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Faruk S, Sanusi KO, Ibrahim KG, Abubakar B, Malami I, Bello MB, Abubakar MB, Abbas AY, Imam MU. Age and sex-based impacts of maternal iron deficiency on offspring's cognitive function and anemia: A systematic review. Eur J Clin Nutr 2024; 78:477-485. [PMID: 38424158 DOI: 10.1038/s41430-024-01423-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 02/15/2024] [Accepted: 02/20/2024] [Indexed: 03/02/2024]
Abstract
Iron deficiency is a recognized global health concern, particularly impactful during pregnancy where the mother serves as the primary source of iron for the developing fetus. Adequate maternal iron levels are crucial for fetal growth and cognitive development. This review investigates the correlation between maternal iron deficiency and cognitive impairment and anemia in offspring, considering age and gender differentials. PubMed, ScienceDirect, and Google Scholar databases were queried using keywords "maternal," "iron," "gender/sex," and "cognition." The review included studies on human and animal subjects where maternal iron deficiency was the exposure and offspring cognitive function and anemia were outcomes. Out of 1139 articles screened, fourteen met inclusion criteria. Twelve studies highlighted cognitive deficits in offspring of iron-deficient mothers, with females generally exhibiting milder impairment compared to males. Additionally, two studies noted increased anemia prevalence in offspring of iron-deficient mothers, particularly affecting males and younger individuals. The findings suggest that male offspring are at higher risk of both anemia and cognitive dysfunction during youth, while females face increased risks in adulthood. Thus, maternal iron deficiency elevates the likelihood of anemia and cognitive impairments in offspring, underscoring the importance of addressing maternal iron status for optimal child health.
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Affiliation(s)
- Saudatu Faruk
- Centre for Advanced Medical Research and Training, Usmanu Danfodiyo University, PMB 2254, Sokoto, Nigeria
- Department of Biochemistry, Faculty of Science, Usmanu Danfodiyo University, P.M.B. 2346, Sokoto, Nigeria
| | - Kamaldeen Olalekan Sanusi
- Centre for Advanced Medical Research and Training, Usmanu Danfodiyo University, PMB 2254, Sokoto, Nigeria
- Department of Physiology, Faculty of Basic Medical Sciences, College of Health Sciences, Usmanu Danfodiyo University, PMB 2254, Sokoto, Nigeria
| | - Kasimu Ghandi Ibrahim
- Centre for Advanced Medical Research and Training, Usmanu Danfodiyo University, PMB 2254, Sokoto, Nigeria
- Department of Physiology, Faculty of Basic Medical Sciences, College of Health Sciences, Usmanu Danfodiyo University, PMB 2254, Sokoto, Nigeria
- Department of Basic Medical and Dental Sciences, Faculty of Dentistry, Zarqa University, P.O.Box 2000, Zarqa, 13110, Jordan
| | - Bilyaminu Abubakar
- Centre for Advanced Medical Research and Training, Usmanu Danfodiyo University, PMB 2254, Sokoto, Nigeria
- Department of Pharmacology and Toxicology, Faculty of Pharmaceutical Sciences, Usmanu Danfodiyo University, PMB 2254, Sokoto, Nigeria
| | - Ibrahim Malami
- Centre for Advanced Medical Research and Training, Usmanu Danfodiyo University, PMB 2254, Sokoto, Nigeria
- Department of Pharmacognosy and Ethnopharmacy, Faculty of Pharmaceutical Sciences, Usmanu Danfodiyo University, PMB 2254, Sokoto, Nigeria
| | - Muhammad Bashir Bello
- Centre for Advanced Medical Research and Training, Usmanu Danfodiyo University, PMB 2254, Sokoto, Nigeria
- Department of Veterinary Microbiology, Faculty of Veterinary Medicine, Usmanu Danfodiyo University, PMB 2254, Sokoto, Nigeria
| | - Murtala Bello Abubakar
- Centre for Advanced Medical Research and Training, Usmanu Danfodiyo University, PMB 2254, Sokoto, Nigeria
- Department of Physiology, Faculty of Basic Medical Sciences, College of Health Sciences, Usmanu Danfodiyo University, PMB 2254, Sokoto, Nigeria
| | - Abdullahi Yahya Abbas
- Department of Biochemistry, Faculty of Science, Usmanu Danfodiyo University, P.M.B. 2346, Sokoto, Nigeria
| | - Mustapha Umar Imam
- Centre for Advanced Medical Research and Training, Usmanu Danfodiyo University, PMB 2254, Sokoto, Nigeria.
- Department of Medical Biochemistry, Faculty of Basic Medical Sciences, College of Health Sciences, Usmanu Danfodiyo University, PMB 2254, Sokoto, Nigeria.
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Smith LM, Harrison TM. Neurodevelopment in the Congenital Heart Disease Population as Framed by the Life Course Health Development Framework. J Cardiovasc Nurs 2024; 39:160-169. [PMID: 36752754 PMCID: PMC10406968 DOI: 10.1097/jcn.0000000000000977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
BACKGROUND Adverse neurodevelopment is a common comorbidity associated with congenital heart disease (CHD). The consequences of adverse neurodevelopment are seen across the life course. The cause of adverse neurodevelopment is multifactorial, and use of a life course perspective can assist with understanding and enhancing neurodevelopment in individuals with CHD. PURPOSE The purposes of this article are to (1) apply the Life Course Health Development framework to neurodevelopment in the population with CHD and (2) discuss how exposure to the pediatric cardiac intensive care unit (PCICU) environment during infancy is a point of intervention for improving neurodevelopmental outcomes. CONCLUSION Individuals with CHD are at an increased risk for adverse neurodevelopment across the life course. The PCICU environment is a point of intervention for improving neurodevelopmental outcomes. Stress can lead to changes in brain structure and function that are associated with negative outcomes in terms of outward behavioral and functional capacity, and the PCICU environment is a source of stressful stimuli. Infancy is a period of rapid brain growth, and the brain is more susceptible to stress during this period of the life course, putting infants receiving care in the PCICU at an increased risk of adverse neurodevelopment. CLINICAL IMPLICATIONS Interventions to support optimal neurodevelopment should focus on the PCICU environment during infancy. Developmentally supportive care models should be explored as a means of modifying the PCICU environment. In addition, more research is needed on the relationship between the PCICU and neurodevelopment. The conceptual model introduced can serve as a starting point for this research.
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Brittenham GM, Moir-Meyer G, Abuga KM, Datta-Mitra A, Cerami C, Green R, Pasricha SR, Atkinson SH. Biology of Anemia: A Public Health Perspective. J Nutr 2023; 153 Suppl 1:S7-S28. [PMID: 37778889 DOI: 10.1016/j.tjnut.2023.07.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 05/04/2023] [Accepted: 07/31/2023] [Indexed: 10/03/2023] Open
Abstract
Our goal is to present recent progress in understanding the biological mechanisms underlying anemia from a public health perspective. We describe important advances in understanding common causes of anemia and their interactions, including iron deficiency (ID), lack of other micronutrients, infection, inflammation, and genetic conditions. ID develops if the iron circulating in the blood cannot provide the amounts required for red blood cell production and tissue needs. ID anemia develops as iron-limited red blood cell production fails to maintain the hemoglobin concentration above the threshold used to define anemia. Globally, absolute ID (absent or reduced body iron stores that do not meet the need for iron of an individual but may respond to iron supplementation) contributes to only a limited proportion of anemia. Functional ID (adequate or increased iron stores that cannot meet the need for iron because of the effects of infection or inflammation and does not respond to iron supplementation) is frequently responsible for anemia in low- and middle-income countries. Absolute and functional ID may coexist. We highlight continued improvement in understanding the roles of infections and inflammation in causing a large proportion of anemia. Deficiencies of nutrients other than iron are less common but important in some settings. The importance of genetic conditions as causes of anemia depends upon the specific inherited red blood cell abnormalities and their prevalence in the settings examined. From a public health perspective, each setting has a distinctive composition of components underlying the common causes of anemia. We emphasize the coincidence between regions with a high prevalence of anemia attributed to ID (both absolute and functional), those with endemic infections, and those with widespread genetic conditions affecting red blood cells, especially in sub-Saharan Africa and regions in Asia and Oceania.
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Affiliation(s)
- Gary M Brittenham
- Department of Pediatrics, College of Physicians and Surgeons, Columbia University, New York, NY, United States.
| | - Gemma Moir-Meyer
- Population Health and Immunity Division, Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia; Department of Medical Biology, The University of Melbourne, Parkville, VIC, Australia
| | - Kelvin Mokaya Abuga
- Kenya Medical Research Institute (KEMRI)-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Ananya Datta-Mitra
- Department of Pathology and Laboratory Medicine, University of California, Davis, CA, United States
| | - Carla Cerami
- The Medical Research Council Unit, The Gambia, London School of Hygiene and Tropical Medicine, London, UK
| | - Ralph Green
- Department of Pathology and Laboratory Medicine, University of California, Davis, CA, United States
| | - Sant-Rayn Pasricha
- Population Health and Immunity Division, Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia; Department of Medical Biology, The University of Melbourne, Parkville, VIC, Australia; Diagnostic Haematology, The Royal Melbourne Hospital; and Clinical Haematology at the Peter MacCallum Cancer Centre and The Royal Melbourne Hospital, Parkville, VIC Australia
| | - Sarah H Atkinson
- Kenya Medical Research Institute (KEMRI)-Wellcome Trust Research Programme, Kilifi, Kenya; Department of Paediatrics, University of Oxford, Oxford, UK
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Toh JY, Cai S, Lim SX, Pang WW, Godfrey KM, Shek LP, Tan KH, Yap F, Lee YS, Chong YS, Eriksson JG, Broekman BFP, Rifkin-Graboi A, Chong MFF. Nutrient trajectories during infancy and their associations with childhood neurodevelopment. Eur J Nutr 2023; 62:2429-2439. [PMID: 37118033 DOI: 10.1007/s00394-023-03164-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 04/21/2023] [Indexed: 04/30/2023]
Abstract
PURPOSE To examine the associations between infants' dietary nutrient trajectories and subsequent neurodevelopment during childhood in the Growing Up in Singapore Towards healthy Outcomes study. METHODS One-day food records were collected at ages 6, 9 and 12 months, whilst Bayley Scales of Infant and Toddler Development-III and Kaufman Brief Intelligence Test-2 were conducted at ages 24 and 54 months respectively. Nutrient trajectories were constructed using multi-level mixed modelling and associations with neurodevelopment (24 months: n = 484; 54 months: n = 444) were examined using adjusted multivariable linear regression. RESULTS At age 24 months, higher protein intake (at 6 months) and increasing rate of intake (from 6 to 12 months) were associated with higher fine motor score [β = 0.17 SD (95% CI 0.03, 0.31) and 0.62 SD (0.10, 1.14) respectively]. Higher fat intake was associated with higher receptive language score [0.04 SD (0.003, 0.07)], but increasing rate of intake was associated with lower expressive language [- 0.20 SD (- 0.39, - 0.01)] and fine motor [- 0.29 SD (- 0.48, - 0.10)] scores. Higher carbohydrate intake was associated with lower gross motor score [- 0.07 SD (- 0.14, - 0.005)], but increasing rate of intake was associated with higher receptive language [0.44 SD (0.08, 0.81)] and fine motor [0.56 SD (0.18, 0.93)] scores. Increasing rate of dietary fibre intake was associated with higher fine motor scores [0.63 SD (0.16, 1.10)]. No significant associations were observed with neurodevelopment at 54 months. CONCLUSION Our findings provide greater understanding of how nutrition over time could have varying effects on child neurodevelopment.
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Affiliation(s)
- Jia Ying Toh
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore, Singapore
| | - Shirong Cai
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore, Singapore
- Human Potential Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Shan Xuan Lim
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Wei Wei Pang
- Department of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Keith M Godfrey
- Medical Research Council Lifecourse Epidemiology Centre and National Institute for Health Research Southampton Biomedical Research Centre, University of Southampton and University Hospital, Southampton National Health Service Foundation Trust, Southampton, UK
| | - Lynette P Shek
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Khoo Teck Puat-National University Children's Medical Institute, National University Health System, Singapore, Singapore
| | - Kok Hian Tan
- Department of Maternal Fetal Medicine, KK Women's and Children's Hospital, Singapore, Singapore
- Duke-National University of Singapore Graduate Medical School, Singapore, Singapore
| | - Fabian Yap
- Duke-National University of Singapore Graduate Medical School, Singapore, Singapore
- Department of Paediatric Endocrinology, KK Women's and Children's Hospital, Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Yung Seng Lee
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore, Singapore
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Division of Paediatric Endocrinology and Diabetes, Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, National University Health System, Singapore, Singapore
| | - Yap-Seng Chong
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore, Singapore
- Department of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Johan G Eriksson
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore, Singapore
- Human Potential Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Folkhälsan Research Center, Helsinki, Finland
- Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Birit F P Broekman
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore, Singapore
- Department of Psychiatry, OLVG and Amsterdam UMC, VU University, Amsterdam, The Netherlands
| | - Anne Rifkin-Graboi
- Centre for Research in Child Development, National Institute of Education, Nanyang Technological University, Singapore, Singapore
| | - Mary F F Chong
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore, Singapore.
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore.
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Susey K, Hanin M, Wortner A, Mandich M, Scott K, Stephenson K, Shepherd E, Mehling M. Validity and reliability of the behavioral signs of respiratory instability (BSRI) © scale during activity for infants with bronchopulmonary dysplasia. J Perinatol 2023; 43:1015-1019. [PMID: 37185368 PMCID: PMC10129300 DOI: 10.1038/s41372-023-01682-9] [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: 01/11/2023] [Revised: 03/17/2023] [Accepted: 04/14/2023] [Indexed: 05/17/2023]
Abstract
OBJECTIVE There is no reliable evidence on how best to evaluate the overall status of infants with severe forms of bronchopulmonary dysplasia (BPD). The Behavioral Signs of Respiratory Instability (BSRI) scale was developed as an objective measure of developmental capacity during occupational and physical therapy sessions. The purpose of this study was to determine the psychometric properties of the BSRI Scale. STUDY DESIGN The BSRI and Respiratory Severity Score (RSS) were compared for 25 infants with BPD and 15 infants without BPD. A cross-sectional design was used to test inter-rater reliability among 10 NICU occupational and physical therapists. A prospective cohort design was used to evaluate validity. RESULTS The BSRI demonstrated good to excellent inter-rater reliability (ρ = 0.47-0.91) and was strongly correlated with RSS (ρ = -0.77, p < 0.001; concurrent validity). CONCLUSION The BSRI Scale has preliminary psychometric support. Standardized measures like the BSRI may provide accurate, objective data that can improve care planning within interdisciplinary teams that supports brain growth and potentially improves neurodevelopment.
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Affiliation(s)
- K Susey
- Neonatal Therapy Department, Nationwide Children's Hospital, Columbus, OH, USA.
| | - M Hanin
- Neonatal Therapy Department, Nationwide Children's Hospital, Columbus, OH, USA
| | - A Wortner
- Neonatal Therapy Department, Nationwide Children's Hospital, Columbus, OH, USA
| | - M Mandich
- Division of Physical Therapy, West Virginia University, Morgantown, WV, USA
| | - K Scott
- School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, OH, USA
| | - K Stephenson
- Department of Psychology, Nationwide Children's Hospital, Columbus, OH, USA
| | - E Shepherd
- Comprehensive Center for Bronchopulmonary Dysplasia, Nationwide Children's Hospital, Columbus, OH, USA
| | - M Mehling
- Department of Psychology, Nationwide Children's Hospital, Columbus, OH, USA
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Kasambala M, Mukaratirwa S, Vengesai A, Mduluza-Jokonya T, Jokonya L, Midzi H, Makota RB, Mutemeri A, Maziti E, Dube-Marimbe B, Chibanda D, Mutapi F, Mduluza T. The association of systemic inflammation and cognitive functions of pre-school aged children residing in a Schistosoma haematobium endemic area in Zimbabwe. Front Immunol 2023; 14:1139912. [PMID: 37143686 PMCID: PMC10151793 DOI: 10.3389/fimmu.2023.1139912] [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: 01/07/2023] [Accepted: 03/31/2023] [Indexed: 05/06/2023] Open
Abstract
Background Cognitive function is negatively impacted by schistosomiasis and might be caused by systemic inflammation which has been hypothesized to be one of the mechanisms driving cognitive decline, This study explored the association of systemic inflammatory biomarkers; interleukin (IL)-10, IL-6, IL-17, transforming growth factor (TGF-β), tumor necrosis factor (TNF-α), C-reactive protein (CRP) and hematological parameters with cognitive performance of preschool-aged children (PSAC) from an Schistosoma haematobium endemic area. Methods The Griffith III tool was used to measure the cognitive performance of 136 PSAC. Whole blood and sera were collected and used to quantify levels of IL-10, TNF-α, IL-6, TGF-β, IL-17 A and CRP using the enzyme-linked immunosorbent assay and hematological parameters using the hematology analyzer. Spearman correlation analysis was used to determine the relationship between each inflammatory biomarker and cognitive performance. Multivariate logistic regression analysis was used to determine whether systemic inflammation due to S. haematobium infection affected cognitive performance in PSAC. Results Higher levels of TNF-α and IL-6, were correlated with lower performance in the Foundations of Learning domain (r = -0.30; p < 0.001 and r = -0.26; p < 0.001), respectively. Low cognitive performance in the Eye-Hand-Coordination Domain was observed in PSAC with high levels of the following inflammatory biomarkers that showed negative correlations to performance; TNF-α (r = -0.26; p < 0.001), IL-6 (r = -0.29; p < 0.001), IL-10 (r = -0.18; p < 0.04), WBC (r = -0.29; p < 0.001), neutrophils (r = -0.21; p = 0.01) and lymphocytes (r = -0.25; p = 0.003) The General Development Domain correlated with TNF-α (r = -0.28; p < 0.001) and IL-6 (r = -0.30; p < 0.001). TGF-β, L-17A and MXD had no significant correlations to performance in any of the cognitive domains. The overall general development of PSAC was negatively impacted by S. haematobium infections (OR = 7.6; p = 0.008) and (OR = 5.6; p = 0.03) where the PSAC had higher levels of TNF-α and IL-6 respectively. Conclusion Systemic inflammation and S. haematobium infections are negatively associated with cognitive function. We recommend the inclusion of PSAC into mass drug treatment programs.
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Affiliation(s)
- Maritha Kasambala
- School of Life Sciences, University of KwaZulu-Natal, Durban, South Africa
- Department of Biological Sciences and Ecology, University of Zimbabwe, Harare, Zimbabwe
- *Correspondence: Maritha Kasambala,
| | - Samson Mukaratirwa
- School of Life Sciences, University of KwaZulu-Natal, Durban, South Africa
- One Health Center for Zoonoses and Tropical Veterinary Medicine, Ross University School of Veterinary Medicine, Basseterre, Saint Kitts and Nevis
| | - Arthur Vengesai
- Department of Biochemistry, Faculty of Medicine and Health Sciences, Midlands State University, Gweru, Zimbabwe
| | - Tariro Mduluza-Jokonya
- Department of Surgery, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Luxwell Jokonya
- Department of Surgery, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Herald Midzi
- School of Medicine and Medical Sciences, University of KwaZulu-Natal, Durban, South Africa
- Department of Biotechnology and Biochemistry, University of Zimbabwe, Harare, Zimbabwe
| | - Rutendo Birri Makota
- Department of Biological Sciences and Ecology, University of Zimbabwe, Harare, Zimbabwe
| | - Arnold Mutemeri
- Department of Psychiatry, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Emmanuel Maziti
- Department of Psychiatry, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Bazondlile Dube-Marimbe
- Department of Psychiatry, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Dixon Chibanda
- Department of Psychiatry, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Francisca Mutapi
- Ashworth Laboratories, Institute for Immunology and Infection Research and Centre for Immunity, Infection and Evolution, School of Biological Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Takafira Mduluza
- School of Medicine and Medical Sciences, University of KwaZulu-Natal, Durban, South Africa
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A Cross-Sectional Study of the Nutritional Status of Infants with Orofacial Clefts in the First 6 Months of Life. J Pediatr 2022; 255:181-189.e3. [PMID: 36462686 DOI: 10.1016/j.jpeds.2022.11.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 10/25/2022] [Accepted: 11/03/2022] [Indexed: 12/05/2022]
Abstract
OBJECTIVE(S) To estimate nutritional status in a large cohort of infants with orofacial clefts in the US, overall and by cleft type from birth to 6 months of age. STUDY DESIGN We conducted a cross-sectional study in infants with orofacial clefts by examining growth by month between birth and 6 months of age. Infants with at least one weight measurement at a single US regional tertiary care pediatric hospital with an interdisciplinary cleft team between 2010 and 2020 were included. We calculated the average weight-for-age z scores and weight-for-length z scores. We calculated the proportion of infants underweight and wasting with z scores below -2 SDs monthly from birth to 6 months of age. We used t tests to compare the distribution of weight for age z-score and weight for length z-score among children with orofacial clefts to a normal distribution. RESULTS We included 883 infants with orofacial clefts. Compared with expected proportion of underweight infants (2.3%), a larger proportion of infants with orofacial clefts were underweight between birth and 1 month (10.6%), peaking between 2 and 3 months (27.1%), and remaining high between 5 and 6 months (16.3%). Compared with the expected proportion of infants with wasting (2.3%), a higher proportion of infants with orofacial clefts experienced wasting between birth and 1 month (7.3%), peaking between 2 and 3 months (12.8%), and remaining high between 5 and 6 months (5.3%). Similar findings were observed for all cleft types and regardless of comorbidities. CONCLUSION(S) A substantial proportion of infants with orofacial clefts compared with normative peers have malnutrition in the first 6 months of life in the US.
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Company-Córdoba R, Accerenzi M, Simpson IC, Ibáñez-Alfonso JA. ‘Mens sana in corpore Sano’: Home food consumption implications over child cognitive performance in vulnerable contexts. Front Psychol 2022; 13:994399. [PMID: 36389522 PMCID: PMC9665114 DOI: 10.3389/fpsyg.2022.994399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 10/05/2022] [Indexed: 11/06/2022] Open
Abstract
Diet directly affects children’s physical and mental development. Nonetheless, how food insecurity and household food consumption impact the cognitive performance of children at risk of social exclusion remains poorly understood. In this regard, children in Guatemala face various hazards, mainly related to the socioeconomic difficulties that thousands of families have in the country. The main objective of this study was to analyze the differences in cognitive performance considering food insecurity and household food consumption in a sample of rural and urban Guatemalan children and adolescents at risk of social exclusion. Child cognitive performance was assessed in 134 children and adolescents (age M = 11.37; SD = 3.54) from rural and urban settings. Language, attention, and executive functions were assessed using neuropsychological tasks. Differences in cognitive performance in each level of food insecurity and household diet consumption were compared using the Mann–Whitney U test. A stepwise multivariate regression analysis was conducted to determine which factors may influence cognitive scores. The results showed that rural and urban groups did not differ in terms of food insecurity. However, considering just rural areas, differences were found between groups with food security and insecurity in attention and executive function tasks. Moreover, differences were found in food consumption for certain groups of food (e.g., meat, U = 1,146, p < 0.001, g = 0.72). Regarding regressions, protein food consumption (e.g., meat and fish), which is related to having a more balanced diet, was a relevant factor in executive performance. Contrary to what we expected, performance in attentional tasks was not related to the consumption of any food group. These findings could help politicians and decision-makers to select actions focused on improving diet balance and food security in families at risk of social exclusion. It is necessary to carry out more specific studies on the factors related to diet that affect the cognitive development of minors at risk of social exclusion. In addition, it is necessary to study the implementation of alternative interventions that include low-cost nutrients, thus ensuring that minors have access to a more balanced diet.
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Affiliation(s)
- Rosalba Company-Córdoba
- Human Neuroscience Lab, Department of Psychology, Universidad Loyola Andalucía, Seville, Spain
- ETEA Foundation, Development Institute of Universidad Loyola Andalucía, Córdoba, Spain
| | - Michela Accerenzi
- ETEA Foundation, Development Institute of Universidad Loyola Andalucía, Córdoba, Spain
| | - Ian Craig Simpson
- Department of Experimental Psychology, Universidad de Granada, Granada, Spain
| | - Joaquín A. Ibáñez-Alfonso
- Human Neuroscience Lab, Department of Psychology, Universidad Loyola Andalucía, Seville, Spain
- ETEA Foundation, Development Institute of Universidad Loyola Andalucía, Córdoba, Spain
- *Correspondence: Joaquín A. Ibáñez-Alfonso,
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Babikako HM, Bourdon C, Mbale E, Aber P, Birabwa A, Chimoyo J, Voskuijl W, Kazi Z, Massara P, Mukisa J, Mupere E, Nampijja M, Saleem AF, Uebelhoer LS, Bandsma R, Walson JL, Berkley JA, Lancioni C, Gladstone M, van den Heuvel M. Neurodevelopment and Recovery From Wasting. Pediatrics 2022; 150:189663. [PMID: 36193695 DOI: 10.1542/peds.2021-055615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/29/2022] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Acute illness with malnutrition is a common indication for hospitalization among children in low- and middle-income countries. We investigated the association between wasting recovery trajectories and neurodevelopmental outcomes in young children 6 months after hospitalization for an acute illness. METHODS Children aged 2 to 23 months were enrolled in a prospective observational cohort of the Childhood Acute Illness & Nutrition Network, in Uganda, Malawi, and Pakistan between January 2017 and January 2019. We grouped children on the basis of their wasting recovery trajectories using change in mid-upper arm circumference for age z-score. Neurodevelopment was assessed with the Malawi Developmental Assessment Tool (MDAT development-for-age z-score [DAZ]) at hospital discharge and after 6 months. RESULTS We included 645 children at hospital discharge (mean age 12.3 months ± 5.5; 55% male); 262 (41%) with severe wasting, 134 (21%) with moderate wasting, and 249 (39%) without wasting. Four recovery trajectories were identified: high-stable, n = 112; wasted-improved, n = 404; severely wasted-greatly improved, n = 48; and severely wasted-not improved, n = 28. The children in the severely wasted-greatly improved group demonstrated a steep positive MDAT-DAZ recovery slope. This effect was most evident in children with both wasting and stunting (interaction wasted-improved × time × stunting: P < .001). After 6 months, the MDAT DAZ in children with wasting recovery did not differ from community children. In children who never recovered from wasting, there remained a significant delay in MDAT DAZ scores. CONCLUSIONS Neurodevelopment recovery occurred in parallel with wasting recovery in children convalescing from acute illness and was influenced by stunting.
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Affiliation(s)
| | - Celine Bourdon
- Childhood Acute Illness and Nutrition Network, Nairobi, Kenya.,Translational Medicine
| | - Emmie Mbale
- Childhood Acute Illness and Nutrition Network, Nairobi, Kenya.,Department of Paediatrics and Child Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Peace Aber
- Childhood Acute Illness and Nutrition Network, Nairobi, Kenya.,Makerere University, Uganda Case Western Reserve University Research Collaboration, Kampala, Uganda
| | - Annet Birabwa
- Childhood Acute Illness and Nutrition Network, Nairobi, Kenya.,Makerere University, Uganda Case Western Reserve University Research Collaboration, Kampala, Uganda
| | - Josephine Chimoyo
- Childhood Acute Illness and Nutrition Network, Nairobi, Kenya.,Department of Paediatrics and Child Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Wieger Voskuijl
- Childhood Acute Illness and Nutrition Network, Nairobi, Kenya.,Child Health and Development Center School of Medicine College of Health Sciences, Makerere University, Kampala, Uganda.,Centre for Global Health.,Amsterdam Center for Global health, Emma Children's Hospital, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | | | - Paraskevi Massara
- Translational Medicine.,Department of Nutritional Sciences, Faculty of Medicine
| | - John Mukisa
- Childhood Acute Illness and Nutrition Network, Nairobi, Kenya.,Departments of Immunology and Molecular Biology, Pathology.,Baylor College of Medicine, Houston, Texas
| | - Ezekiel Mupere
- Childhood Acute Illness and Nutrition Network, Nairobi, Kenya.,Makerere University, Uganda Case Western Reserve University Research Collaboration, Kampala, Uganda.,Paediatrics and Child Health, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Margaret Nampijja
- Childhood Acute Illness and Nutrition Network, Nairobi, Kenya.,MRC/UVRI & London School of Hygiene and Tropical Medicine, Uganda Research Unit, Entebbe, Uganda.,African Population and Health Research Center, Nairobi, Kenya
| | - Ali Faisal Saleem
- Childhood Acute Illness and Nutrition Network, Nairobi, Kenya.,Department of Pediatrics, Aga Khan University Hospital, Karachi, Pakistan
| | - Luke S Uebelhoer
- Childhood Acute Illness and Nutrition Network, Nairobi, Kenya.,Department of Pediatrics, Oregon Health & Science University, Portland, Oregon
| | - Robert Bandsma
- Childhood Acute Illness and Nutrition Network, Nairobi, Kenya.,Translational Medicine.,Centre for Global Health.,Department of Paediatrics and Child Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Judd L Walson
- Childhood Acute Illness and Nutrition Network, Nairobi, Kenya.,Departments of Global Health, Medicine, Pediatrics, and Epidemiology, University of Washington, Seattle, Washington
| | - James A Berkley
- Childhood Acute Illness and Nutrition Network, Nairobi, Kenya.,KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya.,Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
| | - Christina Lancioni
- Childhood Acute Illness and Nutrition Network, Nairobi, Kenya.,Department of Pediatrics, Oregon Health & Science University, Portland, Oregon
| | - Melissa Gladstone
- Childhood Acute Illness and Nutrition Network, Nairobi, Kenya.,Department of Women and Children's Health, Institute of Life Course and Clinical Sciences, University of Liverpool, Alder Hey Children's NHS Foundation Trust, Liverpool, United Kingdom
| | - Meta van den Heuvel
- Childhood Acute Illness and Nutrition Network, Nairobi, Kenya.,Centre for Global Health.,Division of Pediatrics, Hospital for Sick Children, Toronto, Canada.,Department of Pediatrics, University of Toronto, Canada
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10
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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: 26] [Impact Index Per Article: 13.0] [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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11
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Jiang CB, Kao CS, Chien LC, Chen YJ, Liao KW. Associations among prenatal and postnatal arsenic, lead, and cadmium exposures and motor development in 3-year-old children: a longitudinal birth cohort study in Taiwan. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2022; 29:43191-43200. [PMID: 35091938 DOI: 10.1007/s11356-021-18321-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 12/21/2021] [Indexed: 06/14/2023]
Abstract
Prenatal and postnatal exposures to heavy metals have been suggested to interfere with neurodevelopment, but the neurotoxicity of lead (Pb), arsenic (As), and cadmium (Cd) is still unclear. In this study, we aimed to assess the associations between the levels of As, Cd, and Pb and children's neurodevelopment. A total of 299 mother-infant pairs were recruited in this study and their meconium were collected. After three years, 53 children underwent the Bayley Scales of Infant and Toddler Development (Bayley-III) examinations and provided hair and fingernail specimens. The levels of As, Cd, and Pb in the meconium, hair, and fingernail were measured by inductively coupled plasma mass spectrometry; the median levels were the following: meconium, 42.7, 5.57, and 25.6 ng/g, respectively; hair, 0.19, 0.05, and 3.61 μg/g, respectively; and fingernail, 0.29, 0.04, and 0.84 μg/g, respectively. After adjusting for potential confounding factors, we found that the log-transformed levels of As in the hair samples was negatively associated with gross motor development (β = - 0.032; 95% confidence interval: - 0.061 to - 0.004). We conclude that postnatal exposure to As is a crucial period for gross motor development in children, while the effects of Cd and Pb on neurodevelopment are less clear.
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Affiliation(s)
- Chuen-Bin Jiang
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, MacKay Children's Hospital, Taipei, Taiwan
- Department of Medicine, MacKay Medical College, New Taipei City, Taiwan
| | - Chi-Sian Kao
- School of Public Health, Taipei Medical University, Taipei, Taiwan
| | - Ling-Chu Chien
- School of Public Health, Taipei Medical University, Taipei, Taiwan
- Neuroscience Research Center, Taipei Medical University, Taipei, Taiwan
- Nutrition Research Center, Taipei Medical University Hospital, Taipei, Taiwan
| | - Yi-Jhen Chen
- School of Public Health, Taipei Medical University, Taipei, Taiwan
| | - Kai-Wei Liao
- School of Food Safety, College of Nutrition, Taipei Medical University, 250 Wu-Xing Street, Taipei, Taiwan.
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12
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Critical Role of Maternal Selenium Nutrition in Neurodevelopment: Effects on Offspring Behavior and Neuroinflammatory Profile. Nutrients 2022; 14:nu14091850. [PMID: 35565817 PMCID: PMC9104078 DOI: 10.3390/nu14091850] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 04/21/2022] [Accepted: 04/25/2022] [Indexed: 02/06/2023] Open
Abstract
Research in both animals and humans shows that some nutrients are important in pregnancy and during the first years of life to support brain and cognitive development. Our aim was to evaluate the role of selenium (Se) in supporting brain and behavioral plasticity and maturation. Pregnant and lactating female rats and their offspring up to postnatal day 40 were fed isocaloric diets differing in Se content—i.e., optimal, sub-optimal, and deficient—and neurodevelopmental, neuroinflammatory, and anti-oxidant markers were analyzed. We observed early adverse behavioral changes in juvenile rats only in sub-optimal offspring. In addition, sub-optimal, more than deficient supply, reduced basal glial reactivity in sex dimorphic and brain-area specific fashion. In female offspring, deficient and sub-optimal diets reduced the antioxidant Glutathione peroxidase (GPx) activity in the cortex and in the liver, the latter being the key organ regulating Se metabolism and homeostasis. The finding that the Se sub-optimal was more detrimental than Se deficient diet may suggest that maternal Se deficient diet, leading to a lower Se supply at earlier stages of fetal development, stimulated homeostatic mechanisms in the offspring that were not initiated by sub-optimal Se. Our observations demonstrate that even moderate Se deficiency during early life negatively may affect, in a sex-specific manner, optimal brain development.
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13
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Nampijja M, Mutua AM, Elliott AM, Muriuki JM, Abubakar A, Webb EL, Atkinson SH. Low Hemoglobin Levels Are Associated with Reduced Psychomotor and Language Abilities in Young Ugandan Children. Nutrients 2022; 14:nu14071452. [PMID: 35406065 PMCID: PMC9002834 DOI: 10.3390/nu14071452] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 03/22/2022] [Accepted: 03/28/2022] [Indexed: 12/10/2022] Open
Abstract
Children living in Sub-Saharan Africa are vulnerable to developmental delay, particularly in the critical first five years due to various adverse exposures including disease and nutritional deficiencies. Anemia and iron deficiency (ID) are highly prevalent in pregnant mothers and young children and are implicated in abnormal brain development. However, available evidence on the association between anemia, ID and neurodevelopment in sub-Saharan Africa is limited. Using data from the Entebbe Mother and Baby Study prospective birth cohort, we examined the effect of maternal and child hemoglobin (Hb) levels and child iron status on developmental scores in 933 and 530 pre-school Ugandan children respectively. Associations between Hb levels, iron status and developmental scores were assessed using regression analyses adjusting for potential confounders. Lower maternal and child Hb levels were associated with reduced psychomotor scores at 15 months, while only lower Hb levels in infancy were associated with reduced language scores. We found no evidence that anemia or ID was associated with cognitive or motor scores at five years. This study emphasizes the importance of managing anemia in pregnancy and infancy and highlights the need for further studies on the effects of anemia and ID in children living in Sub-Saharan Africa.
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Affiliation(s)
- Margaret Nampijja
- Maternal and Child Wellbeing (MCW) Unit, African Population and Health Research Center, Nairobi 00100, Kenya;
- Medical Research Council, Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe P.O. Box 49, Uganda;
| | - Agnes M. Mutua
- Kenya Medical Research Institute (KEMRI) Wellcome Trust Research Programme, KEMRI Centre for Geographic Medicine Research-Coast, Kilifi 230-80108, Kenya; (J.M.M.); (A.A.)
- Correspondence: (A.M.M.); (S.H.A.); Tel.: +254-709983677-76 (A.M.M. & S.H.A.)
| | - Alison M. Elliott
- Medical Research Council, Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe P.O. Box 49, Uganda;
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
| | - John Muthii Muriuki
- Kenya Medical Research Institute (KEMRI) Wellcome Trust Research Programme, KEMRI Centre for Geographic Medicine Research-Coast, Kilifi 230-80108, Kenya; (J.M.M.); (A.A.)
| | - Amina Abubakar
- Kenya Medical Research Institute (KEMRI) Wellcome Trust Research Programme, KEMRI Centre for Geographic Medicine Research-Coast, Kilifi 230-80108, Kenya; (J.M.M.); (A.A.)
- Department of Public Health, School of Human and Health Sciences, Pwani University, Kilifi 195-80108, Kenya
- Department of Psychiatry, University of Oxford, Oxford OX3 7JX, UK
- Institute for Human Development, Aga Khan University, Nairobi 30270-00100, Kenya
| | - Emily L. Webb
- MRC International Statistics and Epidemiology Group, Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK;
| | - Sarah H. Atkinson
- Kenya Medical Research Institute (KEMRI) Wellcome Trust Research Programme, KEMRI Centre for Geographic Medicine Research-Coast, Kilifi 230-80108, Kenya; (J.M.M.); (A.A.)
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford OX3 7FZ, UK
- Department of Paediatrics, University of Oxford, Oxford OX3 9DU, UK
- Correspondence: (A.M.M.); (S.H.A.); Tel.: +254-709983677-76 (A.M.M. & S.H.A.)
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14
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Privat E, Aumar M, Ley D, Tran LC, Coopman S, Guimber D, Turck D, Gottrand F. Efficacy and tolerance of enteral nutrition in children with biliary atresia awaiting liver transplantation. Front Pediatr 2022; 10:983717. [PMID: 36120654 PMCID: PMC9479203 DOI: 10.3389/fped.2022.983717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 08/01/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Malnutrition is common in children with biliary atresia (BA) awaiting liver transplantation (LT). Few studies have evaluated the effectiveness of enteral nutrition (EN) in these patients. The objective of this work was to assess the efficacy and tolerance of EN in children with BA awaiting LT. METHODS A total of 31 patients with BA followed between 1995 and 2018 were retrospectively included. Anthropometric indicators (weight, length, and head circumference) and adverse effects of EN were noted at the start (T0) and the end (T1) of EN. The z-scores for anthropometric indicators were compared between T0 and T1. RESULTS The median age at T0 was 7 months (interquartile range [IQR] 5-9), and the median duration of EN was 9 months (IQR 3-17). The z-scores for anthropometric variables improved from T0 to T1: -1.6 (IQR -2.5 to -1.0) to -0.5 (IQR -1.8 to 0.3) for median weight for age; -1.3 (IQR -2.4 to 0) to -0.4 (IQR -2.0 to 0.7) for length for age; -0.9 (IQR -2.3 to -0.3) to -0.3 (IQR -1.2 to 0.1) for weight for length; and -1.2 (IQR -2.1 to -0.6) to -0.2 (IQR -1.6 to 0.4) for body mass index (p < 0.05 for all comparisons). Nearly all (94%) of the patients had a weight-for-length z-score > -2 at the end of EN; 23% had adverse effects and 10% had complications leading to the cessation of EN. CONCLUSION EN is effective and well tolerated in infants with BA awaiting LT.
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Affiliation(s)
- Elodie Privat
- Univ. Lille, Division of Gastroenterology, Hepatology and Nutrition, Department of Paediatrics, Jeanne de Flandre Children's Hospital, CHU Lille, Lille, France
| | - Madeleine Aumar
- Univ. Lille, Division of Gastroenterology, Hepatology and Nutrition, Department of Paediatrics, Jeanne de Flandre Children's Hospital, CHU Lille, Lille, France.,Univ. Lille, Inserm, CHU Lille, U1286 - INFINITE - Institute for Translational Research in Inflammation, Lille, France
| | - Delphine Ley
- Univ. Lille, Division of Gastroenterology, Hepatology and Nutrition, Department of Paediatrics, Jeanne de Flandre Children's Hospital, CHU Lille, Lille, France.,Univ. Lille, Inserm, CHU Lille, U1286 - INFINITE - Institute for Translational Research in Inflammation, Lille, France
| | - Léa Chantal Tran
- Univ. Lille, Inserm, CHU Lille, U1286 - INFINITE - Institute for Translational Research in Inflammation, Lille, France
| | - Stéphanie Coopman
- Univ. Lille, Division of Gastroenterology, Hepatology and Nutrition, Department of Paediatrics, Jeanne de Flandre Children's Hospital, CHU Lille, Lille, France
| | - Dominique Guimber
- Univ. Lille, Division of Gastroenterology, Hepatology and Nutrition, Department of Paediatrics, Jeanne de Flandre Children's Hospital, CHU Lille, Lille, France
| | - Dominique Turck
- Univ. Lille, Division of Gastroenterology, Hepatology and Nutrition, Department of Paediatrics, Jeanne de Flandre Children's Hospital, CHU Lille, Lille, France.,Univ. Lille, Inserm, CHU Lille, U1286 - INFINITE - Institute for Translational Research in Inflammation, Lille, France
| | - Frédéric Gottrand
- Univ. Lille, Division of Gastroenterology, Hepatology and Nutrition, Department of Paediatrics, Jeanne de Flandre Children's Hospital, CHU Lille, Lille, France.,Univ. Lille, Inserm, CHU Lille, U1286 - INFINITE - Institute for Translational Research in Inflammation, Lille, France
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15
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Small Intestine Bacterial Overgrowth in Bangladeshi Infants Is Associated With Growth Stunting in a Longitudinal Cohort. Am J Gastroenterol 2022; 117:167-175. [PMID: 34693912 PMCID: PMC8715995 DOI: 10.14309/ajg.0000000000001535] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 09/09/2021] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Small intestine bacterial overgrowth (SIBO) is common in children from low-income countries and has been cross-sectionally associated with growth stunting. We sought to determine whether SIBO was associated with poor growth and neurodevelopmental in a longitudinal analysis. METHODS We measured SIBO by glucose hydrogen breath test (GHBT) at 18, 52, 78, and 104 weeks of life in a prospective longitudinal birth cohort of Bangladeshi children. Sociodemographic information and measures of enteric inflammation were analyzed as covariates. Diarrheal samples were tested for enteropathogens using polymerase chain reaction. Regression models were created using standardized mean GHBT area under the H2 curve (AUC) to determine associations with linear growth and cognitive, language, and motor scores on the Bayley-III Scales of Infant and Toddler Development at 2 years. We also investigated associations between GHBT AUC and enteropathogen exposure. RESULTS A 1-ppm increase in standardized mean GHBT AUC was associated with a 0.01-SD decrease in length-for-age Z score (P = 0.03) and a 0.11-point decrease in Bayley language score (P = 0.05) at 2 years of age in adjusted analysis. Enteroaggregative Escherichia coli, Enteropathogenic Escherichia coli, Giardia, and Enterocytozoon bieneusi were associated with increased GHBT AUC, whereas Clostridium difficile, norovirus GI, sapovirus, rotavirus, and Cryptosporidium were associated with decreased GHBT AUC. None were consistent across all 4 time points. DISCUSSION SIBO in the first 2 years of life is associated with growth stunting and decreased language ability in Bangladeshi infants and may represent a modifiable risk factor in poor growth and neurodevelopment in low-income countries.
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16
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Morton SU, Leyshon BJ, Tamilia E, Vyas R, Sisitsky M, Ladha I, Lasekan JB, Kuchan MJ, Grant PE, Ou Y. A Role for Data Science in Precision Nutrition and Early Brain Development. Front Psychiatry 2022; 13:892259. [PMID: 35815018 PMCID: PMC9259898 DOI: 10.3389/fpsyt.2022.892259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 05/17/2022] [Indexed: 11/13/2022] Open
Abstract
Multimodal brain magnetic resonance imaging (MRI) can provide biomarkers of early influences on neurodevelopment such as nutrition, environmental and genetic factors. As the exposure to early influences can be separated from neurodevelopmental outcomes by many months or years, MRI markers can serve as an important intermediate outcome in multivariate analyses of neurodevelopmental determinants. Key to the success of such work are recent advances in data science as well as the growth of relevant data resources. Multimodal MRI assessment of neurodevelopment can be supplemented with other biomarkers of neurodevelopment such as electroencephalograms, magnetoencephalogram, and non-imaging biomarkers. This review focuses on how maternal nutrition impacts infant brain development, with three purposes: (1) to summarize the current knowledge about how nutrition in stages of pregnancy and breastfeeding impact infant brain development; (2) to discuss multimodal MRI and other measures of early neurodevelopment; and (3) to discuss potential opportunities for data science and artificial intelligence to advance precision nutrition. We hope this review can facilitate the collaborative march toward precision nutrition during pregnancy and the first year of life.
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Affiliation(s)
- Sarah U Morton
- Division of Newborn Medicine, Boston Children's Hospital, Boston, MA, United States.,Fetal-Neonatal Neuroimaging and Developmental Science Center, Boston Children's Hospital, Boston, MA, United States.,Department of Pediatrics, Harvard Medical School, Boston, MA, United States
| | | | - Eleonora Tamilia
- Division of Newborn Medicine, Boston Children's Hospital, Boston, MA, United States.,Fetal-Neonatal Neuroimaging and Developmental Science Center, Boston Children's Hospital, Boston, MA, United States.,Department of Pediatrics, Harvard Medical School, Boston, MA, United States
| | - Rutvi Vyas
- Division of Newborn Medicine, Boston Children's Hospital, Boston, MA, United States.,Fetal-Neonatal Neuroimaging and Developmental Science Center, Boston Children's Hospital, Boston, MA, United States
| | - Michaela Sisitsky
- Division of Newborn Medicine, Boston Children's Hospital, Boston, MA, United States.,Fetal-Neonatal Neuroimaging and Developmental Science Center, Boston Children's Hospital, Boston, MA, United States
| | - Imran Ladha
- Division of Newborn Medicine, Boston Children's Hospital, Boston, MA, United States
| | | | | | - P Ellen Grant
- Division of Newborn Medicine, Boston Children's Hospital, Boston, MA, United States.,Fetal-Neonatal Neuroimaging and Developmental Science Center, Boston Children's Hospital, Boston, MA, United States.,Department of Pediatrics, Harvard Medical School, Boston, MA, United States.,Department of Radiology, Boston Children's Hospital, Boston, MA, United States
| | - Yangming Ou
- Division of Newborn Medicine, Boston Children's Hospital, Boston, MA, United States.,Fetal-Neonatal Neuroimaging and Developmental Science Center, Boston Children's Hospital, Boston, MA, United States.,Department of Pediatrics, Harvard Medical School, Boston, MA, United States.,Department of Radiology, Boston Children's Hospital, Boston, MA, United States
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17
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Keenan K, Fu H, Tung I, Berona J, Krafty RT, Hipwell AE, Stepp SD, Carpio K. Capturing the dynamic nature of stress exposure in the Pittsburgh Girls Study. SSM Popul Health 2021; 16:100983. [PMID: 34950762 PMCID: PMC8671117 DOI: 10.1016/j.ssmph.2021.100983] [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: 04/19/2021] [Revised: 11/23/2021] [Accepted: 11/25/2021] [Indexed: 11/26/2022] Open
Abstract
Background The science of stress exposure and health in humans has been hampered by differences in operational definitions of exposures and approaches to defining timing, leading to results that lack consistency and specificity. In the present study we aim to empirically derive variability in type, timing and chronicity of stress exposure for Black and White females using prospectively collected data in the Pittsburgh Girls Study (PGS). Methods The PGS is an ongoing 20-year longitudinal, community-based study. In this paper we focused on annual caregiver reports of three domains of stress: subsistence (e.g., resource strain, overcrowding); safety (e.g., community violence, inter-adult aggression), and caregiving (e.g., separation, maternal depression) from early childhood through adolescence. Z-scores were used to conduct a finite mixture model-based latent class trajectory analysis. Model fit was compared using the Akaike Information Criterion (AIC) and Bayesian Information Criterion (BIC). We examined differences in timing and chronicity of stress exposure between Black and White girls. Results Distinct trajectory groups characterized by differential timing and chronicity of stress exposure were observed across all stress domains. Six trajectories characterized subsistence and safety stress, and five characterized caregiving stress. Variability in initial level, chronicity, and magnitude and timing of change was observed within and across domains of stressors. Race differences also varied across the domains: race differences in timing and chronicity were most pronounced for the subsistence and safety domains, whereas Black and White girls had similar levels of exposure to caregiving stress. Conclusions Substantial variability in timing and chronicity was observed within and across stress domains. Modeling specific domains and dimensions of stress exposure is likely important in testing associations between exposure and health; such specificity may lead to more effective deployment of preventive interventions based on stress exposure. Distinct trajectories in exposure were observed for subsistence, safety, and caregiving stress domains. Race differences in timing and chronicity of exposure were pronounced for subsistence and safety domains. Patterns of exposure (e.g., level, timing) are likely critical for understanding the impact on stress exposure on health.
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Affiliation(s)
- Kate Keenan
- University of Chicago, Department of Psychiatry and Behavioral Neuroscience, Chicago, IL, USA
| | - Haoyi Fu
- University of Pittsburgh, Department of Biostatistics, Pittsburgh, PA, USA
| | - Irene Tung
- University of Pittsburgh, Department of Psychiatry, Pittsburgh, PA, USA
| | - Johnny Berona
- University of Chicago, Department of Psychiatry and Behavioral Neuroscience, Chicago, IL, USA
| | - Robert T Krafty
- Emory University, Department of Biostatistics & Bioinformatics, Atlanta, GA, USA
| | - Alison E Hipwell
- University of Pittsburgh, Department of Psychiatry, Pittsburgh, PA, USA
| | - Stephanie D Stepp
- University of Pittsburgh, Department of Psychiatry, Pittsburgh, PA, USA
| | - Kristen Carpio
- University of Pittsburgh, Department of Psychiatry, Pittsburgh, PA, USA
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18
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The Role of Vitamin D Supplementation in Children with Autism Spectrum Disorder: A Narrative Review. Nutrients 2021; 14:nu14010026. [PMID: 35010901 PMCID: PMC8746934 DOI: 10.3390/nu14010026] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 12/16/2021] [Accepted: 12/20/2021] [Indexed: 12/18/2022] Open
Abstract
Children with autism spectrum disorder (ASD) present with persistent deficits in both social communication and interactions, along with the presence of restricted and repetitive behaviors, resulting in significant impairment in significant areas of functioning. Children with ASD consistently reported significantly lower vitamin D levels than typically developing children. Moreover, vitamin D deficiency was found to be strongly correlated with ASD severity. Theoretically, vitamin D can affect neurodevelopment in children with ASD through its anti-inflammatory properties, stimulating the production of neurotrophins, decreasing the risk of seizures, and regulating glutathione and serotonin levels. A Title/Abstract specific search for publications on Vitamin D supplementation trials up to June 2021 was performed using two databases: PubMed and Cochrane Library. Twelve experimental studies were included in the synthesis of this review. Children with ASD reported a high prevalence of vitamin D deficiency or insufficiency. In general, it was observed that improved vitamin D status significantly reduced the ASD severity, however, this effect was not consistently different between the treatment and control groups. The variations in vitamin D dose protocols and the presence of concurrent interventions might provide an explanation for the variability of results. The age of the child for introducing vitamin D intervention was identified as a possible factor determining the effectiveness of the treatment. Common limitations included a small number of participants and a short duration of follow-ups in the selected studies. Long-term, well-designed randomized controlled trials are warranted to confirm the effect of vitamin D on severity in children with ASD.
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Breast Milk Micronutrients and Infant Neurodevelopmental Outcomes: A Systematic Review. Nutrients 2021; 13:nu13113848. [PMID: 34836103 PMCID: PMC8624933 DOI: 10.3390/nu13113848] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 10/25/2021] [Accepted: 10/25/2021] [Indexed: 12/22/2022] Open
Abstract
Micronutrients are fundamental for healthy brain development and deficiencies during early development can have a severe and lasting impact on cognitive outcomes. Evidence indicates that undernourished lactating individuals may produce breast milk containing lower concentrations of certain vitamins and minerals. Exclusively breastfed infants born to mothers deficient in micronutrients may therefore be at risk of micronutrient deficiencies, with potential implications for neurodevelopment. This systematic review aims to consider current knowledge on the effects of breast milk micronutrients on the developmental outcomes of infants. The databases Medline, Global Health, PsychInfo, Open Grey, and the Web of Science were searched for papers published before February 2021. Studies were included if they measured micronutrients in breast milk and their association with the neurodevelopmental outcomes of exclusively breastfed infants. Also, randomised control trials investigating neurocognitive outcomes following maternal supplementation during lactation were sought. From 5477 initial results, three observational studies were eligible for inclusion. These investigated associations between breast milk levels of vitamin B6, carotenoids, or selenium and infant development. Results presented suggest that pyroxidal, β-carotene, and lycopene are associated with infant neurodevelopmental outcomes. Limited eligible literature and heterogeneity between included papers prevented quantitative synthesis. Insufficient evidence was identified, precluding any conclusions on the relationship between breast milk micronutrients and infant developmental outcomes. Further, the evidence available was limited by a high risk of bias. This highlights the need for further research in this area to understand the long-term influence of micronutrients in breast milk, the role of other breast milk micronutrients in infant neurodevelopmental outcomes, and the impact of possible lactational interventions.
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Neurocognitive and Motor Functions in Biliary Atresia Patients: A Cross-sectional, Prospective National Cohort Study. J Pediatr Gastroenterol Nutr 2021; 73:491-498. [PMID: 34139745 DOI: 10.1097/mpg.0000000000003206] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVES The aim of the study was to evaluate the neurocognitive and motor development of biliary atresia (BA) patients in childhood and adolescence and to identify risk factors for impaired outcome. METHODS We invited all BA patients between ages 1 and 20 years followed up at Helsinki University Children's Hospital in Finland between 1 January 2019 to 31 January 2020 to participate. All participants underwent age-appropriate validated neurocognitive tests. Participants between 3.0 and 16.9 years of age were assessed with the Movement Assessment Battery for children, version 2. Guardians of participants between ages 5 and 17 years filled the Five-to-Fifteen-Revised (5-15R) parental questionnaire. RESULTS The mean (±standard deviation [SD]) total intelligence quotient (IQ) of the 39 participants was 91 ± 15, lower compared with test norms (mean IQ 100 ± 15, P < 0.01). Earlier clearance of jaundice (COJ) had a positive effect on mean (±SD) total IQ (COJ <3 months 96 ± 13 vs COJ ≥3 months post-portoenterostomy 84 ± 13, P < 0.05). Out of 30 participants assessed, 13 (43%) were either at risk or fulfilled the criteria for impaired motor development. Guardians reported elevated rates of functional difficulties affecting everyday life. There were no significant differences between native liver and liver transplanted (16/41%) groups. CONCLUSIONS IQ is moderately, and motor scores markedly impaired in BA patients compared with normative data. Standardised cognitive and motor assessment before school-age for all BA patients is advisable to identify individuals in need of additional support.
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Wu Q, Farley T, Cui M. Breastfeeding, maternal psychopathological symptoms, and infant problem behaviors among low-income mothers returning to work. Soc Sci Med 2021; 285:114288. [PMID: 34358946 PMCID: PMC8416933 DOI: 10.1016/j.socscimed.2021.114288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 07/20/2021] [Accepted: 07/30/2021] [Indexed: 11/17/2022]
Abstract
RATIONALE One of the biggest challenges for mothers returning to work after childbirth is breastfeeding. Studies documented the physical health benefits of breastfeeding for mothers and children. However, research findings concerning the longitudinal effects of breastfeeding on maternal and children's mental health are mixed. OBJECTIVE The current study investigated the longitudinal effects of the length of breastfeeding on maternal psychopathological symptoms and infants' problem behaviors, among a sample of low-income working mothers. METHODS The sample included 285 infants and their mothers (primarily minority, low-income, and single) who returned to work 3-month postpartum, recruited from an ethnically diverse and economically disadvantaged area in a southern U.S. state. Mothers' breastfeeding behaviors were assessed four times in the first year postpartum, and mothers' psychopathological symptoms and their infants' problem behaviors were reported by mothers two times, at 12-month and 24-month postpartum. RESULTS Path models revealed that high maternal psychopathological symptoms in infancy worsened the effect of breastfeeding on child externalizing behaviors in toddlerhood. Likewise, very high infant externalizing behaviors worsened the effect of breastfeeding on maternal hostility one year later. CONCLUSIONS This study suggests the need for implementing prevention interventions with a lifecycle approach and continued, tailored professional breastfeeding support after hospital discharge among at-risk working mothers. Findings of this study can inform public policy by highlighting the importance of considering joint breastfeeding support and mental health counseling in the delivery of services to mothers and their infants who live in under-resourced environments and struggle with maternal psychopathology.
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Affiliation(s)
- Qiong Wu
- Department of Human Development & Family Science, College of Health and Human Sciences, Florida State University, USA.
| | - Tatjana Farley
- Department of Human Development & Family Science, College of Health and Human Sciences, Florida State University, USA
| | - Ming Cui
- Department of Human Development & Family Science, College of Health and Human Sciences, Florida State University, USA
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22
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Donowitz JR, Drew J, Taniuchi M, Platts-Mills JA, Alam M, Ferdous T, Shama T, Islam MO, Kabir M, Nayak U, Haque R, Petri WA. Diarrheal Pathogens Associated With Growth and Neurodevelopment. Clin Infect Dis 2021; 73:e683-e691. [PMID: 33399861 PMCID: PMC8326554 DOI: 10.1093/cid/ciaa1938] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 01/04/2021] [Indexed: 12/19/2022] Open
Abstract
Background Diarrheal pathogens have been associated with linear growth deficits. The effect of diarrheal pathogens on growth is likely due to inflammation, which also adversely affects neurodevelopment. We hypothesized that diarrheagenic pathogens would be negatively associated with both growth and neurodevelopment. Methods We conducted a longitudinal birth cohort study of 250 children with diarrheal surveillance and measured pathogen burden in diarrheal samples using quantitative polymerase chain reaction. Pathogen attributable fraction estimates of diarrhea over the first 2 years of life, corrected for socioeconomic variables, were used to predict both growth and scores on the Bayley-III Scales of Infant and Toddler Development. Results One hundred eighty children were analyzed for growth and 162 for neurodevelopmental outcomes. Rotavirus, Campylobacter, and Shigella were the leading causes of diarrhea in year 1 while Shigella, Campylobacter, and heat-stable toxin–producing enterotoxigenic Escherichia coli were the leading causes in year 2. Norovirus was the only pathogen associated with length-for-age z score at 24 months and was positively associated (regression coefficient [RC], 0.42 [95% confidence interval {CI}, .04 to .80]). Norovirus (RC, 2.46 [95% CI, .05 to 4.87]) was also positively associated with cognitive scores while sapovirus (RC, –2.64 [95% CI, –4.80 to –.48]) and typical enteropathogenic E. coli (RC, –4.14 [95% CI, –8.02 to –.27]) were inversely associated. No pathogens were associated with language or motor scores. Significant maternal, socioeconomic, and perinatal predictors were identified for both growth and neurodevelopment. Conclusions Maternal, prenatal, and socioeconomic factors were common predictors of growth and neurodevelopment. Only a limited number of diarrheal pathogens were associated with these outcomes.
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Affiliation(s)
- Jeffrey R Donowitz
- Division of Pediatric Infectious Diseases, Children's Hospital of Richmond at Virginia Commonwealth University, Richmond, Virginia, USA.,Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, Virginia, USA
| | - Jeannie Drew
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, Virginia, USA
| | - Mami Taniuchi
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, Virginia, USA
| | - James A Platts-Mills
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, Virginia, USA
| | - Masud Alam
- Division of Parasitology, International Centre for Diarrhoeal Disease Research, Bangladesh , Dhaka, Bangladesh
| | - Tahsin Ferdous
- Division of Parasitology, International Centre for Diarrhoeal Disease Research, Bangladesh , Dhaka, Bangladesh
| | - Talat Shama
- Division of Parasitology, International Centre for Diarrhoeal Disease Research, Bangladesh , Dhaka, Bangladesh
| | - Md Ohedul Islam
- Division of Parasitology, International Centre for Diarrhoeal Disease Research, Bangladesh , Dhaka, Bangladesh
| | - Mamun Kabir
- Division of Parasitology, International Centre for Diarrhoeal Disease Research, Bangladesh , Dhaka, Bangladesh
| | - Uma Nayak
- Department of Public Health Sciences and Center for Public Health Genomics, University of Virginia, Charlottesville, Virginia, USA
| | - Rashidul Haque
- Division of Parasitology, International Centre for Diarrhoeal Disease Research, Bangladesh , Dhaka, Bangladesh
| | - William A Petri
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, Virginia, USA
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Conroy AL, Opoka RO, Bangirana P, Namazzi R, Okullo AE, Georgieff MK, Cusick S, Idro R, Ssenkusu JM, John CC. Parenteral artemisinins are associated with reduced mortality and neurologic deficits and improved long-term behavioral outcomes in children with severe malaria. BMC Med 2021; 19:168. [PMID: 34315456 PMCID: PMC8317420 DOI: 10.1186/s12916-021-02033-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 06/11/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND In 2011, the World Health Organization recommended injectable artesunate as the first-line therapy for severe malaria (SM) due to its superiority in reducing mortality compared to quinine. There are limited data on long-term clinical and neurobehavioral outcomes after artemisinin use for treatment of SM. METHODS From 2008 to 2013, 502 Ugandan children with two common forms of SM, cerebral malaria and severe malarial anemia, were enrolled in a prospective observational study assessing long-term neurobehavioral and cognitive outcomes following SM. Children were evaluated a week after hospital discharge, and 6, 12, and 24 months of follow-up, and returned to hospital for any illness. In this study, we evaluated the impact of artemisinin derivatives on survival, post-discharge hospital readmission or death, and neurocognitive and behavioral outcomes over 2 years of follow-up. RESULTS 346 children received quinine and 156 received parenteral artemisinin therapy (artemether or artesunate). After adjustment for disease severity, artemisinin derivatives were associated with a 78% reduction in in-hospital mortality (adjusted odds ratio, 0.22; 95% CI, 0.07-0.67). Among cerebral malaria survivors, children treated with artemisinin derivatives also had reduced neurologic deficits at discharge (quinine, 41.7%; artemisinin derivatives, 23.7%, p=0.007). Over a 2-year follow-up, artemisinin derivatives as compared to quinine were associated with better adjusted scores (negative scores better) in internalizing behavior and executive function in children irrespective of the age at severe malaria episode. After adjusting for multiple comparisons, artemisinin derivatives were associated with better adjusted scores in behavior and executive function in children <6 years of age at severe malaria exposure following adjustment for child age, sex, socioeconomic status, enrichment in the home environment, and the incidence of hospitalizations over follow-up. Children receiving artesunate had the greatest reduction in mortality and benefit in behavioral outcomes and had reduced inflammation at 1-month follow-up compared to children treated with quinine. CONCLUSIONS Treatment of severe malaria with artemisinin derivatives, particularly artesunate, results in reduced in-hospital mortality and neurologic deficits in children of all ages, reduced inflammation following recovery, and better long-term behavioral outcomes. These findings suggest artesunate has long-term beneficial effects in children surviving severe malaria.
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Affiliation(s)
- Andrea L Conroy
- Ryan White Center for Pediatric Infectious Disease and Global Health, Indiana University School of Medicine, R4 402C 1044 West Walnut St, Indianapolis, IN, 46202, USA.
| | - Robert O Opoka
- Department of Paediatrics and Child Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Paul Bangirana
- Department of Psychiatry, Makerere University College of Health Sciences, Kampala, Uganda
| | - Ruth Namazzi
- Department of Paediatrics and Child Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Allen E Okullo
- Clinical Epidemiology Unit, Makerere University College of Health Sciences, Kampala, Uganda
| | | | - Sarah Cusick
- Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA
| | - Richard Idro
- Department of Paediatrics and Child Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - John M Ssenkusu
- Department of Epidemiology and Biostatistics, Makerere University School of Public Health, Kampala, Uganda
| | - Chandy C John
- Ryan White Center for Pediatric Infectious Disease and Global Health, Indiana University School of Medicine, R4 402C 1044 West Walnut St, Indianapolis, IN, 46202, USA.,Division of Global Pediatrics, University of Minnesota Medical School, Minneapolis, USA
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Volkova A, Ruggles K, Schulfer A, Gao Z, Ginsberg SD, Blaser MJ. Effects of early-life penicillin exposure on the gut microbiome and frontal cortex and amygdala gene expression. iScience 2021; 24:102797. [PMID: 34355145 PMCID: PMC8324854 DOI: 10.1016/j.isci.2021.102797] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 04/26/2021] [Accepted: 06/24/2021] [Indexed: 02/06/2023] Open
Abstract
We have established experimental systems to assess the effects of early-life exposures to antibiotics on the intestinal microbiota and gene expression in the brain. This model system is highly relevant to human exposure and may be developed into a preclinical model of neurodevelopmental disorders in which the gut–brain axis is perturbed, leading to organizational effects that permanently alter the structure and function of the brain. Exposing newborn mice to low-dose penicillin led to substantial changes in intestinal microbiota population structure and composition. Transcriptomic alterations implicate pathways perturbed in neurodevelopmental and neuropsychiatric disorders. There also were substantial effects on frontal cortex and amygdala gene expression by bioinformatic interrogation, affecting multiple pathways underlying neurodevelopment. Informatic analyses established linkages between specific intestinal microbial populations and the early-life expression of particular affected genes. These studies provide translational models to explore intestinal microbiome roles in the normal and abnormal maturation of the vulnerable central nervous system. Low-dose antibiotic exposure perturbs the infant gut mouse microbiome to PND10 Frontal cortex and amygdala gene expression were substantially affected Multiple pathways underlying neurodevelopment were affected Specific gut microbial populations were linked with expression of particular genes
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Affiliation(s)
- Angelina Volkova
- Institute for Systems Genetics, New York University Grossman School of Medicine, New York, NY 10016, USA
| | - Kelly Ruggles
- Institute for Systems Genetics, New York University Grossman School of Medicine, New York, NY 10016, USA.,Department of Medicine, New York University Grossman School of Medicine, New York, NY 10016, USA
| | - Anjelique Schulfer
- Department of Medicine, New York University Grossman School of Medicine, New York, NY 10016, USA
| | - Zhan Gao
- Department of Medicine, New York University Grossman School of Medicine, New York, NY 10016, USA.,Center for Advanced Biotechnology and Medicine, Rutgers University, Piscataway, NJ 08854, USA
| | - Stephen D Ginsberg
- Center for Dementia Research. Nathan Kline Institute, Orangeburg, NY 10962, USA.,Departments of Psychiatry, Neuroscience & Physiology, and NYU Neuroscience Institute, New York University Grossman School of Medicine, New York, NY 10016, USA
| | - Martin J Blaser
- Department of Medicine, New York University Grossman School of Medicine, New York, NY 10016, USA.,Center for Advanced Biotechnology and Medicine, Rutgers University, Piscataway, NJ 08854, USA
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Schott W, Richardson B, Baker E, D'Agostino A, Namaste S, Vosti SA. Comparing costs and cost-efficiency of platforms for micronutrient powder (MNP) delivery to children in rural Uganda. Ann N Y Acad Sci 2021; 1502:28-39. [PMID: 34169531 PMCID: PMC8596512 DOI: 10.1111/nyas.14621] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 05/03/2021] [Accepted: 05/13/2021] [Indexed: 11/28/2022]
Abstract
Micronutrient powder (MNP) can reduce iron deficiency in young children, which has been well established in efficacy trials. However, the cost of different delivery platforms has not been determined. We calculated the cost and cost-efficiency of distributed MNP through community-based mechanisms and in health facilities in a primarily rural district in Uganda. An endline survey (n = 1072) identified reach and adherence. During the 9-month pilot, 37,458 (community platform) and 12,390 (facility platform) packets of MNP were distributed. Each packet consisted of 30 MNP sachets. In 2016, total costs were $277,082 (community platform, $0.24/sachet) and $221,568 (facility platform, $0.59/sachet). The cost per child reached was lower in the community platform ($53.24) than the facility platform ($65.97). The cost per child adhering to a protocol was $58.08 (community platform) and $72.69 (facility platform). The estimated cost of scaling up the community platform pilot to the district level over 3 years to cover approximately 17,890 children was $1.23 million (scale-up integrated into a partner agency program) to $1.62 million (government scale-up scenario). Unlike previous estimates, these included opportunity costs. Community-based MNP delivery costs were greater, yet more cost-efficient per child reached and adhering to protocol than facility-based delivery. However, total costs for untargeted MNP delivery under program settings are potentially prohibitive.
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Affiliation(s)
- Whitney Schott
- Population Studies Center, University of Pennsylvania, Philadelphia, Pennsylvania.,A.J. Drexel Autism Institute, Drexel University, Philadelphia, Pennsylvania
| | - Belinda Richardson
- International Agricultural Development, Department of Plant Sciences, University of California, Davis, Davis, California
| | - Emily Baker
- International Agricultural Development, Department of Plant Sciences, University of California, Davis, Davis, California
| | - Alexis D'Agostino
- County of Santa Clara Public Health Department, San Jose, California
| | | | - Stephen A Vosti
- Department of Agricultural and Resource Economics, University of California-Davis, Davis, California
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Abstract
Human milk is considered the most advantageous source of nourishment for infants. Even though there is no ideal composition of human milk, it still contains a unique combination of components that contribute to brain development. The aim of this review is to provide an overview on the possible correlation of human milk with the neurodevelopment of infants, with a special emphasis on myelination and epigenetic modifications. Research in human milk is a rapidly expanding field and cutting-edge technologies might contribute to identify specific mechanisms underlying the beneficial effects on human milk on neurodevelopment.
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Cerf ME. Healthy lifestyles and noncommunicable diseases: Nutrition, the life‐course, and health promotion. LIFESTYLE MEDICINE 2021. [DOI: 10.1002/lim2.31] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Affiliation(s)
- Marlon E. Cerf
- Grants, Innovation and Product Development South African Medical Research Council Cape Town South Africa
- Biomedical Research and Innovation Platform South African Medical Research Council Cape Town South Africa
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28
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Dong T, Guan Q, Hu W, Zhang M, Zhang Y, Chen M, Wang X, Xia Y. Prenatal exposure to glufosinate ammonium disturbs gut microbiome and induces behavioral abnormalities in mice. JOURNAL OF HAZARDOUS MATERIALS 2020; 389:122152. [PMID: 32004847 DOI: 10.1016/j.jhazmat.2020.122152] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 01/19/2020] [Accepted: 01/20/2020] [Indexed: 06/10/2023]
Abstract
Glufosinate ammonium (GLA) is a widely used organophosphate herbicide, which could be commonly detected in body fluids of both pregnant women and newborns. Existing evidences indicate that GLA has reproductive toxicity, while data concerning the effects of prenatal GLA exposure on neurodevelopment is rather limited. Here we employed a mouse model exposed to GLA prenatally. Reduced locomotor activity, impaired memory formation and autism-like behaviors were observed in the treatment group. Marked alteration in gut microbiome of the treatment offspring mice could be found at 4th week, and seemed to recover over time. Fecal metabolomics analysis indicated remarkable changes in microbiome-related metabolism in the treatment group, which could be the cause of behavioral abnormality in mice. Present study suggested that prenatal exposure to GLA disturbed gut microbiome and metabolism, and thereby induced behavioral abnormalities in mice.
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Affiliation(s)
- Tianyu Dong
- State Key Laboratory of Reproductive Medicine, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, 211166, China; Key Laboratory of Modern Toxicology of Ministry of Education, School of Public Health, Nanjing Medical University, Nanjing, 211166, China
| | - Quanquan Guan
- State Key Laboratory of Reproductive Medicine, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, 211166, China; Key Laboratory of Modern Toxicology of Ministry of Education, School of Public Health, Nanjing Medical University, Nanjing, 211166, China
| | - Weiyue Hu
- State Key Laboratory of Reproductive Medicine, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, 211166, China; Key Laboratory of Modern Toxicology of Ministry of Education, School of Public Health, Nanjing Medical University, Nanjing, 211166, China
| | - Mingzhi Zhang
- State Key Laboratory of Reproductive Medicine, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, 211166, China; Key Laboratory of Modern Toxicology of Ministry of Education, School of Public Health, Nanjing Medical University, Nanjing, 211166, China
| | - Yuqing Zhang
- State Key Laboratory of Reproductive Medicine, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, 211166, China; Key Laboratory of Modern Toxicology of Ministry of Education, School of Public Health, Nanjing Medical University, Nanjing, 211166, China
| | - Minjian Chen
- State Key Laboratory of Reproductive Medicine, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, 211166, China; Key Laboratory of Modern Toxicology of Ministry of Education, School of Public Health, Nanjing Medical University, Nanjing, 211166, China
| | - Xinru Wang
- State Key Laboratory of Reproductive Medicine, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, 211166, China; Key Laboratory of Modern Toxicology of Ministry of Education, School of Public Health, Nanjing Medical University, Nanjing, 211166, China
| | - Yankai Xia
- State Key Laboratory of Reproductive Medicine, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, 211166, China; Key Laboratory of Modern Toxicology of Ministry of Education, School of Public Health, Nanjing Medical University, Nanjing, 211166, China.
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29
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Morton SU, Vyas R, Gagoski B, Vu C, Litt J, Larsen RJ, Kuchan MJ, Lasekan JB, Sutton BP, Grant PE, Ou Y. Maternal Dietary Intake of Omega-3 Fatty Acids Correlates Positively with Regional Brain Volumes in 1-Month-Old Term Infants. Cereb Cortex 2020; 30:2057-2069. [PMID: 31711132 PMCID: PMC8355466 DOI: 10.1093/cercor/bhz222] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 07/31/2019] [Accepted: 08/22/2019] [Indexed: 01/05/2023] Open
Abstract
Maternal nutrition is an important factor for infant neurodevelopment. However, prior magnetic resonance imaging (MRI) studies on maternal nutrients and infant brain have focused mostly on preterm infants or on few specific nutrients and few specific brain regions. We present a first study in term-born infants, comprehensively correlating 73 maternal nutrients with infant brain morphometry at the regional (61 regions) and voxel (over 300 000 voxel) levels. Both maternal nutrition intake diaries and infant MRI were collected at 1 month of life (0.9 ± 0.5 months) for 92 term-born infants (among them, 54 infants were purely breastfed and 19 were breastfed most of the time). Intake of nutrients was assessed via standardized food frequency questionnaire. No nutrient was significantly correlated with any of the volumes of the 61 autosegmented brain regions. However, increased volumes within subregions of the frontal cortex and corpus callosum at the voxel level were positively correlated with maternal intake of omega-3 fatty acids, retinol (vitamin A) and vitamin B12, both with and without correction for postmenstrual age and sex (P < 0.05, q < 0.05 after false discovery rate correction). Omega-3 fatty acids remained significantly correlated with infant brain volumes after subsetting to the 54 infants who were exclusively breastfed, but retinol and vitamin B12 did not. This provides an impetus for future larger studies to better characterize the effect size of dietary variation and correlation with neurodevelopmental outcomes, which can lead to improved nutritional guidance during pregnancy and lactation.
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Affiliation(s)
- Sarah U Morton
- Division of Newborn Medicine, Boston Children’s Hospital, Boston, MA 02115, USA
| | - Rutvi Vyas
- Division of Newborn Medicine, Boston Children’s Hospital, Boston, MA 02115, USA
- Fetal-Neonatal Neuroimaging and Developmental Science Center, Boston Children’s Hospital, Boston, MA 02115, USA
| | - Borjan Gagoski
- Fetal-Neonatal Neuroimaging and Developmental Science Center, Boston Children’s Hospital, Boston, MA 02115, USA
- Department of Radiology, Boston Children’s Hospital, Boston, MA 02115, USA
| | - Catherine Vu
- Fetal-Neonatal Neuroimaging and Developmental Science Center, Boston Children’s Hospital, Boston, MA 02115, USA
| | - Jonathan Litt
- Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, MA 02115, USA
| | - Ryan J Larsen
- Beckman Institute, University of Illinois at Urbana—Champaign, Urbana, IL 61801, USA
| | | | | | - Brad P Sutton
- Beckman Institute, University of Illinois at Urbana—Champaign, Urbana, IL 61801, USA
- Department of Bioengineering, University of Illinois at Urbana—Champaign, Urbana, IL 61801, USA
| | - P Ellen Grant
- Division of Newborn Medicine, Boston Children’s Hospital, Boston, MA 02115, USA
- Fetal-Neonatal Neuroimaging and Developmental Science Center, Boston Children’s Hospital, Boston, MA 02115, USA
- Department of Radiology, Boston Children’s Hospital, Boston, MA 02115, USA
| | - Yangming Ou
- Division of Newborn Medicine, Boston Children’s Hospital, Boston, MA 02115, USA
- Fetal-Neonatal Neuroimaging and Developmental Science Center, Boston Children’s Hospital, Boston, MA 02115, USA
- Department of Radiology, Boston Children’s Hospital, Boston, MA 02115, USA
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Obradović J, Willoughby MT. Studying Executive Function Skills in Young Children in Low‐ and Middle‐Income Countries: Progress and Directions. CHILD DEVELOPMENT PERSPECTIVES 2019. [DOI: 10.1111/cdep.12349] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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31
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Cerdó T, Diéguez E, Campoy C. Early nutrition and gut microbiome: interrelationship between bacterial metabolism, immune system, brain structure, and neurodevelopment. Am J Physiol Endocrinol Metab 2019; 317:E617-E630. [PMID: 31361544 DOI: 10.1152/ajpendo.00188.2019] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Disturbances of diet during pregnancy and early postnatal life may impact colonization of gut microbiota during early life, which could influence infant health, leading to potential long-lasting consequences later in life. This is a nonsystematic review that explores the recent scientific literature to provide a general perspective of this broad topic. Several studies have shown that gut microbiota composition is related to changes in metabolism, energy balance, and immune system disturbances through interaction between microbiota metabolites and host receptors by the gut-brain axis. Moreover, recent clinical studies suggest that an intestinal dysbiosis in gut microbiota may result in cognitive disorders and behavioral problems. Furthermore, recent research in the field of brain imaging focused on the study of the relationship between gut microbial ecology and large-scale brain networks, which will help to decipher the influence of the microbiome on brain function and potentially will serve to identify multiple mediators of the gut-brain axis. Thus, knowledge about optimal nutrition by modulating gut microbiota-brain axis activity will allow a better understanding of the molecular mechanisms involved in the crosstalk between gut microbiota and the developing brain during critical windows. In addition, this knowledge will open new avenues for developing novel microbiota-modulating based diet interventions during pregnancy and early life to prevent metabolic disorders, as well as neurodevelopmental deficits and brain functional disorders.
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Affiliation(s)
- Tomás Cerdó
- Department of Paediatrics, School of Medicine, University of Granada, Granada, Spain
- EURISTIKOS Excellence Centre for Paediatric Research, Biomedical Research Centre, University of Granada, Granada, Spain
- BioHealth Research Institute (Ibs-Granada), Health Sciences Technological Park, Granada, Spain
- Neurosciences Institute, Biomedical Research Centre, University of Granada, Granada, Spain
| | - Estefanía Diéguez
- Department of Paediatrics, School of Medicine, University of Granada, Granada, Spain
- EURISTIKOS Excellence Centre for Paediatric Research, Biomedical Research Centre, University of Granada, Granada, Spain
| | - Cristina Campoy
- Department of Paediatrics, School of Medicine, University of Granada, Granada, Spain
- EURISTIKOS Excellence Centre for Paediatric Research, Biomedical Research Centre, University of Granada, Granada, Spain
- BioHealth Research Institute (Ibs-Granada), Health Sciences Technological Park, Granada, Spain
- Neurosciences Institute, Biomedical Research Centre, University of Granada, Granada, Spain
- Spanish Network of Biomedical Research in Epidemiology and Public Health (CIBERESP), Granada's node, Carlos III Health Institute of Health Carlos III, Madrid, Spain
- Brain, Behavior and Health Excellence Research Unit (SC2). University of Granada, Granada, Spain
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32
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Cando RI, DíazSilva A, Guerendiain M. The cognitive performance of indigenous schoolchildren in relation to their feeding during infancy. Am J Hum Biol 2019; 32:e23326. [DOI: 10.1002/ajhb.23326] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 08/04/2019] [Accepted: 08/30/2019] [Indexed: 02/06/2023] Open
Affiliation(s)
- R. Isabel Cando
- School of Clinical PsychologyFaculty of Health Sciences, National University of Chimborazo Riobamba Ecuador
- Metabolism and Nutrition Disorders Research GroupFaculty of Health Sciences, National University of Chimborazo Riobamba Ecuador
| | - Alicia DíazSilva
- Metabolism and Nutrition Disorders Research GroupFaculty of Health Sciences, National University of Chimborazo Riobamba Ecuador
| | - Marcela Guerendiain
- Metabolism and Nutrition Disorders Research GroupFaculty of Health Sciences, National University of Chimborazo Riobamba Ecuador
- Research Area, School of NutritionUniversity of the Republic Montevideo Uruguay
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33
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Black MM, Yimgang DP, Hurley KM, Harding KB, Fernandez-Rao S, Balakrishna N, Radhakrishna KV, Reinhart GA, Nair KM. Mechanisms linking height to early child development among infants and preschoolers in rural India. Dev Sci 2019; 22:e12806. [PMID: 30715779 PMCID: PMC7428854 DOI: 10.1111/desc.12806] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 10/19/2018] [Accepted: 11/30/2018] [Indexed: 01/16/2023]
Abstract
Stunting has been negatively associated with children's development. We examined the range of height by testing hypotheses: (a) height is positively associated with children's development, with associations moderated by inflammation and (b) home environments characterized by nurturance and early learning opportunities is positively associated with children's development over time and attenuate associations with height. Data included 513 infants (mean age 8.6 months) and 316 preschoolers (mean age 36.6 months) in rural India from a randomized controlled trial of multiple micronutrient powders (MNPs). Measures included height (height-for-age z-scores based on WHO standards), inflammation (C-reactive protein concentration >5 mg/L), nurturance (HOME Inventory), child development (Mullens Scales of Early Learning), and inhibitory control (preschoolers). Linear mixed effects models accounting for repeated measures, clustering, and confounders were used to assess associations between height and child development over time (infants: enrollment, 6 and 12 months; preschoolers: enrollment and 8 months). Moderating effects of inflammation and nurturance were tested with interaction terms. Among infants and preschoolers, height and nurturance were positively associated with all domains of child development over time, with the exception of inhibitory control. Among preschoolers, in the presence of inflammation, height was not associated with child development. Among infants, but not preschoolers, a nurturant home environment attenuated significant associations between height with fine motor and receptive language development. The mechanisms associated with children's development over time are multifactorial and include direct and indirect associations among nutrition, health, and the home environment, as supported by the Nurturing Care Framework.
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Affiliation(s)
- Maureen M Black
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD
- RTI International, Research Triangle Park, NC
| | - Doris P Yimgang
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD
| | - Kristen M Hurley
- Center for Human Nutrition, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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Geletu A, Lelisa A, Baye K. Provision of low-iron micronutrient powders on alternate days is associated with lower prevalence of anaemia, stunting, and improved motor milestone acquisition in the first year of life: A retrospective cohort study in rural Ethiopia. MATERNAL & CHILD NUTRITION 2019; 15:e12785. [PMID: 30676693 PMCID: PMC7198932 DOI: 10.1111/mcn.12785] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Revised: 12/22/2018] [Accepted: 01/08/2019] [Indexed: 12/31/2022]
Abstract
Inappropriate complementary feeding contributes to growth faltering, anaemia, and cognitive impairments. Limited programmatic evidence exists on the effectiveness of low-iron micronutrient powders (MNPs) on anaemia and motor development when provided every other day in the first year of life. This study used an existing demonstration project to evaluate associations between exposure of low-iron MNPs, anaemia, and motor development of infants in Southern Ethiopia. Using a retrospective cohort design, 200 infants aged 9 to 12 months (98 MNP exposed; 102 unexposed) were recruited, and data on socio-economic characteristics, anthropometric measures, dietary diversity scores (DDS), haemoglobin concentrations, and motor development acquisition were collected, and MNP exposed and unexposed groups were compared. Logistic regressions were run to identify predictors of acquisition of motor development milestones. Sociodemographic characteristics and dietary diversity scores were similar between MNP exposed and unexposed groups. Provision of low-iron (6 mg) MNP every other day, for 3 months, was associated with reduced risk of anaemia and stunting and increased achievement of motor development. After adjusting for age, infants exposed to MNPs had a higher likelihood of standing alone (AOR = 3.1; 95% CI [1.53, 6.46]) and walking alone (4.9; 95% CI [2.12, 11.37]) than unexposed ones. Exposure to MNPs, DDS, stunting, and mothers education were associated with acquisition of motor development milestones. Provision of low-iron dose MNPs on alternate days is associated with lower prevalence of anaemia, stunting, and increased motor development achievements. Integrating routine monitoring of motor development milestones with growth monitoring and anaemia screening can inform nutrition interventions to support optimal brain development.
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Affiliation(s)
- Ashenafi Geletu
- Center for Food Science and Nutrition, College of Natural and Computational SciencesAddis Ababa UniversityAddis AbabaEthiopia
- Department of Chemistry, College of Natural and computational SciencesKotebe Metropolitan UniversityAddis AbabaEthiopia
| | - Azeb Lelisa
- Infant and Young Child Nutrition ProgramNutrition InternationalAddis AbabaEthiopia
| | - Kaleab Baye
- Center for Food Science and Nutrition, College of Natural and Computational SciencesAddis Ababa UniversityAddis AbabaEthiopia
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35
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Atukunda P, Muhoozi GKM, van den Broek TJ, Kort R, Diep LM, Kaaya AN, Iversen PO, Westerberg AC. Child development, growth and microbiota: follow-up of a randomized education trial in Uganda. J Glob Health 2019. [PMID: 31131103 PMCID: PMC6513500 DOI: 10.7189/jogh-09-010431] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Background Undernutrition impairs child development outcomes and growth. In this follow-up study of an open cluster-randomized intervention trial we examined the effects of an education package delivered to mothers in rural Uganda on their children’s development, growth and gut microbiota at 36 months of age. Methods The parental trial included 511 mother-child pairs recruited when the children were 6-8 months. In that trial, a nutrition, stimulation and hygiene education was delivered to mothers in the intervention group while the control group received routine health care. A follow-up sample of 155 pairs (intervention n = 77, control n = 78) were re-enrolled when the children were 24 months. Developmental outcomes were assessed with the Bayley Scales of Infant and Toddler Development (BSID-III) composite scores for cognitive (primary endpoint), language and motor development. Development outcomes were also evaluated using the Ages and Stages Questionnaire (ASQ) and the Mullen Scales of Early Learning (MSEL). Other outcomes included growth and gut microbiota composition. Results The demographic characteristics were not different (P > 0.05) between the intervention and control groups and similar to those of the parental study. The intervention group had higher BSID-III scores than controls, with mean difference 10.13 (95% confidence interval (CI): 3.31-17.05, P = 0.002); 7.59 (1.62-13.66, P = 0.01); 9.00 (2.92-15.40, P = 0.005), for cognitive, language and motor composite scores, respectively. An improvement in the intervention compared to the control group was obtained for both the ASQ and the MSEL scores. The mean difference in height-for-age z-score was higher in the intervention compared to the control group: 0.50 (0.25-0.75, P = 0.0001). Gut microbiota composition did not differ significantly between the two study groups. Conclusions The maternal education intervention had positive effects on child development and growth at three years, but did not alter gut microbiota composition. This intervention may be applicable in other low-resource settings. Trial registration ClinicalTrials.gov registration number NCT02098031.
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Affiliation(s)
- Prudence Atukunda
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Grace K M Muhoozi
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway.,Department of Human Nutrition and Home Economics, Kyambogo University, Kampala, Uganda
| | - Tim J van den Broek
- Netherlands Organization for Applied Scientific Research (TNO), Microbiology and Systems Biology, Zeist, the Netherlands
| | - Remco Kort
- Netherlands Organization for Applied Scientific Research (TNO), Microbiology and Systems Biology, Zeist, the Netherlands.,Department of Molecular Cell Biology, VU University Amsterdam, the Netherlands
| | - Lien M Diep
- Oslo Centre for Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway
| | - Archileo N Kaaya
- School of Food Technology, Nutrition and Bioengineering, Makerere University, Kampala, Uganda
| | - Per O Iversen
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway.,Department of Haematology, Oslo University Hospital, Oslo, Norway.,Division of Human Nutrition, Stellenbosch University, Tygerberg, South Africa.,Equal authorship
| | - Ane C Westerberg
- Institute of Health Sciences, Kristiania University College, Oslo, Norway.,Equal authorship
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36
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Atukunda P, Muhoozi GKM, van den Broek TJ, Kort R, Diep LM, Kaaya AN, Iversen PO, Westerberg AC. Child development, growth and microbiota: follow-up of a randomized education trial in Uganda. J Glob Health 2019; 9:010431. [PMID: 31131103 DOI: 10.7189/jogh.09.010431] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Background Undernutrition impairs child development outcomes and growth. In this follow-up study of an open cluster-randomized intervention trial we examined the effects of an education package delivered to mothers in rural Uganda on their children's development, growth and gut microbiota at 36 months of age. Methods The parental trial included 511 mother-child pairs recruited when the children were 6-8 months. In that trial, a nutrition, stimulation and hygiene education was delivered to mothers in the intervention group while the control group received routine health care. A follow-up sample of 155 pairs (intervention n = 77, control n = 78) were re-enrolled when the children were 24 months. Developmental outcomes were assessed with the Bayley Scales of Infant and Toddler Development (BSID-III) composite scores for cognitive (primary endpoint), language and motor development. Development outcomes were also evaluated using the Ages and Stages Questionnaire (ASQ) and the Mullen Scales of Early Learning (MSEL). Other outcomes included growth and gut microbiota composition. Results The demographic characteristics were not different (P > 0.05) between the intervention and control groups and similar to those of the parental study. The intervention group had higher BSID-III scores than controls, with mean difference 10.13 (95% confidence interval (CI): 3.31-17.05, P = 0.002); 7.59 (1.62-13.66, P = 0.01); 9.00 (2.92-15.40, P = 0.005), for cognitive, language and motor composite scores, respectively. An improvement in the intervention compared to the control group was obtained for both the ASQ and the MSEL scores. The mean difference in height-for-age z-score was higher in the intervention compared to the control group: 0.50 (0.25-0.75, P = 0.0001). Gut microbiota composition did not differ significantly between the two study groups. Conclusions The maternal education intervention had positive effects on child development and growth at three years, but did not alter gut microbiota composition. This intervention may be applicable in other low-resource settings. Trial registration ClinicalTrials.gov registration number NCT02098031.
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Affiliation(s)
- Prudence Atukunda
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Grace K M Muhoozi
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway.,Department of Human Nutrition and Home Economics, Kyambogo University, Kampala, Uganda
| | - Tim J van den Broek
- Netherlands Organization for Applied Scientific Research (TNO), Microbiology and Systems Biology, Zeist, the Netherlands
| | - Remco Kort
- Netherlands Organization for Applied Scientific Research (TNO), Microbiology and Systems Biology, Zeist, the Netherlands.,Department of Molecular Cell Biology, VU University Amsterdam, the Netherlands
| | - Lien M Diep
- Oslo Centre for Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway
| | - Archileo N Kaaya
- School of Food Technology, Nutrition and Bioengineering, Makerere University, Kampala, Uganda
| | - Per O Iversen
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway.,Department of Haematology, Oslo University Hospital, Oslo, Norway.,Division of Human Nutrition, Stellenbosch University, Tygerberg, South Africa.,Equal authorship
| | - Ane C Westerberg
- Institute of Health Sciences, Kristiania University College, Oslo, Norway.,Equal authorship
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Maternal Flavonoids Intake Reverts Depression-Like Behaviour in Rat Female Offspring. Nutrients 2019; 11:nu11030572. [PMID: 30866491 PMCID: PMC6470771 DOI: 10.3390/nu11030572] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 02/28/2019] [Accepted: 02/28/2019] [Indexed: 12/18/2022] Open
Abstract
Maternal hypercaloric exposure during pregnancy and lactation is a risk factor for developing diseases associated with inflammation such as obesity, diabetes and, neurological diseases in the offspring. Neuroinflammation might modulate neuronal activation and flavonoids are dietary compounds that have been proven to exert anti-inflammatory properties. Thus, the aim of the present study is to evaluate the effect of maternal supplementation with flavonoids (kaempferol-3-O-glucoside and narirutin) on the prevention of depression-like behaviour in the female offspring of dams fed with an obesogenic diet during the perinatal period. Maternal programming was induced by high fat (HFD), high sugar (HSD), or cafeteria diets exposure and depressive like-behaviour, referred to as swimming, climbing, and immobility events, was evaluated around postnatal day 56–60 before and after 30 mg/kg i.p. imipramine administration in the female offspring groups. Central inflammation was analyzed by measuring the TANK binding kinase 1 (TBK1) expression. We found that the offspring of mothers exposed to HSD programming failed to show the expected antidepressant effect of imipramine. Also, imipramine injection, to the offspring of mothers exposed to cafeteria diet, displayed a pro-depressive like-behaviour phenotype. However, dietary supplementation with flavonoids reverted the depression-like behaviour in the female offspring. Finally, we found that HSD programming increases the TBK1 inflammatory protein marker in the hippocampus. Our data suggest that maternal HSD programming disrupts the antidepressant effect of imipramine whereas cafeteria diet exposure leads to depressive-like behaviour in female offspring, which is reverted by maternal flavonoid supplementation.
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38
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Iron as a model nutrient for understanding the nutritional origins of neuropsychiatric disease. Pediatr Res 2019; 85:176-182. [PMID: 30341413 PMCID: PMC6353667 DOI: 10.1038/s41390-018-0204-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 10/04/2018] [Accepted: 10/04/2018] [Indexed: 12/19/2022]
Abstract
Adequate nutrition during the pre- and early-postnatal periods plays a critical role in programming early neurodevelopment. Disruption of neurodevelopment by nutritional deficiencies can result not only in lasting functional deficits, but increased risk of neuropsychiatric disease in adulthood. Historical periods of famine such as the Dutch Hunger Winter and the Chinese Famine have provided foundational evidence for the long-term effects of developmental malnutrition on neuropsychiatric outcomes. Because neurodevelopment is a complex process that consists of many nutrient- and brain-region-specific critical periods, subsequent clinical and pre-clinical studies have aimed to elucidate the specific roles of individual macro- and micronutrient deficiencies in neurodevelopment and neuropsychiatric pathologies. This review will discuss developmental iron deficiency (ID), the most common micronutrient deficiency worldwide, as a paradigm for understanding the role of early-life nutrition in neurodevelopment and risk of neuropsychiatric disease. We will review the epidemiologic data linking ID to neuropsychiatric dysfunction, as well as the underlying structural, cellular, and molecular mechanisms that are thought to underlie these lasting effects. Understanding the mechanisms driving lasting dysfunction and disease risk is critical for development and implementation of nutritional policies aimed at preventing nutritional deficiencies and their long-term sequelae.
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Wainstock T, Walfisch A, Sergienko R, Sheiner E. Maternal anemia and pediatric neurological morbidity in the offspring - Results from a population based cohort study. Early Hum Dev 2019; 128:15-20. [PMID: 30445347 DOI: 10.1016/j.earlhumdev.2018.11.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 10/17/2018] [Accepted: 11/01/2018] [Indexed: 01/07/2023]
Abstract
OBJECTIVE Maternal anemia (Hemoglobin, <11 mg/dl) has been shown to affect fetal growth and pregnancy outcome. We aimed to study a possible association between maternal anemia and the risk for neurological morbidity in the offspring, during a follow-up period of up to 18 years. STUDY DESIGN A population-based cohort analysis was performed at the Soroka University Medical Center (SUMC), a single regional tertiary center comparing total and specific subtypes of neurological morbidities associated with hospitalizations among children stratified by three maternal post-partum hemoglobin categories: ≥11 mg/dl (no anemia); 11.0 mg/dl > Hb ≥ 7 mg/dl (mild-to-moderate anemia) and <7 mg/dl (severe anemia). Data on pregnancy course and outcome, and later offspring hospitalizations, were compared between the three study groups. All singleton deliveries between the years 1991-2014 were included in the analysis, and congenital malformations were excluded. A Kaplan-Meier survival curve was used to compare cumulative hospitalization incidence based on maternal anemia status, and a Weibull survival multivariable hazard model was constructed to adjust for confounding variables. RESULTS The study population included 217,358 deliveries of which 50.6% were in mothers who were not anemic, 49.0% in mothers with moderate anemia and 0.4% in mothers with severe anemia. During the follow up period (0-18 years, median 10.22 years), 2.1% of offspring were hospitalized with a neurological diagnoses. Neurological hospitalization incidence decreased from 2.95/1000 person years, in the severe anemia group, to 2.32/1000 person years and 2.01/1000 person years, among the mild-to-moderate and no anemia groups, respectively (p = 0.007). The association between maternal anemia and offspring long-term pediatric neurological morbidity remained significant in a Weibull hazards model controlled for gestational age, delivery mode, SGA and insufficient prenatal care (adjusted HR 1.55; 1.05-2.31 and adjusted HR 1.13; 1.06-1.20; among the severe and mild-to-moderate anemia, vs. no anemia, respectively). CONCLUSION Children born to anemic mothers are at an increased risk for pediatric neurological-related hospitalizations.
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Affiliation(s)
- Tamar Wainstock
- The Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
| | - Asnat Walfisch
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Ruslan Sergienko
- The Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Eyal Sheiner
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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DeBoer MD, Platts-Mills JA, Scharf RJ, McDermid JM, Wanjuhi AW, Gratz J, Svensen E, Swann JR, Donowitz JR, Jatosh S, Houpt ER, Mduma E. Early Life Interventions for Childhood Growth and Development in Tanzania (ELICIT): a protocol for a randomised factorial, double-blind, placebo-controlled trial of azithromycin, nitazoxanide and nicotinamide. BMJ Open 2018; 8:e021817. [PMID: 29982218 PMCID: PMC6042604 DOI: 10.1136/bmjopen-2018-021817] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION In many developing areas in the world, a high burden of enteric pathogens in early childhood are associated with growth deficits. The tryptophan-kynurenine-niacin pathway has been linked to enteric inflammatory responses to intestinal infections. However, it is not known in these settings whether scheduled antimicrobial intervention to reduce subclinical enteric pathogen carriage or repletion of the tryptophan-kynurenine-niacin pathway improves linear growth and development. METHODS AND ANALYSIS We are conducting a randomised, placebo-controlled, factorial intervention trial in the rural setting of Haydom, Tanzania. We are recruiting 1188 children within the first 14 days of life, who will be randomised in a 2×2 factorial design to administration of antimicrobials (azithromycin and nitazoxanide, randomised together) and nicotinamide. The nicotinamide is administered as a daily oral dose, which for breast-feeding children aged 0-6 months is given to the mother and for children aged 6-18 months is given to the child directly. Azithromycin is given to the child as a single oral dose at months 6, 9, 12 and 15; nitazoxanide is given as a 3-day course at months 12 and 15. Mother/child pairs are followed via monthly in-home visits. The primary outcome is the child's length-for-age Z-score at 18 months. Secondary outcomes for the child include additional anthropometry measures; stool pathogen burden and bacterial microbiome; systemic and enteric inflammation; blood metabolomics, growth factors, inflammation and nutrition; hydrogen breath assessment to estimate small-intestinal bacterial overgrowth and assessment of cognitive development. Secondary outcomes for the mother include breastmilk content of nicotinamide, other vitamins and amino acids; blood measures of tryptophan-kynurenine-niacin pathway and stool pathogens. ETHICS AND DISSEMINATION This trial has been approved by the Tanzanian National Institute for Medical Research, the Tanzanian FDA and the University of Virginia IRB. Findings will be presented at national and international conferences and published in peer-review journals. PROTOCOL VERSION 5.0, 4 December 2017. PROTOCOL SPONSOR Haydom Lutheran Hospital, Haydom, Manyara, Tanzania. TRIAL REGISTRATION NUMBER NCT03268902; Pre-results.
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Affiliation(s)
- Mark Daniel DeBoer
- Department of Pediatrics, University of Virginia, Charlottesville, Virginia, USA
| | | | - Rebecca J Scharf
- Department of Pediatrics, University of Virginia, Charlottesville, Virginia, USA
- Department of Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - Joann M McDermid
- Department of Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - Anne W Wanjuhi
- Department of Pediatrics, University of Virginia, Charlottesville, Virginia, USA
| | - Jean Gratz
- Department of Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - Erling Svensen
- Department of Global Health and Primary Care, University of Bergen, Bergen, Norway
| | - Jon R Swann
- Department of Surgery & Cancer, Imperial College of London, London, UK
| | - Jeffrey R Donowitz
- Division of Infectious Disease, Children's Hospital of Richmond at Virginia Commonwealth University, Richmond, Virginia, USA
| | - Samwel Jatosh
- Haydom Global Health Research Centre, Haydom Lutheran Hospital, Haydom, Tanzania
| | - Eric R Houpt
- Department of Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - Estomih Mduma
- Haydom Global Health Research Centre, Haydom Lutheran Hospital, Haydom, Tanzania
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Abstract
PURPOSE OF REVIEW Emerging research on the pediatric microbiome implicates the importance of the microbiome on the development of the immune system, nervous system, and growth. Changes to the microbiome during infancy are associated with the development of chronic illnesses such as asthma and inflammatory bowel disease. Additionally, the microbiome provides protection against certain pathogens, affects vaccine responses, and alters drug metabolism. This review highlights what is known about the microbiome, the establishment of a healthy microbiome and the significance that changes to the microbiome composition have on growth and health of children and adolescents. RECENT FINDINGS Vaginal delivery, breastfeeding, maternal health, and nutrition help shape a healthy microbiome. Caesarian delivery, formula feeding, and antibiotic use perturb the microbiome and are associated with the development of type II diabetes, asthma, allergic diseases, and obesity later in life. Specific interventions using pre and probiotics in multiple settings are under investigation with limited success. SUMMARY A better understanding of the microbiome and the interaction with the immune system may help guide interventions to alter the microbiome toward a state of lifelong health.
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42
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Martinez B, Cardona S, Rodas P, Lubina M, Gonzalez A, Farley Webb M, Grazioso MDP, Rohloff P. Developmental outcomes of an individualised complementary feeding intervention for stunted children: a substudy from a larger randomised controlled trial in Guatemala. BMJ Paediatr Open 2018; 2:e000314. [PMID: 30306144 PMCID: PMC6173251 DOI: 10.1136/bmjpo-2018-000314] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 07/16/2018] [Accepted: 07/28/2018] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Stunting is a common cause of early child developmental delay; Guatemala has the fourth highest rate of stunting globally. The goal of this study was to examine the impact of an intensive community health worker-led complementary feeding intervention on early child development in Guatemala. We hypothesised that the intervention would improve child development over usual care. DESIGN A substudy from a larger individually randomised (1:1 allocation ratio), parallel-group superiority trial, with blinding of study staff collecting outcomes data. SETTING Rural, indigenous Maya communities in Guatemala. PARTICIPANTS 210 stunted children (height-for-age z-score ≤-2.5) aged 6-24 months, previously randomised to usual care (106) or an intensive complementary feeding intervention (104). 84 in the intervention and 91 in the usual care arm agreed to participate. INTERVENTIONS Community health workers conducted monthly home visits for 6 months, providing usual care or individualised complementary feeding education. MAIN OUTCOME MEASURES The primary outcomes were change in z-scores for the subscales of the Bayley Scales of Infant Development (BSID), Third Edition. RESULTS 100 individuals were included in the final analysis, 47 in the intervention and 53 in the usual care arm. No statistically significant differences in age-adjusted scores between the arms were observed for any subscale. However, improvements within-subjects in both arms were observed (median duration between measurements 189 days (IQR 182-189)). Mean change for subscales was 0.45 (95% CI 0.23 to 0.67) z-scores in the intervention, and 0.43 (95% CI 0.25 to 0.61) in the usual care arm. CONCLUSIONS An intensive complementary feeding intervention did not significantly improve developmental outcomes more than usual care in stunted, indigenous Guatemalan children. However, both interventions had significant positive impacts on developmental outcomes. TRIAL REGISTRATION NUMBER NCT02509936. STAGE Results.
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Affiliation(s)
- Boris Martinez
- Wuqu' Kawoq, Maya Health Alliance, Santiago Sacatepéquez, Guatemala.,Department of Medicine, Saint Peter's University Hospital, New Brunswick, New Jersey, USA
| | - Sayra Cardona
- Department of Psychology, Universidad del Valle de Guatemala, Guatemala City, Guatemala
| | - Patricia Rodas
- Department of Psychology, Universidad del Valle de Guatemala, Guatemala City, Guatemala
| | - Meri Lubina
- Department of Psychology, Universidad del Valle de Guatemala, Guatemala City, Guatemala
| | - Ana Gonzalez
- Department of Psychology, Universidad del Valle de Guatemala, Guatemala City, Guatemala
| | - Meghan Farley Webb
- Wuqu' Kawoq, Maya Health Alliance, Santiago Sacatepéquez, Guatemala.,Department of Anthropology and Sociology, Albion College, Albion, Michigan, USA
| | | | - Peter Rohloff
- Wuqu' Kawoq, Maya Health Alliance, Santiago Sacatepéquez, Guatemala.,Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA
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Cerami C. Iron Nutriture of the Fetus, Neonate, Infant, and Child. ANNALS OF NUTRITION & METABOLISM 2017; 71 Suppl 3:8-14. [PMID: 29268254 PMCID: PMC6143763 DOI: 10.1159/000481447] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Iron is a key nutrient and is essential for the developing fetus, neonate, infant, and child. Iron requirements are high during early stages of life because it is critically important for the production of new red blood cells and muscle cells as well as brain development. Neonates, infants, and children obtain iron from dietary sources including breast milk (lactoferrin) and heme- and non-heme-containing foods. Iron deficiency (ID) is the most common micronutrient deficiency in children and pregnant women worldwide. ID and iron deficiency anemia (IDA) can affect growth and energy levels as well as motor and cognitive performance in the developing child. The fetus is completely dependent on maternal iron crossing through the placenta and, although it is generally well protected against deficiency at birth, ID in mothers can increase the risk of ID and IDA in their children as early as 4 months. This review will discuss the uses of iron, iron requirements, and the sources of iron from conception through childhood. In addition, it will describe the prevalence and clinical manifestations of ID and IDA in children and discuss recommendations for iron supplementation of children and pregnant women.
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Affiliation(s)
- Carla Cerami
- MRC Unit The Gambia, MRC International Nutrition Group, Fajara, The Gambia
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