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Christifano DN, Chollet-Hinton L, Hoyer D, Schmidt A, Gustafson KM. Intake of eggs, choline, lutein, zeaxanthin, and DHA during pregnancy and their relationship to fetal neurodevelopment. Nutr Neurosci 2022:1-7. [PMID: 35715980 DOI: 10.1080/1028415x.2022.2088944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Maternal intake of eggs and nutrients contained within eggs during pregnancy have the potential to impact fetal neurodevelopment; however, this area is understudied. The purpose of this study was to determine whether maternal egg and choline intake and nutrient interactions between choline, lutein and zeaxanthin (L/Z), and DHA predict fetal neurodevelopment in a large cohort of pregnant women (n = 202). NCT02709239. METHODS Food frequency questionnaires were used to assess egg and nutrient intake during pregnancy. Fetal neurodevelopment was measured using fetal biomagnetometry at 32 and 36wks gestation, and fetal autonomic indices (SDNN, RMSSD) and brain maturation indices (fABAS) were calculated. Generalized linear models tested the relationships between choline intake, egg intake, and nutrient interactions with fetal neurodevelopment. RESULTS Maternal egg intake predicted RMSSD at 32wks and fABAS at 36wks. The interaction between choline and L/Z intake predicted fABAS at 32wks and 36wks and the interaction between choline intake, L/Z intake, and DHA predicted fABAS at 36wks. At 36wks, SDNN was predicted by L/Z intake and interactions between choline and L/Z, L/Z and DHA, and choline, L/Z, and DHA. CONCLUSION Eggs and the nutrients contained within eggs showed synergistic associations with fetal neurodevelopment, and consumption should be encouraged among pregnant women.
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Affiliation(s)
- Danielle N Christifano
- Department of Nutrition and Dietetics, University of Kansas Medical Center, Kansas City, KS, USA.,Department of Dietetics and Nutrition, University of Kansas Medical Center, Kansas City, KS, USA
| | - Lynn Chollet-Hinton
- Department of Biostatistics & Data Science, University of Kansas Medical Center, Kansas City, KS, USA
| | - Dirk Hoyer
- Biomagnetic Center, Hans Berger Department of Neurology, Jena University Hospital, Jena, Germany
| | - Alexander Schmidt
- Biomagnetic Center, Hans Berger Department of Neurology, Jena University Hospital, Jena, Germany.,Department of Obstetrics, Jena University Hospital, Jena, Germany
| | - Kathleen M Gustafson
- Department of Dietetics and Nutrition, University of Kansas Medical Center, Kansas City, KS, USA.,Department of Neurology, University of Kansas Medical Center, Kansas City, KS, USA
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Bragg MG, Prado EL, Stewart CP. Choline and docosahexaenoic acid during the first 1000 days and children's health and development in low- and middle-income countries. Nutr Rev 2021; 80:656-676. [PMID: 34338760 PMCID: PMC8907485 DOI: 10.1093/nutrit/nuab050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Choline and DHA are nutrients that, when provided during the first 1000 days from conception to age 2 years, may have beneficial effects on child neurodevelopment as well as related health factors, including birth outcomes and child growth, morbidity, and inflammation. Because these nutrients are found mainly in animal-source foods, they may be lacking in the diets of pregnant and lactating women and young children in low- and middle-income countries, potentially putting children at risk for suboptimal development and health. Prior reviews of these nutrients have mainly focused on studies from high-income countries. Here, a narrative review is presented of studies describing the pre- and postnatal roles of choline, docosahexaenoic acid, and a combination of the 2 nutrients on child neurodevelopment, birth outcomes, growth, morbidity, and inflammation in low- and middle-income countries. More studies are needed to understand the specific, long-term effects of perinatal choline and docosahexaenoic acid intake in various contexts.
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Affiliation(s)
- Megan G Bragg
- M.G. Bragg, E.L. Prado, and C.P. Stewart are with the Institute for Global Nutrition, University of California Davis, Davis, California, United States
| | - Elizabeth L Prado
- M.G. Bragg, E.L. Prado, and C.P. Stewart are with the Institute for Global Nutrition, University of California Davis, Davis, California, United States
| | - Christine P Stewart
- M.G. Bragg, E.L. Prado, and C.P. Stewart are with the Institute for Global Nutrition, University of California Davis, Davis, California, United States
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Prabhu GS, Prasad K, K G MR, Rai KS. Efficacy of choline and DHA supplements or enriched environment exposure during early adult obesity in mitigating its adverse impact through aging in rats. Saudi J Biol Sci 2021; 28:2396-2407. [PMID: 33911955 PMCID: PMC8071910 DOI: 10.1016/j.sjbs.2021.01.037] [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] [Received: 05/09/2020] [Revised: 01/11/2021] [Accepted: 01/17/2021] [Indexed: 12/22/2022] Open
Abstract
Introduction The aim of this study was to assess the efficacy of choline and DHA or exposure to environmental enrichment in obese adult and aging rats on alterations in body mass index, serum lipid profile and arterial wall changes, despite stopping high fat diet consumption and interventions during adulthood. Methods 21 day old male Sprague Dawley rats were assigned as Experiment-1 & 2 - PND rats were divided into 4 groups with interventions for 7 months (n = 8/group). NC- Normal control fed normal chow diet; OB- Obese group, fed high fat diet; OB + CHO + DHA- fed high fat diet and oral supplementation of choline, DHA. OB + EE- fed high fat diet along with exposure to enriched environment .Experiment-2 had similar groups and interventions as experiment 1 but for next 5 months were fed normal chow diet without any interventions. Body mass index was assessed and blood was analyzed for serum lipid profile. Common Carotid Artery (CCA) was processed for Haematoxylin and eosin, Verhoff Vangeison stains. Images of tissue sections were analyzed and quantified using image J and tissue quant software. Results In experiment.1, mean body mass index (p < 0.001), serum lipid profile (p < 0.01), thickness of tunica intima (p < 0.05), tunica media (p < 0.01) and percentage of collagen fibers (p < 0.01) of CCA were significantly increased in OB compared to NC. These were significantly attenuated in OB + CHO + DHA and OB + EE compared to OB. In experiment.2, mean body mass index (p < 0.01), serum lipid profile (p < 0.05) and thickness of tunica media of CCA (p < 0.01) were significantly increased in OB compared to NC. In OB + CHO + DHA and OB + EE, significant attenuation was observed in mean body mass index and mean thickness of tunica media compared to same in OB. Conclusion Adult obesity has negative impact on body mass index, serum lipid profile and arterial wall structure that persists through aging. Supplementation of choline and DHA or exposure to enriched environment during obesity attenuates these negative impacts through aging.
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Affiliation(s)
- Gayathri S Prabhu
- Department of Anatomy, Melaka Manipal Medical College (Manipal campus), Manipal Academy of Higher Education, Karnataka, India
| | - Keerthana Prasad
- Manipal School of Information Sciences, Manipal Academy of Higher Education, Karnataka, India
| | - Mohandas Rao K G
- Department of Anatomy, Melaka Manipal Medical College (Manipal campus), Manipal Academy of Higher Education, Karnataka, India
| | - Kiranmai S Rai
- Department of Physiology, Melaka Manipal Medical College (Manipal campus), Manipal Academy of Higher Education, Karnataka, India
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4
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Prabhu GS, K G Rao M, Rai KS. Hippocampal neural cell degeneration and memory deficit in high-fat diet-induced postnatal obese rats- exploring the comparable benefits of choline and DHA or environmental enrichment. Int J Neurosci 2020; 131:1066-1077. [PMID: 32498586 DOI: 10.1080/00207454.2020.1773819] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Purpose: Childhood obesity increases risk for neural dysfunctions causing learning and memory deficits. The objective of the study is to identify the effects of high fat diet-induced obesity in postnatal period on serum lipids, memory and neural cell survival in hippocampus and compare the role of choline and DHA or environmental enrichment in attenuating the alterationsMaterials and methods: 21 day postnatal male Sprague Dawley rats were assigned as Normal control [NC] fed normal chow diet, Obesity-induced [OB] fed high fat diet, Obesity-induced fed choline & DHA [OB + CHO + DHA], Obesity-induced environmental enrichment [OB + EE] [n = 8/group]. Memory was assessed using radial arm maze. Subsequently blood was collected for serum lipid analysis and rats were euthanized. 5 µm hippocampal sections were processed for cresyl-violet stain. Surviving neural cells were counted using 100 µm scale.Results: Memory errors were significantly higher [p < 0.001, 0.01] in OB compared to same in NC rats. Mean number of surviving neural cells in hippocampus of OB was significantly lesser [p < 0.01] compared to same in NC. Interventions in OB + CHO + DHA and OB + EE significantly attenuated [p < 0.01] memory errors and number of surviving neural cells in hippocampus [CA1, CA3 and DG] compared to same in OB. Moreover, hippocampal neural cell survival was found to be inversely related to serum lipid profile in OB group and was attenuated in OB + CHO + DHA and OB + EE rats.Conclusions: High fat diet-induced postnatal obesity in rats causes CA1/CA3 hippocampal neuro-degeneration and memory deficits. Supplementation of choline and DHA in obese rats attenuates these deficits.
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Affiliation(s)
- Gayathri S Prabhu
- Department of Anatomy, Melaka Manipal Medical College [Manipal campus], Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Mohandas K G Rao
- Department of Anatomy, Melaka Manipal Medical College [Manipal campus], Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Kiranmai S Rai
- Department of Physiology, Melaka Manipal Medical College [Manipal campus], Manipal Academy of Higher Education, Manipal, Karnataka, India
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Yong-Ping L, Reichetzeder C, Prehn C, Yin LH, Chu C, Elitok S, Krämer BK, Adamski J, Hocher B. Impact of maternal smoking associated lyso-phosphatidylcholine 20:3 on offspring brain development. J Steroid Biochem Mol Biol 2020; 199:105591. [PMID: 31954177 DOI: 10.1016/j.jsbmb.2020.105591] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Revised: 01/10/2020] [Accepted: 01/13/2020] [Indexed: 11/24/2022]
Abstract
Maternal smoking during pregnancy affects fetal neurological development. Metabolomic studies in the general population suggest that smoking is associated with characteristic metabolic alterations. We investigated the association between the maternal smoking status, the fetal metabolome and head circumference at birth, as a surrogate parameter of brain development. 320 mother/newborn pairs of the Berlin Birth Cohort were investigated. Anthropometric parameters, including head circumference, of newborns of smoking mothers, former smoking mothers, and never smoking mothers were compared to assess the impact of maternal smoking behavior. Associations between maternal smoking behavior and 163 cord blood metabolites and associations between newborn head circumference and concentrations of smoking behavior related metabolites were analysed. Male newborns of smoking mothers had a reduced head circumference when compared with newborns from former smoking and never smoking mothers (p < 0.05). Using linear regression models corrected for established confounding factors, maternal smoking during pregnancy showed an independent association with head circumference (95% CI: -0.75~-0.41 cm, p = 2.45×10-11). In a stepwise linear regression model corrected for known confounding factors of brain growth lyso-phosphatidylcholine 20:3 (95% CI: 6.68~39.88 cm, p = 4.62×10-4) was associated with head circumference in male offspring only. None of the metabolites were associated with head circumference of female newborns. In conclusion, maternal smoking during pregnancy impacted on male offspring's development including brain development. The smoking related metabolite lyso-phosphatidylcholine 20:3 was associated with head circumference of male offspring.
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Affiliation(s)
- Lu Yong-Ping
- Department of Nephrology, the First Affiliated Hospital of Jinan University, Guangzhou, China; Fifth Department of Medicine (Nephrology/Endocrinology/Rheumatology), University Medical Centre Mannheim, University of Heidelberg, Heidelberg, Germany
| | - Christoph Reichetzeder
- Department of Nutritional Toxicology, Institute of Nutritional Science, University of Potsdam, Potsdam-Rehbrücke, Germany
| | - Cornelia Prehn
- Research Unit Molecular Endocrinology and Metabolism, Genome Analysis Center, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - Liang-Hong Yin
- Department of Nephrology, the First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Chang Chu
- Fifth Department of Medicine (Nephrology/Endocrinology/Rheumatology), University Medical Centre Mannheim, University of Heidelberg, Heidelberg, Germany
| | - Saban Elitok
- Fifth Department of Medicine (Nephrology/Endocrinology/Rheumatology), University Medical Centre Mannheim, University of Heidelberg, Heidelberg, Germany; Department of Nephrology, Klinikum Ernst Von Bergmann, Potsdam, Germany
| | - Bernhard K Krämer
- Fifth Department of Medicine (Nephrology/Endocrinology/Rheumatology), University Medical Centre Mannheim, University of Heidelberg, Heidelberg, Germany
| | - Jerzy Adamski
- Research Unit Molecular Endocrinology and Metabolism, Genome Analysis Center, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany; Experimentelle Genetik, Technische Universität München, 85350 Freising-Weihenstephan, Germany; Department of Biochemistry, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Berthold Hocher
- Fifth Department of Medicine (Nephrology/Endocrinology/Rheumatology), University Medical Centre Mannheim, University of Heidelberg, Heidelberg, Germany; Key Laboratory of Study and Discovery of Small Targeted Molecules of Hunan Province, School of Medicine, Hunan Normal University, Changsha, China; Reproductive and Genetic Hospital of CITIC-Xiangya, Changsha, China.
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Zhao WN, Hylton NK, Wang J, Chindavong PS, Alural B, Kurtser I, Subramanian A, Mazitschek R, Perlis RH, Haggarty SJ. Activation of WNT and CREB signaling pathways in human neuronal cells in response to the Omega-3 fatty acid docosahexaenoic acid (DHA). Mol Cell Neurosci 2019; 99:103386. [PMID: 31202891 PMCID: PMC7001743 DOI: 10.1016/j.mcn.2019.06.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 06/11/2019] [Accepted: 06/12/2019] [Indexed: 02/06/2023] Open
Abstract
A subset of individuals with major depressive disorder (MDD) elects treatment with complementary and alternative medicines (CAMs), including the omega-3 fatty acids docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA). Previous studies in rodents suggest that DHA modulates neurodevelopmental processes, including adult neurogenesis and neuroplasticity, but the molecular and cellular mechanisms of DHA's potential therapeutic effect in the context of human neurobiology have not been well established. Here we sought to address this knowledge gap by investigating the effects of DHA using human iPSC-derived neural progenitor cells (NPCs) and post-mitotic neurons using pathway-selective reporter genes, multiplexed mRNA expression profiling, and a panel of metabolism-based viability assays. Finally, real-time, live-cell imaging was employed to monitor neurite outgrowth upon DHA treatment. Overall, these studies showed that DHA treatment (0-50 μM) significantly upregulated both WNT and CREB signaling pathways in human neuronal cells in a dose-dependent manner with 2- to 3-fold increases in pathway activation. Additionally, we observed that DHA treatment enhanced survival of iPSC-derived NPCs and differentiation of post-mitotic neurons with live-cell imaging, revealing increased neurite outgrowth with DHA treatment within 24 h. Taken together, this study provides evidence that DHA treatment activates critical pathways regulating neuroplasticity, which may contribute to enhanced neuronal cell viability and neuronal connectivity. The extent to which these pathways represent molecular mechanisms underlying the potential beneficial effects of omega-3 fatty acids in MDD and other brain disorders merits further investigation.
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Affiliation(s)
- Wen-Ning Zhao
- Chemical Neurobiology Laboratory, Center for Genomic Medicine, Massachusetts General Hospital, 185 Cambridge Street, Boston, MA 02114, United States of America; Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, United States of America; Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, United States of America
| | - Norma K Hylton
- Chemical Neurobiology Laboratory, Center for Genomic Medicine, Massachusetts General Hospital, 185 Cambridge Street, Boston, MA 02114, United States of America
| | - Jennifer Wang
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, United States of America; Center for Quantitative Health, Center for Genomic Medicine, Division of Clinical Research, Massachusetts General Hospital, 185 Cambridge Street, Boston, MA 02114, United States of America
| | - Peter S Chindavong
- Chemical Neurobiology Laboratory, Center for Genomic Medicine, Massachusetts General Hospital, 185 Cambridge Street, Boston, MA 02114, United States of America; Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, United States of America; Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, United States of America
| | - Begum Alural
- Chemical Neurobiology Laboratory, Center for Genomic Medicine, Massachusetts General Hospital, 185 Cambridge Street, Boston, MA 02114, United States of America; Department of Neuroscience, Institute of Health Sciences, Dokuz Eylul University, Izmir 35210, Turkey
| | - Iren Kurtser
- Chemical Neurobiology Laboratory, Center for Genomic Medicine, Massachusetts General Hospital, 185 Cambridge Street, Boston, MA 02114, United States of America; Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, United States of America; Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, United States of America
| | - Aravind Subramanian
- Broad Institute of MIT and Harvard, Cambridge, MA 02142, United States of America
| | - Ralph Mazitschek
- Broad Institute of MIT and Harvard, Cambridge, MA 02142, United States of America; Center for Systems Biology, Massachusetts General Hospital, 185 Cambridge Street, Boston, MA 02114, United States of America
| | - Roy H Perlis
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, United States of America; Center for Quantitative Health, Center for Genomic Medicine, Division of Clinical Research, Massachusetts General Hospital, 185 Cambridge Street, Boston, MA 02114, United States of America.
| | - Stephen J Haggarty
- Chemical Neurobiology Laboratory, Center for Genomic Medicine, Massachusetts General Hospital, 185 Cambridge Street, Boston, MA 02114, United States of America; Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, United States of America; Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, United States of America.
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Choline and DHA in Maternal and Infant Nutrition: Synergistic Implications in Brain and Eye Health. Nutrients 2019; 11:nu11051125. [PMID: 31117180 PMCID: PMC6566660 DOI: 10.3390/nu11051125] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 05/06/2019] [Accepted: 05/17/2019] [Indexed: 12/11/2022] Open
Abstract
The aim of this review is to highlight current insights into the roles of choline and docosahexaenoic acid (DHA) in maternal and infant nutrition, with special emphasis on dietary recommendations, gaps in dietary intake, and synergistic implications of both nutrients in infant brain and eye development. Adequate choline and DHA intakes are not being met by the vast majority of US adults, and even more so by women of child-bearing age. Choline and DHA play a significant role in infant brain and eye development, with inadequate intakes leading to visual and neurocognitive deficits. Emerging findings illustrate synergistic interactions between choline and DHA, indicating that insufficient intakes of one or both could have lifelong deleterious impacts on both maternal and infant health.
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Lindsay KL, Buss C, Wadhwa PD, Entringer S. The Interplay Between Nutrition and Stress in Pregnancy: Implications for Fetal Programming of Brain Development. Biol Psychiatry 2019; 85:135-149. [PMID: 30057177 PMCID: PMC6389360 DOI: 10.1016/j.biopsych.2018.06.021] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 06/04/2018] [Accepted: 06/15/2018] [Indexed: 12/17/2022]
Abstract
Growing evidence supports an important role for the intrauterine environment in shaping fetal development and subsequent child health and disease risk. The fetal brain is particularly plastic, whereby even subtle changes in structure and function produced by in utero conditions can have long-term implications. Based on the consideration that conditions related to energy substrate and likelihood of survival to reproductive age are particularly salient drivers of fetal programming, maternal nutrition and stress represent the most commonly, but independently, studied factors in this context. However, the effects of maternal nutrition and stress are context dependent and may be moderated by one another. Studies examining the effects of the bidirectional nutrition-stress interplay in pregnancy on fetal programming of brain development are beginning to emerge in the literature. This review incorporates all currently available animal and human studies of this interplay and provides a synthesis and critical discussion of findings. Nine of the 10 studies included here assessed nutrition-stress interactions and offspring neurodevelopmental or brain development outcomes. Despite significant heterogeneity in study design and methodology, two broad patterns of results emerge to suggest that the effects of prenatal stress on various aspects of brain development may be mitigated by 1) higher fat diets or increased intake and/or status of specific dietary fats and 2) higher dietary intake or supplementation of targeted nutrients. The limitations of these studies are discussed, and recommendations are provided for future research to expand on this important area of fetal programming of brain development.
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Affiliation(s)
- Karen L Lindsay
- Department of Pediatrics, University of California, Irvine, Irvine, California; UC Irvine Development, Health and Disease Research Program, University of California, Irvine, Irvine, California
| | - Claudia Buss
- Department of Pediatrics, University of California, Irvine, Irvine, California; UC Irvine Development, Health and Disease Research Program, University of California, Irvine, Irvine, California; Institute of Medical Psychology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Pathik D Wadhwa
- Department of Pediatrics, University of California, Irvine, Irvine, California; Department of Psychiatry and Human Behavior, University of California, Irvine, Irvine, California; Department of Obstetrics and Gynecology, University of California, Irvine, Irvine, California; UC Irvine Development, Health and Disease Research Program, University of California, Irvine, Irvine, California
| | - Sonja Entringer
- Department of Pediatrics, University of California, Irvine, Irvine, California; UC Irvine Development, Health and Disease Research Program, University of California, Irvine, Irvine, California; Institute of Medical Psychology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.
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9
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Khandelwal S, Swamy MK, Patil K, Kondal D, Chaudhry M, Gupta R, Divan G, Kamate M, Ramakrishnan L, Bellad MB, Gan A, Kodkany BS, Martorell R, Srinath Reddy K, Prabhakaran D, Ramakrishnan U, Tandon N, Stein AD. The impact of DocosaHexaenoic Acid supplementation during pregnancy and lactation on Neurodevelopment of the offspring in India (DHANI): trial protocol. BMC Pediatr 2018; 18:261. [PMID: 30077178 PMCID: PMC6090734 DOI: 10.1186/s12887-018-1225-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Accepted: 07/18/2018] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Evidence suggests a strong association between nutrition during the first 1000 days (conception to 2 years of life) and cognitive development. Maternal docosahexaenoic acid (DHA) supplementation has been suggested to be linked with cognitive development of their offspring. DHA is a structural component of human brain and retina, and can be derived from marine algae, fatty fish and marine oils. Since Indian diets are largely devoid of such products, plasma DHA levels are low. We are testing the effect of pre- and post-natal DHA maternal supplementation in India on infant motor and mental development, anthropometry and morbidity patterns. METHODS DHANI is a double-blinded, parallel group, randomized, placebo controlled trial supplementing 957 pregnant women aged 18-35 years from ≤20 weeks gestation through 6 months postpartum with 400 mg/d algal-derived DHA or placebo. Data on the participant's socio-demographic profile, anthropometric measurements and dietary intake are being recorded at baseline. The mother-infant dyads are followed through age 12 months. The primary outcome variable is infant motor and mental development quotient at 12 months of age evaluated by Development Assessment Scale in Indian Infants (DASII). Secondary outcomes are gestational age, APGAR scores, and infant anthropometry. Biochemical indices (blood and breast-milk) from mother-child dyads are being collected to estimate changes in DHA levels in response to supplementation. All analyses will follow the intent-to-treat principle. Two-sample t test will be used to test unadjusted difference in mean DASII score between placebo and DHA group. Adjusted analyses will be performed using multiple linear regression. DISCUSSION Implications for maternal and child health and nutrition in India: DHANI is the first large pre- and post-natal maternal dietary supplementation trial in India. If the trial finds substantial benefit, it can serve as a learning to scale up the DHA intervention in the country. TRIAL REGISTRATION The trial is retrospectively registered at clinicaltrials.gov ( NCT01580345 , NCT03072277 ) and ctri.nic.in ( CTRI/2013/04/003540 , CTRI/2017/08/009296 ).
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Affiliation(s)
- Shweta Khandelwal
- Public Health Foundation of India, 47, Sector 44, Gurugram, Haryana, India.
- Centre for Chronic Disease Control, Gurugram, India.
| | - M K Swamy
- KLEU's JN Medical College, Belgavi, India
| | | | - Dimple Kondal
- Public Health Foundation of India, 47, Sector 44, Gurugram, Haryana, India
| | - Monica Chaudhry
- Public Health Foundation of India, 47, Sector 44, Gurugram, Haryana, India
| | - Ruby Gupta
- Public Health Foundation of India, 47, Sector 44, Gurugram, Haryana, India
| | | | - Mahesh Kamate
- Child Development Centre, Prabhakar Kore Hospital, Belgavi, India
| | | | | | - Anita Gan
- KLEU's JN Medical College, Belgavi, India
| | | | - Reynaldo Martorell
- Hubert Department of Global Health, Rollins School of Public Health Emory University, Atlanta, USA
| | - K Srinath Reddy
- Public Health Foundation of India, 47, Sector 44, Gurugram, Haryana, India
| | - Dorairaj Prabhakaran
- Public Health Foundation of India, 47, Sector 44, Gurugram, Haryana, India
- Centre for Chronic Disease Control, Gurugram, India
| | - Usha Ramakrishnan
- Hubert Department of Global Health, Rollins School of Public Health Emory University, Atlanta, USA
| | - Nikhil Tandon
- All India Institute of Medical Sciences, New Delhi, India
| | - Aryeh D Stein
- Hubert Department of Global Health, Rollins School of Public Health Emory University, Atlanta, USA
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