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Arcot A, Xing X, Gao X, Font SA, Murray-Kolb LE. Iron status, development, and behavior in young children in the Pennsylvania foster care system. PLoS One 2023; 18:e0289951. [PMID: 37590213 PMCID: PMC10434919 DOI: 10.1371/journal.pone.0289951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 07/28/2023] [Indexed: 08/19/2023] Open
Abstract
BACKGROUND Children in foster care are classified as a highly vulnerable population and struggle with both physical and mental health problems. Medical conditions, like poor nutritional status, remain understudied in children in foster care. To our knowledge, few studies in children in U.S. foster care have quantified the prevalence of anemia, and no studies have examined the association between anemia status and relevant developmental and behavioral outcomes. OBJECTIVE/AIMS (1) To determine the prevalence of anemia among children in or adopted from Pennsylvania foster care, between the ages of six months to ten years and (2) To examine if a child's anemia status is associated with greater odds of relevant developmental and behavioral diagnoses. METHODS We conducted a secondary data analysis utilizing the Medicaid Analytic eXtract database between 2010-2015. Children six months-ten years were included in the analysis if they were in or had been adopted from Pennsylvania foster care. Logistic regression was used to calculate adjusted odds ratios (AOR) with 95% confidence intervals for the association between iron status and health outcomes. RESULTS A total of 50,311 children were included in our sample, of which 1,365 children (2.7%) were diagnosed with anemia. Children diagnosed with anemia had greater odds of delayed milestones (AOR: 2.38 [1.64-3.45]), specific delays in development (AOR: 1.59 [1.23-2.07]), adjustment disorder (AOR: 1.59 [1.06-2.39]), and irritability (AOR: 10.57 [3.36-33.25]), than children not diagnosed with anemia. CONCLUSION The prevalence of anemia among children between six months-ten years in or adopted from the Pennsylvania foster care system is within the national rate of U.S. childhood anemia. Odds of several relevant developmental and behavioral diagnoses were greater among children diagnosed with anemia than children who were not.
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Affiliation(s)
- Amrita Arcot
- Department of Nutritional Sciences, The Pennsylvania State University, University Park, PA, United States of America
| | - Xueyi Xing
- Evidence-to-Impact Collaborative, Social Science Research Institute, The Pennsylvania State University, University Park, PA, United States of America
| | - Xiang Gao
- Department of Nutritional Sciences, The Pennsylvania State University, University Park, PA, United States of America
- Department of Nutrition and Food Hygiene, School of Public Health, Fudan University, Shanghai, China
| | - Sarah A. Font
- Department of Sociology and Criminology, The Pennsylvania State University, University Park, PA, United States of America
| | - Laura E. Murray-Kolb
- Department of Nutrition Science, Purdue University, West Lafayette, IN, United States of America
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Graham AS, Ben-Azu B, Tremblay MÈ, Torre P, Senekal M, Laughton B, van der Kouwe A, Jankiewicz M, Kaba M, Holmes MJ. A review of the auditory-gut-brain axis. Front Neurosci 2023; 17:1183694. [PMID: 37600010 PMCID: PMC10435389 DOI: 10.3389/fnins.2023.1183694] [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: 03/10/2023] [Accepted: 07/17/2023] [Indexed: 08/22/2023] Open
Abstract
Hearing loss places a substantial burden on medical resources across the world and impacts quality of life for those affected. Further, it can occur peripherally and/or centrally. With many possible causes of hearing loss, there is scope for investigating the underlying mechanisms involved. Various signaling pathways connecting gut microbes and the brain (the gut-brain axis) have been identified and well established in a variety of diseases and disorders. However, the role of these pathways in providing links to other parts of the body has not been explored in much depth. Therefore, the aim of this review is to explore potential underlying mechanisms that connect the auditory system to the gut-brain axis. Using select keywords in PubMed, and additional hand-searching in google scholar, relevant studies were identified. In this review we summarize the key players in the auditory-gut-brain axis under four subheadings: anatomical, extracellular, immune and dietary. Firstly, we identify important anatomical structures in the auditory-gut-brain axis, particularly highlighting a direct connection provided by the vagus nerve. Leading on from this we discuss several extracellular signaling pathways which might connect the ear, gut and brain. A link is established between inflammatory responses in the ear and gut microbiome-altering interventions, highlighting a contribution of the immune system. Finally, we discuss the contribution of diet to the auditory-gut-brain axis. Based on the reviewed literature, we propose numerous possible key players connecting the auditory system to the gut-brain axis. In the future, a more thorough investigation of these key players in animal models and human research may provide insight and assist in developing effective interventions for treating hearing loss.
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Affiliation(s)
- Amy S. Graham
- Imaging Sciences, Neuroscience Institute, University of Cape Town, Cape Town, South Africa
- Department of Human Biology, Division of Biomedical Engineering, University of Cape Town, Cape Town, South Africa
| | - Benneth Ben-Azu
- Division of Medical Sciences, University of Victoria, Victoria, BC, Canada
- Department of Pharmacology, Faculty of Basic Medical Sciences, College of Health Sciences, Delta State University, Abraka, Delta State, Nigeria
| | - Marie-Ève Tremblay
- Division of Medical Sciences, University of Victoria, Victoria, BC, Canada
- Département de Médecine Moléculaire, Université Laval, Québec City, QC, Canada
- Axe Neurosciences, Centre de Recherche du CHU de Québec, Université Laval, Quebec City, QC, Canada
- Neurology and Neurosurgery Department, McGill University, Montreal, QC, Canada
- Department of Biochemistry and Molecular Biology, University of British Columbia, Vancouver, BC, Canada
- Centre for Advanced Materials and Related Technology (CAMTEC), University of Victoria, Victoria, BC, Canada
- Institute for Aging and Lifelong Health, University of Victoria, Victoria, BC, Canada
| | - Peter Torre
- School of Speech, Language, and Hearing Sciences, San Diego State University, San Diego, CA, United States
| | - Marjanne Senekal
- Department of Human Biology, Division of Physiological Sciences, University of Cape Town, Cape Town, South Africa
| | - Barbara Laughton
- Family Clinical Research Unit, Department of Pediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
| | - Andre van der Kouwe
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Boston, MA, United States
- Department of Radiology, Harvard Medical School, Boston, MA, United States
| | - Marcin Jankiewicz
- Imaging Sciences, Neuroscience Institute, University of Cape Town, Cape Town, South Africa
- Department of Human Biology, Division of Biomedical Engineering, University of Cape Town, Cape Town, South Africa
| | - Mamadou Kaba
- Department of Pathology, Division of Medical Microbiology, University of Cape Town, Cape Town, South Africa
| | - Martha J. Holmes
- Imaging Sciences, Neuroscience Institute, University of Cape Town, Cape Town, South Africa
- Department of Human Biology, Division of Biomedical Engineering, University of Cape Town, Cape Town, South Africa
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, Canada
- ImageTech, Simon Fraser University, Surrey, BC, Canada
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3
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Roach A, Sherburne E, Snethen J. Intercountry adoption of children with complex health conditions and disabilities: A systematic review. J SPEC PEDIATR NURS 2023; 28:e12398. [PMID: 36285418 DOI: 10.1111/jspn.12398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 10/20/2022] [Indexed: 02/03/2023]
Abstract
PURPOSE The rate of children with complex health conditions or disabilities who are intercountry adopted (ICA) is increasing. These children have unique physical, developmental, and psychological needs that must be addressed as they integrate into adoptive families. The purpose of this systematic review is to identify considerations nurses must recognize when caring for children with complex health conditions or disabilities who are ICA and their families. DESIGN AND METHODS A systematic literature review in accordance with the PRISMA guidelines was conducted. Four databases (PubMed, PsycINFO, Web of Science, and ERIC) located 365 articles about intercountry adoption and complex health conditions or disability. Articles that were non-English language, focused on attachment disorder or infectious disease, book chapters, dissertations, or case studies were excluded. Sixteen articles met inclusion criteria and informed this review. RESULTS The systematic review identified eight themes: primary care resources, interdisciplinary care teams, cost, developmental difficulties, nutritional challenges, mental health issues, parental need for knowledge, and parental need for support. These themes correspond to nursing assessments that should be conducted during clinic visits for children with complex health conditions or disabilities who are ICA. PRACTICE IMPLICATIONS This systematic review demonstrates that a multidisciplinary approach is necessary to address the needs of the child diagnosed with a complex health condition or disability and their family in the context of intercountry adoption. Children with a complex health condition or disability who are ICA have unique needs and require individualized care planning to maximize growth and developmental potential. Adoption is a life-long process and adjustment is complicated by the medical needs that children with complex health conditions or disabilities experience. Parents will benefit from additional support and education as they integrate a new family member while also learning about the medical care needs of a child with a complex health condition or disability.
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Affiliation(s)
- Audrey Roach
- Children's Hospital of Wisconsin, Spina Bifida Clinic, Milwaukee, Wisconsin, USA.,University of Wisconsin-Milwaukee, College of Nursing, Milwaukee, Wisconsin, USA
| | - Eileen Sherburne
- Children's Hospital of Wisconsin, Spina Bifida Clinic, Milwaukee, Wisconsin, USA
| | - Julia Snethen
- University of Wisconsin-Milwaukee, College of Nursing, Milwaukee, Wisconsin, USA
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4
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Sun Y, Zhao J, Song X, Sun Z, Zhang R, Zhong J, Huang X, Dong Y, Yu Q, Dong F, Li Z, Fan L, Wang M, Peng C, Wang F. Effects of marginal zinc deficiency on learning and memory ability after birth. Food Funct 2022; 13:7204-7214. [PMID: 35713090 DOI: 10.1039/d2fo01074g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Zinc deficiency during pregnancy and severe zinc deficiency after birth both impaired learning and memory ability, but the effects of marginal zinc deficiency (MZD) after birth on learning and memory are unclear. In the first experiment, 4-week-old male rats were randomly divided into three groups: the marginal zinc-deficient group (MZG, 10 mg kg-1, 1/3 RNI), normal zinc group (NZG, 30 mg kg-1, RNI), and paired zinc group (PZG, 30 mg kg-1). After a 4-week feeding period, the brain weight, brain coefficient, and serum zinc concentration were measured, and hippocampal proteomics analysis was performed. In the second experiment, 4-week-old male rats were fed the same diet for 8 weeks. In addition to the previously mentioned indicators, the Morris water maze results, brain pathology, post-translational modifications (PTMs) of hippocampal proteins, and the concentrations of indicators known to be related to learning and memory were analyzed. In both experiments, compared with those of the NZG, the food intake, body weight and serum zinc of the MZG were significantly decreased, and the brain weight was unchanged, but the brain coefficient was increased. Two hippocampal proteomics analyses and PTM screening showed that MZD did not change the expression and PTM of proteins. The brain pathology, learning, memory and the concentrations of indicators known to be related to learning and memory were not changed by MZD. Our study confirmed that marginal zinc deficiency (10 mg kg-1, 1/3 RNI) had no effect on the learning and memory abilities of rats after birth.
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Affiliation(s)
- Yongzhi Sun
- National Key Disciplines of Nutrition and Food Hygiene, Department of Nutrition and Food Hygiene, School of Public Health, Harbin Medical University, Harbin 150081, China.
| | - Jiali Zhao
- Yiwu Maternity and Children Hospital, Yiwu, Zhejiang, China
| | - Xinyu Song
- National Key Disciplines of Nutrition and Food Hygiene, Department of Nutrition and Food Hygiene, School of Public Health, Harbin Medical University, Harbin 150081, China.
| | - Zhaohui Sun
- National Key Disciplines of Nutrition and Food Hygiene, Department of Nutrition and Food Hygiene, School of Public Health, Harbin Medical University, Harbin 150081, China.
| | - Rui Zhang
- National Key Disciplines of Nutrition and Food Hygiene, Department of Nutrition and Food Hygiene, School of Public Health, Harbin Medical University, Harbin 150081, China.
| | - Jiayi Zhong
- National Key Disciplines of Nutrition and Food Hygiene, Department of Nutrition and Food Hygiene, School of Public Health, Harbin Medical University, Harbin 150081, China.
| | - Xiaocai Huang
- National Key Disciplines of Nutrition and Food Hygiene, Department of Nutrition and Food Hygiene, School of Public Health, Harbin Medical University, Harbin 150081, China.
| | - Yingran Dong
- National Key Disciplines of Nutrition and Food Hygiene, Department of Nutrition and Food Hygiene, School of Public Health, Harbin Medical University, Harbin 150081, China.
| | - Qingli Yu
- National Key Disciplines of Nutrition and Food Hygiene, Department of Nutrition and Food Hygiene, School of Public Health, Harbin Medical University, Harbin 150081, China.
| | - Feng Dong
- National Key Disciplines of Nutrition and Food Hygiene, Department of Nutrition and Food Hygiene, School of Public Health, Harbin Medical University, Harbin 150081, China.
| | - Zixiang Li
- National Key Disciplines of Nutrition and Food Hygiene, Department of Nutrition and Food Hygiene, School of Public Health, Harbin Medical University, Harbin 150081, China.
| | - Lina Fan
- National Key Disciplines of Nutrition and Food Hygiene, Department of Nutrition and Food Hygiene, School of Public Health, Harbin Medical University, Harbin 150081, China.
| | - Maoqing Wang
- National Key Disciplines of Nutrition and Food Hygiene, Department of Nutrition and Food Hygiene, School of Public Health, Harbin Medical University, Harbin 150081, China.
| | - Chenghai Peng
- Department of Cardiology, The Fourth Affiliated Hospital, Harbin Medical University, Harbin, 150081, China.
| | - Fan Wang
- Department of Epidemiology, School of Public Health, Harbin Medical University, Harbin, China.
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Heikkilä AR, Lapinleimu H, Virtanen I, Rönnlund H, Raaska H, Elovainio M. Changes in objectively measured sleep among internationally adopted children in 1-year follow-up during the first years in new families. Front Pediatr 2022; 10:948010. [PMID: 36160771 PMCID: PMC9500395 DOI: 10.3389/fped.2022.948010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 08/18/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Psychosocial risks and environmental changes experienced by internationally adopted children may predict sleep problems, which are incidentally among the main concerns of adoptive parents. Several questionnaire studies have found sleep of internationally adopted children to be problematic, but none of those used an objective measure in a controlled study. OBJECTIVE To determine whether the objectively recorded sleep of internationally adopted children is worse than their controls who are living with their biological parents. METHODS To this case-control part of the Finnish Adoption Study, we recruited children who were adopted internationally to Finland between October 2012 and December 2016. Simultaneously, control children were recruited from 16 daycare centers. To assess sleep in children, actigraphy recordings were made twice, 1 year apart, between December 2013 and April 2018. In the adopted group, the first assessment took place 10 months after they had arrived in their families. The associations between adoption status and sleep parameters were analyzed using linear mixed modeling and adjusted for multiple potential confounders, including child age. RESULTS Seventy-eight internationally adopted children (boys 64%) aged 1-7 years and 99 controls (boys 53%) aged 2-6 years attended the first sleep recording. The recordings showed that the internationally adopted children slept longer (B = 0.48, 95% CI 0.23-0.73, P < 0.001) than the controls. There were no significant differences in sleep fragmentation or sleep efficiency between the groups. During the 1-year follow-up, the sleep patterns of the adopted children approached those of the controls. CONCLUSIONS The internationally adopted children spent more time in bed and slept more than their control children in both recordings. However, their sleep patterns were not very different from those of their peers and the differences appeared to vanish during the first years in their new family.
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Affiliation(s)
- Anna-Riitta Heikkilä
- Department of Pediatrics, University of Helsinki, Helsinki, Finland.,Department of Pediatrics, Helsinki University Hospital, Helsinki, Finland
| | - Helena Lapinleimu
- Department of Paediatrics and Adolescent Medicine, University of Turku, Turku, Finland.,Department of Paediatrics and Adolescent Medicine, Turku University Hospital, Turku, Finland
| | - Irina Virtanen
- Department of Clinical Neurophysiology, Turku University Hospital, Turku, Finland.,Department of Clinical Neurophysiology, University of Turku, Turku, Finland
| | - Hanni Rönnlund
- Department of Paediatrics and Adolescent Medicine, University of Turku, Turku, Finland.,Kaarina Health Center, Kaarina, Finland
| | - Hanna Raaska
- Department of Child Psychiatry, Helsinki University Hospital, Helsinki, Finland
| | - Marko Elovainio
- Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland.,Department of Health Services Research, National Institute for Health and Welfare, Helsinki, Finland
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Ayiku L, Levay P, Hudson T. The NICE OECD countries' geographic search filters: Part 1-methodology for developing the draft MEDLINE and Embase (Ovid) filters. J Med Libr Assoc 2021; 109:258-266. [PMID: 34285668 PMCID: PMC8270368 DOI: 10.5195/jmla.2021.978] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Objective: There are no existing validated search filters for the group of 37 Organisation for Economic Co-operation and Development (OECD) countries. This study describes how information specialists from the United Kingdom's National Institute for Health and Care Excellence (NICE) developed and evaluated novel OECD countries’ geographic search filters for MEDLINE and Embase (Ovid) to improve literature search effectiveness for evidence about OECD countries. Methods: We created the draft filters using an alternative approach to standard filter construction. They are composed entirely of geographic subject headings and are designed to retain OECD country evidence by excluding non-OECD country evidence using the NOT Boolean operator. To evaluate the draft filters’ effectiveness, we used MEDLINE and Embase literature searches for three NICE guidelines that retrieved >5,000 search results. A 10% sample of the excluded references was screened to check that OECD country evidence was not inadvertently excluded. Results: The draft MEDLINE filter reduced results for each NICE guideline by 9.5% to 12.9%. In Embase, search results were reduced by 10.7% to 14%. Of the sample references, 7 of 910 (0.8%) were excluded inadvertently. These references were from a guideline about looked-after minors that concerns both OECD and non-OECD countries. Conclusion: The draft filters look promising—they reduced search result volumes while retaining most OECD country evidence from MEDLINE and Embase. However, we advise caution when using them in topics about both non-OECD and OECD countries. We have created final versions of the search filters and will validate them in a future study.
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Affiliation(s)
- Lynda Ayiku
- , Information Specialist, Information Services team, National Institute for Health and Care Excellence (NICE), United Kingdom
| | - Paul Levay
- , Information Specialist, Information Services National Institute for Health and Care Excellence (NICE), United Kingdom
| | - Thomas Hudson
- , Information Specialist, Information Services, National Institute for Health and Care Excellence (NICE), United Kingdom
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Ceccarelli M, Chiappini E, Arancio R, Zaffaroni M, La Placa S, D'Andrea M, de Waure C, Da Riol RM, Valentini P. Vitamin D deficiency in a population of migrant children: an Italian retrospective cross-sectional multicentric study. Eur J Public Health 2021; 30:551-556. [PMID: 31598638 DOI: 10.1093/eurpub/ckz182] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Vitamin D is a hot topic in the scientific community. Its deficiency and the implications for the children's health became increasingly discussed during the last 20 years. The main aim of this retrospective study was to determinate the prevalence of vitamin D metabolism disorders in a population of adopted children and their risk factors. METHODS We gathered data from 2140 children observed in five different National Working Group for the Migrant Children of the Italian Society of Pediatrics centers, variously located in Italy. Serum 25-hydroxy (OH)-D concentration was used to determine every child's vitamin D status, defined as severely deficient (serum 25-OH-D < 10 ng/ml), moderately deficient (serum 25-OH-D {≥10 ng/ml U < 20 ng/ml}), mildly deficient (serum 25-OH-D {≥20 ng/ml U < 30 ng/ml}) and normal (serum 25-OH-D ≥ 30 ng/ml). RESULTS Mean value of serum 25-OH-D was 22.7 ng/ml (SD ± 12.1). Vitamin D status was deemed as normal in 483 (22.6%) children, mildly deficient in 718 (33.6%) children, moderately deficient in 730 (34.1%) children and severely deficient in 209 (9.8%) children. CONCLUSIONS A very high percentage of migrant children is affected by hypovitaminosis D, with a strong association with age, geographic origin, season of blood sample collection and time spent in Italy after the arrival. This finding highlights the need for corrective measures. However, these measures cannot be applied without increasing the access of migrant populations to healthcare services.
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Affiliation(s)
- Manuela Ceccarelli
- Department of Clinical and Experimental Medicine, Unit of Infectious Diseases, University of Messina, Messina, Italy
| | - Elena Chiappini
- Department of Health Sciences, "Meyer" Children University Hospital, University of Florence, Florence, Italy
| | | | - Mauro Zaffaroni
- Unit of Pediatrics, "Maggiore" University Hospital, Novara, Italy
| | - Simona La Placa
- Department of Health Promotion Sciences and Mother and Child Sciences "G. D'Alessandro", "P. Giaccone" University Hospital, Palermo, Italy
| | - Marianna D'Andrea
- Public Health Institute, Catholic University of Sacred Heart, Rome, Italy
| | - Chiara de Waure
- Department of Experimental Medicine, University of Perugia, Perugia, Italy
| | - Rosalia Maria Da Riol
- Center of Regional Coordination for Rare Diseases, "Santa Maria della Misericordia" University Hospital, Udine, Italy
| | - Piero Valentini
- Department of Woman and Child Health, Fondazione Policlinico Universitario "A. Gemelli", Università Cattolica del Sacro Cuore, Rome, Italy
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8
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Goutines J, Miller LC, Sorge F. Infections and nutritional status of internationally adopted children in France. Acta Paediatr 2021; 110:1359-1365. [PMID: 33040353 DOI: 10.1111/apa.15612] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Revised: 08/16/2020] [Accepted: 10/05/2020] [Indexed: 11/28/2022]
Abstract
AIM In the context of global changes in the epidemiology of internationally adopted children (IACs), the prevalence of infectious diseases and nutritional impairment has not been recently reviewed. Moreover, in France, these characteristics of the children according to their continents of origin and preadoption special needs (SN) status have been incompletely explored. METHODS Demographic, infectious data and anthropometric of all the newly arrived IACs seen in a specialised clinic for international adoptees in Paris, France, between 2013 and 2016 were retrospectively reviewed. RESULTS Three hundred and fifty IACs [mean age: 3.4 years (±2.7), 204 male] from 39 countries were included; 55% had SN. Ninety-nine patients had at least one infection, 42% being classified as 'serious' (chronic viral infection, tuberculosis or malaria). Chronic viral infection was diagnosed in 26 (7%) patients (HIV: 16 cases, HBV: 5, HCV: 4) and affected especially Asian children (P < .001). The prevalence of stunting, underweight, wasting and microcephaly was, respectively, 25%, 22%, 15% and 8%. Stunting was more frequent in children from Eastern Europe (P = .02), while SN children were more often microcephalic or underweight (respectively P = .03 and .02). CONCLUSION The prevalence of serious infections and nutritional impairment remains high in IACs and requires early detection and careful follow-up.
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Affiliation(s)
- Juliette Goutines
- Department of Paediatrics Necker‐Enfants‐Malades University Hospital Paris France
| | - Laurie C. Miller
- Department of Paediatrics Necker‐Enfants‐Malades University Hospital Paris France
| | - Frederic Sorge
- Department of Paediatrics Necker‐Enfants‐Malades University Hospital Paris France
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9
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Intestinal parasites may be associated with later behavioral problems in internationally adopted children. PLoS One 2021; 16:e0245786. [PMID: 33493225 PMCID: PMC7833226 DOI: 10.1371/journal.pone.0245786] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 12/29/2020] [Indexed: 01/09/2023] Open
Abstract
Aim At arrival in new home country, internationally adopted children often have intestinal parasites. International adoptees also exhibit more behavioral problems than their biological peers. We examined whether intestinal parasite infections in international adoptees on arrival in Finland are associated with their later behavioral and emotional problems. Methods Data for this study were sourced from the Finnish Adoption Study (FinAdo) based on parental questionnaires for all internationally adopted children under 18 years (n = 1450) who arrived in Finland from 1985 to 2007. A total of 1293 families provided sufficient information on the adoptee’s background, parasitic status on arrival, and behavioral symptoms at the median time of 5 years after arrival (mean age = 7.8 years). Behavioral and emotional disorders were evaluated with the Child Behavior Checklist (CBCL). Statistical analyses were conducted using linear regression. Results Of the 1293 families, parents of 206 adoptive children reported intestinal parasites in their adopted children on arrival. Parasite-infected children had subsequently higher CBCL problem scores than the children without parasites (p < 0.001). The association between intestinal parasites and later behavioral problems was stronger than that between intestinal parasites and any other factors measured in this study, except disability. Limitations The control group was naturally provided by the adopted children without parasite infections, but we could not compare the adopted children to non-adopted children without a defined parasite infection. We were unable to specify the effects associated with a specific parasite type. It was not possible either to include multiple environmental factors that could have been associated with behavioral problems in the models, which indicated only modest explanatory values. Conclusions In this study, intestinal parasite infections in early childhood may be associated with children’s later psychological wellbeing, even in children who move to a country with a low prevalence of parasites. Our findings may support further developments pertaining to the gut-brain theory.
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Ivey R, Kerac M, Quiring M, Dam HT, Doig S, DeLacey E. The Nutritional Status of Individuals Adopted Internationally as Children: A Systematic Review. Nutrients 2021; 13:245. [PMID: 33467102 PMCID: PMC7829835 DOI: 10.3390/nu13010245] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 01/12/2021] [Accepted: 01/14/2021] [Indexed: 12/12/2022] Open
Abstract
Since 1955, international adoption has been a way of finding homes for children who have been orphaned or abandoned. We aimed to describe the nutritional status of individuals adopted internationally and their long-term nutritional and health outcomes. We searched four databases for articles published from January 1995 to June 2020, which included information on anthropometric or micronutrient status of children adopted internationally (CAI). Mean Z-scores on arrival to adoptive country ranged from -2.04 to -0.31 for weight for age; -0.94 to 0.39 for weight for height; -0.7 to 0 for body mass index; -1.89 to -0.03 for height for age; -1.43 to 0.80 for head circumference for age. Older children, those adopted from institutionalized care or with underlying disability, were more likely to be malnourished. Though long-term data was scarce, mean Z-scores post-adoption ranged from -0.59 to 0.53 for weight for age; -0.31 to 1.04 for weight for height; 0.39 to 1.04 for body mass index; -1.09 to 0.58 for height for age; -0.06 to 1.23 for head circumference for age. We conclude that though CAI are at high risk of malnutrition at baseline, marked catch-up growth is possible, including for those older than two years of age on arrival. This has implications not only for CAI but for the wider population of malnourished children worldwide. Research on how to optimize catch-up growth is a priority.
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Affiliation(s)
- Richard Ivey
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, University of London, London WC1E 7HU, UK; (M.K.); (E.D.)
- Centre for Maternal, Adolescent, Reproductive & Child Health (MARCH), London School of Hygiene & Tropical Medicine, University of London, London WC1E 7HU, UK
| | - Marko Kerac
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, University of London, London WC1E 7HU, UK; (M.K.); (E.D.)
- Centre for Maternal, Adolescent, Reproductive & Child Health (MARCH), London School of Hygiene & Tropical Medicine, University of London, London WC1E 7HU, UK
| | - Michael Quiring
- Holt International, Eugene, OR 97401, USA; (M.Q.); (H.T.D.); (S.D.)
| | - Hang T. Dam
- Holt International, Eugene, OR 97401, USA; (M.Q.); (H.T.D.); (S.D.)
| | - Susie Doig
- Holt International, Eugene, OR 97401, USA; (M.Q.); (H.T.D.); (S.D.)
| | - Emily DeLacey
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, University of London, London WC1E 7HU, UK; (M.K.); (E.D.)
- Centre for Maternal, Adolescent, Reproductive & Child Health (MARCH), London School of Hygiene & Tropical Medicine, University of London, London WC1E 7HU, UK
- Holt International, Eugene, OR 97401, USA; (M.Q.); (H.T.D.); (S.D.)
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11
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Li D, Ding Z, Gui M, Hou Y, Xie K. Metabolic Enhancement of Glycolysis and Mitochondrial Respiration Are Essential for Neuronal Differentiation. Cell Reprogram 2020; 22:291-299. [DOI: 10.1089/cell.2020.0034] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Affiliation(s)
- Ding Li
- College of Life Sciences and Chemistry, Hunan University of Technology, Zhuzhou, China
| | - Zhexu Ding
- College of Life Sciences and Chemistry, Hunan University of Technology, Zhuzhou, China
| | - Manjin Gui
- College of Life Sciences and Chemistry, Hunan University of Technology, Zhuzhou, China
| | - Yanmei Hou
- Ausnutria Hyproca Nutrition Co. Ltd., Changsha, China
| | - Kui Xie
- College of Life Sciences and Chemistry, Hunan University of Technology, Zhuzhou, China
- Ausnutria Hyproca Nutrition Co. Ltd., Changsha, China
- Institute of Biomedicine, National Engineering Research Center of Genetic Medicine, College of Life Science and Technology, Jinan University, Guangzhou, China
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12
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McCann S, Perapoch Amadó M, Moore SE. The Role of Iron in Brain Development: A Systematic Review. Nutrients 2020; 12:E2001. [PMID: 32635675 PMCID: PMC7400887 DOI: 10.3390/nu12072001] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 06/26/2020] [Accepted: 07/01/2020] [Indexed: 01/12/2023] Open
Abstract
One-third of children falter in cognitive development by pre-school age. Iron plays an important role in many neurodevelopmental processes, and animal studies suggest that iron sufficiency in pregnancy and infancy is particularly important for neurodevelopment. However, it is not clear whether iron deficiency directly impacts developmental outcomes, and, if so, whether impact differs by timing of exposure or developmental domain. We searched four databases for studies on iron deficiency or iron supplementation in pregnancy, or at 0-6 months, 6-24 months, or 2-4 years of age. All studies included neurodevelopmental assessments in infants or children up to 4 years old. We then qualitatively synthesized the literature. There was no clear relationship between iron status and developmental outcomes across any of the time windows or domains included. We identified a large quantity of low-quality studies, significant heterogeneity in study design and a lack of research focused on pregnancy and early infancy. In summary, despite good mechanistic evidence for the role of iron in brain development, evidence for the impact of iron deficiency or iron supplementation on early development is inconsistent. Further high-quality research is needed, particularly within pregnancy and early infancy, which has previously been neglected.
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Affiliation(s)
- Samantha McCann
- Department of Women and Children’s Health, King’s College London, London SE1 7EH, UK;
- Medical Research Council Unit, The Gambia at the London School of Hygiene and Tropical Medicine, Fajara, P.O. Box 273, Banjul, The Gambia
| | - Marta Perapoch Amadó
- Department of Medical Physics and Biomedical Engineering, University College London, London WC1E 6BT, UK;
| | - Sophie E. Moore
- Department of Women and Children’s Health, King’s College London, London SE1 7EH, UK;
- Medical Research Council Unit, The Gambia at the London School of Hygiene and Tropical Medicine, Fajara, P.O. Box 273, Banjul, The Gambia
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13
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Leroy JL, Frongillo EA, Dewan P, Black MM, Waterland RA. Can Children Catch up from the Consequences of Undernourishment? Evidence from Child Linear Growth, Developmental Epigenetics, and Brain and Neurocognitive Development. Adv Nutr 2020; 11:1032-1041. [PMID: 32584399 PMCID: PMC7360439 DOI: 10.1093/advances/nmaa020] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 02/04/2020] [Accepted: 02/12/2020] [Indexed: 11/13/2022] Open
Abstract
Recovery from nutritionally induced height deficits continues to garner attention. The current literature on catch-up growth, however, has 2 important limitations: wide-ranging definitions of catch-up growth are used, and it remains unclear whether children can recover from the broader consequences of undernutrition. We addressed these shortcomings by reviewing the literature on the criteria for catch-up in linear growth and on the potential to recover from undernutrition early in life in 3 domains: linear growth, developmental epigenetics, and child brain and neurocognitive development. Four criteria must be met to demonstrate catch-up growth in height: after a period in which a growth-inhibiting condition (criterion 1) causes a reduction in linear growth velocity (criterion 2), alleviation of the inhibiting condition (criterion 3) leads to higher-than-normal velocity (criterion 4). Accordingly, studies that are observational, do not use absolute height, or have no alleviation of an inhibiting condition cannot be used to establish catch-up growth. Adoption and foster care, which provide dramatic improvements in children's living conditions not typically attained in nutrition interventions, led to some (but incomplete) recovery in linear growth and brain and neurocognitive development. Maternal nutrition around the time of conception was shown to have long-term (potentially permanent) effects on DNA methylation in the offspring. Undernourishment early in life may thus have profound irreversible effects. Scientific, program, and policy efforts should focus on preventing maternal and child undernutrition rather than on correcting its consequences or attempting to prove they can be corrected.
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Affiliation(s)
- Jef L Leroy
- Poverty, Health, and Nutrition Division, International Food Policy Research Institute, Washington, DC, USA
| | - Edward A Frongillo
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, SC, USA
| | - Pragya Dewan
- Poverty, Health, and Nutrition Division, International Food Policy Research Institute, Washington, DC, USA
| | - Maureen M Black
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD, USA
- RTI International, Research Triangle Park, NC, USA
| | - Robert A Waterland
- USDA/Agricultural Research Service Children's Nutrition Research Center, Departments of Pediatrics and Molecular & Human Genetics, Baylor College of Medicine, Houston, TX, USA
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14
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Cheatham CL. Nutritional Factors in Fetal and Infant Brain Development. ANNALS OF NUTRITION AND METABOLISM 2020; 75 Suppl 1:20-32. [PMID: 32564018 DOI: 10.1159/000508052] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 02/12/2020] [Indexed: 11/19/2022]
Abstract
Fetal and infant brain development determine the trajectory of the organism across the lifespan. Optimal maternal and infant nutrition during the period of rapid brain development is vital to the integrity of the neural substrate for subsequent lifelong functions. The goal of this review is to educate the reader on the effects of fetal and infant nutrition on the developing human brain. A review of the literature reveals 6 nutrients that have been studied with respect to maternal nutrition and subsequent offspring brain development: folate, iodine, iron, vitamin D, choline, and docosahexaenoic acid (DHA; 22:6n-3). The research is discussed with a focus on the timing of nutrient needs (preconception, prenatally, and postnatally) as well as potential confounding and unobserved variables.
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Affiliation(s)
- Carol L Cheatham
- Department of Psychology and Neuroscience and Nutrition Research Institute, University of North Carolina at Chapel Hill, Kannapolis, North Carolina, USA,
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15
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Moody EC, Colicino E, Wright RO, Mupere E, Jaramillo EG, Amarasiriwardena C, Cusick SE. Environmental exposure to metal mixtures and linear growth in healthy Ugandan children. PLoS One 2020; 15:e0233108. [PMID: 32413070 PMCID: PMC7228047 DOI: 10.1371/journal.pone.0233108] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 04/28/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Stunting is an indicator of poor linear growth in children and is an important public health problem in many countries. Both nutritional deficits and toxic exposures can contribute to lower height-for-age Z-score (HAZ) and stunting (HAZ < -2). OBJECTIVES In a community-based cross-sectional sample of 97 healthy children ages 6-59 months in Kampala, Uganda, we examined whether exposure to Pb, As, Cd, Se, or Zn were associated with HAZ individually or as a mixture. METHODS Blood samples were analyzed for a mixture of metals, which represent both toxins and essential nutrients. The association between HAZ and metal exposure was tested using multivariable linear regression and Weighted Quantile Sum (WQS) regression, which uses mixtures of correlated exposures as a predictor. RESULTS There were 22 stunted children in the sample, mean HAZ was -0.74 (SD = 1.84). Linear regression showed that Pb (β = -0.80, p = 0.021) and Se (β = 1.92, p = 0.005) were significantly associated with HAZ. The WQS models separated toxic elements with a presumed negative effect on HAZ (Pb, As, Cd) from essential nutrients with presumed positive effect on HAZ (Se and Zn). The toxic mixture was significantly associated with lower HAZ (β = -0.47, p = 0.03), with 62% of the effect from Pb. The nutrient WQS index did not reach statistical significance (β = -0.47, p = 0.16). DISCUSSION Higher blood lead and lower blood selenium level were both associated with lower HAZ. The significant associations by linear regression were reinforced by the WQS models, although not all associations reached statistical significance. These findings suggest that healthy children in this neighborhood of Kampala, Uganda, who have a high burden of toxic exposures, may experience detrimental health effects associated with these exposures in an environment where exposure sources are not well characterized.
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Affiliation(s)
- Emily C. Moody
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Elena Colicino
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Robert O. Wright
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Ezekiel Mupere
- Department of Paediatrics & Child Health, Mulago Hospital, Kampala, Uganda
| | - Ericka G. Jaramillo
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Chitra Amarasiriwardena
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Sarah E. Cusick
- Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota, United States of America
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16
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Fetene DM, Betts KS, Alati R. The role of maternal prenatal thyroid function on offspring depression: Findings from the ALSPAC cohort. Dev Psychopathol 2020; 32:189-196. [PMID: 30688193 DOI: 10.1017/s0954579418001657] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Maternal thyroid dysfunction during pregnancy may contribute to offspring neurobehavioral disorders. In this paper, we investigate the relationship between maternal thyroid function during pregnancy and offspring depression and anxiety. Data were taken from the Avon Longitudinal Study of Parents and Children. A total of 2,920 mother-child pairs were included. Thyroid-stimulating hormone levels, free thyroxine (FT4), and thyroid peroxidase antibodies were assessed during the first trimester of pregnancy because maternal supply is the only source of thyroid hormone for the fetus during the first 12 weeks of gestation. Child symptoms of depression and anxiety were assessed using the Development and Well-Being Assessment at ages 7.5 and 15 years. The odds of presenting with depression and anxiety were estimated using the generalized estimating equation. The level of FT4 during the first trimester of pregnancy was associated with child depression combined at ages 7.5 and 15 (odds ratio = 1.21, 95% confidence interval [1.00, 1.14]. An increase of 1 standard deviation of FT4 during pregnancy increased the odds of child depression by 28% after adjustment made for potential confounders. No association was found among maternal levels of thyroid-stimulating hormone, FT4, and thyroid peroxidase antibodies and childhood anxiety. In conclusion, increased levels of FT4 during the first trimester of pregnancy appear be linked to greater risk of offspring depression.
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Affiliation(s)
- Dagnachew Muluye Fetene
- Institute for Social Science Research, University of Queensland, Brisbane, Australia
- College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- School of Public Health, University of Queensland, Brisbane, Australia
| | - Kim S Betts
- Institute for Social Science Research, University of Queensland, Brisbane, Australia
| | - Rosa Alati
- Institute for Social Science Research, University of Queensland, Brisbane, Australia
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17
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Keating EM, Sanders J, Ngo K, Mohapi EQ, Mandalakas AM. Development of a Tool for Health Screening and Assessment in Orphanages in Lesotho. Am J Trop Med Hyg 2020; 100:1290-1293. [PMID: 30915954 DOI: 10.4269/ajtmh.18-0853] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
In low- and middle-income countries that have high burdens of disease, simple interventions such as health screenings can have a significant impact on health outcomes. Among vulnerable children, orphans in particular, deaths are often caused by conditions preventable through early identification and provision of basic health and nutritional needs. After consulting local preventative care guidelines and medical providers, a health screening tool for use in orphanages was created. This tool was used to screen children in two orphanages in Lesotho. Overall, the tool was found to be easy, efficient, and valuable in identifying both preventable and immediately treatable conditions in orphans. As a result, orphans with long-term medical needs were linked to community-based providers by developing individualized care plans in collaboration with orphanage colleagues. This preventative tool offers a screening strategy that directly aligns with the United Nations Agency for Development's Sustainable Development Goals and helps to advance the goal of universal health coverage.
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Affiliation(s)
- Elizabeth M Keating
- Division of Pediatric Emergency Medicine, University of Utah, Salt Lake City, Utah.,Department of Pediatrics, Baylor College of Medicine, Houston, Texas.,Baylor College of Medicine Children's Foundation Lesotho, Maseru, Lesotho
| | - Jill Sanders
- Baylor College of Medicine Children's Foundation Lesotho, Maseru, Lesotho.,Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | | | - Edith Q Mohapi
- Baylor College of Medicine Children's Foundation Lesotho, Maseru, Lesotho
| | - Anna M Mandalakas
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas
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18
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Health status and nutritional development of adopted Ethiopian children living in southern Spain: A prospective cohort study. Nutrition 2019; 71:110611. [PMID: 31785516 DOI: 10.1016/j.nut.2019.110611] [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: 06/09/2019] [Revised: 08/12/2019] [Accepted: 09/01/2019] [Indexed: 11/23/2022]
Abstract
OBJECTIVE The first aim of this study was to evaluate the health status and anthropometrical development of adopted children from Ethiopia living in southern Spain. A second aim was to evaluate the association between these parameters and adherence to the Mediterranean dietary pattern. METHODS The study sample included 53 adopted children from Ethiopia and a matched sample of 54 native-born children. A physical examination of the children, including height and weight, was conducted in Ethiopia at the time of entry into the adoption process. Height and weight were re-measured at the first day of adoption and 6, 12, and 24 mo after adoption. After 2 y of follow-up, another physical examination was performed, including the KIDMED test, to measure adherence to the Mediterranean diet. RESULTS Skin and digestive conditions were the most prevalent disorders in Ethiopian children before adoption and at the end of follow-up. Baseline anthropometric characteristics indicated a low wasting prevalence (7.5%); however, stunted growth was more prevalent (35.8%). After 6 mo, the weight-for-age of Ethiopian children was restored (change from baseline P < 0.001), and not significantly different from the Spanish children at 1-y after adoption. Height-for-age also increased from baseline (P < 0.001. A higher KIDMED score was associated with increased weight-for-age (r = 0.279; P = 0.045) and height-for-age (r = 0.385; P = 0.004). CONCLUSIONS This prospective study of adopted Ethiopian children confirmed a rapid growth development that occurred from the beginning of the adoption process and continued after the 2-y of follow-up. A higher adherence to the Mediterranean diet was associated with better growth development, which reinforces the importance of a balanced and adequate diet in growing children.
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19
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Castillo Castejón O, González I, Prieto E, Pérez T, Pablo LE, Pueyo V. Visual cognitive impairments in children at risk of prenatal alcohol exposure. Acta Paediatr 2019; 108:2222-2228. [PMID: 31206198 DOI: 10.1111/apa.14904] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 05/06/2019] [Accepted: 06/13/2019] [Indexed: 11/29/2022]
Abstract
AIM To evaluate the relationship between visoperception and anthropometric features related to prenatal alcohol exposure. METHODS We compared two cohorts of infants aged between 5 and 18 years. Seventy-nine children, adopted from Eastern Europe, were included in the study group. The control group was formed by age and gender matched children born in Spain. All children underwent a full ophthalmologic assessment and standardised testing of visual cognitive skills. RESULTS Adoptees presented worse visual motor and visual perceptual outcomes in all skills compared with control subjects, with statistically significant difference in test of visual perceptual skills (TVPS) global centile (50.3 vs 66.8; P = 0.001), spatial relationships (64.6 vs 81.9; P = 0.004) and visual figure-ground (52.1 vs 74.1; P = 0.002) tasks. Face recognition was as well significantly worse in adopted children (42.4 vs 57.1; P = 0.009). Twenty-one adopted children (26.6%) had sentinel finding for foetal alcohol spectrum disorders (FASD). Main facial features related to FASD correlated with visual cognitive outcomes. Of the adopted children, those diagnosed of FASD showed incrementally worse visual perceptual and visual motor outcomes (TVPS global centile = 36.86, P = 0.001; TVAS = 10.38, P = 0.002). CONCLUSION Children adopted from eastern Europe are at increased risk of visual perceptual disabilities, especially those with sentinel findings of foetal alcohol syndrome disorders.
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Affiliation(s)
- Olimpia Castillo Castejón
- Ophthalmology Department Aragon Institute for Health Research (IIS Aragón) Miguel Servet University Hospital Zaragoza Spain
| | - Inmaculada González
- Ophthalmology Department Aragon Institute for Health Research (IIS Aragón) Miguel Servet University Hospital Zaragoza Spain
| | - Esther Prieto
- Ophthalmology Department Aragon Institute for Health Research (IIS Aragón) Miguel Servet University Hospital Zaragoza Spain
| | - Teresa Pérez
- Ophthalmology Department Aragon Institute for Health Research (IIS Aragón) Miguel Servet University Hospital Zaragoza Spain
| | - Luis E. Pablo
- Ophthalmology Department Aragon Institute for Health Research (IIS Aragón) Miguel Servet University Hospital Zaragoza Spain
| | - Victoria Pueyo
- Ophthalmology Department Aragon Institute for Health Research (IIS Aragón) Miguel Servet University Hospital Zaragoza Spain
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20
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Vandenplas Y, Rakhecha A, Edris A, Shaaban B, Tawfik E, Bashiri FA, AlAql F, Alsabea H, Haddad J, El Barbary M, Salah M, Abouelyazid M, Kumar M, Alsaad S. Physicians' Understanding of Nutritional Factors Determining Brain Development and Cognition in the Middle East and Africa. Pediatr Gastroenterol Hepatol Nutr 2019; 22:536-544. [PMID: 31777719 PMCID: PMC6856510 DOI: 10.5223/pghn.2019.22.6.536] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 07/20/2019] [Indexed: 01/24/2023] Open
Abstract
PURPOSE Proper nutrition is essential for brain development during infancy, contributing to the continued development of cognitive, motor, and socio-emotional skills throughout life. Considering the insufficient published data in the Middle East and North Africa, experts drafted a questionnaire to assess the opinions and knowledge of physicians on the impact of nutrition on brain development and cognition in early life. METHODS The questionnaire consisted of two parts: The first focused on the responders' demographic and professional characteristics and the second questioned the role of nutrition in brain development and cognition. Descriptive statistics were used to summarize respondents' characteristics and their responses to questions. RESULTS A total of 1,500 questionnaires were distributed; 994 physicians responded. The majority of the surveyed physicians (64.4%) felt that nutrition impacts brain development in early childhood (0-4 years), with almost 90% of physicians agreeing/strongly agreeing that preventing iron, zinc, and iodine deficiency would improve global intelligence quotient. The majority of physicians (83%) agreed that head circumference was the most important measure of brain development. The majority of physicians (68.9%) responded that the period from the last trimester until 18 months postdelivery was crucial for brain growth and neurodevelopment, with 76.8% believing that infants breast-fed by vegan mothers have an increased risk of impaired brain development. CONCLUSION The results of this study show that practicing physicians significantly agree that nutrition plays an important role in brain and cognitive development and function in early childhood, particularly during the last trimester until 18 months postdelivery.
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Affiliation(s)
- Yvan Vandenplas
- KidZ Health Castle, UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | | | - Amira Edris
- Department of Pediatrics, Kasr Al Ainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Bassel Shaaban
- Departments of Pediatric and NICU, Mediclinic Airport Road Hospital, Abu Dhabi, UAE
| | - Eslam Tawfik
- Department of Pediatric, Sheikh Khalifa Medical City, Abu Dhabi, UAE
| | - Fahad A Bashiri
- Division of Neurology, Department of Pediatrics, College of Medicine & King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - Fahd AlAql
- King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia
| | | | - Joseph Haddad
- Department of Pediatrics, Saint George Hospital, University Medical Center, Balamand University, Beirut, Lebanon
| | - Mohammed El Barbary
- Department of Pediatrics and Neonatology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | | | | | - Mudit Kumar
- Consultant Pediatrician, Mediclinic Parkview Hospital, Dubai, UAE
| | - Sulaiman Alsaad
- Department of Pediatrics, Neonatal Intensive Care Unit, Kuwait Oil Company Hospital, Al Ahmadi City, Kuwait
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21
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Jones VF, Schulte EE, Springer S, Szilagyi MA, Forkey H, Greiner MV, Harmon D, Lee P, Nalven LM, Sagor LD, Thackery JD, Waite D, Zetley LW. Comprehensive Health Evaluation of the Newly Adopted Child. Pediatrics 2019; 143:peds.2019-0657. [PMID: 31036671 DOI: 10.1542/peds.2019-0657] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Children who join families through the process of adoption, whether through a domestic or international route, often have multiple health care needs. Pediatricians and other health care personnel are in a unique position to guide families in achieving optimal health for the adopted children as families establish a medical home. Shortly after placement in an adoptive home, it is recommended that children have a timely comprehensive health evaluation to provide care for known medical needs and identify health issues that are unknown. It is important to begin this evaluation with a review of all available medical records and pertinent verbal history. A complete physical examination then follows. The evaluation should also include diagnostic testing based on findings from the history and physical examination as well as the risks presented by the child's previous living conditions. Age-appropriate screenings may include, but are not limited to, newborn screening panels and hearing, vision, dental, and formal behavioral and/or developmental screenings. The comprehensive assessment may occur at the time of the initial visit to the physician after adoptive placement or can take place over several visits. Adopted children can be referred to other medical specialists as deemed appropriate. The Council on Adoption, Foster Care, and Kinship Care is a resource within the American Academy of Pediatrics for physicians providing care for children who are being adopted.
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Affiliation(s)
- Veronnie Faye Jones
- Division of General Pediatrics, Department of Pediatrics, School of Medicine, University of Louisville, Louisville, Kentucky; and
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23
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Iron as a model nutrient for understanding the nutritional origins of neuropsychiatric disease. Pediatr Res 2019; 85:176-182. [PMID: 30341413 PMCID: PMC6353667 DOI: 10.1038/s41390-018-0204-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 10/04/2018] [Accepted: 10/04/2018] [Indexed: 12/19/2022]
Abstract
Adequate nutrition during the pre- and early-postnatal periods plays a critical role in programming early neurodevelopment. Disruption of neurodevelopment by nutritional deficiencies can result not only in lasting functional deficits, but increased risk of neuropsychiatric disease in adulthood. Historical periods of famine such as the Dutch Hunger Winter and the Chinese Famine have provided foundational evidence for the long-term effects of developmental malnutrition on neuropsychiatric outcomes. Because neurodevelopment is a complex process that consists of many nutrient- and brain-region-specific critical periods, subsequent clinical and pre-clinical studies have aimed to elucidate the specific roles of individual macro- and micronutrient deficiencies in neurodevelopment and neuropsychiatric pathologies. This review will discuss developmental iron deficiency (ID), the most common micronutrient deficiency worldwide, as a paradigm for understanding the role of early-life nutrition in neurodevelopment and risk of neuropsychiatric disease. We will review the epidemiologic data linking ID to neuropsychiatric dysfunction, as well as the underlying structural, cellular, and molecular mechanisms that are thought to underlie these lasting effects. Understanding the mechanisms driving lasting dysfunction and disease risk is critical for development and implementation of nutritional policies aimed at preventing nutritional deficiencies and their long-term sequelae.
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24
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Silver MK, Arain AL, Shao J, Chen M, Xia Y, Lozoff B, Meeker JD. Distribution and predictors of 20 toxic and essential metals in the umbilical cord blood of Chinese newborns. CHEMOSPHERE 2018; 210:1167-1175. [PMID: 30208542 PMCID: PMC6179361 DOI: 10.1016/j.chemosphere.2018.07.124] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 07/12/2018] [Accepted: 07/22/2018] [Indexed: 05/12/2023]
Abstract
Early-life exposure to heavy metals and/or trace metal imbalances can have negative developmental effects. Here we sought to characterize exposure profiles for 20 heavy metals and trace elements in umbilical cord blood plasma and identify demographic predictors of exposure. Twenty metals were measured in cord plasma from 357 Chinese infants using ICP-MS. Relationships between demographic variables and metals were analyzed using generalized linear models and logistic regression. Ten metals (antimony [Sb], cobalt [Co], cesium [Cs], copper [Cu], lead [Pb], molybdenum [Mo], rubidium [Rb], selenium [Se], strontium [Sr], titanium [Ti], zinc [Zn]) were detected in all samples. Season of birth was the strongest predictor of metals in cord blood across analyses. Infants born in the spring had 0.1-0.2 μg L-1 higher logAs and logCo in their cord blood (β [95%CI] = 0.22 [0.01,0.42], p = 0.04; 0.11 [0.01,0.22], p = 0.04), while infants born in the summer had higher Sb, logB, logHg, and logZn (β [95%CI] = 0.74 [0.24,1.24], p = 0.004; 0.11 [0.00,0.21], p = 0.04; 0.29 [0.08,0.49], p = 0.007; 0.18 [0.06,0.31], p = 0.005), compared to those born in fall/winter. Prenatal heavy metal exposure and/or trace metal deficiencies are global concerns because of increasing awareness of downstream developmental effects.
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Affiliation(s)
- Monica K Silver
- Department of Environmental Health Sciences, University of Michigan, Ann Arbor, MI 48109, USA
| | - Aubrey L Arain
- Department of Environmental Health Sciences, University of Michigan, Ann Arbor, MI 48109, USA
| | - Jie Shao
- Department of Child Health Care, Children's Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Minjian Chen
- Institute of Toxicology, Nanjing Medical University, Nanjing 210029, China
| | - Yankai Xia
- Institute of Toxicology, Nanjing Medical University, Nanjing 210029, China
| | - Betsy Lozoff
- Center for Human Growth and Development, University of Michigan, Ann Arbor, MI 48109, USA
| | - John D Meeker
- Department of Environmental Health Sciences, University of Michigan, Ann Arbor, MI 48109, USA.
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Medizinische Maßnahmen bei immigrierenden Kindern und Jugendlichen – Aktualisierung vom 28.02.2018. Monatsschr Kinderheilkd 2018. [DOI: 10.1007/s00112-018-0497-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Shankar K, Pivik RT, Johnson SL, van Ommen B, Demmer E, Murray R. Environmental Forces that Shape Early Development: What We Know and Still Need to Know. Curr Dev Nutr 2018; 2:nzx002. [PMID: 30167570 PMCID: PMC6111237 DOI: 10.3945/cdn.117.001826] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 09/18/2017] [Accepted: 11/15/2017] [Indexed: 01/22/2023] Open
Abstract
Understanding health requires more than knowledge of the genome. Environmental factors regulate gene function through epigenetics. Collectively, environmental exposures have been called the "exposome." Caregivers are instrumental in shaping exposures in a child's initial years. Maternal dietary patterns, physical activity, degree of weight gain, and body composition while pregnant will influence not only fetal growth, but also the infant's metabolic response to nutrients and energy. Maternal over- or underweight, excess caloric intake, nutrient imbalances, glucose dysregulation, and presence of chronic inflammatory states have been shown to establish risk for many later chronic diseases. During the period from birth to age 3 y, when the infant's metabolic rate is high and synaptogenesis and myelination of the brain are occurring extremely rapidly, the infant is especially prone to damaging effects from nutrient imbalances. During this period, the infant changes from a purely milk-based diet to one including a wide variety of foods. The process, timing, quality, and ultimate dietary pattern acquired are a direct outcome of the caregiver-infant feeding relationship, with potentially lifelong consequences. More research on how meal time interactions shape food acceptance is needed to avoid eating patterns that augment existing disease risk. Traditional clinical trials in nutrition, meant to isolate single factors for study, are inadequate to study the highly interconnected realm of environment-gene interactions in early life. Novel technologies are being used to gather broad exposure data on disparate populations, employing pioneering statistical approaches and correlations applied specifically to the individual, based on their genetic make-up and unique environmental experiences.
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Affiliation(s)
- Kartik Shankar
- Arkansas Children's Nutrition Research Center and Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR
| | - R T Pivik
- Arkansas Children's Nutrition Research Center and Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Susan L Johnson
- Department of Pediatrics, Section of Nutrition, University of Colorado, Anschutz Medical Campus, Aurora, CO
| | - Ben van Ommen
- Netherlands Organization of Applied Scientifc Research (TNO), Zeist, Netherlands
| | | | - Robert Murray
- Department of Human Nutrition, Ohio State University, Columbus, OH
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Georgieff MK, Tran PV, Carlson ES. Atypical fetal development: Fetal alcohol syndrome, nutritional deprivation, teratogens, and risk for neurodevelopmental disorders and psychopathology. Dev Psychopathol 2018; 30:1063-1086. [PMID: 30068419 PMCID: PMC6074054 DOI: 10.1017/s0954579418000500] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Accumulating evidence indicates that the fetal environment plays an important role in brain development and sets the brain on a trajectory across the life span. An abnormal fetal environment results when factors that should be present during a critical period of development are absent or when factors that should not be in the developing brain are present. While these factors may acutely disrupt brain function, the real cost to society resides in the long-term effects, which include important mental health issues. We review the effects of three factors, fetal alcohol exposure, teratogen exposure, and nutrient deficiencies, on the developing brain and the consequent risk for developmental psychopathology. Each is reviewed with respect to the evidence found in epidemiological and clinical studies in humans as well as preclinical molecular and cellular studies that explicate mechanisms of action.
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Affiliation(s)
| | - Phu V Tran
- University of Minnesota School of Medicine
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Van Kesteren L, Wojciechowski M. International adoption from Ethiopia: An overview of the health status at arrival in Belgium. Acta Clin Belg 2017; 72:300-305. [PMID: 27892847 DOI: 10.1080/17843286.2016.1258178] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Ethiopia is a densely populated country with a fast growing economy. Still socioeconomic and health issues render many children parentless. One thousand and twenty eight Ethiopian children have been adopted in Belgium from September 2005 to September 2015. Little has been published about their health status at arrival. METHODS Three hundred and fifteen children adopted from Ethiopia were clinically evaluated at the Institute of Tropical Medicine in Antwerp from 1 January 2008 until 31 December 2014. Epidemiological and medical data were collected and analysed retrospectively. RESULTS Data about 164 boys and 151 girls with a mean age of three years were analysed. Twenty per cent was adequately vaccinated, for 66.7% of children these data were absent. About 8.6% of the children were wasted/thin, 28.9% stunted. Skin abnormalities were seen in 40.3%, especially Tinea capitis. No children tested positive for HIV, syphilis or hepatitis C. Four children had an acute or chronic hepatitis B (HBV) infection, eight children had a cured HBV infection. Two children tested positive for malaria. Active pulmonary tuberculosis was found in six children. Sixty-two per cent had one or more intestinal parasite. Giardia lamblia (41.9%) and Blastocystis hominis (27.0%) were most frequently isolated. There is a statistically relevant association between the number of intestinal parasites and age at presentation. In this group eosinophilia had a sensitivity of 30.2%, a specificity of 79.1% for intestinal parasites and a positive likelihood ratio of 1.44 with a negative likelihood ratio of 0.88. CONCLUSION Apart from the high prevalence of stunting and intestinal parasites important medical problems were infrequent. A systematic clinical examination and screening for infectious diseases remain important to ensure a healthy start of a new life in Belgium.
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Affiliation(s)
- Lydia Van Kesteren
- Department of Paediatrics, Antwerp University Hospital, University of Antwerp, Edegem, Belgium
| | - Marek Wojciechowski
- Department of Paediatrics, Antwerp University Hospital, University of Antwerp, Edegem, Belgium
- Department of Travel Medicine/Tropical and Import Pathology, Institute of Tropical Medicine, Antwerp, Belgium
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Tooley UA, Makhoul Z, Fisher PA. Nutritional status of foster children in the U.S.: Implications for cognitive and behavioral development. CHILDREN AND YOUTH SERVICES REVIEW 2016; 70:369-374. [PMID: 28626279 PMCID: PMC5472390 DOI: 10.1016/j.childyouth.2016.10.027] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
OBJECTIVE Children in foster care are at greater risk for poor health, physical, cognitive, behavioral, and developmental outcomes than are children in the general population. Considerable research links early nutrition to later cognitive and behavioral outcomes. The aim of this narrative review is to examine the prevalence of poor nutrition and its relation to subsequent health and development in foster children. METHOD Relevant studies for inclusion were identified from numerous sources (e.g., PubMed, Google Scholar, and reference sections). Inclusion criteria were studies published between 1990 and 2016 of (i) the nutritional status of children in foster care or (ii) the nutritional status of children exposed to early adversity (e.g., low-income and internationally adopted children) or (iii) the developmental effects of poor nutrition and micronutrient deficiencies. RESULTS Two key findings that have adverse implications for cognitive development emerged: (i) the prevalence of anemia and iron-deficiency anemia is higher among foster children than among the general population of children in the U.S., and (ii) the developmental demands of catch-up growth post-placement may lead to micronutrient deficiencies even after children have begun sufficient dietary intake of these nutrients. Moreover, there is a paucity of recent studies on the nutritional status of children in foster care, despite the multiple factors that may place them at risk for malnutrition. CONCLUSION Attention to nutritional status among care providers and medical professionals may remove one of the possible negative influences on foster children's development and in turn significantly alter their trajectories and place them on a more positive path early in life. Recommendations for further research, policy, and practice are discussed.
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Affiliation(s)
- Ursula A. Tooley
- Department of Psychology, University of Oregon, UO Prevention Science Institute, 6217 University of Oregon, Eugene, OR 97403, USA
| | - Zeina Makhoul
- SPOON Foundation, 135 SE Main St, Suite 201, Portland, OR 97214, USA
| | - Philip A. Fisher
- Department of Psychology, University of Oregon, UO Prevention Science Institute, 6217 University of Oregon, Eugene, OR 97403, USA
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Chiappini E, Vierucci F, Ghetti F, de Martino M, Galli L. Vitamin D Status and Predictors of Hypovitaminosis D in Internationally Adopted Children. PLoS One 2016; 11:e0158469. [PMID: 27685941 PMCID: PMC5042493 DOI: 10.1371/journal.pone.0158469] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Accepted: 06/16/2016] [Indexed: 11/19/2022] Open
Abstract
Objectives To evaluate vitamin D status in internationally adopted children at first medical evaluation in Italy and to identify possible risk factors for hypovitaminosis D in this population. Methods 25-hydroxyvitamin D [25(OH)D] levels were analyzed in internationally adopted children consecutively recruited at one Italian Center between 2010 and 2014 as part of the first screening protocol. Demographic, clinical and laboratory data were prospectively collected. Serum 25(OH)D levels <10 ng/mL, <20 ng/mL, and <30 ng/mL were used to define severe vitamin D deficiency, vitamin D deficiency and hypovitaminosis D, respectively. Results 962 internationally adopted children (median age: 5.47 years; IQR:3.14–7.93) were included in the study. Median 25(OH)D level was 22.0 ng/mL (IQR:15.0–30.0 ng/mL); 710/962 (73.8%) children showed hypovitaminosis D (<30 ng/mL), 388/962 (40.3%) had vitamin D deficiency (<20 ng/dL), and 92/962 (9.6%) had severe vitamin D deficiency (<10ng/mL). No case of clinical rickets was observed. Hypovitaminosis D was particularly frequent (>90%) in children adopted from Ethiopia, Peru, India, Bulgaria and Lithuania. At multivariate analysis an increased risk of hypovitaminosis D was found to be associated with: age ≥ 6 years, time spent in Italy ≥ 3 months, blood sample taken in winter, spring or fall, compared to summer. Gender, ethnicity/continent of origin, tubercular infection, intestinal parassitosis and BMI-z-score < -2 were not associated with vitamin D status. Conclusion Hypovitaminosis D is common in internationally adopted children, from all ethnic group. The evaluation of serum 25(OH)D level could be useful early after the adoption to promptly start vitamin D supplementation/treatment if needed.
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Affiliation(s)
- Elena Chiappini
- Department of Health Sciences, Meyer Children University Hospital, University of Florence, Florence, Italy
- * E-mail:
| | | | - Francesca Ghetti
- Department of Health Sciences, Meyer Children University Hospital, University of Florence, Florence, Italy
| | - Maurizio de Martino
- Department of Health Sciences, Meyer Children University Hospital, University of Florence, Florence, Italy
| | - Luisa Galli
- Department of Health Sciences, Meyer Children University Hospital, University of Florence, Florence, Italy
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Abstract
PURPOSE OF REVIEW To examine the most recent literature that provides new data regarding the potential and emerging biomarkers for zinc status in individuals. RECENT FINDINGS Suboptimal dietary zinc intake is estimated to affect 17% of the world's population; however, the assessment of zinc status is notoriously difficult. A systematic review and meta-analysis of studies investigating biochemical biomarkers of zinc status was conducted by the European Micronutrient Recommendations Aligned network. This review summarized the data published from inception to 2007. More recently (2016), an international expert panel, convened by the biomarker of nutrition for development initiative, published an extensive review of the literature addressing biomarkers of zinc status in populations and individuals and categorized the biomarkers as useful [dietary intake, serum Zn concentration and stunting], potentially useful [hair Zn concentration, urine Zn concentration and neurobehavioural function] and emerging [nail Zn concentration, oxidative stress and DNA integrity, zinc kinetics, zinc-dependent proteins and taste acuity]. SUMMARY The most recent data on the potentially useful biomarkers support the further investigation of hair Zn concentration and indices of neurological function, particularly those assessing memory and attention. Of the emerging biomarkers, the measurement of DNA integrity and the expression of zinc transport proteins look promising.
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