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Choedon T, Brennan E, Joe W, Lelijveld N, Huse O, Zorbas C, Backholer K, Murira Z, Wrottesley SV, Sethi V. Nutritional status of school-age children (5-19 years) in South Asia: A scoping review. MATERNAL & CHILD NUTRITION 2024; 20:e13607. [PMID: 38095279 PMCID: PMC10981491 DOI: 10.1111/mcn.13607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 11/22/2023] [Accepted: 11/23/2023] [Indexed: 04/01/2024]
Abstract
Information on malnutrition for school-age children and adolescents (5-19 years) in South Asia is fragmented and inconsistent, which limits the prioritization of nutrition policies, programmes and research for this age group. This scoping review aimed to synthesize existing evidence on the burden of malnutrition for children and adolescents aged 5-19 years in South Asia, and on interventions to improve their nutritional status. Cochrane Library, EMBASE, Medline and Google Scholar were systematically searched for articles published between January 2016 and November 2022. Eligible studies reported the prevalence of undernutrition, overweight/obesity, micronutrient deficiencies and unhealthy dietary intakes, and interventions that aimed to address these in South Asia. In total, 296 articles met our inclusion criteria. Evidence revealed widespread, yet heterogeneous, prevalence of undernutrition among South Asian children and adolescents: thinness (1.9%-88.8%), wasting (3%-48%), underweight (9.5%-84.4%) and stunting (3.7%-71.7%). A triple burden of malnutrition was evident: the prevalence of overweight and obesity ranged from 0.2% to 73% and 0% to 38% (with rapidly rising trends), respectively, alongside persistent micronutrient deficiencies. Diets often failed to meet nutritional requirements and high levels of fast-food consumption were reported. Education, fortification, supplementation and school feeding programmes demonstrated beneficial effects on nutritional status. Comprehensive and regular monitoring of all forms of malnutrition among children and adolescents, across all countries in South Asia is required. Further, more large-scale intervention research is needed to ensure policy and programmes effectively target and address malnutrition among children and adolescents in South Asia.
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Affiliation(s)
| | | | - William Joe
- Institute of Economic Growth (IEG)DelhiIndia
| | | | - Oliver Huse
- Global Centre for Preventive Health and Nutrition (GLOBE), Institute for Health Transformation, Faculty of HealthDeakin UniversityGeelongVictoriaAustralia
| | - Christina Zorbas
- Global Centre for Preventive Health and Nutrition (GLOBE), Institute for Health Transformation, Faculty of HealthDeakin UniversityGeelongVictoriaAustralia
| | - Kathryn Backholer
- Global Centre for Preventive Health and Nutrition (GLOBE), Institute for Health Transformation, Faculty of HealthDeakin UniversityGeelongVictoriaAustralia
| | | | | | - Vani Sethi
- UNICEF South Asia Regional OfficeKathmanduNepal
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Světnička M, Heniková M, Selinger E, Ouřadová A, Potočková J, Kuhn T, Gojda J, El-Lababidi E. Prevalence of iodine deficiency among vegan compared to vegetarian and omnivore children in the Czech Republic: cross-sectional study. Eur J Clin Nutr 2023; 77:1061-1070. [PMID: 37488261 PMCID: PMC10630131 DOI: 10.1038/s41430-023-01312-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 07/11/2023] [Accepted: 07/13/2023] [Indexed: 07/26/2023]
Abstract
BACKGROUND The intake and homeostasis of iodine, an essential micronutrient that plays a vital role in thyroid physiology, is of particular concern with the increasing popularity of vegetarian (VG) and vegan (VN) diets. Children on these restrictive diets may be at risk of possible adverse effects on growth and development, but there is currently a lack of recent epidemiological studies on this topic. METHODS We gathered clinical, anthropometric, and blood/urine data on iodine status and thyroid function from children aged 0-18 years who followed either a VG diet (n = 91), VN diet (n = 75), or omnivore diet (OM, n = 52). Cross-sectional comparison of the groups and linear regression was used. Stratified analyses were performed based on age (according to WHO): 0-5 years and 6-18 years. RESULTS Our study revealed no significant differences in levels of thyroid-stimulating hormone (TSH), triiodothyronine (fT3), thyroglobulin (TG) or anti-thyroid peroxidase antibody (ATPOc) between the VG, VN, and OM groups. However, thyroxine (fT4) levels were found to be higher in the VN group compared to the OM group (15.00 ± 1.73 vs. 16.17 ± 1.82 pmol/l, p < 0.001). The presence of anti-thyroglobulin antibodies (AhTGc) was notably more common in the VG (18.2%)/VN (35.0%) groups than in the OM group (2.1%) (p < 0.001). Regarding iodine status, the concentration of iodine in spot urine (UIC) was found to be highest in the OM group (197.28 ± 105.35 vs. VG: 177.95 ± 155.88 vs. VN: 162.97 ± 164.51 µg/l, p < 0.001). Notably, the lowest (5.99 µg/l) and highest (991.80 µg/l) levels were measured in the VN group. Of the participants, 31 VN, 31 VG and 10 OM children met the criteria for iodine deficiency (i.e., UIC < 100 µg/l). We found that children with regular iodine supplementation had higher UIC (p < 0.001). Importantly, the median UIC was above 100 µg/l in all three groups, through the recommended intake (RDI) of iodine was rarely met throughout the groups. CONCLUSION We have observed a trend to lower UIC values in VN as compared to OM. This trend is also reflected in the median UIC values, even though the median UIC values were above the WHO cut-off (e.g., 100 µg/l) for iodine deficiency in all dietary groups. These results suggest that VN and VG children may be more at higher risk of iodine deficiency, this theory is also supported by higher prevalence of AhTGc positivity. Further research is needed to investigate the long-term impact of these dietary patterns on iodine status and thyroid function in children. Given our findings, it may also be necessary to consider new guidelines for supplementing children following VG and VN diets to ensure their iodine needs are met.
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Affiliation(s)
- Martin Světnička
- Centre for Research on Diabetes Metabolism, and Nutrition of Third Faculty of Medicine, Charles University, Prague, Czech Republic.
- Department of Internal Medicine, University Hospital Královské Vinohrady and Third Faculty of Medicine, Charles University, Prague, Czech Republic.
- Department of Paediatrics, University Hospital Královské Vinohrady and Third Faculty of Medicine, Charles University, Prague, Czech Republic.
| | - Marina Heniková
- Centre for Research on Diabetes Metabolism, and Nutrition of Third Faculty of Medicine, Charles University, Prague, Czech Republic
- Department of Internal Medicine, University Hospital Královské Vinohrady and Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Eliška Selinger
- Centre for Research on Diabetes Metabolism, and Nutrition of Third Faculty of Medicine, Charles University, Prague, Czech Republic
- Department of Internal Medicine, University Hospital Královské Vinohrady and Third Faculty of Medicine, Charles University, Prague, Czech Republic
- The National Institute of Public Health, Centre for Public Health Promotion, Prague, Czech Republic
| | - Anna Ouřadová
- Centre for Research on Diabetes Metabolism, and Nutrition of Third Faculty of Medicine, Charles University, Prague, Czech Republic
- Department of Internal Medicine, University Hospital Královské Vinohrady and Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Jana Potočková
- Centre for Research on Diabetes Metabolism, and Nutrition of Third Faculty of Medicine, Charles University, Prague, Czech Republic
- Department of Internal Medicine, University Hospital Královské Vinohrady and Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Tilman Kuhn
- The Institute for Global Food Security, Queen's University Belfast, Belfast, Northern Ireland, UK
- Heidelberg Institute of Global Health (HIGH), Faculty of Medicine and University Hospital, Heidelberg, Germany
- Department of Nutritional Sciences, University of Vienna, Vienna, Austria
- Medical University of Vienna, Centre for Public Health, Vienna, Austria
| | - Jan Gojda
- Centre for Research on Diabetes Metabolism, and Nutrition of Third Faculty of Medicine, Charles University, Prague, Czech Republic
- Department of Internal Medicine, University Hospital Královské Vinohrady and Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Eva El-Lababidi
- Centre for Research on Diabetes Metabolism, and Nutrition of Third Faculty of Medicine, Charles University, Prague, Czech Republic
- Department of Paediatrics, University Hospital Královské Vinohrady and Third Faculty of Medicine, Charles University, Prague, Czech Republic
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Sharma VK, Niraula A, Tuladhar ET, Bhattarai A, Raut M, Dubey RK, Baidya S, Parajuli N. Autoimmune thyroid status in subclinical thyroid disorders in patients attending a tertiary care center in Nepal: a hospital-based cross-sectional study. BMC Endocr Disord 2023; 23:221. [PMID: 37821852 PMCID: PMC10566047 DOI: 10.1186/s12902-023-01480-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 10/08/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND Thyroid dysfunction is the leading endocrine disorder worldwide. Iodine deficiency disorders, which were once the major etiology of thyroid dysfunctions, now have been succeeded by autoimmune thyroid diseases with the rise in aberrant salt ionization protocols. This study endeavors to access the level of thyroid autoantibodies viz. anti-thyroid peroxidase (anti-TPO), anti-thyroglobulin (TGA), and anti-thyroid stimulating hormone receptor (TRAb) in individuals with subnormal thyroid profiles. METHODS This hospital-based cross-sectional study was conducted at the Department of Clinical Biochemistry, Tribhuvan University for a period of six months. Using non-probability (purposive) sampling method, a total of 60 patients were enrolled with subnormal thyroid profiles to include the population who have not yet started medication. Thyroid hormones (free T3, free T4, TSH) and thyroid antibodies (anti-TPO, TGA, and TRAb) were measured. For non-parametric data, Chi-square test and Kruskal-Wallis test were used. Spearman's correlation was done to determine the association between variables. RESULTS Out of 60 participants, the majority of the population between 25 and 44 years were diagnosed with thyroid dysfunction with female preponderance. Among all, 40% (n = 24) had subclinical hyperthyroid states while, 60% (n = 36) had subclinical hypothyroid states, and 75% (n = 45) of the total exhibited positive thyroid antibodies. In subclinical hypothyroid patients with TSH above 10 µIU/ml, anti TPO (58.5%) and TGA (66.7%) positivity were highly prevalent. On the other hand, TRAb was exclusively positive in hyperthyroid condition (50% among the group) which is by far the first of its kind reported in Nepal. CONCLUSION The rise in autoimmune thyroid disease among the Nepalese population infers that addressing iodine deficiency simply through salt iodinization may not be adequate to deal with the rising burden of thyroid disorders, especially in iodine-depleted areas. Also, the increasing prevalence of thyroid autoantibodies positivity in subclinical hypothyroidism in the Nepalese population accounts for the arduous screening and monitoring of autoimmune thyroid disorders in Nepal.
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Affiliation(s)
- Vijay Kumar Sharma
- Department of Clinical Biochemistry, Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University Teaching Hospital, Kathmandu, Nepal.
| | - Apeksha Niraula
- Department of Clinical Biochemistry, Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - Eans Tara Tuladhar
- Department of Clinical Biochemistry, Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - Aseem Bhattarai
- Department of Clinical Biochemistry, Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - Mithileshwer Raut
- Department of Clinical Biochemistry, Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - Raju Kumar Dubey
- Department of Clinical Biochemistry, Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - Sujata Baidya
- Department of Clinical Biochemistry, Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - Naresh Parajuli
- Department of Internal Medicine (Endocrinology), Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
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Bhattacharya S, Kalra S. South Asian Endocrinology: Challenges and Concerns, Collaboration and Consolidation. Indian J Endocrinol Metab 2023; 27:373-376. [PMID: 38107736 PMCID: PMC10723606 DOI: 10.4103/ijem.ijem_334_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 09/10/2023] [Indexed: 12/19/2023] Open
Abstract
The practice of endocrinology in South Asia poses many challenges but simultaneously offers unique opportunities. The population in this region is predisposed to diabetes and cardiovascular disease at a much lower body mass index compared to Caucasians. Dietary deficiencies, higher prevalence of infection and distinct environmental and genetic factors further complicate the presentation of endocrine disorders. Over the past few decades, important breakthroughs have been made to confront these challenges. Collaboration among the endocrine fraternity of the South Asian countries will help to consolidate these gains and pave the way forward for a healthier region.
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Affiliation(s)
| | - Sanjay Kalra
- Department of Endocrinology, Bharti Hospital, Karnal, Haryana, India
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Zhao X, Sun Y, Zhang H, Zhang Y, Zhao H, Yao X, Zhang W. Effect of different iodide intake during pregnancy and lactation on thyroid and cardiovascular function in maternal and offspring rats. J Trace Elem Med Biol 2023; 79:127267. [PMID: 37506535 DOI: 10.1016/j.jtemb.2023.127267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 07/13/2023] [Accepted: 07/23/2023] [Indexed: 07/30/2023]
Abstract
OBJECTIVE We aimed to investigate the impact of different iodide intake during pregnancy and lactation on iodine concentration in urine and serum, fatty acid metabolism, thyroid and cardiovascular function in maternal and offspring rats. METHODS Pregnant rats were randomly assigned to four groups: normal adult iodide intake (NAI, 7.5 μg/d), normal pregnant iodide intake (NPI, 12.5 μg/d), 5 times (5 HI, 62.5 μg/d) and 10 times higher-than-normal pregnant iodide intake (10 HI, 125 μg/d). The maternal rats were continuously administered potassium iodide until postnatal day 16 (PN16). Thyroid function was measured by enzyme-linked immunosorbent assay (ELISA). The iodine concentration in urine and serum were detected by inductively coupled plasma mass spectrometry (ICP-MS). The messenger ribonucleic acid (mRNA) expressions of Krüppel-like factor 9 (KLF9) and thioredoxin reductase 2 (Txnrd2) were measured using quantitative real-time polymerase chain reaction (RT-qPCR). Characteristic distribution of KLF9 expression and its interaction with TRβ was assessed by immunohistochemical and immunofluorescence staining. Serum fatty acids were analyzed by Liquid Chromatography-Mass Spectrometry (LC-MS). Cardiac function and blood pressure were measured by echocardiography and a non-invasive tail-cuff system. RESULTS High iodide intake (5 HI and 10 HI) during pregnancy and lactation results in increased urinary iodine concentration (UIC), serum total iodine concentration (STIC) and serum non-protein-bound iodine concentration (SNBIC) in both maternal and offspring rats, along with significantly increased FT3 and its target gene expression of KLF9. In maternal rats of both 5 HI and 10 HI groups, systolic blood pressure (SBP) was significantly higher, the increased SBP was significantly correlated with the increased UIC (r = 0.968, p = 0.002; r = 0.844, p = 0.035), KLF9 (r = 0.935, p = 0.006; r = 0.954, p = 0.003) and the decreased Txnrd2 (r = -0.909, p = 0.012; r = -0.912, p = 0.011). In maternal rats of 10 HI group, cardiac hyperfunction with increased LVEF, LVFS and decreased LVESD were observed. The increased LVEF and decreased LVESD were significantly correlated with UIC, STIC and SNBIC (r = 0.976, p = 0.001; r = 0.945, p = 0.005; r = 0.953, p = 0.003; r = -0.917, p = 0.01; r = -0.859, p = 0.028; r = -0.847, p = 0.033), LVEF, LVFS and LVESD were significant correlated with KLF9 (r = 0.950, p = 0.004; r = 0.963, p = 0.002; r = -0.990, p = 0.0002) and Txnrd2 expression (r = -0.979, p = 0.001; r = -0.915, p = 0.01; r = 0.933, p = 0.007), and the decreased LVESD was correlated with decreased epoxyeicosatrienoic acid (EET) metabolites: 5,6-EET, 8,9-DHET and 11,12-DHET (r = 0.999, p = 0.034; r = 1.000, p = 0.017; r = 1.000, p = 0.017). While in offspring rats, no significant change in SBP and cardiac function was found. STIC and SNBIC were much lower than those in maternal rats, and eicosapentaenoic acid (EPA) metabolites (9-HEPE, 15-HEPE and 14,15 DiHETE) were significantly increased. CONCLUSION In addition to thyroid hormones, STIC, SNBIC, KLF9, Txnrd2, EET and EPA metabolites might be promising biomarkers in high iodide intake-induced thyroid and cardiovascular function.
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Affiliation(s)
- Xiuxiu Zhao
- Department of Physiology and Pathophysiology, School of Basic Medical Sciences, Tianjin Medical University, Tianjin 300070, China
| | - Yue Sun
- Department of Physiology and Pathophysiology, School of Basic Medical Sciences, Tianjin Medical University, Tianjin 300070, China
| | - Hexi Zhang
- Department of Nutrition and Food Hygiene, School of Public Health, Tianjin Medical University, Tianjin 300070, China
| | - Yue Zhang
- Tianjin Key Laboratory of Ionic-Molecular of Cardiovascular disease, Department of Cardiology, Tianjin Institute of Cardiology, the Second Hospital of Tianjin Medical University, Tianjin 300211, China
| | - Hailing Zhao
- Department of Physiology and Pathophysiology, School of Basic Medical Sciences, Tianjin Medical University, Tianjin 300070, China
| | - Xiaomei Yao
- Department of Physiology and Pathophysiology, School of Basic Medical Sciences, Tianjin Medical University, Tianjin 300070, China.
| | - Wanqi Zhang
- Department of Nutrition and Food Hygiene, School of Public Health, Tianjin Medical University, Tianjin 300070, China
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