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Chen J, Adhikari RK, Wu LSF, Khatry SK, Christian P, LeClerq SC, Katz J, West KP. Early childhood height is a determinant of young adult stature in rural Nepal. BMC Public Health 2024; 24:2046. [PMID: 39080560 PMCID: PMC11289932 DOI: 10.1186/s12889-024-19469-8] [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: 11/21/2023] [Accepted: 07/12/2024] [Indexed: 08/02/2024] Open
Abstract
BACKGROUND Does preschool height predict adult stature in undernourished settings? The extent to which preschool length or height forecasts young adult stature is unclear in chronically undernourished populations. METHODS In 2006-8, we assessed height in a cohort of 2074 young adults, aged 16-23 years, in rural Nepal who, as preschoolers (≤ 4 year), were measured at baseline and again 16 months later during a vitamin A supplementation trial in 1989-91. We assessed by linear regression the ability of preschool length (L, measured < 24 mo) or height (Ht, 24-59 mo), at each year of age to predict 16-23 year old height, adjusted for month of young adult age, interval duration (in months), caste, preschool weight-for-height z-score and, in young women, time since menarche, marriage status and pregnancy history. RESULTS Young women were a mean of 0.81, 1.11, 0.82, 0.24, 0.44 cm taller (all p < 0.01) and young men, 0.84, 1.18, 0.74, 0.64 and 0.48 cm taller (all p < 0.001) per cm of attained L/Ht at each successive preschool year of age and, overall, were 2.04 and 2.40 cm taller for each unit increase in preschool L/Ht z-score (L/HAZ) (both p < 0.001). Coefficients were generally larger for 16-month follow-up measurements. The percent of young adult height attained by children with normal L/HAZ (>-1) increased from 38-40% mid-infancy to ∼ 69-74% by 6 years of age. By 3-6 years of age heights of stunted children (L/HAZ<-2) were consistently ∼ 4-7% lower in their young adult height versus normal statured children. There was no effect of preschool vitamin A receipt. CONCLUSIONS Shorter young children become shorter adults but predictive effects can vary by sex, age assessed, and may be influenced by year or season of measurement.
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Affiliation(s)
- Jiaxin Chen
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Lee S-F Wu
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Subarna K Khatry
- Nepal Nutrition Intervention Project - Sarlahi (NNIPS), Kathmandu, Nepal
| | - Parul Christian
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Nepal Nutrition Intervention Project - Sarlahi (NNIPS), Kathmandu, Nepal
| | - Steven C LeClerq
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Nepal Nutrition Intervention Project - Sarlahi (NNIPS), Kathmandu, Nepal
| | - Joanne Katz
- Nepal Nutrition Intervention Project - Sarlahi (NNIPS), Kathmandu, Nepal
- Global Disease Epidemiology and Control Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Keith P West
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
- Nepal Nutrition Intervention Project - Sarlahi (NNIPS), Kathmandu, Nepal.
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Marzolino R, Castro V, Gambacorta V, Tonon E, Cattaruzzi E, Orzan E. A Case Report of Malignant Cerebellopontine Angle Lesion Highlighting the Interdisciplinary Diagnostic Challenge in the Case of Unilateral Progressive Hearing Loss. J Clin Med 2024; 13:3483. [PMID: 38930012 PMCID: PMC11204955 DOI: 10.3390/jcm13123483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Revised: 06/10/2024] [Accepted: 06/13/2024] [Indexed: 06/28/2024] Open
Abstract
The authors present the case of a young boy who experienced progressive unilateral hearing loss initially believed to be unrelated to any other medical condition. Methods: The patient received a thorough evaluation, which included a comprehensive battery of audiological tests, a CT scan, and a gadolinium-enhanced MRI. Results: A repeated imaging investigation revealed the presence of a mass that mimicked a vestibular schwannoma (VS), but despite this, the boy was ultimately diagnosed with cerebral manifestations of B-cell acute lymphoblastic leukemia (B-ALL). Conclusions: Cerebral lesions originating from the internal auditory canal are rare in cases of B-ALL. In this case, the initial signs and symptoms of the disease were solely related to the audiovestibular system, making the diagnostic process particularly complicated. Unilateral hearing loss cases may indicate the presence of potentially life-threatening conditions, even if the hearing loss appears to be clinically non-syndromic. For these reasons, unilateral hearing losses necessitate a comprehensive interdisciplinary diagnostic approach from the very start of auditory manifestation and, in particular, if the hearing impairment demonstrates threshold progression.
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Affiliation(s)
- Riccardo Marzolino
- Otorhinolaryngology and Audiology Unit, Institute for Maternal and Child Health—IRCCS “Burlo Garofolo”, Via dell’Istria 63, 34137 Trieste, Italy
| | - Veronica Castro
- Otorhinolaryngology and Audiology Unit, Institute for Maternal and Child Health—IRCCS “Burlo Garofolo”, Via dell’Istria 63, 34137 Trieste, Italy
| | - Valeria Gambacorta
- Section of Otorhinolaryngology, Department of Medicine and Surgery, University of Perugia, 06129 Perugia, Italy
| | - Eleonora Tonon
- Otorhinolaryngology and Audiology Unit, Institute for Maternal and Child Health—IRCCS “Burlo Garofolo”, Via dell’Istria 63, 34137 Trieste, Italy
| | - Elisabetta Cattaruzzi
- Pediatric Radiology Department, Institute for Maternal and Child Health IRCCS “Burlo Garofolo,” 34137 Trieste, Italy
| | - Eva Orzan
- Otorhinolaryngology and Audiology Unit, Institute for Maternal and Child Health—IRCCS “Burlo Garofolo”, Via dell’Istria 63, 34137 Trieste, Italy
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Boesoirie SF, Hasansulama W, Lasminingrum L, Novianto AT, Gatera VA, Aroeman NA, Boesoirie TS. The Role of Vitamins A and E Level in Chronic Suppurative Otitis Media with and without Cholesteatoma. J Multidiscip Healthc 2023; 16:3435-3442. [PMID: 38024126 PMCID: PMC10645589 DOI: 10.2147/jmdh.s414115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 10/25/2023] [Indexed: 12/01/2023] Open
Abstract
Aim High expression of lytic enzymes and cytokines is related to cell proliferation in Otitis Media Chronic Suppurative (CSOM) with cholesteatoma. In addition, the process of inflammation healing and maintenance of homeostatic conditions requires Reactive Oxygen Species (ROS), which can cause significant damage to cells. To address this issue, secondary antioxidants such as Vitamins A and E are used to inhibit and neutralize the occurrence of oxidation reactions. These vitamins complement each other, with vitamin A working effectively at low concentrations of oxygen, while vitamin E functions in the opposite manner. Purpose This study aims to investigate the roles of vitamin A and E levels in CSOM patients with Cholesteatoma. Patients and Methods The study was conducted between July and December 2020, and the method used was an analytical observational approach with a case-control design. The sample population comprised 60 CSOM patients divided into 2 groups. These included those with and without cholesteatoma. Results The results showed that there was no significant difference between these two groups in terms of the impact of vitamin A and E levels (respectively, p = 0.626, p = 0.864). Conclusion Considering these results, it was discovered that vitamins A and E levels do not influence the occurrence of CSOM with or without cholesteatoma.
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Affiliation(s)
- Shinta Fitri Boesoirie
- Department of Otorhinolaryngology-Head and Neck Surgery Faculty of Medicine Universitas Padjadjaran/Dr. Hasan Sadikin General Hospital, Bandung, Indonesia
| | - Wijana Hasansulama
- Department of Otorhinolaryngology-Head and Neck Surgery Faculty of Medicine Universitas Padjadjaran/Dr. Hasan Sadikin General Hospital, Bandung, Indonesia
| | - Lina Lasminingrum
- Department of Otorhinolaryngology-Head and Neck Surgery Faculty of Medicine Universitas Padjadjaran/Dr. Hasan Sadikin General Hospital, Bandung, Indonesia
| | - Arif Tria Novianto
- Department of Otorhinolaryngology-Head and Neck Surgery Faculty of Medicine Universitas Padjadjaran/Dr. Hasan Sadikin General Hospital, Bandung, Indonesia
| | - Vesara Ardhe Gatera
- Department of Pharmacy and Health Sciences, Universiti Kuala Lumpur – Royal College of Medicine Perak, Ipoh, Perak, Malaysia
- Center of Excellence in Higher Education for Pharmaceutical Care Innovation, Universitas Padjadjaran, Bandung, Indonesia
| | - Nur Akbar Aroeman
- Department of Otorhinolaryngology-Head and Neck Surgery Faculty of Medicine Universitas Padjadjaran/Dr. Hasan Sadikin General Hospital, Bandung, Indonesia
| | - Thaufiq Siddiq Boesoirie
- Department of Otorhinolaryngology-Head and Neck Surgery Faculty of Medicine Universitas Padjadjaran/Dr. Hasan Sadikin General Hospital, Bandung, Indonesia
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Deng Y, Chen S, Hu J. Diabetes mellitus and hearing loss. Mol Med 2023; 29:141. [PMID: 37875793 PMCID: PMC10599066 DOI: 10.1186/s10020-023-00737-z] [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: 07/26/2023] [Accepted: 10/02/2023] [Indexed: 10/26/2023] Open
Abstract
Diabetes mellitus (DM) is a major disease threatening human health and its incidence is increasing year on year. As a chronic complication of DM, hearing loss mostly occurs undetectably. However, the mechanism of this diabetes-related hearing loss (DRHL) remains unclear and there is no effective clinical treatment. Studies of animal or human pathology show that DM causes damage to the blood vessels, spiral ganglion neurons, afferent nerve fibers, the organ of Corti, and the stria vascularis of the inner ear. In recent years, more advances in pathological research have revealed the possible mechanism of DRHL. In addition, a large number of clinical studies suggest that the duration and severity of DM are closely related to the incidence and severity of DRHL. This review focuses on the relationship between DM and hearing loss. The clinical audiological characteristics of diabetic patients, risk factors for DRHL, typical pathology, and potential interventions of DRHL are summarized. This will help reveal the pathogenesis and intervention approaches for DRHL.
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Affiliation(s)
- Yuxin Deng
- Department of Endocrinology, Liyuan Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei, China
| | - Sen Chen
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
| | - Jun Hu
- Department of Endocrinology, Liyuan Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei, China.
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Zhou J, Fan Z, Bi Y, Li D, Chen X, Hou K, Ji S. The significance of serum Klotho to hearing loss: a potential protector under noise pollution. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2023; 30:104464-104476. [PMID: 37700133 DOI: 10.1007/s11356-023-29788-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 09/05/2023] [Indexed: 09/14/2023]
Abstract
The issue of hearing protection in the presence of noise pollution is of great importance in the fields of environmental science and clinical medicine. Currently, the clinical significance of Klotho in relation to hearing has not been revealed. The aim of this study was to examine the correlation between serum Klotho levels and Pure Tone Average (PTA) hearing thresholds among individuals in the U.S.. The analysis involved a sample of 1,781 individuals aged 20 to 69, obtained from the 2007-2012 National Health and Nutrition Examination Survey. Various methods were utilized for the analysis, including univariate and multivariate linear regression, stratified analysis, smooth curve fitting, a two-segment linear regression model, and log-likelihood ratio analysis. The results of the univariate analysis indicated that serum Klotho concentration, age, education level, hypertension, diabetes, and smoking all exhibited a significant influence on PTAs. After adjusting for potential confounding factors, it was observed that a decrease in serum Klotho was significantly associated with PTA thresholds at low frequency (β = -0.002; 95% CI: -0.003, -0.001; P = 0.004), speech frequency (β = -0.002; 95% CI: -0.003, -0.001; P = 0.007), and high frequency (β = -0.002; 95% CI: -0.003, -0.001; P = 0.045). Specifically, for every 1 pg/ml decrease in serum Klotho concentration, the PTAs increased by 0.002 dB. Moreover, age and gender-specific analyses revealed significant associations. For individuals aged 59-69, a significant association was found between serum Klotho concentration and high-frequency PTA (β = -4.153; 95% CI: -7.948, -0.358; P = 0.032). Additionally, among females, significant associations were observed between serum Klotho concentration and speech-frequency PTA (β = -1.648, 95% CI: -3.197, -0.099; P = 0.037) as well as high-frequency PTA (β = -3.046; 95% CI: -5.319, -0.772; P = 0.009). Finally, the results of smooth curve fitting and threshold effect analyses indicated a potential negative linear correlation between serum Klotho concentration and PTA thresholds. In conclusion, a lower level of serum Klotho was found to be associated with increased hearing thresholds, particularly among the elderly population. This finding has significant implications for the prevention and treatment of hearing damage.
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Affiliation(s)
- Jingcheng Zhou
- Senior Department of Otolaryngology-Head & Neck Surgery, Chinese PLA General Hospital, Beijing, 100083, China
- National Clinical Research Center for Otolaryngologic Diseases, Beijing, 100083, China
- State Key Lab of Hearing Science, Ministry of Education, Beijing, 100083, China
- Beijing Key Lab of Hearing Impairment Prevention and Treatment, Beijing, 100083, China
- Chinese PLA General Hospital and PLA Medical College, Beijing, 100083, China
| | - Zheqi Fan
- Chinese PLA General Hospital and PLA Medical College, Beijing, 100083, China
| | - Yiming Bi
- Chinese PLA General Hospital and PLA Medical College, Beijing, 100083, China
| | - Dingchang Li
- Chinese PLA General Hospital and PLA Medical College, Beijing, 100083, China
| | - Xuemin Chen
- Senior Department of Otolaryngology-Head & Neck Surgery, Chinese PLA General Hospital, Beijing, 100083, China
- National Clinical Research Center for Otolaryngologic Diseases, Beijing, 100083, China
- State Key Lab of Hearing Science, Ministry of Education, Beijing, 100083, China
- Beijing Key Lab of Hearing Impairment Prevention and Treatment, Beijing, 100083, China
- Chinese PLA General Hospital and PLA Medical College, Beijing, 100083, China
| | - Kun Hou
- Senior Department of Otolaryngology-Head & Neck Surgery, Chinese PLA General Hospital, Beijing, 100083, China
- National Clinical Research Center for Otolaryngologic Diseases, Beijing, 100083, China
- State Key Lab of Hearing Science, Ministry of Education, Beijing, 100083, China
- Beijing Key Lab of Hearing Impairment Prevention and Treatment, Beijing, 100083, China
- Chinese PLA General Hospital and PLA Medical College, Beijing, 100083, China
| | - Shuaifei Ji
- Chinese PLA General Hospital and PLA Medical College, Beijing, 100083, China.
- Research Center for Tissue Repair and Regeneration Affiliated To Medical Innovation Research Department, Chinese PLA General Hospital and PLA Medical College, 28 Fu Xing Road, Beijing, 100853, China.
- Medical School of Chinese PLA, Beijing, 100083, China.
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Retinol and Pro-Vitamin A Carotenoid Nutritional Status during Pregnancy Is Associated with Newborn Hearing Screen Results. Nutrients 2023; 15:nu15040800. [PMID: 36839158 PMCID: PMC9967333 DOI: 10.3390/nu15040800] [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: 01/18/2023] [Revised: 01/30/2023] [Accepted: 02/01/2023] [Indexed: 02/09/2023] Open
Abstract
The prenatal period is critical for auditory development; thus, prenatal influences on auditory development may significantly impact long-term hearing ability. While previous studies identified a protective effect of carotenoids on adult hearing, the impact of these nutrients on hearing outcomes in neonates is not well understood. The purpose of this study is to investigate the relationship between maternal and umbilical cord plasma retinol and carotenoid concentrations and abnormal newborn hearing screen (NHS) results. Mother-infant dyads (n = 546) were enrolled at delivery. Plasma samples were analyzed using HPLC and LC-MS/MS. NHS results were obtained from medical records. Statistical analysis utilized Mann-Whitney U tests and logistic regression models, with p ≤ 0.05 considered statistically significant. Abnormal NHS results were observed in 8.5% of infants. Higher median cord retinol (187.4 vs. 162.2 μg/L, p = 0.01), maternal trans-β-carotene (206.1 vs. 149.4 μg/L, p = 0.02), maternal cis-β-carotene (15.9 vs. 11.2 μg/L, p = 0.02), and cord trans-β-carotene (15.5 vs. 8.0 μg/L, p = 0.04) were associated with abnormal NHS. Significant associations between natural log-transformed retinol and β-carotene concentrations and abnormal NHS results remained after adjustment for smoking status, maternal age, and corrected gestational age. Further studies should investigate if congenital metabolic deficiencies, pesticide contamination of carotenoid-rich foods, maternal hypothyroidism, or other variables mediate this relationship.
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Haselow NJ, Joshi V, Bayo PN, Murye JW, Shaban SN, Abebe KT, Kassim I, Shiweredo T, Vinathan H, Jaiswal CP, Miluwa KA, Ategbo EA, Ndiaye B, Ayoya MA. A Review of Vitamin A Supplementation in South Sudan: Successes, Challenges, and Opportunities for the Way Forward. GLOBAL HEALTH: SCIENCE AND PRACTICE 2022; 10:GHSP-D-21-00660. [PMID: 36332070 PMCID: PMC9242605 DOI: 10.9745/ghsp-d-21-00660] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 04/05/2022] [Indexed: 11/17/2022]
Abstract
Although South Sudan's vitamin A supplementation program has demonstrated success, vitamin A supplementation remains a critical public health need for young children. How can South Sudan best maintain high vitamin A supplementation coverage for the short to medium term while planning a more sustainable delivery approach for the longer term? Aim: To identify vitamin A supplementation (VAS) trends in South Sudan and provide insights to refocus VAS programming vis a vis polio eradication campaigns recently phased out while access to health care, land, food, and markets remain challenging. Method: Review of data from survey and coverage reports; review of policy and program documents; key informant responses; general literature search. Results: Vitamin A deficiency (VAD) is likely a severe public health problem among preschool-aged children in South Sudan based on a high under-5 mortality rate (96.2 deaths/1,000 live births) and high levels of undernutrition, infections, and food insecurity. Vitamin A capsules, with deworming tablets (VASD), have been delivered to preschool-aged children during national immunization days (NIDs) for the past decade. Although areas of South Sudan and certain populations continue to have low VAS coverage, when comparing national VAS coverage (reported in the last 6 months) between 2010 and August 2019, a large improvement is noted from 4% to 76%. In 2021, VAS coverage was more than 90% at the national level during 2 stand-alone distribution campaigns. Deworming coverage trends generally mimicked VAS coverage. VAS is provided to postpartum mothers who deliver at health facilities (approximately 12%–25%), but coverage data are not available. Conclusion: Twice-yearly VAS should remain a key lifesaving intervention to address VAD, but alternative delivery strategies will be needed. Conducting events, such as child health days, supported by promotional activities or community-based VASD distribution activities for the youngest children and those missed during campaigns, should be considered. For the long term, a hybrid approach targeting underserved areas with mass distribution events while integrating VASD into community-based programs such as quarterly screening for wasting should be tested further and gradually scaled up everywhere as this has the potential to sustainably reach all vulnerable children twice yearly.
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Affiliation(s)
| | - Vandana Joshi
- UNICEF South Sudan, Juba, The Republic of South Sudan.
| | | | - Jesca W Murye
- UNICEF South Sudan, Juba, The Republic of South Sudan
| | | | | | | | | | - Hari Vinathan
- UNICEF Lao People's Democratic Republic, Vientiane, Lao People's Democratic Republic
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Bigman G. Deficiency in Vitamin D is Associated with Bilateral Hearing Impairment and Bilateral Sensorineural Hearing Loss in Older Adults. Nutr Res 2022; 105:1-10. [DOI: 10.1016/j.nutres.2022.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 05/20/2022] [Accepted: 05/23/2022] [Indexed: 10/18/2022]
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Imdad A, Mayo-Wilson E, Haykal MR, Regan A, Sidhu J, Smith A, Bhutta ZA. Vitamin A supplementation for preventing morbidity and mortality in children from six months to five years of age. Cochrane Database Syst Rev 2022; 3:CD008524. [PMID: 35294044 PMCID: PMC8925277 DOI: 10.1002/14651858.cd008524.pub4] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Vitamin A deficiency (VAD) is a major public health problem in low- and middle-income countries, affecting 190 million children under five years of age and leading to many adverse health consequences, including death. Based on prior evidence and a previous version of this review, the World Health Organization has continued to recommend vitamin A supplementation (VAS) for children aged 6 to 59 months. The last version of this review was published in 2017, and this is an updated version of that review. OBJECTIVES To assess the effects of vitamin A supplementation (VAS) for preventing morbidity and mortality in children aged six months to five years. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, six other databases, and two trials registers up to March 2021. We also checked reference lists and contacted relevant organisations and researchers to identify additional studies. SELECTION CRITERIA Randomised controlled trials (RCTs) and cluster-RCTs evaluating the effect of synthetic VAS in children aged six months to five years living in the community. We excluded studies involving children in hospital and children with disease or infection. We also excluded studies evaluating the effects of food fortification, consumption of vitamin A rich foods, or beta-carotene supplementation. DATA COLLECTION AND ANALYSIS For this update, two review authors independently assessed studies for inclusion resolving discrepancies by discussion. We performed meta-analyses for outcomes, including all-cause and cause-specific mortality, disease, vision, and side effects. We used the GRADE approach to assess the quality of the evidence. MAIN RESULTS The updated search identified no new RCTs. We identified 47 studies, involving approximately 1,223,856 children. Studies were set in 19 countries: 30 (63%) in Asia, 16 of these in India; 8 (17%) in Africa; 7 (15%) in Latin America, and 2 (4%) in Australia. About one-third of the studies were in urban/periurban settings, and half were in rural settings; the remaining studies did not clearly report settings. Most studies included equal numbers of girls and boys and lasted about one year. The mean age of the children was about 33 months. The included studies were at variable overall risk of bias; however, evidence for the primary outcome was at low risk of bias. A meta-analysis for all-cause mortality included 19 trials (1,202,382 children). At longest follow-up, there was a 12% observed reduction in the risk of all-cause mortality for VAS compared with control using a fixed-effect model (risk ratio (RR) 0.88, 95% confidence interval (CI) 0.83 to 0.93; high-certainty evidence). Nine trials reported mortality due to diarrhoea and showed a 12% overall reduction for VAS (RR 0.88, 95% CI 0.79 to 0.98; 1,098,538 children; high-certainty evidence). There was no evidence of a difference for VAS on mortality due to measles (RR 0.88, 95% CI 0.69 to 1.11; 6 studies, 1,088,261 children; low-certainty evidence), respiratory disease (RR 0.98, 95% CI 0.86 to 1.12; 9 studies, 1,098,538 children; low-certainty evidence), and meningitis. VAS reduced the incidence of diarrhoea (RR 0.85, 95% CI 0.82 to 0.87; 15 studies, 77,946 children; low-certainty evidence), measles (RR 0.50, 95% CI 0.37 to 0.67; 6 studies, 19,566 children; moderate-certainty evidence), Bitot's spots (RR 0.42, 95% CI 0.33 to 0.53; 5 studies, 1,063,278 children; moderate-certainty evidence), night blindness (RR 0.32, 95% CI 0.21 to 0.50; 2 studies, 22,972 children; moderate-certainty evidence), and VAD (RR 0.71, 95% CI 0.65 to 0.78; 4 studies, 2262 children, moderate-certainty evidence). However, there was no evidence of a difference on incidence of respiratory disease (RR 0.99, 95% CI 0.92 to 1.06; 11 studies, 27,540 children; low-certainty evidence) or hospitalisations due to diarrhoea or pneumonia. There was an increased risk of vomiting within the first 48 hours of VAS (RR 1.97, 95% CI 1.44 to 2.69; 4 studies, 10,541 children; moderate-certainty evidence). AUTHORS' CONCLUSIONS This update identified no new eligible studies and the conclusions remain the same. VAS is associated with a clinically meaningful reduction in morbidity and mortality in children. Further placebo-controlled trials of VAS in children between six months and five years of age would not change the conclusions of this review, although studies that compare different doses and delivery mechanisms are needed. In populations with documented VAD, it would be unethical to conduct placebo-controlled trials.
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Affiliation(s)
- Aamer Imdad
- Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology and Nutrition, SUNY Upstate Medical University, Syracuse, New York, USA
| | - Evan Mayo-Wilson
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Maya R Haykal
- College of Medicine, SUNY Upstate Medical University, Syracuse, New York, USA
| | - Allison Regan
- College of Medicine, SUNY Upstate Medical University, Syracuse, New York, USA
| | - Jasleen Sidhu
- College of Medicine, SUNY Upstate Medical University, Syracuse, New York, USA
| | - Abigail Smith
- Health Sciences Library, SUNY Upstate Medical University, Syracuse, New York, USA
| | - Zulfiqar A Bhutta
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Canada
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Awasthi S, Awasthi A. Role of vitamin a in child health and nutrition. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2020. [DOI: 10.1016/j.cegh.2020.03.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
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Thorne-Lyman AL, Parajuli K, Paudyal N, Chitekwe S, Shrestha R, Manandhar DL, West KP. To see, hear, and live: 25 years of the vitamin A programme in Nepal. MATERNAL AND CHILD NUTRITION 2020; 18 Suppl 1:e12954. [PMID: 32108438 PMCID: PMC8770656 DOI: 10.1111/mcn.12954] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 12/20/2019] [Accepted: 12/29/2019] [Indexed: 11/30/2022]
Abstract
Nepal has a rich history of vitamin A research and a national, biannual preschool vitamin A supplementation (VAS) programme that has sustained high coverage for 25 years despite many challenges, including conflict. Key elements of programme success have included (a) evidence of a 26–30% reduction in child mortality from two, in‐country randomized trials; (b) strong political and donor support; (c) positioning local female community health volunteers as key operatives; (d) nationwide community mobilization and demand creation for the programme; and (e) gradual expansion of the programme over a period of several years, conducting and integrating delivery research, and monitoring to allow new approaches to be tested and adapted to available resources. The VAS network has served as a platform for delivering other services, including anthelmintic treatment and screening for acute malnutrition. We estimate that VAS has saved over 45,000 young lives over the past 15 years of attained national coverage. Consumption of vitamin A‐ and carotenoid‐rich foods by children and women nationally remains low, indicating that supplementation is still needed. Current challenges and opportunities to improving vitamin A status include lower VAS coverage among younger children (infants 6–11 months of age), finding ways to increase availability and access to dietary vitamin A sources, and ensuring local programme investments given the recent decentralization of the government.
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Affiliation(s)
- Andrew L Thorne-Lyman
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Kedar Parajuli
- Nutrition Section, Family Welfare Division, Ministry of Health and Population Nepal, Kathmandu, Nepal
| | | | | | - Ram Shrestha
- Nepali Technical Assistance Group, Kathmandu, Nepal
| | | | - Keith P West
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Clarke S, Richmond R, Worth H, Wagle R, Hayen A. Effect of a participatory intervention in women's self-help groups for the prevention of chronic suppurative otitis media in their children in Jumla Nepal: a cluster-randomised trial. BMC Pediatr 2019; 19:163. [PMID: 31122224 PMCID: PMC6533658 DOI: 10.1186/s12887-019-1539-y] [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: 11/28/2018] [Accepted: 05/14/2019] [Indexed: 11/13/2022] Open
Abstract
Background Chronic suppurative otitis media (CSOM) causes preventable deafness and disproportionately affects children living in poverty. Our hypothesis was that health promotion in women’s groups would increase their knowledge, attitudes and practices (KAP) regarding ear disease and reduce the prevalence of CSOM in their children. Methods We did a cluster randomised trial in two village development committees (VDCs) in Jumla, Nepal. In July 2014, 30 women’s groups were randomly allocated to intervention or control, stratified by VDC and distance to the road. The intervention groups participated in three sessions of health promotion using the WHO Hearing and Ear Care Training Resource Basic Level. The primary outcome was women’s KAP score and the secondary outcome was prevalence of CSOM in their children at 12 month follow-up. Analyses were by intention to treat. Participants and the research team were not masked to allocation. Results In June and July 2014 we recruited 508 women and 937 of their children. 12 months later there was no difference in the women’s KAP score (mean difference 0.14, 95% CI − 0.1 to 0.38, P = 0.25) or the prevalence of CSOM in their children (OR 1.10, 95%CI 0.62 to 1.84, P = 0.75) between intervention and control groups. However, overall, there was a significant improvement in the KAP score (mean difference − 0.51, 95% CI − 0.71,to − 0.31, P < 0.0001) and in the prevalence of CSOM from baseline 11.2% to follow-up 7.1% (P < 0.0001). Conclusions Health promotion in women’s groups did not improve maternal KAP or reduce prevalence of CSOM. Over time there was a significant improvement in women’s KAP score and reduction in the prevalence of CSOM which may be attributable to our presence in the community offering treatment to affected children, talking to their parents and providing ciprofloxacin drops to the local health posts. More research is needed in low resource settings to test our findings. Trial registration Australia and New Zealand Clinical Trial Registry 12,614,000,231,640; Date of registration: 5.3.2014: Prospectively registered. Electronic supplementary material The online version of this article (10.1186/s12887-019-1539-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Susan Clarke
- School of Public Health and Community Medicine, University of New South Wales Sydney, High St, Kensington, NSW, 2052, Australia.
| | - Robyn Richmond
- School of Public Health and Community Medicine, University of New South Wales Sydney, High St, Kensington, NSW, 2052, Australia
| | - Heather Worth
- School of Public Health and Community Medicine, University of New South Wales Sydney, High St, Kensington, NSW, 2052, Australia
| | - Rajendra Wagle
- Institute of Medicine, Tribhuvan University, Maharaganj, Kathmandu, Nepal
| | - Andrew Hayen
- Faculty of Health, University of Technology Sydney, 15 Broadway, Ultimo, NSW, 2007, Australia
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Ropers FG, Pham ENB, Kant SG, Rotteveel LJC, Rings EHHM, Verbist BM, Dekkers OM. Assessment of the Clinical Benefit of Imaging in Children With Unilateral Sensorineural Hearing Loss: A Systematic Review and Meta-analysis. JAMA Otolaryngol Head Neck Surg 2019; 145:431-443. [PMID: 30946449 PMCID: PMC6537917 DOI: 10.1001/jamaoto.2019.0121] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2018] [Accepted: 01/21/2019] [Indexed: 01/13/2023]
Abstract
IMPORTANCE Imaging used to determine the cause of unilateral sensorineural hearing loss (USNHL) in children is often justified by the high likelihood of detecting abnormalities, which implies that these abnormalities are associated with hearing loss and that imaging has a positive contribution to patient outcome or well-being by providing information on the prognosis, hereditary factors, or cause of hearing loss. OBJECTIVES To evaluate the diagnostic yield of computed tomography (CT) and magnetic resonance imaging (MRI) in children with isolated unexplained USNHL and investigate the clinical relevance of these findings. EVIDENCE REVIEW Cochrane Library, Embase, PubMed, and Web of Science databases were searched for articles published from 1978 to 2017 on studies of children with USNHL who underwent CT and/or MRI of the temporal bone. Two authors (F.G.R. and E.N.B.P.) independently extracted information on population characteristics, imaging modality, and the prevalence of abnormalities and assessed the studies for risk of bias. Eligibility criteria included studies with 20 or more patients with USNHL who had CT and/or MRI scans, a population younger than 18 years, and those published in English. MAIN OUTCOMES AND MEASURES The pooled prevalence with 95% CI of inner ear abnormalities grouped according to finding and imaging modality. FINDINGS Of 1562 studies, 18 were included with a total of 1504 participants included in the analysis. Fifteen studies were consecutive case studies and 3 were retrospective cohort studies. The pooled diagnostic yield for pathophysiologic relevant findings in patients with unexplained USNHL was 37% for CT (95% CI, 25%-48%) and 35% for MRI (95% CI, 22%-49%). Cochleovestibular abnormalities were found with a pooled frequency of 19% for CT (95% CI, 14%-25%) and 16% for MRI (95% CI, 7%-25%). Cochlear nerve deficiency and associated cochlear aperture stenosis had a pooled frequency of 16% for MRI (95% CI, 3%-29%) and 44% for CT (95% CI, 36%-53%), respectively. Enlarged vestibular aqueduct (EVA) was detected with a pooled frequency of 7% for CT and 12% for MRI in children with USNHL. CONCLUSIONS AND RELEVANCE Imaging provided insight into the cause of hearing loss in a pooled frequency of about 35% to 37% in children with isolated unexplained USNHL. However, none of these findings had therapeutic consequences, and imaging provided information on prognosis and hereditary factors only in a small proportion of children, namely those with EVA. Thus, there is currently no convincing evidence supporting a strong recommendation for imaging in children who present with USNHL. The advantages of imaging should be carefully balanced against the drawbacks during shared decision making.
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Affiliation(s)
- Fabienne G. Ropers
- Department of Pediatrics, Leiden University Medical Center, Leiden, Netherlands
| | - Eveline N. B. Pham
- Department of Pediatrics, Leiden University Medical Center, Leiden, Netherlands
| | - Sarina G. Kant
- Department of Human Genetics, Leiden University Medical Center, Leiden, Netherlands
| | | | - Edmond H. H. M. Rings
- Department of Pediatrics, Leiden University Medical Center, Leiden, Netherlands
- Department of Pediatrics, Erasmus Medical Center, Rotterdam, Netherlands
| | - Berit M. Verbist
- Department of Radiology, Leiden University Medical Center, Leiden, Netherlands
| | - Olaf M. Dekkers
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, Netherlands
- Department of Medicine, Section Endocrinology, Leiden University Medical Center, Leiden, Netherlands
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Bastos Maia S, Rolland Souza AS, Costa Caminha MDF, Lins da Silva S, Callou Cruz RDSBL, Carvalho Dos Santos C, Batista Filho M. Vitamin A and Pregnancy: A Narrative Review. Nutrients 2019; 11:nu11030681. [PMID: 30909386 PMCID: PMC6470929 DOI: 10.3390/nu11030681] [Citation(s) in RCA: 94] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 03/15/2019] [Accepted: 03/19/2019] [Indexed: 12/13/2022] Open
Abstract
Vitamin A is a crucial micronutrient for pregnant women and their fetuses. In addition to being essential for morphological and functional development and for ocular integrity, vitamin A exerts systemic effects on several fetal organs and on the fetal skeleton. Vitamin A requirements during pregnancy are therefore greater. Vitamin A deficiency (VAD) remains the leading cause of preventable blindness in the world. VAD in pregnant women is a public health issue in most developing countries. In contrast, in some developed countries, excessive vitamin A intake during pregnancy can be a concern since, when in excess, this micronutrient may exert teratogenic effects in the first 60 days following conception. Routine prenatal vitamin A supplementation for the prevention of maternal and infant morbidity and mortality is not recommended; however, in regions where VAD is a public health issue, vitamin A supplementation is recommended to prevent night blindness. Given the importance of this topic and the lack of a complete, up-to-date review on vitamin A and pregnancy, an extensive review of the literature was conducted to identify conflicting or incomplete data on the topic as well as any gaps in existing data.
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Affiliation(s)
- Sabina Bastos Maia
- Maternal and Child Healthcare Postgraduate Program, Instituto de Medicina Integral Prof. Fernando Figueira (IMIP), Recife 50070-550, Pernambuco, Brazil.
- Department of Obstetrics and Gynecology, Lauro Wanderley University Hospital, Federal University of Paraíba (UFPB), João Pessoa 58059-900, Paraíba, Brazil.
| | - Alex Sandro Rolland Souza
- Maternal and Child Healthcare Postgraduate Program, Instituto de Medicina Integral Prof. Fernando Figueira (IMIP), Recife 50070-550, Pernambuco, Brazil.
- Department of Maternal and Child Healthcare, Federal University of Pernambuco (UFPE), Recife 50670-901, Pernambuco, Brazil.
- Biological and Health Sciences Center, Catholic University of Pernambuco (UNICAP), Recife 50050-900, Pernambuco, Brazil.
| | - Maria de Fátima Costa Caminha
- Maternal and Child Healthcare Postgraduate Program, Instituto de Medicina Integral Prof. Fernando Figueira (IMIP), Recife 50070-550, Pernambuco, Brazil.
- Coordination of the Nursing Mentoring Program, Faculdade Pernambucana de Saúde (FPS), Recife 51180-001, Pernambuco, Brazil.
| | - Suzana Lins da Silva
- Maternal and Child Healthcare Postgraduate Program, Instituto de Medicina Integral Prof. Fernando Figueira (IMIP), Recife 50070-550, Pernambuco, Brazil.
- Coordination of the Nursing Mentoring Program, Faculdade Pernambucana de Saúde (FPS), Recife 51180-001, Pernambuco, Brazil.
| | | | | | - Malaquias Batista Filho
- Maternal and Child Healthcare Postgraduate Program, Instituto de Medicina Integral Prof. Fernando Figueira (IMIP), Recife 50070-550, Pernambuco, Brazil.
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Puga AM, Pajares MA, Varela-Moreiras G, Partearroyo T. Interplay between Nutrition and Hearing Loss: State of Art. Nutrients 2018; 11:nu11010035. [PMID: 30586880 PMCID: PMC6356655 DOI: 10.3390/nu11010035] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 12/17/2018] [Accepted: 12/21/2018] [Indexed: 12/14/2022] Open
Abstract
Hearing loss has been recently ranked as the fifth leading cause of years lived with disability, ahead of many other chronic diseases such as diabetes, dementia, or chronic obstructive pulmonary disease. Moreover, according to the World Health Organization, moderate-to-profound hearing loss affects about 466 million people worldwide. Its incidence varies in each population segment, affecting approximately 10% of children and increasing to 30% of the population over 65 years. However, hearing loss receives still very limited research funding and public awareness. This sensory impairment is caused by genetic and environmental factors, and among the latter, the nutritional status has acquired relevance due its association to hearing loss detected in recent epidemiological studies. Several experimental models have proved that the onset and progression of hearing loss are closely linked to the availability of nutrients and their metabolism. Here, we have reviewed studies focused on nutrient effects on auditory function. These studies support the potential of nutritional therapy for the protection against hearing loss progression, which is especially relevant to the aging process and related quality of life.
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Affiliation(s)
- Ana M Puga
- Department of Pharmaceutical and Health Sciences, Faculty of Pharmacy, CEU San Pablo University, 28668 Madrid, Spain.
| | - María A Pajares
- Department of Structural and Chemical Biology, Centro de Investigaciones Biológicas (CSIC), 28040 Madrid, Spain.
- Molecular Hepatology Group, Hospital La Paz Institute for Health Research (IdiPAZ), 28046 Madrid, Spain.
| | - Gregorio Varela-Moreiras
- Department of Pharmaceutical and Health Sciences, Faculty of Pharmacy, CEU San Pablo University, 28668 Madrid, Spain.
| | - Teresa Partearroyo
- Department of Pharmaceutical and Health Sciences, Faculty of Pharmacy, CEU San Pablo University, 28668 Madrid, Spain.
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Assessment of auditory function and lipid levels in patients receiving oral isotretinoin (13- cis retinoid) therapy for acne vulgaris. Postepy Dermatol Alergol 2018; 37:360-363. [PMID: 32792876 PMCID: PMC7394152 DOI: 10.5114/ada.2018.79566] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 10/28/2018] [Indexed: 11/23/2022] Open
Abstract
Introduction Isotretinoin (13-cis retinoid) is a synthetic retinoid. It was approved by the FDA in 1982 for use of oral isotretinoin in severe acne. It is also used in moderate-severe acne that does not respond to conventional treatments. Isotretinoin is the only available drug that affects all stages of acne pathogenesis. Aim To prospectively investigate whether there is an effect of isotretinoin therapy on auditory function and, if so, to demonstrate its association with simultaneous blood lipid levels. Material and methods Thirty patients (60 ears) with acne vulgaris, who received 0.5 mg/kg of isotretinoin therapy, were included in the study. Distortion product otoacoustic emissions (DPOAEs) and pure tone audiometry tests were performed to evaluate auditory function at the beginning of the procedure and the 6th month of treatment. In addition, aspartate aminotransferase (AST), alanine aminotransferase (ALT), total cholesterol, triglyceride, high-density lipoproteins (HDL) and low-density lipoproteins (LDL) cholesterol levels were recorded. Results There was no statistically significant difference between pre-treatment and post-treatment mean pure tone audiometry threshold and DPOAE values; however, the increase in total blood cholesterol, triglyceride and LDL levels and the decrease in HDL levels were statistically significant. Conclusions According to our study findings, isotretinoin did not cause worsening of the bilateral hearing threshold, but increased blood lipid levels. There is no need for follow-up auditory functions in routine practice during therapy, but blood lipid levels should be monitored.
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Gi M, Shim DB, Wu L, Bok J, Song MH, Choi JY. Progressive hearing loss in vitamin A-deficient mice which may be protected by the activation of cochlear melanocyte. Sci Rep 2018; 8:16415. [PMID: 30401931 PMCID: PMC6219529 DOI: 10.1038/s41598-018-34653-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Accepted: 09/21/2018] [Indexed: 11/29/2022] Open
Abstract
Vitamin A deficiency (VAD) produces various pathologic phenotypes in humans and animals. However, evidence regarding the effect of VAD on hearing function has been inconsistent. In this study, we evaluated the effect of VAD on hearing function in two mouse models of VAD. Hearing ability was evaluated on the basis of auditory brainstem response from 3 to 20 weeks after birth in C57BL/6 (pigmented) and imprinting control region (albino) mice. The two mice strains were divided into the VAD (purified vitamin A-free diet from 7 days after pregnancy) and control (normal diet) groups. Albino VAD mice exhibited hearing loss after 6 weeks and became deaf at 18 weeks. Histological findings revealed degenerative changes in outer hair cells and neuronal loss in the spiral ganglion in albino VAD mice. In contrast, pigmented VAD mice, except those with middle-ear infection, showed no significant hearing loss. Interestingly, pigmented VAD mice exhibited melanocyte activation in the stria vascularis and upregulation of tyrosinase. Recovery of hearing after noise exposure was poorer in pigmented VAD mice than in control mice. In conclusion, complete VAD might be related to age-related or noise-induced hearing loss in mice, protection against which might involve melanocyte activation.
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Affiliation(s)
- Mia Gi
- Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, South Korea
| | - Dae Bo Shim
- Department of Otorhinolaryngology, Myongji Hospital, Hanyang University College of Medicine, Goyang, South Korea
| | - Ling Wu
- Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, South Korea
| | - Jinwoong Bok
- Department of Anatomy, Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, South Korea
| | - Mee Hyun Song
- Department of Otorhinolaryngology, Myongji Hospital, Hanyang University Medical Center, Goyang, South Korea
| | - Jae Young Choi
- Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, South Korea. .,Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, South Korea. .,Research Center for Natural Human Defense System, Yonsei University College of Medicine, Seoul, South Korea. .,The Airway Mucus Institute, Yonsei University College of Medicine, Seoul, South Korea.
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Emmett SD, Schmitz J, Karna SL, Khatry SK, Wu L, LeClerq SC, Pillion J, West KP. Early childhood undernutrition increases risk of hearing loss in young adulthood in rural Nepal. Am J Clin Nutr 2018; 107:268-277. [PMID: 29425280 PMCID: PMC6669330 DOI: 10.1093/ajcn/nqx022] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 11/07/2017] [Indexed: 12/04/2022] Open
Abstract
Background Prevalence of young adult hearing loss is high in low-resource societies; the reasons for this are likely complex but could involve early childhood undernutrition. Objective We evaluated preschool childhood stunting, wasting, and underweight as risk factors for hearing loss in young adulthood in Sarlahi District, southern Nepal. Design Ear health was assessed in 2006-2008 in a cohort of 2193 subjects aged 16-23 y, who as children <60 mo of age participated in a 16-mo placebo-controlled, randomized vitamin A supplementation trial from 1989 to 1991. At each of five 4-mo assessments, field staff measured children's weight, height, and mid-upper arm circumference (MUAC) and recorded validated parental history of ear discharge in the previous 7 d. Children were classified as stunted [<-2 z score height-for-age (HAZ)], underweight [<-2 z score weight-for-age (WAZ)], or wasted [<-2 z score MUAC-for-age (MUACAZ) or body mass index-for-age (BMIAZ)]. At follow-up, hearing was tested by audiometry and tympanometry, with hearing loss defined as pure-tone average >30dB in the worse ear (0.5, 1, 2, 4 kHz) and middle-ear dysfunction as abnormal tympanometric peak height (<0.3 or >1.4 mmho) or width (<50 or >110 daPa). Results Hearing loss, present in 5.9% (95% CI: 5.01%, 7.00%) of subjects, was associated with early childhood stunting (OR: 1.64; 95% CI: 1.10, 1.45), underweight (OR: 1.70; 95% CI: 1.18, 2.44) and wasting by BMIAZ (OR: 1.88; 95% CI: 1.19, 2.97) and MUACAZ (OR: 2.14; 95% CI: 1.47, 3.12). Abnormal tympanometry, affecting 16.6% (95% CI: 15.06%, 18.18%), was associated with underweight (OR: 1.46; 95% CI: 1.16, 1.84) and wasting by BMIAZ (OR: 1.80; 95% CI: 1.32, 2.46) and MUACAZ (OR: 1.42; 95% CI: 1.10, 1.84), but not stunting (OR: 1.18; 95% CI: 0.93, 1.49) in early childhood. Highest ORs were observed for subjects with both hearing loss and abnormal tympanometry, ranging from 1.87 to 2.24 (all lower 95% CI >1.00). Conclusions Early childhood undernutrition is a modifiable risk factor for early adulthood hearing loss.
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Affiliation(s)
- Susan D Emmett
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD,Division of Head & Neck Surgery and Communication Sciences, Duke University School of Medicine, Durham, NC,Duke Global Health Institute, Durham, NC,Address correspondence to SDE (e-mail: )
| | - Jane Schmitz
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Sureswor L Karna
- Speech and Hearing Unit, Ganesh Man Singh Memorial ENT Centre, Tribhuvan University Institute of Medicine, Kathmandu, Nepal
| | - Subarna K Khatry
- Nepal Nutrition Intervention Project-Sarlahi (NNIPS), Kathmandu, Nepal
| | - Lee Wu
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Steven C LeClerq
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD,Nepal Nutrition Intervention Project-Sarlahi (NNIPS), Kathmandu, Nepal
| | - Joseph Pillion
- Department of Audiology, Kennedy Krieger Institute, Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Keith P West
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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Effects of Retinoid Treatment on Cochlear Development, Connexin Expression and Hearing Thresholds in Mice. JOURNAL OF OTORHINOLARYNGOLOGY, HEARING AND BALANCE MEDICINE 2017. [DOI: 10.3390/ohbm1010002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
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Imdad A, Mayo‐Wilson E, Herzer K, Bhutta ZA. Vitamin A supplementation for preventing morbidity and mortality in children from six months to five years of age. Cochrane Database Syst Rev 2017; 3:CD008524. [PMID: 28282701 PMCID: PMC6464706 DOI: 10.1002/14651858.cd008524.pub3] [Citation(s) in RCA: 133] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Vitamin A deficiency (VAD) is a major public health problem in low- and middle-income countries, affecting 190 million children under five years of age and leading to many adverse health consequences, including death. Based on prior evidence and a previous version of this review, the World Health Organization has continued to recommend vitamin A supplementation for children aged 6 to 59 months. There are new data available from recently published randomised trials since the previous publication of this review in 2010, and this update incorporates this information and reviews the evidence. OBJECTIVES To assess the effects of vitamin A supplementation (VAS) for preventing morbidity and mortality in children aged six months to five years. SEARCH METHODS In March 2016 we searched CENTRAL, Ovid MEDLINE, Embase, six other databases, and two trials registers. We also checked reference lists and contacted relevant organisations and researchers to identify additional studies. SELECTION CRITERIA Randomised controlled trials (RCTs) and cluster-RCTs evaluating the effect of synthetic VAS in children aged six months to five years living in the community. We excluded studies involving children in hospital and children with disease or infection. We also excluded studies evaluating the effects of food fortification, consumption of vitamin A rich foods, or beta-carotene supplementation. DATA COLLECTION AND ANALYSIS For this update, two reviewers independently assessed studies for inclusion and abstracted data, resolving discrepancies by discussion. We performed meta-analyses for outcomes, including all-cause and cause-specific mortality, disease, vision, and side effects. We used the GRADE approach to assess the quality of the evidence. MAIN RESULTS We identified 47 studies (4 of which are new to this review), involving approximately 1,223,856 children. Studies took place in 19 countries: 30 (63%) in Asia, 16 of these in India; 8 (17%) in Africa; 7 (15%) in Latin America, and 2 (4%) in Australia. About one-third of the studies were in urban/periurban settings, and half were in rural settings; the remaining studies did not clearly report settings. Most of the studies included equal numbers of girls and boys and lasted about a year. The included studies were at variable overall risk of bias; however, evidence for the primary outcome was at low risk of bias. A meta-analysis for all-cause mortality included 19 trials (1,202,382 children). At longest follow-up, there was a 12% observed reduction in the risk of all-cause mortality for vitamin A compared with control using a fixed-effect model (risk ratio (RR) 0.88, 95% confidence interval (CI) 0.83 to 0.93; high-quality evidence). This result was sensitive to choice of model, and a random-effects meta-analysis showed a different summary estimate (24% reduction: RR 0.76, 95% CI 0.66 to 0.88); however, the confidence intervals overlapped with that of the fixed-effect model. Nine trials reported mortality due to diarrhoea and showed a 12% overall reduction for VAS (RR 0.88, 95% CI 0.79 to 0.98; 1,098,538 participants; high-quality evidence). There was no significant effect for VAS on mortality due to measles, respiratory disease, and meningitis. VAS reduced incidence of diarrhoea (RR 0.85, 95% CI 0.82 to 0.87; 15 studies; 77,946 participants; low-quality evidence) and measles (RR 0.50, 95% CI 0.37 to 0.67; 6 studies; 19,566 participants; moderate-quality evidence). However, there was no significant effect on incidence of respiratory disease or hospitalisations due to diarrhoea or pneumonia. There was an increased risk of vomiting within the first 48 hours of VAS (RR 1.97, 95% CI 1.44 to 2.69; 4 studies; 10,541 participants; moderate-quality evidence). AUTHORS' CONCLUSIONS Vitamin A supplementation is associated with a clinically meaningful reduction in morbidity and mortality in children. Therefore, we suggest maintaining the policy of universal supplementation for children under five years of age in populations at risk of VAD. Further placebo-controlled trials of VAS in children between six months and five years of age would not change the conclusions of this review, although studies that compare different doses and delivery mechanisms are needed. In populations with documented vitamin A deficiency, it would be unethical to conduct placebo-controlled trials.
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Affiliation(s)
- Aamer Imdad
- Vanderbilt University School of MedicineDepartment of Pediatrics, D. Brent Polk Division of Gastroenterology, Hepatology and NutritionNashvilleTNUSA37212
| | - Evan Mayo‐Wilson
- Johns Hopkins University Bloomberg School of Public HealthDepartment of Epidemiology615 North Wolfe StreetBaltimoreMarylandUSA21205
| | - Kurt Herzer
- Johns Hopkins School of MedicineTower 711600 North Wolfe St.BaltimoreMDUSA21287
| | - Zulfiqar A Bhutta
- Hospital for Sick ChildrenCentre for Global Child HealthTorontoONCanadaM5G A04
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Emmett SD, West KP. Nutrition and hearing loss: a neglected cause and global health burden. Am J Clin Nutr 2015; 102:987-8. [PMID: 26468119 PMCID: PMC4625599 DOI: 10.3945/ajcn.115.122598] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- Susan D Emmett
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD; and Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Keith P West
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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Abstract
OBJECTIVE To evaluate the association between adolescent and young-adult hearing loss and nonverbal intelligence in rural Nepal. STUDY DESIGN Cross-sectional assessment of hearing loss among a population cohort of adolescents and young adults. SETTING Sarlahi District, southern Nepal. PATIENTS Seven hundred sixty-four individuals aged 14 to 23 years. INTERVENTION Evaluation of hearing loss, defined by World Health Organization criteria of pure-tone average greater than 25 decibels (0.5, 1, 2, 4 kHz), unilaterally and bilaterally. MAIN OUTCOME MEASURE Nonverbal intelligence, as measured by the Test of Nonverbal Intelligence, 3rd Edition standardized score (mean, 100; standard deviation, 15). RESULTS Nonverbal intelligence scores differed between participants with normal hearing and those with bilateral (p = 0.04) but not unilateral (p = 0.74) hearing loss. Demographic and socioeconomic factors including male sex; higher caste; literacy; education level; occupation reported as student; and ownership of a bicycle, watch, and latrine were strongly associated with higher nonverbal intelligence scores (all p < 0.001). Subjects with bilateral hearing loss scored an average of 3.16 points lower (95% confidence interval, -5.56 to -0.75; p = 0.01) than subjects with normal hearing after controlling for socioeconomic factors. There was no difference in nonverbal intelligence score based on unilateral hearing loss (0.97; 95% confidence interval, -1.67 to 3.61; p = 0.47). CONCLUSION Nonverbal intelligence is adversely affected by bilateral hearing loss even at mild hearing loss levels. Socio economic well-being appears compromised in individuals with lower nonverbal intelligence test scores.
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Kang JW, Choi HS, Kim K, Choi JY. Dietary vitamin intake correlates with hearing thresholds in the older population: the Korean National Health and Nutrition Examination Survey. Am J Clin Nutr 2014; 99:1407-13. [PMID: 24646817 DOI: 10.3945/ajcn.113.072793] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Previous animal studies have shown that vitamins may prevent age-related hearing loss. However, no concrete conclusions have been reached about the association between vitamin intake and presbycusis in humans. OBJECTIVE We investigated the association between dietary vitamin intake and hearing thresholds in adults between 50 and 80 y of age by using data from a large population-based survey. DESIGN We used data from the 2011 Korea National Health and Nutrition Examination Survey. A pure-tone audiogram and physical examination of the ear were performed, and vitamin intake was calculated by using the 24-h recall method. Data from 1910 participants were analyzed through univariate and multivariate linear regression analyses. RESULTS After adjustment for age, sex, smoking, and exposure to occupational and explosive noise, intake of vitamin C correlated with better hearing at midfrequency (2000 and 3000 Hz) (coefficient: -0.012; 95% CI: -0.022, -0.002). Dietary supplement use was positively associated with better hearing at all frequencies. The univariate analysis indicated that dietary intakes of retinol, riboflavin, niacin, and vitamin C were positively correlated with better hearing at most frequencies. In contrast, serum concentrations of vitamin D were associated with worse hearing at mid and high (4000 and 6000 Hz) frequencies. CONCLUSIONS Dietary intake of vitamin C was associated with better hearing in the older population. Because less than one-half of elderly participants in this study consumed a sufficient amount of vitamins, and vitamin intake decreased with age, we should consider proper diet counseling to prevent hearing decline.
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Affiliation(s)
- Ju Wan Kang
- From the Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, South Korea (JWK and JYC); the Department of Otorhinolaryngology, National Health Insurance Corporation Ilsan Hospital, Gyeonggi-do, South Korea (HSC); and the Department of Otorhinolaryngology-Head and Neck Surgery, Hallym University College of Medicine, Kangdong Sacred Heart Hospital, Seoul, South Korea (KK)
| | - Hyun Seung Choi
- From the Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, South Korea (JWK and JYC); the Department of Otorhinolaryngology, National Health Insurance Corporation Ilsan Hospital, Gyeonggi-do, South Korea (HSC); and the Department of Otorhinolaryngology-Head and Neck Surgery, Hallym University College of Medicine, Kangdong Sacred Heart Hospital, Seoul, South Korea (KK)
| | - Kyubo Kim
- From the Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, South Korea (JWK and JYC); the Department of Otorhinolaryngology, National Health Insurance Corporation Ilsan Hospital, Gyeonggi-do, South Korea (HSC); and the Department of Otorhinolaryngology-Head and Neck Surgery, Hallym University College of Medicine, Kangdong Sacred Heart Hospital, Seoul, South Korea (KK)
| | - Jae Young Choi
- From the Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, South Korea (JWK and JYC); the Department of Otorhinolaryngology, National Health Insurance Corporation Ilsan Hospital, Gyeonggi-do, South Korea (HSC); and the Department of Otorhinolaryngology-Head and Neck Surgery, Hallym University College of Medicine, Kangdong Sacred Heart Hospital, Seoul, South Korea (KK)
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Emmett SD, West KP. Gestational vitamin A deficiency: a novel cause of sensorineural hearing loss in the developing world? Med Hypotheses 2014; 82:6-10. [PMID: 24120698 PMCID: PMC4391953 DOI: 10.1016/j.mehy.2013.09.028] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Revised: 09/11/2013] [Accepted: 09/17/2013] [Indexed: 10/26/2022]
Abstract
Hearing loss is a substantial public health problem with profound social and economic consequences in the developing world. The World Health Organization (WHO) estimates that there are 360 million people living with disabling hearing loss globally, and 80% of these individuals are from low- and middle-income countries. The epidemiology of hearing impairment remains poorly defined in most impoverished societies. Middle ear infections in childhood are a key determinant; however, congenital anomalies may also comprise an important etiology and may arise from gestational malnutrition. While evidence exists that preventable vitamin A deficiency exacerbates the severity of ear infections and, consequently, hearing loss, antenatal vitamin A deficiency during sensitive periods of fetal development may represent an etiologically distinct and virtually unexplored causal pathway. Evidence from multiple animal systems clearly shows that fetal inner ear development requires adequate vitamin A nutriture to proceed normally. Inner ear malformations occur in experimentally imposed maternal vitamin A deficiency in multiple species in a dose-response manner. These anomalies are likely due to the loss of retinoic acid-dependent regulation of both hindbrain development and otic morphogenic processes. Based on in vivo evidence in experimental animals, we hypothesize that preventable gestational vitamin A deficiency, especially during early stages of fetal development, may predispose offspring to inner ear malformations and sensorineural hearing loss. As vitamin A deficiency affects an estimated 20 million pregnant women globally, we hypothesize that, in undernourished settings, routine provision of supplemental vitamin A at the recommended allowance throughout pregnancy may promote normal inner ear development and reduce risk of an as yet unknown fraction of sensorineural hearing loss. If our hypothesis proves correct, gestational vitamin A deficiency would represent a potentially preventable etiology of sensorineural hearing loss of substantial public health significance.
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Affiliation(s)
- Susan D Emmett
- Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins University School of Medicine, 601 N Caroline Street, Baltimore, MD 21287, USA; Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe Street, W2041, Baltimore, MD 21205, USA.
| | - Keith P West
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe Street, W2041, Baltimore, MD 21205, USA
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Akhtar S, Ahmed A, Randhawa MA, Atukorala S, Arlappa N, Ismail T, Ali Z. Prevalence of vitamin A deficiency in South Asia: causes, outcomes, and possible remedies. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2013; 31:413-23. [PMID: 24592582 PMCID: PMC3905635 DOI: 10.3329/jhpn.v31i4.19975] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Vitamin A deficiency (VAD) has been recognized as a public-health issue in developing countries. Economic constraints, sociocultural limitations, insufficient dietary intake, and poor absorption leading to depleted vitamin A stores in the body have been regarded as potential determinants of the prevalence of VAD in South Asian developing countries. VAD is exacerbated by lack of education, poor sanitation, absence of new legislation and enforcement of existing food laws, and week monitoring and surveillance system. Several recent estimates confirmed higher morbidly and mortality rate among children and pregnant and non-pregnant women of childbearing age. Xerophthalmia is the leading cause of preventable childhood blindness with its earliest manifestations as night blindness and Bitot's spots, followed by blinding keratomalacia, all of which are the ocular manifestations of VAD. Children need additional vitamin A because they do not consume enough in their normal diet. There are three general ways for improving vitamin A status: supplementation, fortification, and dietary diversification. These approaches have not solved the problem in South Asian countries to the desired extent because of poor governmental support and supervision of vitamin A supplementation twice a year. An extensive review of the extant literature was carried out, and the data under various sections were identified by using a computerized bibliographic search via PubMed, Web of Science, and Google Scholar. All abstracts and full-text articles were examined, and the most relevant articles were selected for screening and inclusion in this review. Conclusively, high prevalence of VAD in South Asian developing countries leads to increased morbidity and mortality among infants, children, and pregnant women. Therefore, stem efforts are needed to address this issue of public-health significance at local and international level in lower- and middle-income countries of South Asia.
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Affiliation(s)
- Saeed Akhtar
- Department of Food Science &Technology, Bahauddin Zakariya University, Multan, Pakistan.
| | - Anwaar Ahmed
- Department of Food Technology, PMAS-Arid Agriculture University, Rawalpindi 46300, Pakistan
| | - Muhammad Atif Randhawa
- National Institute of Food Science and Technology, University of Agriculture, Faisalabad, Pakistan
| | - Sunethra Atukorala
- Department of Biochemistry & Molecular Biology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Nimmathota Arlappa
- Division of Community Studies, National Institute of Nutrition, Indian Council of Medical Research, Tarnaka-Hyderabad 500 007, India
| | - Tariq Ismail
- Department of Food Science &Technology, Bahauddin Zakariya University, Multan, Pakistan
| | - Zulfiqar Ali
- Department of Agriculture and Food Technology, Karakoram International University, Gilgit-Baltistan, Pakistan
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Stewart CP, Christian P, Wu LS, LeClerq SC, Khatry SK, West KP. Prevalence and risk factors of elevated blood pressure, overweight, and dyslipidemia in adolescent and young adults in rural Nepal. Metab Syndr Relat Disord 2013; 11:319-28. [PMID: 23682595 PMCID: PMC3817862 DOI: 10.1089/met.2013.0016] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Chronic disease begins early in life, yet population data are sparse on potential causal factors in children and young adults in South Asia. METHODS We assessed risk factors for chronic disease in two population cohorts, aged 9-23 years, in rural Nepal. Assessed variables included short height (less than -2 z), high body mass index (BMI) (z>0.42), waist circumference (WC) >90 cm (male) or 80 cm (female) or age-adjusted child cutoff], high blood pressure (>120/80 mmHg), fasting glucose (≥100 mg/dL), glycosylated hemoglobin (HbA1c) (>7%), blood lipids [triglyceride, high-density lipoprotein cholesterol (HDL-C), and total cholesterol], diet, smoking, alcohol, and socioeconomic status (SES) factors. RESULTS The population was stunted (46%) and few were overweight (∼2%-4% with high BMI or WC). Twelve percent had high blood pressure. Plasma hypertriglyceridemia (≥150 mg/dL) affected ∼8.5%, and 78% had low HDL-C concentrations <40 mg/dL (male) or <50 mg/dL (female)], while few (≤3%) had elevated total cholesterol (≥180 mg/dL), glucose, and HbA1c. Females were at higher risk than males for high blood pressure [odds ratio (OR) 1.9; 95% confidence interval (CI) 1.6-2.3] and overweight (4.2; 3.0-5.8), but had lower risk of dyslipidemia (0.7; 0.6-0.9). Ethnic plains Madheshi were less likely to be overweight (0.3; 0.2-0.4), but had greater risk of dyslipidemia (1.4; 1.1-1.7) versus those of Hill origin. Some dietary factors were significantly associated with high blood pressure or dyslipidemia, but not overweight. CONCLUSIONS Dyslipidemia and high blood pressure are emerging health concerns among young adults in rural Nepal.
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Affiliation(s)
- Christine P. Stewart
- Program in International and Community Nutrition, University of California, Davis, California
| | - Parul Christian
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Lee S.F. Wu
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Steven C. LeClerq
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Nepal Nutrition Intervention Project–Sarlahi, Kathmandu, Nepal
| | | | - Keith P. West
- Nepal Nutrition Intervention Project–Sarlahi, Kathmandu, Nepal
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Cunha A. Nutrition: Vitamin A prevents hearing loss. Nat Rev Endocrinol 2012; 8:195. [PMID: 22290359 DOI: 10.1038/nrendo.2012.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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