding of long-term outcomes is limited. We aimed to identify studies assessing neurodevelopmental, cognitive, behavioural and mental health outcomes following childhood malnutrition. METHODS We systematically searched MEDLINE, EMBASE, Global Health and PsycINFO for studies assessing these outcomes in those exposed to childhood malnutrition in low-income and middle-income settings. We included studies assessing undernutrition measured by low mid-upper arm circumference, weight-for-height, weight-for-age or nutritional oedema. We used guidelines for synthesis of results without meta-analysis to analyse three outcome areas: neurodevelopment, cognition/academic achievement, behaviour/mental health. RESULTS We identified 30 studies, including some long-term cohorts reporting outcomes through to adulthood. There is strong evidence that malnutrition in childhood negatively impacts neurodevelopment based on high-quality studies using validated neurodevelopmental assessment tools. There is also strong evidence that malnutrition impairs academic achievement with agreement across seven studies investigating this outcome. Eight of 11 studies showed an association between childhood malnutrition and impaired cognition. This moderate evidence is limited by some studies failing to measure important confounders such as socioeconomic status. Five of 7 studies found a difference in behavioural assessment scores in those exposed to childhood malnutrition compared with controls but this moderate evidence is similarly limited by unmeasured confounders. Mental health impacts were difficult to ascertain due to few studies with mixed results. CONCLUSIONS Childhood malnutrition is associated with impaired neurodevelopment, academic achievement, cognition and behavioural problems but evidence regarding possible mental health impacts is inconclusive. Future research should explore the interplay of childhood and later-life adversities on these outcomes. While evidence on improving nutritional and clinical therapies to reduce long-term risks is also needed, preventing and eliminating child malnutrition is likely to be the best way of preventing long-term neurocognitive harms. PROSPERO REGISTRATION NUMBER CRD42021260498.
Collapse
Affiliation(s)
- Amir Kirolos
- Department of Women's and Children's Health, Institute of Life Course and Medical Sciences, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Blantyre, Malawi
| | - Magdalena Goyheneix
- Fundación ACNUR Argentina (Agencia de la ONU para los Refugiados, UNHCR), Buenos Aires, Argentina
| | - Mike Kalmus Eliasz
- Department of Women's and Children's Health, Institute of Life Course and Medical Sciences, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
| | - Mphatso Chisala
- Malawi Epidemiology and Intervention Research Unit, Lilongwe/Karonga, Malawi
| | - Samantha Lissauer
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Blantyre, Malawi
- Institute of Infection, Veterinary & Ecological Sciences, University of Liverpool, Liverpool, UK
| | - Melissa Gladstone
- Department of Women's and Children's Health, Institute of Life Course and Medical Sciences, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
| | - Marko Kerac
- Centre for Maternal, Child, Adolescent & Reproductive Health (MARCH), London School of Hygiene & Tropical Medicine, London, UK
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
| |
Collapse
|
10
|
Crawford M. A study of severe malnutrition in Malawian children illustrates the need for appropriate lipid nutrition to protect the brain. Am J Clin Nutr 2022; 115:1257-1258. [PMID: 35445701 DOI: 10.1093/ajcn/nqab425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Michael Crawford
- Chelsea and Westminster Hospital Campus of Imperial College, London, United Kingdom
| |
Collapse
|