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Konkolÿ Thege B, Kinzel E, Hartmann-Boyce J, Choy O. PROTOCOL: The efficacy of nutritional interventions in reducing childhood/youth aggressive and antisocial behavior: A systematic review and meta-analysis. CAMPBELL SYSTEMATIC REVIEWS 2024; 20:e1400. [PMID: 38638327 PMCID: PMC11024636 DOI: 10.1002/cl2.1400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 02/08/2024] [Accepted: 03/21/2024] [Indexed: 04/20/2024]
Abstract
This is a protocol for a Campbell systematic review of intervention effectiveness. The goal of this systematic review is to answer the following questions based on the available empirical evidence: Are there nutritional interventions (dietary manipulation, fortification or supplementation) that can reduce excessive aggression towards others in children/youth? If yes, how strong is their effect and is there a difference among the three intervention types? Are there nutritional interventions that can reduce antisocial behaviors in children/youth? If yes, how strong is their effect and is there a difference among the intervention types? Are there nutritional interventions that can reduce violent offending in children/youth? If yes, how strong is their effect and is there a difference among the intervention types? Are there nutritional interventions that can reduce non-violent offending in children/youth? If yes, how strong is their effect and is there a difference among the intervention types? What implementation barriers and solutions to these exist in relation to the above nutritional interventions in children/youth?
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Affiliation(s)
- Barna Konkolÿ Thege
- Waypoint Centre for Mental Health Care Waypoint Research Institute Penetanguishene Canada
- Department of Psychiatry University of Toronto, Temerty Faculty of Medicine Toronto Canada
| | - Eden Kinzel
- Gerstein Science Information Centre University of Toronto Toronto Canada
| | - Jamie Hartmann-Boyce
- Department of Health Policy and Promotion University of Massachusetts Amherst Amherst USA
| | - Olivia Choy
- School of Social Sciences Nanyang Technological University Singapore Singapore
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Roger K, Vannasing P, Tremblay J, Bringas Vega ML, Bryce CP, Rabinowitz A, Valdes-Sosa PA, Galler JR, Gallagher A. Early childhood malnutrition impairs adult resting brain function using near-infrared spectroscopy. Front Hum Neurosci 2024; 17:1287488. [PMID: 38298205 PMCID: PMC10827877 DOI: 10.3389/fnhum.2023.1287488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 12/15/2023] [Indexed: 02/02/2024] Open
Abstract
Introduction Early childhood malnutrition affects 200+ million children under 5 years of age worldwide and is associated with persistent cognitive, behavioral and psychiatric impairments in adulthood. However, very few studies have investigated the long-term effects of childhood protein-energy malnutrition (PEM) on brain function using a functional hemodynamic brain imaging technique. Objective and methods This study aims to investigate functional brain network alterations using near infrared spectroscopy (NIRS) in adults, aged 45-51 years, from the Barbados Nutrition Study (BNS) who suffered from a single episode of malnutrition restricted to their first year of life (n = 26) and controls (n = 29). A total of 55 individuals from the BNS cohort underwent NIRS recording at rest. Results and discussion Using functional connectivity and permutation analysis, we found patterns of increased Pearson's correlation with a specific vulnerability of the frontal cortex in the PEM group (ps < 0.05). Using a graph theoretical approach, mixed ANCOVAs showed increased segregation (ps = 0.0303 and 0.0441) and decreased integration (p = 0.0498) in previously malnourished participants compared to healthy controls. These results can be interpreted as a compensatory mechanism to preserve cognitive functions, that could also be related to premature or pathological brain aging. To our knowledge, this study is the first NIRS neuroimaging study revealing brain function alterations in middle adulthood following early childhood malnutrition limited to the first year of life.
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Affiliation(s)
- Kassandra Roger
- LION Lab, Sainte-Justine University Hospital Research Center, University of Montreal, Montreal, QC, Canada
| | - Phetsamone Vannasing
- LION Lab, Sainte-Justine University Hospital Research Center, University of Montreal, Montreal, QC, Canada
| | - Julie Tremblay
- LION Lab, Sainte-Justine University Hospital Research Center, University of Montreal, Montreal, QC, Canada
| | - Maria L. Bringas Vega
- MOE Key Lab for Neuroinformation, The Clinical Hospital of Chengdu Brain Science Institute, University of Electronic Science and Technology of China, Chengdu, China
| | | | - Arielle Rabinowitz
- Montreal Neurological Institute, McGill University, Montreal, QC, Canada
| | - Pedro Antonio Valdes-Sosa
- MOE Key Lab for Neuroinformation, The Clinical Hospital of Chengdu Brain Science Institute, University of Electronic Science and Technology of China, Chengdu, China
| | - Janina R. Galler
- Division of Pediatric Gastroenterology and Nutrition, MassGeneral Hospital for Children, Boston, MA, United States
| | - Anne Gallagher
- LION Lab, Sainte-Justine University Hospital Research Center, University of Montreal, Montreal, QC, Canada
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Roger K, Vannasing P, Tremblay J, Bringas Vega ML, Bryce CP, Rabinowitz AG, Valdés-Sosa PA, Galler JR, Gallagher A. Impact of Early Childhood Malnutrition on Adult Brain Function: An Evoked-Related Potentials Study. Front Hum Neurosci 2022; 16:884251. [PMID: 35845242 PMCID: PMC9283562 DOI: 10.3389/fnhum.2022.884251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 05/27/2022] [Indexed: 11/13/2022] Open
Abstract
More than 200 million children under the age of 5 years are affected by malnutrition worldwide according to the World Health Organization. The Barbados Nutrition Study (BNS) is a 55-year longitudinal study on a Barbadian cohort with histories of moderate to severe protein-energy malnutrition (PEM) limited to the first year of life and a healthy comparison group. Using quantitative electroencephalography (EEG), differences in brain function during childhood (lower alpha1 activity and higher theta, alpha2 and beta activity) have previously been highlighted between participants who suffered from early PEM and controls. In order to determine whether similar differences persisted into adulthood, our current study used recordings obtained during a Go-No-Go task in a subsample of the original BNS cohort [population size (N) = 53] at ages 45-51 years. We found that previously malnourished adults [sample size (n) = 24] had a higher rate of omission errors on the task relative to controls (n = 29). Evoked-Related Potentials (ERP) were significantly different in participants with histories of early PEM, who presented with lower N2 amplitudes. These findings are typically associated with impaired conflict monitoring and/or attention deficits and may therefore be linked to the attentional and executive function deficits that have been previously reported in this cohort in childhood and again in middle adulthood.
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Affiliation(s)
- Kassandra Roger
- LION Lab, Sainte-Justine University Hospital Research Center, University of Montreal, Montreal, QC, Canada
| | - Phetsamone Vannasing
- LION Lab, Sainte-Justine University Hospital Research Center, University of Montreal, Montreal, QC, Canada
| | - Julie Tremblay
- LION Lab, Sainte-Justine University Hospital Research Center, University of Montreal, Montreal, QC, Canada
| | - Maria L. Bringas Vega
- MOE Key Lab for Neuroinformation, The Clinical Hospital of Chengdu Brain Science Institute, University of Electronic Science and Technology of China, Chengdu, China
| | | | | | - Pedro A. Valdés-Sosa
- MOE Key Lab for Neuroinformation, The Clinical Hospital of Chengdu Brain Science Institute, University of Electronic Science and Technology of China, Chengdu, China
| | - Janina R. Galler
- Division of Pediatric Gastroenterology and Nutrition, MassGeneral Hospital for Children, Boston, MA, United States
| | - Anne Gallagher
- LION Lab, Sainte-Justine University Hospital Research Center, University of Montreal, Montreal, QC, Canada
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Kirolos A, Goyheneix M, Kalmus Eliasz M, Chisala M, Lissauer S, Gladstone M, Kerac M. Neurodevelopmental, cognitive, behavioural and mental health impairments following childhood malnutrition: a systematic review. BMJ Glob Health 2022; 7:e009330. [PMID: 35793839 PMCID: PMC9260807 DOI: 10.1136/bmjgh-2022-009330] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 06/11/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Severe childhood malnutrition impairs growth and development short-term, but current understanding of long-term outcomes is limited. We aimed to identify studies assessing neurodevelopmental, cognitive, behavioural and mental health outcomes following childhood malnutrition. METHODS We systematically searched MEDLINE, EMBASE, Global Health and PsycINFO for studies assessing these outcomes in those exposed to childhood malnutrition in low-income and middle-income settings. We included studies assessing undernutrition measured by low mid-upper arm circumference, weight-for-height, weight-for-age or nutritional oedema. We used guidelines for synthesis of results without meta-analysis to analyse three outcome areas: neurodevelopment, cognition/academic achievement, behaviour/mental health. RESULTS We identified 30 studies, including some long-term cohorts reporting outcomes through to adulthood. There is strong evidence that malnutrition in childhood negatively impacts neurodevelopment based on high-quality studies using validated neurodevelopmental assessment tools. There is also strong evidence that malnutrition impairs academic achievement with agreement across seven studies investigating this outcome. Eight of 11 studies showed an association between childhood malnutrition and impaired cognition. This moderate evidence is limited by some studies failing to measure important confounders such as socioeconomic status. Five of 7 studies found a difference in behavioural assessment scores in those exposed to childhood malnutrition compared with controls but this moderate evidence is similarly limited by unmeasured confounders. Mental health impacts were difficult to ascertain due to few studies with mixed results. CONCLUSIONS Childhood malnutrition is associated with impaired neurodevelopment, academic achievement, cognition and behavioural problems but evidence regarding possible mental health impacts is inconclusive. Future research should explore the interplay of childhood and later-life adversities on these outcomes. While evidence on improving nutritional and clinical therapies to reduce long-term risks is also needed, preventing and eliminating child malnutrition is likely to be the best way of preventing long-term neurocognitive harms. PROSPERO REGISTRATION NUMBER CRD42021260498.
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Affiliation(s)
- Amir Kirolos
- Department of Women's and Children's Health, Institute of Life Course and Medical Sciences, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Blantyre, Malawi
| | - Magdalena Goyheneix
- Fundación ACNUR Argentina (Agencia de la ONU para los Refugiados, UNHCR), Buenos Aires, Argentina
| | - Mike Kalmus Eliasz
- Department of Women's and Children's Health, Institute of Life Course and Medical Sciences, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
| | - Mphatso Chisala
- Malawi Epidemiology and Intervention Research Unit, Lilongwe/Karonga, Malawi
| | - Samantha Lissauer
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Blantyre, Malawi
- Institute of Infection, Veterinary & Ecological Sciences, University of Liverpool, Liverpool, UK
| | - Melissa Gladstone
- Department of Women's and Children's Health, Institute of Life Course and Medical Sciences, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
| | - Marko Kerac
- Centre for Maternal, Child, Adolescent & Reproductive Health (MARCH), London School of Hygiene & Tropical Medicine, London, UK
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
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Leppänen JM, Butcher JW, Godbout C, Stephenson K, Hendrixson DT, Griswold S, Rogers BL, Webb P, Koroma AS, Manary MJ. Assessing infant cognition in field settings using eye-tracking: a pilot cohort trial in Sierra Leone. BMJ Open 2022; 12:e049783. [PMID: 35177442 PMCID: PMC8860005 DOI: 10.1136/bmjopen-2021-049783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES To investigate the feasibility of eye-tracking-based testing of the speed of visual orienting in malnourished young children at rural clinics in Sierra Leone. DESIGN Prospective dual cohort study nested in a cluster-randomised trial. SETTING 8 sites participating in a cluster-randomised trial of supplementary feeding for moderate acute malnutrition (MAM). PARTICIPANTS For the MAM cohort, all infants aged 7-11 months at the eight sites were enrolled, 138 altogether. For controls, a convenience sample of all non-malnourished infants aged 7-11 months at the same sites were eligible, 60 altogether. A sample of 30 adults at the sites also underwent eye-tracking tests as a further control. INTERVENTIONS Infants with MAM were provided with supplementary feeding. OUTCOME MEASURES The primary outcomes were feasibility and reliability of eye-tracking-based testing of saccadic reaction time (SRT). Feasibility was assessed by the percent of successful tests in the infants. Reliability was measured with intraclass correlation coefficients (ICCs). Secondary outcomes were mean SRT based on nutritional state as well as and changes in mean SRT after supplementary feeding of MAM children. RESULTS Infants exhibited consistent orienting to targets on a computer screen (>95% of valid trials). Mean SRTs had moderate stability within visits (ICCs 0.60-0.69) and across the 4-week test-retest interval (0.53) in infants; the adult control group had greater SRT stability (within visit ICC=0.92). MAM infants had a trend toward higher adjusted SRT at baseline (difference=12.4 ms, 95% CI -2 to 26.9, p=0.09) and improvement in SRT 4 weeks thereafter (difference=-14 ms, 95% CI -26.2 to -1.7, p=0.025) compared with age-matched controls. CONCLUSIONS The results demonstrate the feasibility of eye-tracking-based testing in a resource-poor field setting and suggest eye-tracking measures have utility in the detection of group level effects of supplementary feeding.
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Affiliation(s)
- Jukka M Leppänen
- Department of Psychology and Speech-Language Pathology, University of Turku, Turku, Finland
| | | | - Claire Godbout
- Department of Pediatrics, Washington University in St Louis School of Medicine, St Louis, Missouri, USA
| | - Kevin Stephenson
- Department of Internal Medicine, Washington University in St Louis School of Medicine, St Louis, Missouri, USA
| | - D Taylor Hendrixson
- Department of Pediatrics, Washington University in St Louis School of Medicine, St Louis, Missouri, USA
| | - Stacy Griswold
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, USA
| | - Beatrice Lorge Rogers
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, USA
| | - Patrick Webb
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, USA
| | - Aminata S Koroma
- Food and Nutrition, Sierra Leone Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Mark J Manary
- Department of Pediatrics, Washington University in St Louis School of Medicine, St Louis, Missouri, USA
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A resource-poor developmental diet reduces adult aggression in male Drosophila melanogaster. Behav Ecol Sociobiol 2021; 75:110. [PMID: 34720349 PMCID: PMC8549984 DOI: 10.1007/s00265-021-03050-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 06/26/2021] [Accepted: 06/30/2021] [Indexed: 12/01/2022]
Abstract
Aggressive behaviours occur throughout the animal kingdom and agonistic contests often govern access to resources. Nutrition experienced during development has the potential to influence aggressive behaviours in adults through effects on growth, energy budgets and an individual’s internal state. In particular, resource-poor developmental nutrition might decrease adult aggression by limiting growth and energy budgets, or alternatively might increase adult aggression by enhancing motivation to compete for resources. However, the direction of this relationship—and effects of developmental nutrition experienced by rivals—remains unknown in most species, limiting understanding of how early-life environments contribute to variation in aggression. We investigated these alternative hypotheses by assessing male-male aggression in adult fruit flies, Drosophila melanogaster, that developed on a low-, medium- or high-resource diet, manipulated via yeast content. We found that a low-resource developmental diet reduced the probability of aggressive lunges in adults, as well as threat displays against rivals that developed on a low-resource diet. These effects appeared to be independent of diet-related differences in body mass. Males performed relatively more aggression on a central food patch when facing rivals of a low-resource diet, suggesting that developmental diet affects aggressive interactions through social effects in addition to individual effects. Our finding that resource-poor developmental diets reduce male-male aggression in D. melanogaster is consistent with the idea that resource budgets mediate aggression and in a mass-independent manner. Our study improves understanding of the links between nutrition and aggression. Significance statement Early-life nutrition can influence social behaviours in adults. Aggression is a widespread social behaviour with important consequences for fitness. Using the fruit fly, Drosophila melanogaster, we show that a poor developmental diet reduces aspects of adult aggressive behaviour in males. Furthermore, males perform more aggression near food patches when facing rivals of poor nutrition. This suggests that early-life nutrition affects aggressive interactions through social effects in addition to individual effects.
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Rushmore RJ, McGaughy JA, Mokler DJ, Rosene DL. The enduring effect of prenatal protein malnutrition on brain anatomy, physiology and behavior. Nutr Neurosci 2020; 25:1392-1399. [PMID: 33314995 DOI: 10.1080/1028415x.2020.1859730] [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: 12/11/2022]
Abstract
There is increasing evidence that the maternal environment exerts enduring influences on the fetal brain. In response to certain environmental stimuli such as reduced protein content, the fetus changes the course of its brain development, which leads to specific and programed changes in brain anatomy and physiology. These alterations produce a brain with a fundamentally altered organization, which then translates to alterations in adult cognitive function. The effects on brain and behavior may be linked, such that a prenatal stimulus relays a signal to alter brain development and encourage the selection and development of brain circuits and behaviors that would be beneficial for the environment in which the animal was anticipated to emerge. At the same time, the signal would deselect behaviors unlikely to be adaptive. We draw on evidence from rodent models to suggest that the brain that develops after a reduction in protein during the prenatal phase is not uniformly dysfunctional, but simply different. This perspective has implications for the role of prenatal factors in the production and expression of behavior, and may account for the elevation of risk factors for neurological and psychiatric illnesses.
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Affiliation(s)
- R J Rushmore
- Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, MA, USA.,Psychiatric Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Boston, MA, USA.,Center for Morphometric Analysis, Massachusetts General Hospital, Boston, MA, USA
| | - J A McGaughy
- Department of Psychology, University of New Hampshire, Durham, NH, USA
| | - D J Mokler
- Department of Biomedical Sciences, College of Osteopathic Medicine, University of New England, Biddeford, ME, USA
| | - D L Rosene
- Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, MA, USA
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Amegbor PM, Yankey O, Sabel CE. Examining the Effect of Geographic Region of Residence on Childhood Malnutrition in Uganda. J Trop Pediatr 2020; 66:598-611. [PMID: 32791526 DOI: 10.1093/tropej/fmaa019] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES In our study, we examine how geographic region of residence may predict childhood malnutrition, expressed as stunting, wasting and underweight, among children under the age of 5 years in Uganda. METHODS Using data from the 2016 Uganda Demographic and Health Survey, we performed an incremental multivariate multilevel mixed-effect modelling to examine the effect of a child, parental and household factors on the association between region of residence and each indicator of childhood malnutrition. RESULTS Approximately 28%, 3% and 9% of children under age 5 suffered from stunting, wasting and underweight, respectively. The bivariate result shows that the proportion of children suffering from stunting and underweight was relatively lower in the Kampala region compared with the other regions. With the exception of the Northern region (6.44%), wasting was higher (4.12%) among children in the Kampala region. Children in the other regions were more likely to experience stunting and underweight. When controlling for child, parent and household factors, children in the other regions were less likely to suffer from underweight and stunting, compared with those in Kampala region. Children in the other regions, except the Northern region, were less likely to be wasted compared with those in Kampala region. CONCLUSION Our finding suggests that child, parental and household characteristics have effects on the association between region of residence and childhood malnutrition. Addressing individual and household socioeconomic disparities may be vital in tackling regional differences in childhood malnutrition.
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Affiliation(s)
- Prince M Amegbor
- BERTHA Big Data Centre for Environment and Health, Aarhus University, Frederiksborgvej 399, DK-4000 Roskilde, Denmark.,Department of Environmental Science, Aarhus University, Frederiksborgvej 399, DK-4000 Roskilde, Denmark
| | - Ortis Yankey
- Department of Geography, Kent State University, Kent, OH 44240, USA
| | - Clive E Sabel
- BERTHA Big Data Centre for Environment and Health, Aarhus University, Frederiksborgvej 399, DK-4000 Roskilde, Denmark.,Department of Environmental Science, Aarhus University, Frederiksborgvej 399, DK-4000 Roskilde, Denmark
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Berkel C, Smith JD, Bruening MM, Jordan N, Fu E, Mauricio AM, Grimm KJ, Winslow E, Ray K, Bourne A, Dishion TJ. The Family Check-Up 4 Health: Study protocol of a randomized type II hybrid effectiveness-implementation trial in integrated primary care (the healthy communities 4 healthy students study). Contemp Clin Trials 2020; 96:106088. [PMID: 32707101 PMCID: PMC7374139 DOI: 10.1016/j.cct.2020.106088] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 07/13/2020] [Accepted: 07/17/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND Parenting interventions like the Family Check-Up have demonstrated effects on child physical and behavioral health outcomes. However, access to these programs is limited, particularly for populations experiencing health disparities. Primary care settings have become recognized as a potential delivery system in which these programs may be implemented at scale. The purpose of this trial is to test the effectiveness of the Family Check-Up 4 Health (FCU4Health) program, an adaptation of the FCU for primary care, and assess program implementation in an integrated primary care setting. METHODS We will conduct a hybrid type 2 effectiveness-implementation trial in partnership with a primary care clinic in a low-income, majority Latino community. Families with 2- to 5-year-old children will be eligible to participate. Families will be randomized to receive the intervention (n = 130) or services as usual (n = 70) and will be assessed annually over three years. Outcomes are informed by the RE-AIM framework (i.e., reach, effectiveness, adoption, implementation, and maintenance). Effectiveness outcomes include child health behaviors (e.g., Dietary Screener Questionnaire), behavioral health (e.g., Strengths and Difficulties Questionnaire), and parenting (e.g., Proactive Parenting). Early stage implementation outcomes are also included (e.g., cost, acceptability, appropriateness, and feasibility). Effectiveness outcomes will be assessed via intent-to-treat (ITT) analyses. Implementation outcomes will be primarily descriptive with comparisons to prior trials of FCU4Health and the original FCU. PROJECTED OUTCOMES This trial will provide evidence related to the potential of integrated primary care settings to deliver evidence-based preventive interventions with a dual focus on behavioral and physical health.
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Affiliation(s)
- Cady Berkel
- REACH Institute, Arizona State University, Tempe, AZ, USA; Phoenix Children's Hospital, Phoenix, AZ, USA.
| | - Justin D Smith
- Center for Prevention Implementation Methodology (Ce-PIM), Department of Psychiatry and Behavioral Sciences, Department of Preventive Medicine, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Meg M Bruening
- Department of Nutrition, Arizona State University, Tempe, AZ, USA
| | - Neil Jordan
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Emily Fu
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | - Kevin J Grimm
- Department of Psychology, Arizona State University, Tempe, AZ, USA
| | - Emily Winslow
- REACH Institute, Arizona State University, Tempe, AZ, USA
| | - Kristen Ray
- Bayless Integrated Healthcare, Phoenix, AZ, USA
| | - Annette Bourne
- Southwest Maricopa Regional Council, First Things First, Peoria, AZ, USA
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Sujan AC, Öberg AS, Quinn PD, D’Onofrio BM. Annual Research Review: Maternal antidepressant use during pregnancy and offspring neurodevelopmental problems - a critical review and recommendations for future research. J Child Psychol Psychiatry 2019; 60:356-376. [PMID: 30515808 PMCID: PMC6438736 DOI: 10.1111/jcpp.13004] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/11/2018] [Indexed: 12/11/2022]
Abstract
Children of women treated with antidepressants during pregnancy are more likely to develop neurodevelopmental problems than are unexposed children. Associations between prenatal antidepressant exposure and neurodevelopmental problems could reflect a causal effect or could be partially or fully explained by other factors that differ between exposed and unexposed offspring, including having mothers with conditions requiring antidepressant treatment (e.g. depression), environmental risk factors, and/or genetic risk factors shared across disorders. This translational review aims to provide a brief overview of findings from rodent experiments and critically evaluate observational studies in humans to assess the extent to which associations between prenatal antidepressant exposure and neurodevelopmental problems are due to causal mechanisms versus other influences. We focus our review on two important neurodevelopmental outcomes - autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD). In general, rodent studies have reported adverse effects of perinatal antidepressant exposure on neurodevelopment. Between-species differences raise questions about the generalizability of these findings to humans. Indeed, converging evidence from studies using multiple designs and approaches suggest that observed associations between prenatal antidepressant exposure and neurodevelopmental problems in humans are largely due to confounding factors. We also provide specific recommendations for future research. Animal research should explicitly evaluate the impact of timing of exposure and dosage of medications, as well as better map outcome measures in rodents to human neurodevelopmental problems. Observational studies should investigate specific confounding factors, specific antidepressant drugs and classes, the potential impact of timing of exposure, and a wider range of other potential offspring outcomes. The findings summarized in this review may help women and their doctors make informed decisions about antidepressant use during pregnancy by providing reassurance that use of these medications during pregnancy is unlikely to substantially increase the risk of ASD and ADHD.
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Affiliation(s)
- Ayesha C. Sujan
- Department of Psychological and Brain Sciences, Indiana University, Bloomington, IN, USA
| | - A. Sara Öberg
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Patrick D. Quinn
- Department of Applied Health Science, School of Public Health, Indiana University, Bloomington, IN, USA
| | - Brian M. D’Onofrio
- Department of Psychological and Brain Sciences, Indiana University, Bloomington, IN, USA
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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Abstract
Emotional and behavioral problems (EBP) during childhood and adolescence are a common concern for parents and mental health stakeholders. However, little has been documented about their prevalence in Kenyan children and adolescents. This study aimed to close this gap. The study included Child Behavior Checklist reports from 1022 Kenyan parents on their children (ages 6-18 years) and Youth Self-Reports from 533 adolescents (ages 12-18) living in Kenya's Central Province. EBP in Kenya are highly prevalent compared to multi-cultural standards for parent reports, with 27 and 17% scoring in the borderline and clinical range, respectively. Based on parent reports, younger children scored higher on EBP than older children, and higher on internalizing problems. Based on self-reports girls scored higher than boys, particularly on internalizing problems. The study provides evidence on elevated parent-reported EBP in Kenyan youths. Mental health providers should focus on interventions that reduce EBP in Kenyan youths.
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Affiliation(s)
- Dorcas N Magai
- KEMRI-Wellcome Trust Collaborative Research Programme, Kilifi, Kenya
- Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Van der Boechorststraat 1, 1081 BT, Amsterdam, The Netherlands
| | - Jamil A Malik
- National Institute of Psychology, Quaid-i-Azam University, Islamabad, Pakistan
| | - Hans M Koot
- Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Van der Boechorststraat 1, 1081 BT, Amsterdam, The Netherlands.
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12
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Valdés-Sosa PA, Galler JR, Bryce CP, Rabinowitz AG, Bringas-Vega ML, Hernández-Mesa N, Taboada-Crispi A. Seeking Biomarkers of Early Childhood Malnutrition's Long-term Effects. MEDICC Rev 2018; 20:43-48. [PMID: 29773777 PMCID: PMC6310420 DOI: 10.37757/mr2018.v20.n2.10] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023]
Abstract
Protein-energy malnutrition affects one in nine people worldwide and is most prevalent among children aged less than five years in low-income countries. Early childhood malnutrition can have damaging neurodevelopmental effects, with significant increases in cognitive, neurological and mental health problems over the lifespan, outcomes which can also extend to the next generation. This article describes a research collaboration involving scientists from five centers in Barbados, China, Cuba and the USA. It builds on longer-term joint work between the Barbados Nutrition Study (which, over a 45-year span, has extensively documented nutritional, health, behavioral, social and economic outcomes of individuals who experienced protein-energy malnutrition in the first year of life and healthy controls from the same classrooms and neighborhoods) and the Cuban Neuroscience Center (which has developed low-cost brain imaging methods that can be readily used in low income settings to identify biomarkers for early detection and treatment of adverse consequences of childhood malnutrition). This collaboration, which involved Barbadian, Cuban and US scientists began in the 1970s, when quantitative EEG techniques were applied to EEG data collected in 1977-78, at which time study participants were aged 5-11 years. These EEG records were never fully analyzed but were stored in New York and made available to this project in 2016. These data have now been processed and analyzed, comparing EEG findings in previously malnourished and control children, and have led to the identification of early biomarkers of long-term effects of early childhood protein-energy malnutrition. The next stage of the project will involve extending earlier work by collecting EEG recordings in the same individuals at ages 45-51 years, 40 years later, and comparing findings to earlier data and to these individuals' behavioral and cognitive outcomes. Quantitative EEG biomarkers of the effects of protein-energy malnutrition may help identify children at greatest risk for early malnutrition's adverse neurodevelopmental effects and inform development of targeted interventions to mitigate the long-term adverse effects of protein-energy malnutrition in developing countries. KEYWORDS Protein-energy malnutrition, electroencephalography, EEG, biomarkers, neurosciences, Barbados, Cuba, USA.
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Murray J, Shenderovich Y, Gardner F, Mikton C, Derzon JH, Liu J, Eisner M. Risk Factors for Antisocial Behavior in Low- and Middle-Income Countries: A Systematic Review of Longitudinal Studies. CRIME AND JUSTICE (CHICAGO, ILL.) 2018; 47:255-364. [PMID: 30310248 PMCID: PMC6176906 DOI: 10.1086/696590] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Violent crime is a major cause of social instability, injury, and death in low- and middle-income countries. Longitudinal studies in high-income countries have provided important evidence on developmental precursors of violence and other antisocial behaviors. However, there may be unique influences or different risk factor effects in other social settings. Extensive searches in seven languages and screening of over 60,000 references identified 39 longitudinal studies of antisocial behavior in low- and middle-income countries. Many risk factors have roughly the same average effects as when studied in high-income countries. Stability of aggression over a 3-year period is almost identical across low- and middle-income countries and high-income countries. Dimensions of comorbid psychopathology such as low self-control, hyperactivity, and sensation seeking are associated with antisocial behavior in low- and middle-income countries, but some early physical health factors have consistently weak or null effects.
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Affiliation(s)
- Joseph Murray
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Brazil
| | | | - Frances Gardner
- Department of Social Policy and Intervention, Oxford University
| | - Christopher Mikton
- Department of Health and Social Sciences, University of the West of England
| | - James H Derzon
- Center for Advanced Methods Development, Research Triangle Institute
| | - Jianghong Liu
- School of Nursing and Perelman School of Medicine, University of Pennsylvania
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Ogundele MO. Behavioural and emotional disorders in childhood: A brief overview for paediatricians. World J Clin Pediatr 2018; 7:9-26. [PMID: 29456928 PMCID: PMC5803568 DOI: 10.5409/wjcp.v7.i1.9] [Citation(s) in RCA: 130] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 11/30/2017] [Accepted: 12/05/2017] [Indexed: 02/06/2023] Open
Abstract
Mental health problems in children and adolescents include several types of emotional and behavioural disorders, including disruptive, depression, anxiety and pervasive developmental (autism) disorders, characterized as either internalizing or externalizing problems. Disruptive behavioural problems such as temper tantrums, attention deficit hyperactivity disorder, oppositional, defiant or conduct disorders are the commonest behavioural problems in preschool and school age children. The routine Paediatric clinic or Family Medicine/General Practitioner surgery presents with several desirable characteristics that make them ideal for providing effective mental health services to children and adolescents. DSM-5 and ICD-10 are the universally accepted standard criteria for the classification of mental and behaviour disorders in childhood and adults. The age and gender prevalence estimation of various childhood behavioural disorders are variable and difficult to compare worldwide. A review of relevant published literature was conducted, including published meta-analyses and national guidelines. We searched for articles indexed by Ovid, PubMed, PubMed Medical Central, CINAHL, EMBASE, Database of Abstracts and Reviews, and the Cochrane Database of Systematic reviews and other online sources. The searches were conducted using a combination of search expressions including "childhood", "behaviour", "disorders" or "problems". Childhood behaviour and emotional problems with their related disorders have significant negative impacts on the individual, the family and the society. They are commonly associated with poor academic, occupational, and psychosocial functioning. It is important for all healthcare professionals, especially the Paediatricians to be aware of the range of presentation, prevention and management of the common mental health problems in children and adolescents.
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Affiliation(s)
- Michael O Ogundele
- Department of Community Paediatrics, NHS Fife, Glenwood Health Centre, Glenrothes KY6 1HK, United Kingdom
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Wang X, Luo R, Liu C, Zhang L, Yue A, Medina A, Rozelle S. Using daily text messages to improve adherence to infant micronutrient powder (MNP) packets in rural western China: A cluster-randomized controlled trial. PLoS One 2018; 13:e0191549. [PMID: 29352304 PMCID: PMC5774801 DOI: 10.1371/journal.pone.0191549] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 01/04/2018] [Indexed: 11/24/2022] Open
Abstract
Objective To evaluate the effectiveness of daily text messages as a means to improve caregivers’ adherence to infant micronutrient powder (MNP) in rural Shaanxi Province of China. Methodology 638 infants aged 6–11 months in 234 villages were involved in a cluster-randomized controlled trial (RCT). All caregivers were given free infant MNP packets at baseline in April 2013 and the follow-up survey was in July 2013. We randomly assigned 318 infants in 117 villages to treatment group (receiving daily text message) and 320 infants in the other 117 villages as control group. Results On average, daily text messages increased the number of MNP packets fed (marginal effect = 4.63; 95% confidence interval (CI) = 0.16, 9.10). The text message is more likely to increase the consumption of MNP packets if the primary caregiver was the mother (marginal effect = 12.19; 95% CI = 0.69, 23.68). Receiving the text message appears to significantly increase the likelihood of full adherence when the primary caregiver can either check (odds ratio = 2.93; 95% CI = 1.34, 6.40) or knows how to send (odds ratio = 3.26; 95% CI = 1.53, 6.97) text messages. Conclusion Daily text messages improved the consumption of infant MNP packets. However, the impact was not large enough to increase the probability of caregivers being fully adherent to the feeding instruction, which is to feed 5–7 packets per week as recommended. In addition, when the mother is the caregiver and when the caregiver can check or knows how to send text messages there is greater adherence by the primary caregivers. Trial registration http://www.isrctn.com/ISRCTN44149146
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Affiliation(s)
- Xu Wang
- Education Global Practices (East and South Africa), the World Bank Group, NW, Washington DC, United States of America
| | - Renfu Luo
- China Center for Agricultural Policy, School of Advanced Agricultural Sciences, Peking University, Haidian District, Beijing, China
- * E-mail:
| | - Chengfang Liu
- China Center for Agricultural Policy, School of Advanced Agricultural Sciences, Peking University, Haidian District, Beijing, China
| | - Linxiu Zhang
- Center for Chinese Agricultural Policy, Institute of Geographical Sciences and Natural Resources Research, Chinese Academy of Sciences, Chaoyang District, Beijing, China
| | - Ai Yue
- Center for Experimental Economics in Education (CEEE), Shaanxi Normal University, Xi’an, Shaanxi, China
| | - Alexis Medina
- Freeman Spogli Institute for International Studies, Stanford University, Stanford, United States of America
| | - Scott Rozelle
- Freeman Spogli Institute for International Studies, Stanford University, Stanford, United States of America
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Abessa TG, Bruckers L, Kolsteren P, Granitzer M. Developmental performance of hospitalized severely acutely malnourished under-six children in low- income setting. BMC Pediatr 2017; 17:197. [PMID: 29179758 PMCID: PMC5704634 DOI: 10.1186/s12887-017-0950-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Accepted: 11/15/2017] [Indexed: 11/21/2022] Open
Abstract
Background Retrospective studies show that severe acute malnutrition (SAM) affects child development. However, to what extent SAM affects children of different ages at its acute stage is not well documented. This study was aimed at comparing the developmental performance of severely acutely malnourished children under six with that of age and gender-matched non-malnourished healthy children. Methods The developmental performances of 310 children with SAM (male = 155, female = 155); mean age = 30.7 mo; SD = 15.2 mo) admitted to the nutritional rehabilitation unit (NRU) at Jimma University’s Hospital was compared with that of 310 age and gender-matched, non-malnourished healthy children (male = 155, female = 155; mean age = 29.6 mo; SD = 15.4 mo) living in Jimma Town in Ethiopia. Two culturally adapted tools were used: (1) the Denver II-Jimma, to assess the children’s performance on personal social (PS), fine motor (FM) language (LA), gross motor (GM) skills, and (2) the Ages and Stages Questionnaires: Social-Emotional (ASQ:SE), to assess social-emotional (SE) skills. Multivariable Poisson regression analysis was conducted to compare the developmental performance scores of SAM and non-malnourished children. Results For one-year-old children, SAM delays their developmental performance on GM, FM, PS and LA by 300%, 200%, 140% and 71.4% respectively. For three-years-old children, SAM delays their developmental performance on GM by 80%, on FM and LA by 50% each, and on PS by 28.6%. Of the skills assessed on Denver II-Jimma, GM is the most, and PS is the least affected. Younger SAM children are more affected than older ones on all the domains of development. The delay in FM, GM, LA and PS generally decreases with an increase in age. Social-emotional behavior problems seem to be most pronounced in the very young and older age ranges. Conclusions SAM has a differential age effect on the different dimensions of development in children under 6 years of age. Electronic supplementary material The online version of this article (10.1186/s12887-017-0950-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Teklu Gemechu Abessa
- Department of Special Needs and Inclusive Education, College of Behavioral Sciences and Education, Jimma University, Jimma, Ethiopia. .,REVAL Rehabilitation Research Center, Biomedical Research Institute, Faculty of Medicine and Life Sciences, University of Hasselt, Hasselt, Belgium.
| | | | - Patrick Kolsteren
- Department of Food Safety and Food Quality, University of Gent, Ghent, Belgium
| | - Marita Granitzer
- REVAL Rehabilitation Research Center, Biomedical Research Institute, Faculty of Medicine and Life Sciences, University of Hasselt, Hasselt, Belgium
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17
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Sosu EM, Schmidt P. Economic Deprivation and Its Effects on Childhood Conduct Problems: The Mediating Role of Family Stress and Investment Factors. Front Psychol 2017; 8:1580. [PMID: 28955283 PMCID: PMC5601177 DOI: 10.3389/fpsyg.2017.01580] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Accepted: 08/29/2017] [Indexed: 11/24/2022] Open
Abstract
This study investigated the mechanisms by which experiences of poverty influence the trajectory of conduct problems among preschool children. Drawing on two theoretical perspectives, we focused on family stress (stress and harsh discipline) and investment variables (educational investment, nutrition, and cognitive ability) as key mediators. Structural equation modeling techniques with prospective longitudinal data from the Growing Up in Scotland survey (N = 3,375) were used. Economic deprivation measured around the first birthday of the sample children had both direct and indirect effects on conduct problems across time (ages 4, 5, and 6). In line with the family stress hypothesis, higher levels of childhood poverty predicted conduct problems across time through increased parental stress and punitive discipline. Consistent with the investment model, childhood deprivation was associated with higher levels of conduct problems via educational investment and cognitive ability. The study extends previous knowledge on the mechanisms of this effect by demonstrating that cognitive ability is a key mediator between poverty and the trajectory of childhood conduct problems. This suggests that interventions aimed at reducing child conduct problems should be expanded to include factors that compromise parenting as well as improve child cognitive ability.
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Affiliation(s)
- Edward M. Sosu
- School of Education, University of StrathclydeGlasgow, United Kingdom
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18
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Hock RS, Bryce CP, Waber DP, McCuskee S, Fitzmaurice GM, Henderson DC, Galler JR. Relationship between infant malnutrition and childhood maltreatment in a Barbados lifespan cohort. VULNERABLE CHILDREN AND YOUTH STUDIES 2017; 12:304-313. [PMID: 30034507 PMCID: PMC6051436 DOI: 10.1080/17450128.2017.1371817] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Childhood malnutrition and maltreatment (abuse, neglect) are both prevalent, particularly in resource-limited settings. Despite their known negative impact on child development, there is surprisingly little research documenting their interrelationships. To address this gap, we administered the Childhood Trauma Questionnaire-Short Form (CTQ-SF), a retrospective structured self-report of childhood abuse and neglect, in a Barbadian cohort of 77 adult survivors of infant malnutrition, limited to the first year of life, and 62 healthy controls from the same classrooms and neighborhoods (mean age ± SD = 43.8±2.3 years). This cohort has been followed since birth. Using factor analysis and comparison with archival data addressing similar constructs, we found evidence for reliability and validity of the CTQ-SF in this population. Linear regression analyses, with and without adjusting for childhood household standard of living at three childhood ages, revealed that a history of infant malnutrition was significantly associated with increased levels of self-reported physical neglect in childhood, and, to a somewhat lesser degree, emotional neglect. This study highlights the co-occurrence of infant malnutrition and self-reported maltreatment in childhood in Barbados, with potential public health implications.
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Affiliation(s)
- Rebecca S. Hock
- The Chester M. Pierce, MD Division of Global Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Cyralene P. Bryce
- Harvard Medical School, Boston, MA, USA
- Barbados Nutrition Study, Bridgetown, Barbados
| | - Deborah P. Waber
- Harvard Medical School, Boston, MA, USA
- Children’s Hospital Boston, Boston, MA, USA
| | - Sarah McCuskee
- School of Medicine, Stanford University, Stanford, CA, USA
| | - Garrett M. Fitzmaurice
- McLean Hospital, Belmont, MA, USA
- Department of Biostatistics, Harvard School of Public Health, Boston, MA, USA
| | - David C. Henderson
- Department of Psychiatry, Boston University School of Medicine and Boston Medical Center, Boston, MA, USA
| | - Janina R. Galler
- The Chester M. Pierce, MD Division of Global Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Center on the Developing Child, Harvard University, Cambridge, MA, USA
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Adenuga W, Obembe T, Odebunmi K, Asuzu M. PREVALENCE AND DETERMINANTS OF STUNTING AMONG PRIMARY SCHOOL CHILDREN IN RURAL AND URBAN COMMUNITIES IN OBAFEMI OWODE LOCAL GOVERNMENT AREA, SOUTHWESTERN NIGERIA. Ann Ib Postgrad Med 2017; 15:7-15. [PMID: 28970765 PMCID: PMC5598447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Studies on stunting in children have largely focused on the underfive, establishing it as a strong predictor of mortality in these children. Few studies have documented the prevalence or determinants of stunting among school children in southwestern Nigeria. The aim of the study was to determine the prevalence and predictors of stunting among selected primary school children in rural and urban communities of Obafemi Owode Local Government Area, Ogun State. METHOD A cross-sectional study of rural and urban primary school children was conducted. An interviewer-administered questionnaire was used to collect information on respondents' and parents' socio-demographic characteristics. Stunting was defined as height-for-age less than two standard deviations from the median height-for-age of the standard World Health Organization reference population. Using EPI-INFO version 6.03, children were classified as stunted if z-scores of height-for-age were less than 2 standard deviations below the National Centre for Health statistics (NCHS)/WHO median. Height and weight were taken using a stadiometer and weighing scale respectively. Data were analyzed using the Statistical Package for the Social Sciences (SPSS) Version 16.0 while predictors were determined using logistic regression at 95% level of significance. RESULTS A total of 1,160 primary school children were studied with 52.2% from rural schools. Males constituted 57.1% and 51.8% in the rural and urban school respectively. Prevalence of stunting among rural school children was 46.2%, and was significantly higher (p≤0.001) than among urban children at 33.8%. Younger children <10 years (OR: 0.088; 95CI: 0.052 - 0.150) and children between 11-12 years (OR: 0.534; 95CI: 0.322 - 0.886) were at a significantly lower risk of stunting both in rural schools compared to children >13 years. CONCLUSION The prevalence of stunting was high especially among pupils from schools in the rural communities. This underscores the need for urgent feasible and effective nutrition programs for primary school children especially those in rural schools within the study area.
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Affiliation(s)
- W.U. Adenuga
- Dept. of Community Medicine, Faculty of Clinical Sciences, College of Medicine, University of Ibadan
| | - T.A. Obembe
- Dept. of Health Policy and Management, Faculty of Public Health, College of Medicine, University of Ibadan
- University of Witwatersrand, School of Public Health, Wits Education Campus, Johannesburg, South Africa
| | - K.O. Odebunmi
- Department of Palliative Medicine, University College Hospital, Ibadan, Ibadan
| | - M.C. Asuzu
- Dept. of Community Medicine, Faculty of Clinical Sciences, College of Medicine, University of Ibadan
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20
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Galler JR, Koethe JR, Yolken RH. Neurodevelopment: The Impact of Nutrition and Inflammation During Adolescence in Low-Resource Settings. Pediatrics 2017; 139:S72-S84. [PMID: 28562250 PMCID: PMC5374755 DOI: 10.1542/peds.2016-2828i] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/21/2016] [Indexed: 12/12/2022] Open
Abstract
Approximately 1 out of 5 children worldwide suffers from childhood malnutrition or stunting and associated health conditions, including an increased susceptibility to infections and inflammation. Due to improved early interventions, most children even in low-resource settings now survive early childhood malnutrition, yet exhibit continuing evidence of neurodevelopmental deficits, including poor school achievement and behavioral problems. These conditions are compounded in children who continue to be undernourished throughout the adolescent years. At present, these sequelae of malnutrition and infection are of major concern in the adolescent population, given that young people between the ages of 10 and 24 years represent nearly one-quarter of the world's population. Therefore, there is an urgent need to focus on the well-being of this age group and, in particular, on behavioral, cognitive, and brain disorders of adolescents who experienced malnutrition, infection, and inflammation prenatally, in early childhood, and during adolescence itself. Because one-third of all women globally become pregnant during their adolescent years, brain and behavioral disorders during this period can have an intergenerational impact, affecting the health and well-being of the next generation. This article summarizes the current state of knowledge and evidence gaps regarding childhood and adolescent malnutrition and inflammation and their impact on adolescent neurodevelopment, the limited evidence regarding nutrition and psychosocial interventions, and the role of resilience and protective factors in this age group. This overview should help to inform the development of new strategies to improve the neurodevelopmental outcomes of high risk adolescent populations.
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Affiliation(s)
- Janina R Galler
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts;
- Chester M. Pierce, MD Division of Global Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
- Center on the Developing Child, Harvard University, Cambridge, Massachusetts
| | - John R Koethe
- Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee; and
| | - Robert H Yolken
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland
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21
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Bekele A, Janakiraman B. Physical therapy guideline for children with malnutrition in low income countries: clinical commentary. J Exerc Rehabil 2016; 12:266-75. [PMID: 27656622 PMCID: PMC5031388 DOI: 10.12965/jer.1632674.337] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2016] [Accepted: 07/14/2016] [Indexed: 11/22/2022] Open
Abstract
Physical therapy intervention along with nutritional rehabilitation has recently become an inevitable combo after recent evidences suggesting a strong interaction between malnutrition and neuro-muscular disabilities which contribute to a significant burden in global settings. Recent studies confirm that appropriate physical assessment of neuro-musculo skeletal system, developmental assessment or cognitive tools along with nutritional assessments followed by exercise rehabilitation will yield positive results in children with malnutrition. There is an obvious need to make available a simple physical therapy exercise guidelines with simple measure and exercise to be used in resource limited settings of developing countries. The purpose of this clinical commentary is to summarize simple assessment tools to evaluate activity impairment, participation restriction, gross motor activity and simple physical therapy intervention program for children with disability secondary to malnutrition.
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Affiliation(s)
- Abey Bekele
- Department of Physiotherapy, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Balamurugan Janakiraman
- Department of Physiotherapy, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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22
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Perfiles psicopatológicos de niños obesos y desnutridos medidos con el CBCL/6-18. REVISTA LATINOAMERICANA DE PSICOLOGIA 2016. [DOI: 10.1016/j.rlp.2015.10.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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23
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Szlagatys-Sidorkiewicz A, Borkowska A, Popińska K, Toporowska-Kowalska E, Grzybowska-Chlebowczyk U, Wernicka A, Hapyn E, Sibilska M, Gębora-Kowalska B, Więcek S, Zagożdżon P, Kierkuś J. Complications of PEG are not related to age - The result of 10-year multicenter survey. Adv Med Sci 2016; 61:1-5. [PMID: 26342669 DOI: 10.1016/j.advms.2015.07.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Revised: 06/12/2015] [Accepted: 07/24/2015] [Indexed: 02/07/2023]
Abstract
PURPOSE The aim of this study was to analyze whether the insertion of Percutaneous Endoscopic Gastrostomy (PEG) during infancy is related to higher morbidity. Moreover, we analyzed the structure of indications to PEG placement in various age groups of pediatric patients. MATERIAL/METHODS The study involved medical data of children after PEG insertion from six Polish endoscopic centers: infants (<12 months of age), toddlers (12-36 months), and preadolescents (>36 months). RESULTS The overall prevalence of early complications associated with PEG insertion was 5.14%; while they were noted in infants and preadolescents, none were recorded in toddlers. The analyzed age groups did not differ significantly in terms of the prevalence of late complications. Cerebral palsy (34.86%) and other chronic neurological conditions (34.29%) were the most frequent indications to PEG insertion in the whole group. Patients with congenital heart defects and multiple defect syndrome were inserted PEG at the youngest age; in contrast, the age at insertion was the highest in cystic fibrosis patients. CONCLUSIONS The early qualification to nutritional intervention via endoscopically formed gastrostomy can have important clinical implications with regards to improved therapeutic outcomes and reduced morbidity rates.
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Koss KJ, Hostinar CE, Donzella B, Gunnar MR. Social deprivation and the HPA axis in early development. Psychoneuroendocrinology 2014; 50:1-13. [PMID: 25150507 PMCID: PMC4252479 DOI: 10.1016/j.psyneuen.2014.07.028] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Revised: 07/29/2014] [Accepted: 07/30/2014] [Indexed: 11/28/2022]
Abstract
Growing evidence suggests that early social deprivation impacts the activity of the hypothalamic-pituitary-adrenocortical axis. Early adverse care in the form of institutional or orphanage care provides a human model for early social deprivation. The present study examined changes in diurnal cortisol during the transition to family care in the first 2 years post-adoption. Children adopted between 15 and 36 months from institutional care were examined four times during their first 2 years post-adoption (N=58). Comparison groups included same-aged peers reared in their birth families (N=50) and children adopted during their first year from overseas foster care (N=47). Children provided daily cortisol samples at roughly 2, 9, 17, and 25 months post-adoption. Post-institutionalized and post-foster care children exhibited less steep diurnal cortisol compared to non-adopted same-aged peers; these differences did not diminish across the 2 year period. For post-institutionalized children, lower social care quality in institutions was associated with less steep cortisol slopes. Lastly, shallower diurnal cortisol was a mediator between adoption status and increased behavioral problems 2 years post-adoption. Consistent with the non-human primate literature, early social deprivation may contribute to early programming of the HPA axis.
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Affiliation(s)
- Kalsea J Koss
- Institute of Child Development, University of Minnesota, Minneapolis, MN 55455, USA.
| | - Camelia E Hostinar
- Institute for Policy Research, Northwestern University, Evanston, IL 60208, USA
| | - Bonny Donzella
- Institute of Child Development, University of Minnesota, Minneapolis, MN 55455, USA
| | - Megan R Gunnar
- Institute of Child Development, University of Minnesota, Minneapolis, MN 55455, USA.
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25
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Kerac M, Postels DG, Mallewa M, Alusine Jalloh A, Voskuijl WP, Groce N, Gladstone M, Molyneux E. The interaction of malnutrition and neurologic disability in Africa. Semin Pediatr Neurol 2014; 21:42-9. [PMID: 24655404 DOI: 10.1016/j.spen.2014.01.003] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Malnutrition and neurodisability are both major public health problems in Africa. This review highlights key areas where they interact. This happens throughout life and starts with maternal malnutrition affecting fetal neurodevelopment with both immediate (eg, folate deficiency causing neural tube defects) and lifelong implications (eg, impaired cognitive function). Maternal malnutrition can also increase the risk of perinatal problems, including birth asphyxia, a major cause of neurologic damage and cerebral palsy. Macronutrient malnutrition can both cause and be caused by neurodisability. Mechanisms include decreased food intake, increased nutrient losses, and increased nutrient requirement. Specific micronutrient deficiencies can also lead to neurodisability, for example, blindness (vitamin A), intractable epilepsy (vitamin B6), and cognitive impairment (iodine and iron). Toxin ingestion (eg, from poorly processed cassava) can cause neurodisability including a peripheral polyneuropathy and a spastic paraparesis. We conclude that there is an urgent need for nutrition and disability programs to work more closely together.
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Affiliation(s)
- Marko Kerac
- Leonard Cheshire Disability and Inclusive Development Centre, University College London, UK; Malawi-Liverpool Wellcome Trust Clinical Research Programme, Malawi
| | - Douglas G Postels
- International Neurologic and Psychiatric Epidemiology Program, Michigan State University, MI
| | - Mac Mallewa
- Malawi-Liverpool Wellcome Trust Clinical Research Programme, Malawi; Department of Paediatrics and Child Health, College of Medicine, Malawi
| | | | - Wieger P Voskuijl
- Leonard Cheshire Disability and Inclusive Development Centre, University College London, UK
| | - Nora Groce
- Malawi-Liverpool Wellcome Trust Clinical Research Programme, Malawi
| | | | - Elizabeth Molyneux
- Department of Paediatrics and Child Health, College of Medicine, Malawi.
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Chaudhary R, Chugh M, Darokhan Z, Katreddi RR, Ramachandra R, Rema V. Physiological slowing and upregulation of inhibition in cortex are correlated with behavioral deficits in protein malnourished rats. PLoS One 2013; 8:e76556. [PMID: 24098531 PMCID: PMC3789706 DOI: 10.1371/journal.pone.0076556] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2013] [Accepted: 08/27/2013] [Indexed: 11/19/2022] Open
Abstract
Protein malnutrition during early development has been correlated with cognitive and learning disabilities in children, but the neuronal deficits caused by long-term protein deficiency are not well understood. We exposed rats from gestation up to adulthood to a protein-deficient (PD) diet, to emulate chronic protein malnutrition in humans. The offspring exhibited significantly impaired performance on the 'Gap-crossing' (GC) task after reaching maturity, a behavior that has been shown to depend on normal functioning of the somatosensory cortex. The physiological state of the somatosensory cortex was examined to determine neuronal correlates of the deficits in behavior. Extracellular multi-unit recording from layer 4 (L4) neurons that receive direct thalamocortical inputs and layers 2/3 (L2/3) neurons that are dominated by intracortical connections in the whisker-barrel cortex of PD rats exhibited significantly low spontaneous activity and depressed responses to whisker stimulation. L4 neurons were more severely affected than L2/3 neurons. The response onset was significantly delayed in L4 cells. The peak response latency of L4 and L2/3 neurons was delayed significantly. In L2/3 and L4 of the barrel cortex there was a substantial increase in GAD65 (112% over controls) and much smaller increase in NMDAR1 (12-20%), suggesting enhanced inhibition in the PD cortex. These results show that chronic protein deficiency negatively affects both thalamo-cortical and cortico-cortical transmission during somatosensory information processing. The findings support the interpretation that sustained protein deficiency interferes with features of cortical sensory processing that are likely to underlie the cognitive impairments reported in humans who have suffered from prolonged protein deficiency.
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Affiliation(s)
| | - Manisha Chugh
- National Brain Research Centre, Manesar, Haryana, India
| | | | | | | | - V. Rema
- National Brain Research Centre, Manesar, Haryana, India
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Galler JR, Bryce CP, Waber DP, Medford G, Eaglesfield GD, Fitzmaurice G. Early malnutrition predicts parent reports of externalizing behaviors at ages 9-17. Nutr Neurosci 2012; 14:138-44. [PMID: 21902884 DOI: 10.1179/147683011x13009738172521] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE To determine whether externalizing behaviors are more prevalent in youth who have experienced an episode of malnutrition in the first year of life than in healthy comparison youth. METHOD Parents of previously malnourished youth and a matched healthy comparison group completed a behavior rating scale when the youth were 9-15 years of age and again, 2 years later, when they were 11-17 years of age. Longitudinal multiple regression analysis was applied to evaluate group differences adjusted for baseline age, sex, household standard of living, and maternal depressive symptoms. RESULTS Early childhood malnutrition was associated with problems in executive functioning at both occasions. Malnutrition also predicted discernibly higher parent-reported levels of aggression toward peers at 9-15 years than at 11-17 years. These findings were independent of baseline age, sex, household standard of living, and maternal depressive symptoms. Problem behaviors in general decreased during follow-up. CONCLUSION Parents report persisting problems with executive functioning through adolescence in youth who suffered an episode of moderate-to-severe protein-energy malnutrition in the first year of life, while reports of aggression, although more common when this cohort were younger, did not persist at follow-up.
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Affiliation(s)
- Janina R Galler
- Judge Baker Children's Center, Harvard Medical School, Boston, MA 02120, USA.
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