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Martín-Adrados A, Fernández-Leal A, Martínez-Pérez J, Delgado-Ojeda J, Santamaría-Orleans A. Clinically Relevant Topics and New Tendencies in Childhood Nutrition during the First 2 Years of Life: A Survey among Primary Care Spanish Paediatricians. Nutrients 2024; 16:2146. [PMID: 38999893 PMCID: PMC11243411 DOI: 10.3390/nu16132146] [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: 05/29/2024] [Revised: 06/25/2024] [Accepted: 07/01/2024] [Indexed: 07/14/2024] Open
Abstract
A multicenter cross-sectional study was conducted among 245 experienced Spanish paediatricians, who completed an online survey based on clinically relevant topics in nutrition during the first two years of life and their recommendations to parents in daily clinical practice. Most participants advise about the choking risk associated with baby-led weaning (BLW) and more than 60% consider that infants can receive an insufficient variety and quantity of nutrients with this practice. The general opinion is that there is a lack of evidence for delaying the introduction of gluten and other allergenic foods in the complementary feeding of healthy infants. Most participants agree/strongly agree that two servings of dairy products are the adequate daily amount in a diversified diet and 93.4% disagree/strongly disagree with the use of vegetal beverages under 1 year of life. There is a general agreement to avoid added salt and sugar before 12 months of life, the consideration that organic foods do not have a better nutritional profile than non-organic ones, and the limitations of vegetarian diets especially for adequate provision of micronutrients. Overall, there is an adequate knowledge of the new trends by paediatricians and younger ones seemed more in favor of them and interested in receiving more information on most topics.
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Affiliation(s)
- Ana Martín-Adrados
- Gastroenterology and Nutrition Service, Hospital Infantil Universitario Niño Jesús, 28009 Madrid, Spain (A.F.-L.); (J.M.-P.)
| | - Amalio Fernández-Leal
- Gastroenterology and Nutrition Service, Hospital Infantil Universitario Niño Jesús, 28009 Madrid, Spain (A.F.-L.); (J.M.-P.)
| | - Jorge Martínez-Pérez
- Gastroenterology and Nutrition Service, Hospital Infantil Universitario Niño Jesús, 28009 Madrid, Spain (A.F.-L.); (J.M.-P.)
| | - Jesús Delgado-Ojeda
- Medical Department, Laboratorios Ordesa S.L., 08830 Sant Boi de Llobregat, Spain
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Deng F, Han X, Ji Y, Jin Y, Shao Y, Zhang J, Ning C. Distinct mechanisms of iron and zinc metal ions on osteo-immunomodulation of silicocarnotite bioceramics. Mater Today Bio 2024; 26:101086. [PMID: 38765245 PMCID: PMC11098954 DOI: 10.1016/j.mtbio.2024.101086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 04/14/2024] [Accepted: 05/04/2024] [Indexed: 05/21/2024] Open
Abstract
The immunomodulatory of implants have drawn more and more attention these years. However, the immunomodulatory of different elements on the same biomaterials have been rarely investigated. In this work, two widely used biosafety elements, iron and zinc added silicocarnotite (Ca5(PO4)2SiO4, CPS) were applied to explore the routine of elements on immune response. The immune reactions over time of Fe-CPS and Zn-CPS were explored at genetic level and protein level, and the effects of their immune microenvironment with different time points on osteogenesis were also investigated in depth. The results confirmed that both Fe-CPS and Zn-CPS had favorable ability to secret anti-inflammatory cytokines. The immune microenvironment of Fe-CPS and Zn-CPS also could accelerate osteogenesis and osteogenic differentiation in vitro and in vivo. In terms of mechanism, RNA-seq analysis and Western-blot experiment revealed that PI3K-Akt signaling pathway and JAK-STAT signaling pathways were activated of Fe-CPS to promote macrophage polarization from M1 to M2, and its immune microenvironment induced osteogenic differentiation through the activation of Hippo signaling pathway. In comparison, Zn-CPS inhibited polarization of M1 macrophage via the up-regulation of Rap1 signaling pathway and complement and coagulation cascade pathway, while its osteogenic differentiation related pathway of immune environment was NF-κB signaling pathway.
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Affiliation(s)
- Fanyan Deng
- The Education Ministry Key Lab of Resource Chemistry and Shanghai Frontiers Science Center of Biomimetic Catalysis and Shanghai Engineering Research Center of Green Energy Chemical Engineering, Shanghai Normal University, Shanghai, China
| | - Xianzhuo Han
- Department of Stomatology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, No.100 Haining Road, Shanghai 200080, PR China
| | - Yingqi Ji
- State Key Laboratory of High Performance Ceramics and Superfine Microstructure, Institute of Ceramics, Chinese Academy of Sciences, Shanghai, 200050, China
| | - Ying Jin
- The Education Ministry Key Lab of Resource Chemistry and Shanghai Frontiers Science Center of Biomimetic Catalysis and Shanghai Engineering Research Center of Green Energy Chemical Engineering, Shanghai Normal University, Shanghai, China
| | - Yiran Shao
- SHNU-YAPENG Joint Lab of Tissue Repair Materials, Shanghai Yapeng Biological Technology Co., Ltd, Shanghai, China
| | - Jingju Zhang
- Tongji University, Shanghai Engineering Research Center of Tooth Restoration and Regeneration, Department of Orthodontics, School & Hospital of Stomatology, Shanghai, China
| | - Congqin Ning
- The Education Ministry Key Lab of Resource Chemistry and Shanghai Frontiers Science Center of Biomimetic Catalysis and Shanghai Engineering Research Center of Green Energy Chemical Engineering, Shanghai Normal University, Shanghai, China
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Proctor KB, Mansoura M, Rodrick E, Volkert V, Sharp WG, Kindler JM. The relationship between food selectivity and stature in pediatric patients with avoidant-restrictive food intake disorder - an electronic medical record review. J Eat Disord 2024; 12:64. [PMID: 38773584 PMCID: PMC11110304 DOI: 10.1186/s40337-024-01020-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 05/13/2024] [Indexed: 05/24/2024] Open
Abstract
BACKGROUND We aimed to characterize stature in pediatric patients with avoidant/restrictive food intake disorder (ARFID), including associations between body size and nutrient intake and height. METHODS We conducted a secondary analysis of pre-treatment data from 60 patients diagnosed with ARFID that were collected from the electronic medical record. Anthropometric measurements were converted to age- and sex-specific Z-scores using pediatric CDC growth charts. Spearman correlations were performed to test the relationship between height and weight/BMI Z-scores as well as height Z-score and diet variables. RESULTS On average, height (-0.35 ± 1.38), weight (-0.58 ± 1.56), and BMI (-0.56 ± 1.48) Z-scores tended to be lower than what would be expected in a generally healthy pediatric population. Percent of individuals with height, weight, or BMI Z-score < -2.0 was 8%, 20%, and 17%, respectively. BMI (P < 0.05) and weight (P < 0.05) were positively associated with height Z-score. Further, intake of some nutrients (e.g., calcium, vitamin D) correlated positively with height Z-score (all P < 0.05). CONCLUSIONS The cross-sectional relationships reported in this study suggest that in children with ARFID, body weight and consumption of bone-augmenting nutrients such as calcium and vitamin D correlated with height. A thorough understanding of the clinical manifestations of malnutrition and longitudinal effects of restrictive eating in patients with ARFID is critical.
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Affiliation(s)
- Kaitlin B Proctor
- Division of Autism & Related Disorders, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
- Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Maryam Mansoura
- Medical College of Georgia, Augusta University, University of Georgia Medical Partnership, Augusta, GA, USA
| | - Eugene Rodrick
- Department of Nutritional Sciences, University of Georgia, Athens, GA, USA
| | - Valerie Volkert
- Division of Autism & Related Disorders, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
- Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - William G Sharp
- Division of Autism & Related Disorders, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
- Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Joseph M Kindler
- Department of Nutritional Sciences, University of Georgia, Athens, GA, USA.
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Mehta R, Wenndt AJ. Mycotoxins and bone growth: a review of the literature on associations between xenobiotic exposure and bone growth and development. Nutr Rev 2024:nuae032. [PMID: 38578611 DOI: 10.1093/nutrit/nuae032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024] Open
Abstract
Mycotoxins are secondary metabolites of fungi that are known to be associated with linear growth faltering because of their impact on inflammation, intestinal damage, inhibition of protein synthesis, and micronutrient absorption. In this narrative review, we aim to extend this analysis to further explore associations between mycotoxins (aflatoxins, ochratoxins, trichothecenes including deoxynivalenol, T-2 toxin, and fumonisins) and long-bone growth, particularly during the saltatory periods of development. Linear growth is a direct function of skeletal development and long-bone growth. We therefore explored biological pathways and mechanisms of impact of these toxins in both animal and human studies, in addition to the epidemiology literature (post-2020). Given what is known of the effects of individual and combinations of mycotoxins based on the animal literature, we have identified a need for further research and examination of how these toxins and exposures may be studied in humans to elucidate the downstream impact on bone-related biomarkers and anthropometric indices used to identify and predict stunting in population-based studies.
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Affiliation(s)
- Rukshan Mehta
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Ontario, Canada
- Division of Nutritional Sciences, Cornell University, Ithaca, New York, USA
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Fatmah F, Utomo SW. Effectiveness of orange almond potato cookie vs. orange potato cookie supplementation on nutritional wellbeing of the Indonesian stunted preschool-aged children during COVID-19 pandemic. Front Nutr 2023; 10:1235841. [PMID: 37818338 PMCID: PMC10560736 DOI: 10.3389/fnut.2023.1235841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 09/08/2023] [Indexed: 10/12/2023] Open
Abstract
Background Preschool-aged children who experience stunting due to insufficient consumption of macro- and micronutrients exhibit weakened immune systems, rendering them susceptible to contracting COVID-19 during the ongoing epidemic. Therefore, it is imperative to implement interventions aimed at enhancing the nutritional status of preschool-aged children by providing them with nutrient-rich food supplements as a preventive measure against illness transmission. The objective of the study was to evaluate the impact of incorporating potato almond orange cookies into the diet on the nutritional status of preschool-aged children who are experiencing stunting. Methods A non-randomized pre-post intervention study was done on 42 individuals aged 12-58 months during 4 weeks. The intervention group was provided with almond potato cookies, while the control group was given orange potato cookies. During the study period, educational sessions on balanced nutrition in preschool-aged children with stunting and COVID-19 were provided to the mothers of both groups. The data analysis involved conducting univariate and bivariate analyses, namely utilizing the independent t-test. Results The intervention group exhibited the most significant enhancements in -for-Age Z-score. The mean -for-Age Z-score of the intervention group increased by 0.51 (from -3.15 to -2.64), whereas the control group saw a smaller gain of 0.25 (from -2.69 to -2.44). This increase was influenced by the mother's age; mother's education; father's occupation; family size; good sanitation facilities; healthy home environment; and fat, calcium, and zinc intake from the cookies (p < 0.05). From the perspective of knowledge about balanced nutrition and COVID-19, there was no significant difference in the -for-Age Z-score in the intervention group. Conclusion The ingestion of orange almond potato cookies has the potential to enhance the nutritional wellbeing of children in the preschool age group who are experiencing stunted growth.
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Affiliation(s)
- Fatmah Fatmah
- Disaster Management Program, School of Environmental Studies at Universitas Indonesia, Jakarta, Indonesia
| | - Suyud W. Utomo
- School of Environmental Studies at Universitas Indonesia, Jakarta, Indonesia
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Ernawati F, Efriwati, Nurjanah N, Aji GK, Hapsari Tjandrarini D, Widodo Y, Retiaty F, Prihatini M, Arifin AY, Sundari D, Rachmalina R, Salimar, Julianti ED, Aidi MN, Syauqy A. Micronutrients and Nutrition Status of School-Aged Children in Indonesia. J Nutr Metab 2023; 2023:4610038. [PMID: 37705875 PMCID: PMC10497362 DOI: 10.1155/2023/4610038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 07/21/2023] [Accepted: 08/26/2023] [Indexed: 09/15/2023] Open
Abstract
Micronutrient deficiencies (MNDs) in school-aged children are still a major health problem in Indonesia. This study was designed to examine the status of micronutrients and their relationship to the nutritional status of children aged 5-12 years since an up-to-date database on the micronutrient status of children aged 5-12 years is needed. Data from the 2018 Indonesian Basic Health Research (Riskesdas) were used in this study, with 2456 subjects for analysis. Micronutrient analysis was carried out, including iron status (ferritin, C reactive protein (CRP)), levels of zinc, vitamin D, calcium, and vitamin A (retinol) in school-aged children (5-12 years). The ELISA measurement was applied to measure CRP, ferritin, and vitamin D. Zinc levels were analysed with atomic absorbance spectroscopy (AAS). Moreover, high-performance liquid chromatography (HPLC) was applied to calculate vitamin A. In addition, stunting and thinness data were also obtained from the Riskesdas study. The results showed that the prevalence of stunting and thinness in school-aged children was 11.4% and 9.2%, respectively, showing that the stunting prevalence in the city was lower than in the village (4.5% vs. 6.9%, P = 0.000, respectively). In addition, the prevalence of MNDs in Indonesian children was 13.4%, 19.7%, 4.2%, 3%, and 12.7% for ferritin, zinc, calcium, vitamin A, and vitamin D, respectively. The mean serum level of vitamin A and zinc was significantly lower in stunted children compared to normal school children (P = 0.010 and P = 0.014). The serum concentration of vitamin D was significantly lower in overweight children compared to thin and normal children (P = 0.000). Serum values of ferritin, zinc, and vitamin A were significantly higher in overweight children compared to thin and normal children (P = 0.000). A poor correlation was observed between the z-score of height-for-age (HAZ) and the levels of zinc (r = 0.089, P = 0.000), vitamin A (r = 0.105, P = 0.000), and vitamin D (-0.073, P = 0.000). In addition, very weak correlations between z-scores of body mass index-for-age (BAZ) and the serum concentrations of ferritin (0.091, P = 0.000), zinc (r = 0.115, P = 0.000), vitamin A (r = 0.137, P = 0.000), and vitamin D (r = -0.112, P = 0.000) were also seen. In conclusion, school-aged children in Indonesia experienced stunting, thinness, and micronutrient deficiency. Furthermore, stunting and thinness were also related to micronutrient deficiencies.
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Affiliation(s)
- Fitrah Ernawati
- Research Center for Public Health and Nutrition, National Research and Innovation Agency, Cibinong Science Center, Jl. Raya Jakarta-Bogor No. KM 46, Pakansari, Kecamatan Cibinong, Kabupaten Bogor, Jawa Barat 16911, Indonesia
| | - Efriwati
- Research Center for Public Health and Nutrition, National Research and Innovation Agency, Cibinong Science Center, Jl. Raya Jakarta-Bogor No. KM 46, Pakansari, Kecamatan Cibinong, Kabupaten Bogor, Jawa Barat 16911, Indonesia
| | - Nunung Nurjanah
- Research Center for Public Health and Nutrition, National Research and Innovation Agency, Cibinong Science Center, Jl. Raya Jakarta-Bogor No. KM 46, Pakansari, Kecamatan Cibinong, Kabupaten Bogor, Jawa Barat 16911, Indonesia
| | - Galih Kusuma Aji
- Research Center for Agroindustry, National Research and Innovation Agency, BJ Habibie Science Center, Setu, Kota Tangerang Selatan, Banten 15314, Indonesia
| | - Dwi Hapsari Tjandrarini
- Research Center for Public Health and Nutrition, National Research and Innovation Agency, Cibinong Science Center, Jl. Raya Jakarta-Bogor No. KM 46, Pakansari, Kecamatan Cibinong, Kabupaten Bogor, Jawa Barat 16911, Indonesia
| | - Yekti Widodo
- Research Center for Public Health and Nutrition, National Research and Innovation Agency, Cibinong Science Center, Jl. Raya Jakarta-Bogor No. KM 46, Pakansari, Kecamatan Cibinong, Kabupaten Bogor, Jawa Barat 16911, Indonesia
| | - Fifi Retiaty
- Research Center for Public Health and Nutrition, National Research and Innovation Agency, Cibinong Science Center, Jl. Raya Jakarta-Bogor No. KM 46, Pakansari, Kecamatan Cibinong, Kabupaten Bogor, Jawa Barat 16911, Indonesia
| | - Mutiara Prihatini
- Health Policy Agency (BKPK), Ministry of Health, Jl. Percetakan Negara, Jakarta Pusat 10560, Indonesia
| | - Aya Yuriestia Arifin
- Research Center for Public Health and Nutrition, National Research and Innovation Agency, Cibinong Science Center, Jl. Raya Jakarta-Bogor No. KM 46, Pakansari, Kecamatan Cibinong, Kabupaten Bogor, Jawa Barat 16911, Indonesia
| | - Dian Sundari
- Research Center for Public Health and Nutrition, National Research and Innovation Agency, Cibinong Science Center, Jl. Raya Jakarta-Bogor No. KM 46, Pakansari, Kecamatan Cibinong, Kabupaten Bogor, Jawa Barat 16911, Indonesia
| | - Rika Rachmalina
- Research Center for Public Health and Nutrition, National Research and Innovation Agency, Cibinong Science Center, Jl. Raya Jakarta-Bogor No. KM 46, Pakansari, Kecamatan Cibinong, Kabupaten Bogor, Jawa Barat 16911, Indonesia
| | - Salimar
- Research Center for Public Health and Nutrition, National Research and Innovation Agency, Cibinong Science Center, Jl. Raya Jakarta-Bogor No. KM 46, Pakansari, Kecamatan Cibinong, Kabupaten Bogor, Jawa Barat 16911, Indonesia
| | - Elisa Diana Julianti
- Research Center for Public Health and Nutrition, National Research and Innovation Agency, Cibinong Science Center, Jl. Raya Jakarta-Bogor No. KM 46, Pakansari, Kecamatan Cibinong, Kabupaten Bogor, Jawa Barat 16911, Indonesia
| | - Muhammad Nur Aidi
- Department of Statistics, IPB University, Jalan Meranti Wing 22 Level 4, Babakan, Dramaga, Kabupaten Bogor, Jawa Barat 16680, Indonesia
| | - Ahmad Syauqy
- Department of Nutrition Science, Diponegoro University, Jl. Prof Sudarto, Tembalang, Kota Semarang 50275, Indonesia
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Issarapu P, Arumalla M, Elliott HR, Nongmaithem SS, Sankareswaran A, Betts M, Sajjadi S, Kessler NJ, Bayyana S, Mansuri SR, Derakhshan M, Krishnaveni GV, Shrestha S, Kumaran K, Di Gravio C, Sahariah SA, Sanderson E, Relton CL, Ward KA, Moore SE, Prentice AM, Lillycrop KA, Fall CHD, Silver MJ, Chandak GR. DNA methylation at the suppressor of cytokine signaling 3 (SOCS3) gene influences height in childhood. Nat Commun 2023; 14:5200. [PMID: 37626025 PMCID: PMC10457295 DOI: 10.1038/s41467-023-40607-0] [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: 01/14/2023] [Accepted: 08/01/2023] [Indexed: 08/27/2023] Open
Abstract
Human height is strongly influenced by genetics but the contribution of modifiable epigenetic factors is under-explored, particularly in low and middle-income countries (LMIC). We investigate links between blood DNA methylation and child height in four LMIC cohorts (n = 1927) and identify a robust association at three CpGs in the suppressor of cytokine signaling 3 (SOCS3) gene which replicates in a high-income country cohort (n = 879). SOCS3 methylation (SOCS3m)-height associations are independent of genetic effects. Mendelian randomization analysis confirms a causal effect of SOCS3m on height. In longitudinal analysis, SOCS3m explains a maximum 9.5% of height variance in mid-childhood while the variance explained by height polygenic risk score increases from birth to 21 years. Children's SOCS3m is associated with prenatal maternal folate and socio-economic status. In-vitro characterization confirms a regulatory effect of SOCS3m on gene expression. Our findings suggest epigenetic modifications may play an important role in driving child height in LMIC.
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Affiliation(s)
- Prachand Issarapu
- Genomic Research on Complex Diseases (GRC-Group), CSIR-Centre for Cellular and Molecular Biology, Hyderabad, Telangana, India
- MRC Unit The Gambia at The London School of Hygiene and Tropical Medicine (LSHTM), London, UK
| | - Manisha Arumalla
- Genomic Research on Complex Diseases (GRC-Group), CSIR-Centre for Cellular and Molecular Biology, Hyderabad, Telangana, India
| | - Hannah R Elliott
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Suraj S Nongmaithem
- Genomic Research on Complex Diseases (GRC-Group), CSIR-Centre for Cellular and Molecular Biology, Hyderabad, Telangana, India
| | - Alagu Sankareswaran
- Genomic Research on Complex Diseases (GRC-Group), CSIR-Centre for Cellular and Molecular Biology, Hyderabad, Telangana, India
- Academy of Scientific and Innovative Research, AcSIR, Ghaziabad, India
| | - Modupeh Betts
- MRC Unit The Gambia at The London School of Hygiene and Tropical Medicine (LSHTM), London, UK
| | - Sara Sajjadi
- Genomic Research on Complex Diseases (GRC-Group), CSIR-Centre for Cellular and Molecular Biology, Hyderabad, Telangana, India
- Academy of Scientific and Innovative Research, AcSIR, Ghaziabad, India
| | - Noah J Kessler
- Department of Genetics, University of Cambridge, Cambridge, UK
| | - Swati Bayyana
- Genomic Research on Complex Diseases (GRC-Group), CSIR-Centre for Cellular and Molecular Biology, Hyderabad, Telangana, India
- Academy of Scientific and Innovative Research, AcSIR, Ghaziabad, India
| | - Sohail R Mansuri
- Genomic Research on Complex Diseases (GRC-Group), CSIR-Centre for Cellular and Molecular Biology, Hyderabad, Telangana, India
- Academy of Scientific and Innovative Research, AcSIR, Ghaziabad, India
| | - Maria Derakhshan
- MRC Unit The Gambia at The London School of Hygiene and Tropical Medicine (LSHTM), London, UK
| | - G V Krishnaveni
- Epidemiology Research Unit, CSI Holdsworth Memorial Hospital, Mysore, Karnataka, India
| | - Smeeta Shrestha
- Genomic Research on Complex Diseases (GRC-Group), CSIR-Centre for Cellular and Molecular Biology, Hyderabad, Telangana, India
| | - Kalyanaraman Kumaran
- Epidemiology Research Unit, CSI Holdsworth Memorial Hospital, Mysore, Karnataka, India
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
| | - Chiara Di Gravio
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Eleanor Sanderson
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Caroline L Relton
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Kate A Ward
- MRC Unit The Gambia at The London School of Hygiene and Tropical Medicine (LSHTM), London, UK
- Department of Women & Children's Health, King's College London, London, UK
| | - Sophie E Moore
- MRC Unit The Gambia at The London School of Hygiene and Tropical Medicine (LSHTM), London, UK
- Department of Women & Children's Health, King's College London, London, UK
| | - Andrew M Prentice
- MRC Unit The Gambia at The London School of Hygiene and Tropical Medicine (LSHTM), London, UK
| | - Karen A Lillycrop
- School of Medicine, University of Southampton, Southampton, UK
- Biological Sciences, University of Southampton, Southampton, UK
| | - Caroline H D Fall
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
| | - Matt J Silver
- MRC Unit The Gambia at The London School of Hygiene and Tropical Medicine (LSHTM), London, UK.
| | - Giriraj R Chandak
- Genomic Research on Complex Diseases (GRC-Group), CSIR-Centre for Cellular and Molecular Biology, Hyderabad, Telangana, India.
- Academy of Scientific and Innovative Research, AcSIR, Ghaziabad, India.
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Morton CM, Pullabhotla H, Bevis L, Lobell DB. Soil micronutrients linked to human health in India. Sci Rep 2023; 13:13591. [PMID: 37604890 PMCID: PMC10442378 DOI: 10.1038/s41598-023-39084-8] [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: 05/12/2023] [Accepted: 07/20/2023] [Indexed: 08/23/2023] Open
Abstract
Trace soil minerals are a critical determinant of both crop productivity and the mineral concentration of crops, therefore potentially impacting the nutritional status of human populations relying on those crops. We link health data from nearly 0.3 million children and one million adult women across India with over 27 million soil tests drawn from a nationwide soil health program. We find that soil zinc availability is positively associated with children's linear height growth, and soil iron availability is positively associated with hemoglobin levels. The link between soil zinc and childhood stunting is particularly robust-a one standard deviation increase in satisfactory soil zinc tests is associated with approximately 11 fewer children stunted per 1000. We also find that this zinc-stunting relationship is strongest in wealthier households. Our results suggest that soil mineral availability impacts human nutritional status and health in at least some areas of India, and that agronomic fortification may be a beneficial intervention.
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Affiliation(s)
- Claire M Morton
- Mathematical and Computational Science Program, Stanford University, Stanford, USA.
| | | | - Leah Bevis
- Department of Agricultural, Environmental and Development Economics, Ohio State University, Columbus, USA
| | - David B Lobell
- Department of Earth System Science and Center on Food Security and the Environment, Stanford University, Stanford, USA
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9
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Khlevner J, Naranjo K, Hoyer C, Carullo AS, Kerr KW, Marriage B. Healthcare Burden Associated with Malnutrition Diagnoses in Hospitalized Children with Critical Illnesses. Nutrients 2023; 15:3011. [PMID: 37447337 DOI: 10.3390/nu15133011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 06/28/2023] [Accepted: 06/29/2023] [Indexed: 07/15/2023] Open
Abstract
Our primary study objectives were to (i) determine the proportion of children admitted to the Pediatric Intensive Care Unit (PICU) with malnutrition diagnoses, (ii) compare healthcare utilization by malnourished and non-malnourished PICU patients, and (iii) examine the impact of implementing malnutrition screening and coding practices at a major academic urban tertiary care medical center. Using patient records, we conducted a retrospective analysis of 4106 children admitted to the PICU for severe illnesses between 2011 and 2019. Patients were identified as malnourished if records showed an ICD-9 or ICD-10 code for malnutrition. We compared malnourished and non-malnourished patients by age, admitting diagnoses, number of comorbid conditions, and clinical outcomes (length of stay, hospital readmission). About 1 of every 5 PICU-admitted patients (783/4106) had a malnutrition diagnosis. Patients with malnutrition were younger (mean age 6.2 vs. 6.9 years, p < 0.01) and had more comorbid conditions (14.3 vs. 7.9, p < 0.01) than those without. Malnourished patients had longer hospital stays (26.1 vs. 10.0 days, p < 0.01) and higher 30-day readmission rates (10% vs. 7%, p = 0.03). Implementation of malnutrition screening and coding practices was associated with an increase in malnutrition diagnosis. In this study of children admitted to the PICU, malnourished patients had more comorbid diagnoses and used more healthcare resources (prolonged hospitalizations and higher 30-day readmission rates), leading to higher healthcare costs. Such findings underscore the need for policies, training, and programs emphasizing identification and treatment of malnutrition at hospitals caring for critically ill children.
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Affiliation(s)
- Julie Khlevner
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Columbia University Vagelos College of Physicians and Surgeons, New York, NY 10032, USA
| | - Kelly Naranjo
- Department of Biology, New York University, New York, NY 10032, USA
| | - Christine Hoyer
- New York Presbyterian Morgan Stanley Children's Hospital, New York, NY 10032, USA
| | - Angela S Carullo
- New York Presbyterian Morgan Stanley Children's Hospital, New York, NY 10032, USA
| | - Kirk W Kerr
- Abbott Laboratories, Columbus, OH 43023, USA
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10
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Bevis L, Kim K, Guerena D. Soil zinc deficiency and child stunting: Evidence from Nepal. JOURNAL OF HEALTH ECONOMICS 2023; 87:102691. [PMID: 36521402 DOI: 10.1016/j.jhealeco.2022.102691] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 09/27/2022] [Accepted: 09/30/2022] [Indexed: 06/17/2023]
Abstract
We examine the negative child health impacts of soil zinc (Zn) deficiency in Nepal. Soil Zn deficiency limits both crop yields and the Zn concentration in food crops, leading many to speculate that it underlies human Zn deficiency and child stunting, globally and particularly in South Asia. We find strong evidence that soil Zn deficiency does have a causal impact on child stunting in Nepal's Tarai region, the breadbasket of the country. Using causal bounds, we find that a 1 part per million increase in plant-available soil Zn - achievable with application of Zn-enriched fertilizer - decreases child stunting by between 1 and 7.5 percentage points. Multiple statistical sensitivity tests indicate that this relationship is unlikely to be manufactured by omitted, relevant variables.
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Affiliation(s)
- Leah Bevis
- Department of Agricultural, Environmental and Development Economics, Ohio State University, United States
| | | | - David Guerena
- The Alliance of Bioversity International and the International Center for Tropical Agriculture, United States
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11
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Fooken J, Vo LK. Are stunted child - overweight mother pairs a real defined entity or a statistical artifact? ECONOMICS AND HUMAN BIOLOGY 2022; 47:101199. [PMID: 36410087 DOI: 10.1016/j.ehb.2022.101199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 10/27/2022] [Accepted: 11/09/2022] [Indexed: 06/16/2023]
Abstract
In a methodological contribution, Dieffenbach & Stein (DS) (The Journal of Nutrition, 142(4), 771-773.) concluded that the double burden of malnutrition (DBM), represented by stunted child - overweight mother pairs (SCOM), is a statistical artifact, meaning that SCOM does not describe a unique phenomenon because the observed rates of SCOM across a number of countries were not strongly different from the product of observed rates of maternal overweight (OM) and child stunting (SC), which DS referred to as the expected rate of SCOM. However, a growing literature continues to use SCOM as an indicator of the DBM. This study shows that the analysis by DS is not sufficient to conclude that SCOM can be explained by the co-occurrence of OM and SC due to chance alone because the analysis by DS was conducted at the country level, but applied to SCOM, which is a household-level variable. Using Demographic and Health Surveys data from 202 country-year data sets, we do not confirm important implicit assumptions that are required for the claim by DS to be supported. We also outline that comparing the expected to the observed rate of SCOM is primarily informative when putting it in relation to factors that influence the supply and demand of food consumed by households. When considering these factors, we find further evidence that it is misleading to consider SCOM as a statistical artifact, as the difference between the observed and the expected rate of SCOM significantly differs by household wealth. Recognizing that SCOM is a distinct phenomenon is important for policymakers who develop double-duty strategies that address malnutrition, and for researchers who need useful indicators to study the determinants of malnutrition at the household level.
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Affiliation(s)
- Jonas Fooken
- Centre for the Business and Economics of Health, The University of Queensland, Level 5, Sir Llew Edwards Building (#14), Corner of Campbell Rd and University Drive, St Lucia, QLD 4072, Australia.
| | - Linh K Vo
- Australian Centre for Health Services Innovation, Queensland University of Technology, 60 Musk Avenue, Kelvin Grove, QLD 4059, Australia
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12
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Saavedra JM, Prentice AM. Nutrition in school-age children: a rationale for revisiting priorities. Nutr Rev 2022:6811793. [PMID: 36346900 DOI: 10.1093/nutrit/nuac089] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Middle childhood and early adolescence have received disproportionately low levels of scientific attention relative to other life stages, especially as related to nutrition and health. This is partly due to the justified emphasis on the first 1000 days of life, and the idea that early deficits and consequences may not be fully reversible. In addition, these stages of life may superficially appear less "eventful" than infancy or late adolescence. Finally, there has been historical ambiguity and inconsistency in terminology, depending on whether viewing "childhood" through physiologic, social, legal, or other lenses. Nevertheless, this age bracket, which encompasses most of the primary education and basic schooling years for most individuals, is marked by significant changes, inflection points, and sexually driven divergence in somatic and brain growth and development trajectories. These constitute transformative changes, and thus middle childhood and early adolescence represents a major and last opportunity to influence long-term health and productivity. This review highlights the specificities of growth and development in school age, with a focus on middle childhood and early adolescence (5 years-15 years of age, for the purposes of this review), the role of nutrition, the short- and long-term consequences of inadequate nutrition, and the current global status of nutrition in this age group. Adequate attention and emphasis on nutrition in the school-age years is critical: (a) for maintaining an adequate course of somatic and cognitive development, (b) for taking advantage of this last major opportunity to correct deficits of undernutrition and "catch-up" to normal life course development, and (c) for addressing the nutritional inadequacies and mitigating the longer-term consequences of overnutrition. This review summarizes and provides a rationale for prioritizing nutrition in school-age children, and for the need to revisit priorities and focus on this part of the life cycle to maximize individuals' potential and their contribution to society.
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Affiliation(s)
- Jose M Saavedra
- with the Division of Gastroenterology and Nutrition, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Andrew M Prentice
- is with the MRC Unit, The Gambia and MRC International Nutrition Group, London School of Hygiene & Tropical Medicine, London, UK
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13
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The Effects of Nutrition on Linear Growth. Nutrients 2022; 14:nu14091752. [PMID: 35565716 PMCID: PMC9100533 DOI: 10.3390/nu14091752] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 04/10/2022] [Accepted: 04/17/2022] [Indexed: 12/16/2022] Open
Abstract
Linear growth is a complex process and is considered one of the best indicators of children’s well-being and health. Genetics, epigenetics and environment (mainly stress and availability of nutrients) are the main regulators of growth. Nutrition exerts its effects on growth throughout the course of life with different, not completely understood mechanisms. Cells have a sophisticated sensing system, which allows growth processes to occur in the presence of an adequate nutrient availability. Most of the nutritional influence on growth is mediated by hormonal signals, in turn sensitive to nutritional cues. Both macro- and micro-nutrients are required for normal growth, as demonstrated by the impairment of growth occurring when their intake is insufficient. Clinical conditions characterized by abnormal nutritional status, including obesity and eating disorders, are associated with alterations of growth pattern, confirming the tight link between growth and nutrition. The precise molecular mechanisms connecting nutrition to linear growth are far from being fully understood and further studies are required. A better understanding of the interplay between nutrients and the endocrine system will allow one to develop more appropriate and effective nutritional interventions for optimizing child growth.
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Chouraqui JP. Dietary Approaches to Iron Deficiency Prevention in Childhood—A Critical Public Health Issue. Nutrients 2022; 14:nu14081604. [PMID: 35458166 PMCID: PMC9026685 DOI: 10.3390/nu14081604] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 04/03/2022] [Accepted: 04/08/2022] [Indexed: 12/15/2022] Open
Abstract
Iron is an essential nutrient, and individual iron status is determined by the regulation of iron absorption, which is driven by iron requirements. Iron deficiency (ID) disproportionately affects infants, children, and adolescents, particularly those who live in areas with unfavorable socioeconomic conditions. The main reason for this is that diet provides insufficient bioavailable iron to meet their needs. The consequences of ID include poor immune function and response to vaccination, and moderate ID anemia is associated with depressed neurodevelopment and impaired cognitive and academic performances. The persistently high prevalence of ID worldwide leads to the need for effective measures of ID prevention. The main strategies include the dietary diversification of foods with more bioavailable iron and/or the use of iron-fortified staple foods such as formula or cereals. However, this strategy may be limited due to its cost, especially in low-income countries where biofortification is a promising approach. Another option is iron supplementation. In terms of health policy, the choice between mass and targeted ID prevention depends on local conditions. In any case, this remains a critical public health issue in many countries that must be taken into consideration, especially in children under 5 years of age.
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Affiliation(s)
- Jean-Pierre Chouraqui
- Pediatric Nutrition and Gastroenterology Unit, Woman, Mother and Child Department, University Hospital of Lausanne, 1011 Lausanne, Switzerland
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15
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Soliman A, Alaaraj N, Hamed N, Alyafei F, Ahmed S, Shaat M, Itani M, Elalaily R, Soliman N. Review Nutritional interventions during adolescence and their possible effects. ACTA BIO-MEDICA : ATENEI PARMENSIS 2022; 93:e2022087. [PMID: 35315384 PMCID: PMC8972883 DOI: 10.23750/abm.v93i1.12789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 01/17/2022] [Indexed: 11/21/2022]
Abstract
Nutrition is one of the most important factors affecting pubertal development. Increasing demands for energy proteins and micronutrients are necessary to cope with the rapid linear pubertal growth and development, change in body composition, and increased physical activity. Adequate nutrition is a key permissive factor for the normal timing and tempo of pubertal development. Severe primary or secondary malnutrition also can adversely delay the onset and progression of puberty. The higher incidence of anorexia nervosa and bulimia in adolescents imposes a nutritional risk on pubertal development. Here we provide an overview of nutritional requirements (macronutrients and micronutrients) necessary to cope with these changes. In addition, we discuss possible nutritional interventions trials and their effects on several aspects of growth and development in undernourished and stunted adolescents, in low- and middle-income countries (LMIC), who require nutritional rehabilitation. This mini-review sums up some important findings in this important complex that links between nutrition, nutritional interventions, and pubertal development.
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Affiliation(s)
- Ashraf Soliman
- Department of Pediatrics, Hamad General Hospital, Doha, Qatar; Qatar
| | - Nada Alaaraj
- Department of Pediatrics, Hamad General Hospital, Doha, Qatar; Qatar
| | - Noor Hamed
- Department of Pediatrics, Hamad General Hospital, Doha, Qatar; Qatar
| | - Fawzia Alyafei
- Department of Pediatrics, Hamad General Hospital, Doha, Qatar; Qatar
| | - Shayma Ahmed
- Department of Pediatrics, Hamad General Hospital, Doha, Qatar; Qatar
| | - Mona Shaat
- Dietetics and Nutrition, Hamad General Hospital
| | - Maya Itani
- Dietetics and Nutrition, Hamad General Hospital
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16
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Fisch Shvalb N, Lazar L, Demol S, Mouler M, Rachmiel M, Hershkovitz E, Shamir R, Phillip M, Yackobovitch‐Gavan M. Effect of a nutritional supplementation on growth and body composition in short and lean preadolescent boys: A randomised, double-blind, placebo-controlled study. Acta Paediatr 2022; 111:141-150. [PMID: 34346091 DOI: 10.1111/apa.16054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 08/01/2021] [Accepted: 08/02/2021] [Indexed: 11/30/2022]
Abstract
AIM To evaluate the effect of nutritional supplementation on height, weight and body composition in short and lean male preadolescents. METHODS A randomised, double-blinded, placebo-controlled trial of nutritional supplementation of short and lean prepubertal 10-14.5-year-old boys. Primary outcomes included Δheight-SDS and Δweight-SDS. Secondary outcomes included changes in body composition and BMI-SDS. RESULTS Of 160 boys enrolled, 126 (80%) completed 6 months' intervention. Baseline age, height-SDS, weight-SDS, BMI-SDS, body composition and dietary intake were similar in the formula and placebo groups. 'Good' formula consumers (intake of ≥50% of the recommended dose, n = 30) gained significantly more in weight-SDS, BMI-SDS, fat-free-mass and muscle mass (p < 0.05) than did 'poor' consumers (n = 35) and the placebo group (n = 61). Only in the formula group, positive dose-response correlations were found between consumption of the formula and changes in the outcome parameters examined, including Δheight-SDS (r = 0.301, p = 0.015). Boys aged >11.4 years who were 'good' formula consumers maintained their Δheight-SDS, while Δheight-SDS declined in 'poor' consumers and the placebo group of the same age (p = 0.033). CONCLUSION Intervention with a multi-nutrient, protein-rich formula was effective in increasing weight-SDS, fat-free-mass, muscle mass and BMI-SDS in short and lean prepubertal male adolescents. Good consumption of the formula prevented Δheight-SDS decline in the older participants.
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Affiliation(s)
- Naama Fisch Shvalb
- National Center for Childhood Diabetes Schneider Children's Medical Center of Israel The Jesse Z and Sara Lea Shafer Institute for Endocrinology and Diabetes Petah Tikva Israel
| | - Liora Lazar
- National Center for Childhood Diabetes Schneider Children's Medical Center of Israel The Jesse Z and Sara Lea Shafer Institute for Endocrinology and Diabetes Petah Tikva Israel
- Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
| | - Sharon Demol
- National Center for Childhood Diabetes Schneider Children's Medical Center of Israel The Jesse Z and Sara Lea Shafer Institute for Endocrinology and Diabetes Petah Tikva Israel
| | - Marie Mouler
- National Center for Childhood Diabetes Schneider Children's Medical Center of Israel The Jesse Z and Sara Lea Shafer Institute for Endocrinology and Diabetes Petah Tikva Israel
| | - Marianna Rachmiel
- Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
- Pediatric Endocrinology Unit Shamir (Assaf Harofeh) Medical Center Zerifin Israel
| | - Eli Hershkovitz
- Pediatric Diabetes Unit Soroka Medical Center Beer‐Sheva affiliated with Faculty of Health Sciences Ben‐Gurion University of the Negev Beer‐Sheva Israel
| | - Raanan Shamir
- Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
- Schneider Children's Medical Center Institute for Gastroenterology, Nutrition and Liver Diseases Petach Tikva Israel
| | - Moshe Phillip
- National Center for Childhood Diabetes Schneider Children's Medical Center of Israel The Jesse Z and Sara Lea Shafer Institute for Endocrinology and Diabetes Petah Tikva Israel
- Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
| | - Michal Yackobovitch‐Gavan
- National Center for Childhood Diabetes Schneider Children's Medical Center of Israel The Jesse Z and Sara Lea Shafer Institute for Endocrinology and Diabetes Petah Tikva Israel
- Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
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17
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Chouraqui JP, Darmaun D, Salmon-Legagneur A, Shamir R. Protein intake pattern in non-breastfed infants and toddlers: A survey in a nationally representative sample of French children. Clin Nutr 2021; 41:269-278. [PMID: 34998033 DOI: 10.1016/j.clnu.2021.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 10/30/2021] [Accepted: 12/04/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND AND AIMS Protein intake plays a key role in infants and children's growth, but high protein intake may have adverse long-term effects. Data on actual intakes in various populations are scarce. The aims of this study were (i) to assess daily protein intake (DPI) in non-breastfed infants and children aged 0.5-35 months in comparison with the population reference intake (PRI) set by the European Food Safety Authority, and to examine (ii) the various sources of this intake and their consumption patterns, and (iii) time-related changes in DPI over the last 4 decades. METHODS Data from the Nutri-Bébé cross-sectional survey were used to assess DPI, DPI/kg BW and the protein-energy ratio (E%) by age group. The amounts and quality of each food consumed were recorded over three non-consecutive days and validated by two face-to-face interviews. RESULTS Overall, this study included 1035 children. Median DPI were consistently above the PRI, reaching 4 times PRI in the older toddlers (41.4 g/d; range 15.1-64.0). Regardless of age, more than 95% of children had a DPI/kg BW above the PRI. Protein intake remained below 14 E% until 6 months of age and increased thereafter from 10% to 75% in children older than one year. Overall, DPI gradually decreased from 1981 to 2013. Milk and dairy products were the main contributors to DPI up to 2 years, while the share of other animal sources became predominant later. Plant contribution remained below 25% of DPI. CONCLUSION Despite a gradual decrease over the last few decades, DPI have remained well above the PRI. As the predominant contributors to these intakes are animal sources, the potential long term health consequences of such high intake deserve consideration. CLINICAL TRIAL REGISTRY NUMBER NCT03327415 on ClinicalTrials.gov.
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Affiliation(s)
- Jean-Pierre Chouraqui
- Paediatric Nutrition and Gastroenterology, Division of Pediatrics, Woman, Mother and Child Department, Pediatric Nutrition and Gastroenterology Unit, University Hospital of Lausanne, Lausanne, Switzerland.
| | - Dominique Darmaun
- Nantes University, INRAE, IMAD, CRNH-Ouest, UMR 1280, (PhAN), & Nutrition Support Team, University Hospital, Nantes, France.
| | - Aurée Salmon-Legagneur
- CREDOC (Centre de Recherche pour L'Étude et L'Observation des Conditions de Vie), 75013 Paris, France.
| | - Raanan Shamir
- Institute of Gastroenterology, Nutrition and Liver Diseases, Schneider Children's Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Israel.
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Oral Nutritional Supplementation Improves Growth in Children at Malnutrition Risk and with Picky Eating Behaviors. Nutrients 2021; 13:nu13103590. [PMID: 34684591 PMCID: PMC8538528 DOI: 10.3390/nu13103590] [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: 09/13/2021] [Revised: 10/05/2021] [Accepted: 10/10/2021] [Indexed: 11/23/2022] Open
Abstract
The problem of poor nutrition with impaired growth persists in young children worldwide, including in India, where wasting occurs in 20% of urban children (<5 years). Exacerbating this problem, some children are described by their parent as a picky eater with behaviors such as eating limited food and unwillingness to try new foods. Timely intervention can help prevent nutritional decline and promote growth recovery; oral nutritional supplements (ONS) and dietary counseling (DC) are commonly used. The present study aimed to determine the effects of ONS along with DC on growth in comparison with the effects of DC only. Enrolled children (N = 321) were >24 to ≤48 months old, at malnutrition risk (weight-for-height percentile 3rd to 15th), and described as a picky eater by their parent. Enrollees were randomized to one of the three groups (N = 107 per group): ONS1 + DC; ONS2 + DC; and DC only. From day 1 to day 90, study findings showed significant increases in weight-for-height percentile for ONS1 + DC and for ONS2 + DC interventions, as compared to DC only (p = 0.0086 for both). There was no significant difference between the two ONS groups. Anthropometric measurements (weight and body mass index) also increased significantly over time for the two ONS groups (versus DC only, p < 0.05), while ONS1 + DC significantly improved mid-upper-arm circumference (p < 0.05 versus DC only), as well. ONS groups showed a trend toward greater height gain when compared to DC only group, but the differences were not significant within the study interval. For young Indian children with nutritional risk and picky eating behaviors, our findings showed that a 90-day nutritional intervention with either ONS1 or ONS2, along with DC, promoted catch-up growth more effectively than did DC alone.
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Zhang Z, Li F, Hannon BA, Hustead DS, Aw MM, Liu Z, Chuah KA, Low YL, Huynh DTT. Effect of Oral Nutritional Supplementation on Growth in Children with Undernutrition: A Systematic Review and Meta-Analysis. Nutrients 2021; 13:nu13093036. [PMID: 34578914 PMCID: PMC8468927 DOI: 10.3390/nu13093036] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 08/12/2021] [Accepted: 08/23/2021] [Indexed: 11/16/2022] Open
Abstract
Oral nutritional supplements (ONS) are used to promote catch-up growth in children with undernutrition. We conducted a systematic review and meta-analysis to summarize the evidence of ONS intervention effects on growth for 9-month- to 12-year-old children who were undernourished or at nutritional risk. Eleven randomized controlled trials met the inclusion criteria; trials compared changes in anthropometric measures in children using ONS or ONS + DC (dietary counselling) to measures for those following usual diet or placebo or DC alone. The RCTs included 2287 children without chronic diseases (mean age 5.87 years [SD, 1.35]; 56% boys). At follow-up time points up to 6 months, results showed that children in the ONS intervention group had greater gains in weight (0.423 kg, [95% confidence interval 0.234, 0.613], p < 0.001) and height (0.417 cm [0.059, 0.776], p = 0.022) versus control; greater gains in weight (0.089 kg [0.049, 0.130], p < 0.001) were evident as early as 7–10 days. Longitudinal analyses with repeated measures at 30, 60, and 90 days showed greater gains in weight parameters from 30 days onwards (p < 0.001), a trend towards greater height gains at 90 days (p = 0.056), and significantly greater gains in height-for-age percentiles and Z-scores at 30 and 90 days, respectively (p < 0.05). Similar results were found in subgroup analyses of studies comparing ONS + DC to DC alone. For children with undernutrition, particularly those who were mildly and moderately undernourished, usage of ONS in a nutritional intervention resulted in significantly better growth outcomes when compared to control treatments (usual diet, placebo or DC alone).
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Affiliation(s)
- Zhiying Zhang
- Abbott Nutrition Research and Development Asia-Pacific Center, 20 Biopolis Way, Unit 09-01/02 Centros Building, Singapore 138668, Singapore; (Z.Z.); (Z.L.); (K.A.C.)
| | - Fei Li
- Abbott Nutrition China Research and Development Center, Building 14, No. 1036 Tianlin Road, Shanghai 200233, China;
| | - Bridget A. Hannon
- Abbott Nutrition Research and Development, 3300 Stelzer Road, Columbus, OH 43219, USA; (B.A.H.); (D.S.H.); (Y.L.L.)
| | - Deborah S. Hustead
- Abbott Nutrition Research and Development, 3300 Stelzer Road, Columbus, OH 43219, USA; (B.A.H.); (D.S.H.); (Y.L.L.)
| | - Marion M. Aw
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119077, Singapore;
| | - Zhongyuan Liu
- Abbott Nutrition Research and Development Asia-Pacific Center, 20 Biopolis Way, Unit 09-01/02 Centros Building, Singapore 138668, Singapore; (Z.Z.); (Z.L.); (K.A.C.)
| | - Khun Aik Chuah
- Abbott Nutrition Research and Development Asia-Pacific Center, 20 Biopolis Way, Unit 09-01/02 Centros Building, Singapore 138668, Singapore; (Z.Z.); (Z.L.); (K.A.C.)
| | - Yen Ling Low
- Abbott Nutrition Research and Development, 3300 Stelzer Road, Columbus, OH 43219, USA; (B.A.H.); (D.S.H.); (Y.L.L.)
| | - Dieu T. T. Huynh
- Abbott Nutrition Research and Development Asia-Pacific Center, 20 Biopolis Way, Unit 09-01/02 Centros Building, Singapore 138668, Singapore; (Z.Z.); (Z.L.); (K.A.C.)
- Correspondence: ; Tel.: +65-8322-9798
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20
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Dor C, Stark AH, Dichtiar R, Keinan-Boker L, Shimony T, Sinai T. Milk and dairy consumption is positively associated with height in adolescents: results from the Israeli National Youth Health and Nutrition Survey. Eur J Nutr 2021; 61:429-438. [PMID: 34406484 DOI: 10.1007/s00394-021-02661-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 08/10/2021] [Indexed: 01/17/2023]
Abstract
PURPOSE Milk consumption is associated with increased height primarily in early childhood. However, in adolescents, data are scarce with inconsistent results. Since height is a proxy for overall health and well-being, this study evaluated the association of dairy intake with height in adolescents. METHODS Students in 7th-12th grades, participating in the 2015-2016 Israeli Health and Nutrition Youth Survey, a school-based cross-sectional study, completed self-administered questionnaires, including a semi-quantitative food frequency questionnaire (n = 3529, 48% males, 15.2 ± 1.6 years). Anthropometric measurements were also performed. Dairy servings were calculated as the calcium equivalent of 1 cup of milk, and consumption was divided into four categories from very low (< 1 serving/day) to high (3 + servings/day). BMI- and Height-for-age z scores (HAZs) were calculated according to WHO growth standard; relatively short stature (RSS) was defined as HAZ < - 0.7 SD (< 25th percentile). Multivariable linear and logistic regression analyses were performed to evaluate the association of dairy intake with HAZ and prevalence of RSS, respectively. RESULTS Median consumption of dairy products was 2 servings/day, 1.4 from unsweetened products (milk, cheese and yogurt). Controlling for age, sex, BMI-z-score and socioeconomic status, each increment of unsweetened dairy intake was associated with on average 0.04 higher HAZ (equivalent to 0.3-0.4 cm, p < 0.05), and with reduced risk for RSS: OR 0.90, 95%CI: 0.84, 0.97, p < 0.01. No such associations were found with sweetened dairy products. CONCLUSION Consumption of unsweetened dairy products (3-4 servings/day) appears to contribute to achieving growth potential in adolescents. Intervention studies are necessary to determine the causal relationship between dairy intake and linear growth.
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Affiliation(s)
- Chen Dor
- School of Nutritional Sciences, The Robert H. Smith Faculty of Agriculture, Food and Environment, The Hebrew University of Jerusalem, 7610001, Rehovot, Israel
| | - Aliza Hannah Stark
- School of Nutritional Sciences, The Robert H. Smith Faculty of Agriculture, Food and Environment, The Hebrew University of Jerusalem, 7610001, Rehovot, Israel
| | - Rita Dichtiar
- Israel Center for Disease Control, Israel Ministry of Health, 5262100, Ramat Gan, Israel
| | - Lital Keinan-Boker
- Israel Center for Disease Control, Israel Ministry of Health, 5262100, Ramat Gan, Israel
- School of Public Health, University of Haifa, 3498838, Haifa, Israel
| | - Tal Shimony
- Israel Center for Disease Control, Israel Ministry of Health, 5262100, Ramat Gan, Israel
| | - Tali Sinai
- School of Nutritional Sciences, The Robert H. Smith Faculty of Agriculture, Food and Environment, The Hebrew University of Jerusalem, 7610001, Rehovot, Israel.
- Israel Center for Disease Control, Israel Ministry of Health, 5262100, Ramat Gan, Israel.
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21
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Abbag FI, Abu-Eshy SA, Mahfouz AA, Alsaleem MA, Alsaleem SA, Patel AA, Mirdad TM, Shati AA, Awadalla NJ. Iodine Deficiency Disorders as a Predictor of Stunting among Primary School Children in the Aseer Region, Southwestern Saudi Arabia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:7644. [PMID: 34300095 PMCID: PMC8307288 DOI: 10.3390/ijerph18147644] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 07/15/2021] [Accepted: 07/16/2021] [Indexed: 12/17/2022]
Abstract
OBJECTIVES To investigate the present occurrence of stunting and explore the role of iodine deficiency disorders (IDDs) as a predictor of stunting among primary school children in the Aseer Region. METHODS In a cross-sectional investigation on school children in the Aseer region, thyroid enlargement was evaluated clinically. Urine was collected to evaluate iodine content. RESULTS The present study involved 3046 school-age pupils. The study disclosed a total goiter rate of 24.0% (95% CI: 22.5-25.5%). The median urinary iodine content (UIC) was 17.0 µg/L. A prevalence of stunting (height for age z score of less than -2) of 7.8% (95% CI: 6.9-8.8%) was found. In a logistic regression model, pupils having clinical goiter (aOR = 1.739; 95% CI: 1.222-2.475) and students having UIC of less than 17 µg/L (aOR = 1.934; 95% CI: 1.457-2.571) were considerably related with stunting. In the receiver operating characteristic (ROC) curve, urinary iodine content to forecast stunting was good (AUC = 0.611, 95% CI: 0.594-0.629). The curve recognized the optimum cutoff point of urinary iodine content to be ≤19.0 µg/L. The sensitivity was 59.66% (95% CI: 53.1-66.0) and the specificity was 57.62% (95% CI: 55.8-59.5). Conclusion: The present study showed that stunting among school-aged children presents a mild public health problem. On the other hand, a severe iodine deficiency situation was revealed among school children in the Aseer region. Continuous monitoring of iodine status among school children is therefore necessary. Concerted interventions that blend nutrition-sensitive with nutrition-specific approaches are expected to influence decreasing stunting significantly.
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Affiliation(s)
- Fuad I. Abbag
- Department of Child Health, College of Medicine, King Khalid University, Abha 61421, Saudi Arabia; (F.I.A.); (A.A.S.)
| | - Saeed A. Abu-Eshy
- Department of Surgery, College of Medicine, King Khalid University, Abha 61421, Saudi Arabia;
| | - Ahmed A. Mahfouz
- Department of Family and Community Medicine, College of Medicine, King Khalid University, Abha 61421, Saudi Arabia; (M.A.A.); (S.A.A.); (N.J.A.)
| | - Mohammed A. Alsaleem
- Department of Family and Community Medicine, College of Medicine, King Khalid University, Abha 61421, Saudi Arabia; (M.A.A.); (S.A.A.); (N.J.A.)
| | - Safar A. Alsaleem
- Department of Family and Community Medicine, College of Medicine, King Khalid University, Abha 61421, Saudi Arabia; (M.A.A.); (S.A.A.); (N.J.A.)
| | - Ayyub A. Patel
- Department of Clinical Biochemistry, College of Medicine, King Khalid University, Abha 61421, Saudi Arabia;
| | - Tarek M. Mirdad
- Department of Orthopedics, College of Medicine, King Khalid University, Abha 61421, Saudi Arabia;
| | - Ayed A. Shati
- Department of Child Health, College of Medicine, King Khalid University, Abha 61421, Saudi Arabia; (F.I.A.); (A.A.S.)
| | - Nabil J. Awadalla
- Department of Family and Community Medicine, College of Medicine, King Khalid University, Abha 61421, Saudi Arabia; (M.A.A.); (S.A.A.); (N.J.A.)
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Nutritional Adequacy and Diet Quality Are Associated with Standardized Height-for-Age among U.S. Children. Nutrients 2021; 13:nu13051689. [PMID: 34065650 PMCID: PMC8156872 DOI: 10.3390/nu13051689] [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: 04/16/2021] [Revised: 05/04/2021] [Accepted: 05/13/2021] [Indexed: 12/01/2022] Open
Abstract
Nutritional status affects linear growth and development. However, studies on the associations between nutritional status, diet quality, and age-standardized height in children are limited. The aim of this study was to assess the relationship between macro- and micronutrient intake and food consumption and height-for-age Z score (HAZ) among US children in the National Health and Nutrition Examination Survey (NHANES). This cross-sectional population-based study included 6116 US children aged 2–18 years. The usual dietary intake of nutrients and food groups was estimated by the multiple source method (MSM) using two-day food consumption data from NHANES 2007–2014. After adjusting for covariates, HAZ was positively associated with intakes of energy, protein, carbohydrate, fat, vitamins A, D, E, B6, and B12, thiamin, riboflavin, niacin, calcium, and iron. Children in the highest tertile of HAZ were less likely to consume lower than the EAR for vitamin E and calcium. Major foods consumed by children with lower HAZ were soft drinks, high-fat milk products, cakes, cookies, pastries, and pies, whereas children with higher HAZ tended to consume low-fat milk products, tea, and low-calorie fruit juice. These findings suggest that adequate nutritional intake, diet quality, and nutrient-dense food are important factors for height in children.
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Pesu H, Mutumba R, Mbabazi J, Olsen MF, Mølgaard C, Michaelsen KF, Ritz C, Filteau S, Briend A, Mupere E, Friis H, Grenov B. The Role of Milk Protein and Whey Permeate in Lipid-based Nutrient Supplements on the Growth and Development of Stunted Children in Uganda: A Randomized Trial Protocol (MAGNUS). Curr Dev Nutr 2021; 5:nzab067. [PMID: 34027295 PMCID: PMC8128719 DOI: 10.1093/cdn/nzab067] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 03/25/2021] [Accepted: 04/16/2021] [Indexed: 11/13/2022] Open
Abstract
Stunting is associated with cognitive impairment and later chronic disease. Previous trials to prevent stunting have had little effect, and no trials seem to have provided larger amounts of energy and high-quality proteins to already stunted children. We aimed to assess the effects of milk protein (MP) and whey permeate (WP) in large-quantity lipid-based nutrient supplements (LNS-LQ), among stunted children, on linear growth and child development. This was a randomized, double-blind, 2-by-2 factorial trial. Stunted children aged 12-59 mo from eastern Uganda (n = 750) were randomly assigned to receive 100 g LNS-LQ with or without MP and WP (n = 4 × 150) or no supplement (n = 150) for 3 mo. The primary outcomes were change in knee-heel and total length. Secondary outcomes included child development, body composition, anthropometry, and hemoglobin. Micronutrient status, intestinal function, and microbiota were also assessed. Our findings will contribute to an understanding of the role of milk ingredients and LNS in linear catch-up growth. This trial was registered at www.isrctn.com as ISRCTN13093195.
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Affiliation(s)
- Hannah Pesu
- Department of Nutrition, Exercise, and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Rolland Mutumba
- Department of Nutrition, Exercise, and Sports, University of Copenhagen, Copenhagen, Denmark
- Department of Paediatrics and Child Health, School of Medicine College of Health Sciences, Makerere University, Kampala, Uganda
| | - Joseph Mbabazi
- Department of Nutrition, Exercise, and Sports, University of Copenhagen, Copenhagen, Denmark
- Department of Paediatrics and Child Health, School of Medicine College of Health Sciences, Makerere University, Kampala, Uganda
| | - Mette F Olsen
- Department of Nutrition, Exercise, and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Christian Mølgaard
- Department of Nutrition, Exercise, and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Kim F Michaelsen
- Department of Nutrition, Exercise, and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Christian Ritz
- Department of Nutrition, Exercise, and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Suzanne Filteau
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - André Briend
- Department of Nutrition, Exercise, and Sports, University of Copenhagen, Copenhagen, Denmark
- Tampere Centre for Child Health Research, Tampere University, Tampere, Finland
| | - Ezekiel Mupere
- Department of Paediatrics and Child Health, School of Medicine College of Health Sciences, Makerere University, Kampala, Uganda
| | - Henrik Friis
- Department of Nutrition, Exercise, and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Benedikte Grenov
- Department of Nutrition, Exercise, and Sports, University of Copenhagen, Copenhagen, Denmark
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Ali M, Arif M, Shah AA. Complementary feeding practices and associated factors among children aged 6-23 months in Pakistan. PLoS One 2021; 16:e0247602. [PMID: 33630931 PMCID: PMC7906416 DOI: 10.1371/journal.pone.0247602] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 02/10/2021] [Indexed: 12/03/2022] Open
Abstract
Premature mortality and undernutrition rates in Pakistan are among the highest in the world. Inadequate infant and young child feeding are the major causes of premature mortality and undernutrition. Yet, very little is known about the determinants of complementary feeding practices in Pakistan. Therefore, this study aims to identify the determinants of inadequate complementary feeding practices among children aged 6 to 23 months in Pakistan by using the latest nationally representative data from the Pakistan Demographic and Health Survey (2017–18). The results show that only 12% of children consume a minimum acceptable diet, 21% achieve minimum dietary diversity, and 38% reach minimum meal frequency. Multivariate regression analysis shows that child age, child weight at birth, mother’s access to newspapers/magazines at the individual level, wealth at the household level, and prenatal visits at the community level are significant predictors of complementary feeding practices among children aged 6–23 months in Pakistan. These findings show that, in addition to poverty alleviation, raising awareness through health practitioners, increasing access to media, and expanding access to child and maternal healthcare can improve complementary feeding practices in Pakistan. This consequently reduces premature mortality and undernutrition.
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Affiliation(s)
- Muhammad Ali
- Department of Economics, School of Social Sciences and Humanities, National University of Sciences and Technology, Islamabad, Pakistan
| | - Muhammad Arif
- Department of Mass Communication, School of Social Sciences and Humanities, National University of Sciences and Technology, Islamabad, Pakistan
| | - Ashfaq Ahmad Shah
- School of Management Science and Engineering, Nanjing University of Information Science and Technology (NUIST), Nanjing Jiangsu Province, P. R. China
- * E-mail:
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Shorey S, Ng ED, Law EC, Wong JCM, Loke KY, Tam WWS. Physical activity interventions and nutrition-based interventions for children and adolescents with type 1 diabetes mellitus. Hippokratia 2021. [DOI: 10.1002/14651858.cd013858] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Affiliation(s)
- Shefaly Shorey
- Alice Lee Center for Nursing Studies, Yong Loo Lin School of Medicine; National University of Singapore, National University Health System; Singapore Singapore
| | - Esperanza Debby Ng
- Alice Lee Center for Nursing Studies, Yong Loo Lin School of Medicine; National University of Singapore, National University Health System; Singapore Singapore
| | - Evelyn C Law
- Paediatrics, Yong Loo Lin School of Medicine; National University of Singapore, National University Health System; Singapore Singapore
- Translational Neuroscience Programme; Agency for Science, Technology and Research Singapore Institute for Clinical Sciences; Singapore Singapore
| | - John CM Wong
- Department of Psychological Medicine; Yong Loo Lin School of Medicine, National University of Singapore; Singapore Singapore
| | - Kah Yin Loke
- Paediatrics, Yong Loo Lin School of Medicine; National University of Singapore, National University Health System; Singapore Singapore
| | - Wilson Wai San Tam
- Alice Lee Center for Nursing Studies, Yong Loo Lin School of Medicine; National University of Singapore, National University Health System; Singapore Singapore
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Rozga M, Handu D. Current Systems-Level Evidence on Nutrition Interventions to Prevent and Treat Cardiometabolic Risk in the Pediatric Population: An Evidence Analysis Center Scoping Review. J Acad Nutr Diet 2021; 121:2501-2523. [PMID: 33495106 DOI: 10.1016/j.jand.2020.12.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 12/07/2020] [Accepted: 12/15/2020] [Indexed: 10/22/2022]
Abstract
Improving and maintaining cardiometabolic health remains a major focus of health efforts for the pediatric population. Recent research contributes understanding of the systems-level nutrition factors influencing cardiometabolic health in pediatric individuals. This scoping review examines current evidence on interventions and exposures influencing pediatric cardiometabolic health to inform registered dietitian nutritionists working at each systems level, ranging from individual counseling to public policy. A literature search of MEDLINE, CINAHL, Cochrane Databases of Systematic Reviews, and other databases was conducted to identify evidence-based practice guidelines, systematic reviews, and position statements published in English from January 2017 until April 2020. Included studies addressed nutrition interventions or longitudinal exposures for participants 2 to 17 years of age who were healthy or had cardiometabolic risk factors. Studies were categorized according level of the social-ecological framework addressed. The databases and hand searches identified 2614 individual articles, and 169 articles were included in this scoping review, including 6 evidence-based practice guidelines, 141 systematic reviews, and 22 organization position statements. The highest density of systematic reviews focused on the effects of dietary intake (n = 58) and interventions with an individual child or family through counseling or education (n = 54). The least frequently examined levels of interventions or exposures were at the policy level (n = 12). Registered dietitian nutritionists can leverage this considerable body of recent systematic reviews to inform a systems-level, collaborative approach to prevention and treatment of pediatric cardiometabolic risk factors.
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Kangas ST, Salpéteur C, Nikièma V, Talley L, Briend A, Ritz C, Friis H, Kaestel P. Vitamin A and iron status of children before and after treatment of uncomplicated severe acute malnutrition. Clin Nutr 2020; 39:3512-3519. [DOI: 10.1016/j.clnu.2020.03.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 02/28/2020] [Accepted: 03/10/2020] [Indexed: 02/04/2023]
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Harrison E, Syed S, Ehsan L, Iqbal NT, Sadiq K, Umrani F, Ahmed S, Rahman N, Jakhro S, Ma JZ, Hughes M, Ali SA. Machine learning model demonstrates stunting at birth and systemic inflammatory biomarkers as predictors of subsequent infant growth - a four-year prospective study. BMC Pediatr 2020; 20:498. [PMID: 33126871 PMCID: PMC7597024 DOI: 10.1186/s12887-020-02392-3] [Citation(s) in RCA: 2] [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: 06/23/2020] [Accepted: 10/15/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Stunting affects up to one-third of the children in low-to-middle income countries (LMICs) and has been correlated with decline in cognitive capacity and vaccine immunogenicity. Early identification of infants at risk is critical for early intervention and prevention of morbidity. The aim of this study was to investigate patterns of growth in infants up through 48 months of age to assess whether the growth of infants with stunting eventually improved as well as the potential predictors of growth. METHODS Height-for-age z-scores (HAZ) of children from Matiari (rural site, Pakistan) at birth, 18 months, and 48 months were obtained. Results of serum-based biomarkers collected at 6 and 9 months were recorded. A descriptive analysis of the population was followed by assessment of growth predictors via traditional machine learning random forest models. RESULTS Of the 107 children who were followed up till 48 months of age, 51% were stunted (HAZ < - 2) at birth which increased to 54% by 48 months of age. Stunting status for the majority of children at 48 months was found to be the same as at 18 months. Most children with large gains started off stunted or severely stunted, while all of those with notably large losses were not stunted at birth. Random forest models identified HAZ at birth as the most important feature in predicting HAZ at 18 months. Of the biomarkers, AGP (Alpha- 1-acid Glycoprotein), CRP (C-Reactive Protein), and IL1 (interleukin-1) were identified as strong subsequent growth predictors across both the classification and regressor models. CONCLUSION We demonstrated that children most children with stunting at birth remained stunted at 48 months of age. Value was added for predicting growth outcomes with the use of traditional machine learning random forest models. HAZ at birth was found to be a strong predictor of subsequent growth in infants up through 48 months of age. Biomarkers of systemic inflammation, AGP, CRP, IL1, were also strong predictors of growth outcomes. These findings provide support for continued focus on interventions prenatally, at birth, and early infancy in children at risk for stunting who live in resource-constrained regions of the world.
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Affiliation(s)
- Elizabeth Harrison
- School of Medicine, University of Virginia, Charlottesville, VA, USA.,Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Sana Syed
- School of Medicine, University of Virginia, Charlottesville, VA, USA. .,Department of Paediatrics and Child Health, Aga Khan University, Stadium Road, P. O. Box 3500, Karachi, 74800, Pakistan.
| | - Lubaina Ehsan
- School of Medicine, University of Virginia, Charlottesville, VA, USA
| | - Najeeha T Iqbal
- Department of Paediatrics and Child Health, Aga Khan University, Stadium Road, P. O. Box 3500, Karachi, 74800, Pakistan
| | - Kamran Sadiq
- Department of Paediatrics and Child Health, Aga Khan University, Stadium Road, P. O. Box 3500, Karachi, 74800, Pakistan
| | - Fayyaz Umrani
- Department of Paediatrics and Child Health, Aga Khan University, Stadium Road, P. O. Box 3500, Karachi, 74800, Pakistan
| | - Sheraz Ahmed
- Department of Paediatrics and Child Health, Aga Khan University, Stadium Road, P. O. Box 3500, Karachi, 74800, Pakistan
| | - Najeeb Rahman
- Department of Paediatrics and Child Health, Aga Khan University, Stadium Road, P. O. Box 3500, Karachi, 74800, Pakistan
| | - Sadaf Jakhro
- Department of Paediatrics and Child Health, Aga Khan University, Stadium Road, P. O. Box 3500, Karachi, 74800, Pakistan
| | - Jennie Z Ma
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA, USA
| | - Molly Hughes
- Department of Medicine, University of Virginia, Charlottesville, VA, USA
| | - S Asad Ali
- Department of Paediatrics and Child Health, Aga Khan University, Stadium Road, P. O. Box 3500, Karachi, 74800, Pakistan.
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Association of age of initiation and type of complementary foods with body mass index and weight-for-length at 12 months of age in preterm infants. J Perinatol 2020; 40:1394-1404. [PMID: 32152493 DOI: 10.1038/s41372-020-0637-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 02/19/2020] [Accepted: 02/25/2020] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To assess whether in very preterm infants (1) body mass index (BMI) Z-score and weight-for-length (WtFL) Z-score at 1 year of age and (2) head growth from discharge to 1 year are associated with breastfeeding at discharge and the age of onset and type of complementary foods. STUDY DESIGN Observational cohort study. RESULTS Infants started on only ready-made complementary (RMC) feedings at ≤26 weeks adjusted age had the highest adjusted BMI Z-score and WtFL Z-score at 1 year of age. Adjusted change in fronto-occipital circumference was highest in infants either discharged on breastmilk or receiving home-made complementary food with/without RMC (HMM) at ≤26 weeks adjusted age. CONCLUSIONS Infants started on RMC ≤26 weeks adjusted age had the highest BMI Z-score and WtFL Z-score at 1 year. Head growth from discharge to 1 year was highest in infants either discharged on breastmilk or receiving HMM at ≤26 weeks adjusted age.
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Weingarten SE, Dearden KA, Crookston BT, Penny ME, Behrman JR, Humphries DL. Are Household Expenditures on Food Groups Associated with Children's Future Heights in Ethiopia, India, Peru, and Vietnam? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E4739. [PMID: 32630270 PMCID: PMC7370180 DOI: 10.3390/ijerph17134739] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 06/16/2020] [Accepted: 06/24/2020] [Indexed: 11/16/2022]
Abstract
Household expenditure surveys, routinely conducted in low-and middle-income countries (LMICs), usually include questions pertaining to recent household expenditures on key food groups. When child anthropometrics are also available, such expenditure data can provide insights into household food purchasing patterns that are associated with subsequent child growth measures. We used data from 6993 children, born around 2001, from Ethiopia, India, Peru, and Vietnam, from the Young Lives younger cohort. We compared associations between two weeks of household food expenditures (in PPP-Purchasing Power Parity adjusted dollars) on food groups and child height-for-age-Z score (HAZ) at subsequent time points to assess longitudinal associations. Total food expenditures, rural/urban residence, maternal and paternal schooling, and child sex were included in our adjusted models because they may affect the relations between household food group expenditures and future child HAZ. In Ethiopia, India, and Peru every extra PPP$ spent on fats was associated with 0.02-0.07 higher future HAZ. In Vietnam every extra PPP$ spent on starches, was significantly associated with a 0.01 lower future HAZ. Across countries, different patterns of food expenditure and procurement may be differentially critical for predicting child HAZ. Our results demonstrate how expenditures on specific food groups can be associated with children's linear growth. This study provides additional evidence of the utility of longitudinal household food expenditure data in understanding child nutritional status.
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Affiliation(s)
- Sarah E. Weingarten
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT 06510, USA;
| | | | | | - Mary E. Penny
- Instituto de Investigación Nutricional, La Molina 15024, Peru;
| | - Jere R. Behrman
- Departments of Economics and Sociology, University of Pennsylvania, Philadelphia, PA 19104, USA;
| | - Debbie L. Humphries
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT 06510, USA;
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Abstract
PURPOSE OF REVIEW Bone elongation is a complex process driven by multiple intrinsic (hormones, growth factors) and extrinsic (nutrition, environment) variables. Bones grow in length by endochondral ossification in cartilaginous growth plates at ends of developing long bones. This review provides an updated overview of the important factors that influence this process. RECENT FINDINGS Insulin-like growth factor-1 (IGF-1) is the major hormone required for growth and a drug for treating pediatric skeletal disorders. Temperature is an underrecognized environmental variable that also impacts linear growth. This paper reviews the current state of knowledge regarding the interaction of IGF-1 and environmental factors on bone elongation. Understanding how internal and external variables regulate bone lengthening is essential for developing and improving treatments for an array of bone elongation disorders. Future studies may benefit from understanding how these unique relationships could offer realistic new approaches for increasing bone length in different growth-limiting conditions.
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Affiliation(s)
- Holly L Racine
- Department of Natural Sciences and Mathematics, West Liberty University, West Liberty, WV, 26074, USA
| | - Maria A Serrat
- Department of Biomedical Sciences, Joan C. Edwards School of Medicine, Marshall University, 1 John Marshall Drive, Huntington, WV, 25755, USA.
- Department of Clinical and Translational Sciences, Joan C. Edwards School of Medicine, Marshall University, Huntington, WV, 25755, USA.
- Department of Orthopaedics, Joan C. Edwards School of Medicine, Marshall University, Huntington, WV, 25755, USA.
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Kearney S, Strang NC, Cagnolati B, Gray LS. Change in body height, axial length and refractive status over a four-year period in caucasian children and young adults. JOURNAL OF OPTOMETRY 2020; 13:128-136. [PMID: 31992535 PMCID: PMC7182783 DOI: 10.1016/j.optom.2019.12.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 11/12/2019] [Accepted: 12/22/2019] [Indexed: 06/10/2023]
Abstract
INTRODUCTION Body height and axial length (AL) increase during childhood with excessive axial elongation resulting in myopia. There is no consensus regarding the association between body growth and AL during refractive development. This study explored the association between change in body height, AL and refractive status over 4-years in children and young adults. MATERIAL AND METHODS Measures were collected biennially (timepoints: t1, t2, t3) (t1 n = 140, aged 5-20years). Non-cycloplegic autorefraction was obtained using the Shin-Nippon openfield autorefractor. AL, corneal curvature (CC) and anterior chamber depth (ACD) were measured by IOL Master. Body height (cm) was measured using a wall mounted tape measure. Refractive status was classified using spherical equivalent refraction (SER): persistent emmetropes (PE) (-0.50D to +1.00D), persistent myopes (PM) (≤-0.50D), progressing myopes (PrM) (increase of ≤-0.50D between timepoints), incident myopes (IM) (subsequent SER≤-0.50D) and persistent hyperopes (PH) (>+1.00D). RESULTS Change in AL and change in height were correlated in the PE (all t:p ≤ 0.003) and the IM (t1-t2 p = 0.04). For every increase in body height of 1 cm: t1-t2: AL increased by 0.03 mm in the PE, 0.15 in the PM, 0.11 mm in the IM, 0.14 mm in the PrM, -0.006 mm in the PH. T2-t3: AL increased by 0.02 mm in the PE, 0.06 in the PM, 0.16 mm in the PrM, 0.12 mm in the IM and -0.03 mm in the PH. CONCLUSIONS In emmetropia body growth and axial elongation are correlated. In participants with myopia, body growth appears to stabilise whilst axial elongation continues at a much faster rate indicating dysregulation of normal ocular growth.
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Affiliation(s)
- Stephanie Kearney
- Department of Vision Sciences, Glasgow Caledonian University, Glasgow, UK.
| | - Niall C Strang
- Department of Vision Sciences, Glasgow Caledonian University, Glasgow, UK
| | | | - Lyle S Gray
- Department of Vision Sciences, Glasgow Caledonian University, Glasgow, UK
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Iannotti LL, Chapnick M, Nicholas J, Gallegos‐Riofrio CA, Moreno P, Douglas K, Habif D, Cui Y, Stewart C, Lutter CK, Waters WF. Egg intervention effect on linear growth no longer present after two years. MATERNAL & CHILD NUTRITION 2020; 16:e12925. [PMID: 31849201 PMCID: PMC7083396 DOI: 10.1111/mcn.12925] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 10/10/2019] [Accepted: 11/14/2019] [Indexed: 02/01/2023]
Abstract
The Lulun Project, a randomized controlled trial conducted in 2015, found that one egg per day for 6 months during early complementary feeding reduced stunting by 47% and increased linear growth by 0.63 length-for-age Z (LAZ). This follow-up cohort study (Lulun Project II) aimed to test whether the growth effect remained in the egg intervention group compared with the control group after approximately 2 years. Mothers or caregivers from the Lulun Project were recontacted and recruited for this study. Enumerators collected data on socio-economic and demographic factors, 24-hr frequency of dietary intakes, morbidities, and anthropometric measures of height, weight, and head circumference using World Health Organization protocols. Statistical analyses followed the same analytical plan as Lulun Project, applying generalized linear models and regression modelling to test group differences in height-for-age z (HAZ) from LAZ at Lulun Project endline, and structural equation modelling for mediation. One hundred thirty-five mother-child dyads were included in Lulun II, with 11% losses to follow-up from endline Lulun Project. Growth faltering across all children was evident with HAZ -2.07 ± 0.91 and a stunting prevelance of 50%. Regression modelling showed no difference between egg and control groups for the HAZ outcome and other anthropometric outcomes, and significant declines in HAZ from endline Lulun Project in the egg intervention are compared with control groups. Current dietary egg intake, however, was associated with reduced growth faltering in HAZ from Lulun Project endline to Lulun Project II, independent of group assignment and through mediation, explaining 8.8% of the total effect. Findings suggest the need for a longer intervention period and ongoing nutrition support to young children during early childhood.
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Affiliation(s)
- Lora L. Iannotti
- Institute for Public Health, Brown SchoolWashington University in St. LouisSt. LouisMissouri
| | - Melissa Chapnick
- Institute for Public Health, Brown SchoolWashington University in St. LouisSt. LouisMissouri
| | - Jennifer Nicholas
- School of Medicine, Pediatric Radiology, Mallinckrodt Institute of RadiologyWashington University in St. LouisSt. LouisMissouri
| | - Carlos Andres Gallegos‐Riofrio
- Institute for Public Health, Brown SchoolWashington University in St. LouisSt. LouisMissouri
- Instituto de Investigación en Salud y Nutrición, Diego de Robles y Via InteroceánicaUniversidad San Francisco de QuitoQuitoEcuador
| | - Patricia Moreno
- Instituto de Investigación en Salud y Nutrición, Diego de Robles y Via InteroceánicaUniversidad San Francisco de QuitoQuitoEcuador
| | - Katherine Douglas
- School of Medicine, Pediatric Radiology, Mallinckrodt Institute of RadiologyWashington University in St. LouisSt. LouisMissouri
| | - David Habif
- Institute for Public Health, Brown SchoolWashington University in St. LouisSt. LouisMissouri
| | - Yuhan Cui
- Institute for Public Health, Brown SchoolWashington University in St. LouisSt. LouisMissouri
| | - Christine Stewart
- Department of NutritionUniversity of California DavisDavisCalifornia
| | - Chessa K. Lutter
- PAHO, Food Security and AgricultureRTI InternationalWashingtonDCUnited States
- School of Public HealthUniversity of MarylandCollege ParkMaryland
| | - William F. Waters
- Instituto de Investigación en Salud y Nutrición, Diego de Robles y Via InteroceánicaUniversidad San Francisco de QuitoQuitoEcuador
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Shapiro MJ, Downs SM, Swartz HJ, Parker M, Quelhas D, Kreis K, Kraemer K, West KP, Fanzo J. A Systematic Review Investigating the Relation Between Animal-Source Food Consumption and Stunting in Children Aged 6-60 Months in Low and Middle-Income Countries. Adv Nutr 2019; 10:827-847. [PMID: 31177279 PMCID: PMC6743850 DOI: 10.1093/advances/nmz018] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 01/15/2019] [Accepted: 01/29/2019] [Indexed: 11/12/2022] Open
Abstract
Animal-source foods (ASFs) are a food group of interest for interventions aimed at reducing stunting and other inadequate growth measures in early childhood. The aim of this systematic review was to examine the relation between ASF consumption and stunting in children aged 6-60 mo in low- and middle-income countries (LMICs). The secondary aim was to examine the relation between ASF consumption and other indicators of growth and development (length/height, weight, head circumference, and anemia). A search of the peer-reviewed and grey literature published from January 1980 to June 2017 was conducted. Databases searched included CINAHL, Embase, Global Index Medicus, PubMed, and Web of Science. There were 14,783 records and 116 full text articles dual screened; 21 studies were included in the review and were dual evaluated for risk of bias (RoB). The relation between ASF and stunting (length- or height-for-age z-score←2) was examined in randomized-controlled trials [(RCTs), n = 3] and cross-sectional studies (n = 4) only; ASF reduced stunting in 1 RCT and was associated with reduced stunting in 1 cross-sectional study. We did not identify any longitudinal cohorts that examined this relation. The relation between ASF and secondary indicators length/height, weight, head circumference, and anemia were largely nonsignificant across study designs. The intervention/exposure, comparator, outcome measures, methods, and analyses were highly heterogeneous. Although we did not find a consistent relation between ASF consumption and our primary and secondary outcomes, this may have been a function of inconsistencies in study design. Foods in the whole diet, particularly combination dishes, are inherently difficult to assess. To quantitatively assess the relation between ASF and stunting and other indicators of growth and iron status in early childhood, future research should provide consistency in the definition and quantification of the exposure and outcomes allowing for interstudy quantitative comparisons.
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Affiliation(s)
- Myra J Shapiro
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Shauna M Downs
- Berman Institute of Bioethics, Johns Hopkins University, Baltimore, MD
- School of Public Health, Rutgers University, Piscataway, NJ
| | - Haley J Swartz
- Berman Institute of Bioethics, Johns Hopkins University, Baltimore, MD
- National Consumers League, Washington DC
| | | | | | | | - Klaus Kraemer
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Sight and Life, Basel, Switzerland
| | - Keith P West
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Jessica Fanzo
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Berman Institute of Bioethics, Johns Hopkins University, Baltimore, MD
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Ferguson MC, O'Shea KJ, Hammer LD, Hertenstein DL, Schwartz NJ, Winch LE, Siegmund SS, Lee BY. The Impact of Following Solid Food Feeding Guides on BMI Among Infants: A Simulation Study. Am J Prev Med 2019; 57:355-364. [PMID: 31353163 PMCID: PMC6871772 DOI: 10.1016/j.amepre.2019.04.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Revised: 04/08/2019] [Accepted: 04/09/2019] [Indexed: 11/29/2022]
Abstract
INTRODUCTION There are several recommendations advising caregivers when and how to introduce solid food to infants. These complementary feeding guides vary in terms of the recommendations for timing and portions. The objective of this study is to determine the impact of following different guidelines on weight trajectories of infants. METHODS In 2018, the study team developed a computational simulation model to capture feeding behaviors, activity levels, metabolism, and body size of infants from 6 months to 1 year. Daily food intake of virtual infants based on feeding recommendations translated to changes in body weight. Next, simulations tested the impact of the following complementary feeding recommendations that provided amount, type, and timing of foods: Children's Hospital of Philadelphia, Johns Hopkins Medicine, Enfamil, and Similac. RESULTS When virtual caregivers fed infants according to the four different guides, none of the simulated situations resulted in normal weight at 12 months when infants were also being breastfed along average observed patterns. Reducing breast milk portions in half while caregivers fed infants according to complementary feeding guidelines resulted in overweight BMIs between 9 and 11 months for Children's Hospital of Philadelphia, Johns Hopkins Medicine, and Enfamil guidelines. Cutting breast milk portions in half also led to infants reaching unhealthy underweight BMI percentiles between 7 and 11 months for female and male infants when caregivers followed Children's Hospital of Philadelphia, Johns Hopkins Medicine, and Similac guidelines. CONCLUSIONS This study identified situations in which infants could reach unhealthy weights, even while following complementary feeding guidelines, suggesting that current recommended portion sizes should be tightened.
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Affiliation(s)
- Marie C Ferguson
- Global Obesity Prevention Center (GOPC) at Johns Hopkins, Baltimore, Maryland; Public Health Computational and Operations Research (PHICOR), Baltimore, Maryland
| | - Kelly J O'Shea
- Global Obesity Prevention Center (GOPC) at Johns Hopkins, Baltimore, Maryland; Public Health Computational and Operations Research (PHICOR), Baltimore, Maryland
| | | | - Daniel L Hertenstein
- Global Obesity Prevention Center (GOPC) at Johns Hopkins, Baltimore, Maryland; Public Health Computational and Operations Research (PHICOR), Baltimore, Maryland
| | - Nathaniel J Schwartz
- Global Obesity Prevention Center (GOPC) at Johns Hopkins, Baltimore, Maryland; Public Health Computational and Operations Research (PHICOR), Baltimore, Maryland
| | - Lucas E Winch
- Global Obesity Prevention Center (GOPC) at Johns Hopkins, Baltimore, Maryland; Public Health Computational and Operations Research (PHICOR), Baltimore, Maryland
| | - Sheryl S Siegmund
- Global Obesity Prevention Center (GOPC) at Johns Hopkins, Baltimore, Maryland; Public Health Computational and Operations Research (PHICOR), Baltimore, Maryland
| | - Bruce Y Lee
- Global Obesity Prevention Center (GOPC) at Johns Hopkins, Baltimore, Maryland; Public Health Computational and Operations Research (PHICOR), Baltimore, Maryland.
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Wuneh AG, Ahmed W, Bezabih AM, Reddy PS. Dietary Diversity and Meal Frequency Practices among Children Aged 6-23 Months in Agro Pastoral Communities in Afar Region, Ethiopia: A Cross-sectional Study. Ecol Food Nutr 2019; 58:575-596. [PMID: 31353951 DOI: 10.1080/03670244.2019.1644328] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Introduction: Inappropriate infant and young child feeding practices in the first two years of life are among the major causes of childhood malnutrition in developing countries, including Ethiopia. Dietary diversity refers to increasing the consumption of a variety of foods across and within the food groups. Therefore, this study aimed to assess the minimum dietary diversity and minimum meal frequency practices among children aged 6-23 months in Agro pastoral communities, Afar Region, Ethiopia.Methods: A community-based cross-sectional study was conducted from December 1-30, 2018. A multi-stage stratified sampling followed by a systematic random sampling technique was used to select participants. An interviewer-administered questionnaire was used to collect data. Bivariate and multivariable logistic regression analysis was employed to identify factors associated with minimum dietary diversity and meal frequency. The adjusted odds ratios (AOR) together with their corresponding 95% confidence intervals (CI) were computed to see the association between the outcome and independent variables. The statistical significance was declared at p-value <0.05.Results: The proportion of children who met the minimum dietary diversity and meal frequency were 21.8% (95% CI: 19.0%-24.7%) and 43.8% (95% CI: 40.4%-47.2%) respectively. Maternal education (AOR = 2.5, 95% CI = 1.1-5.3 and AOR = 3.9, 95% CI = 1.3-11.5), maternal occupation (AOR = 4.2, 95% CI = 2.3-7.8), sex of child (AOR = 2.6, 95% CI = 1.5-4.5) and history of postnatal care visit (AOR = 1.8, 95% CI = 1.1-3.2) were independently associated with minimum dietary diversity. Similarly, age of child (AOR = 2.8, 95% CI = 1.4-5.5 and AOR = 5.3, 95% CI = 2.3-12.4), sex of child (AOR = 2.6, 95% CI = 1.4-4.6) and history of postnatal care visit (AOR = 2.2, 95% CI = 1.3-3.8) were the factors significantly associated with minimum meal frequency practices.Conclusions: The current study showed that the proportions of children who met the minimum dietary diversity and meal frequency were low. Increasing maternal education, being a housewife, being a male child and attending a postnatal care visit were independently associated with minimum dietary diversity. Likewise, increasing the age of a child, being a male child and attending a postnatal care visit were significantly associated with minimum meal frequency. Improving maternal education and health care utilization, health and nutrition counseling during postnatal care visits are highly recommended to improve infant and young child feeding practices.Abbreviations ANC: Ante Natal Care, DHS: Demographic and Health Surveys, EDHS: Ethiopian Demographic and Health Surveys, RERC: Research and Ethical Review Committee, IYCF: Infant and Young Child Feeding, MDD: Minimum Dietary Diversity, MMF: Minimum Meal Frequency, PNC: Post Natal Care, WHO: World Health Organization.
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Affiliation(s)
- Abel Gebre Wuneh
- Department of Public Health, College of Medical and Health Sciences, Samara University, Semera, Ethiopia
| | - Woisa Ahmed
- Department of Public Health, WHO-Ethiopia: Afar Region Branch Office, Semera, Ethiopia
| | | | - P Surender Reddy
- Department of Public Health, College of Medical and Health Sciences, Samara University, Semera, Ethiopia
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Tumilowicz A, Beal T, Neufeld LM, Frongillo EA. Perspective: Challenges in Use of Adolescent Anthropometry for Understanding the Burden of Malnutrition. Adv Nutr 2019; 10:563-575. [PMID: 31046079 PMCID: PMC6628942 DOI: 10.1093/advances/nmy133] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Revised: 12/22/2018] [Accepted: 12/31/2018] [Indexed: 01/22/2023] Open
Abstract
Improving nutritional status during adolescence is an opportunity to improve the lives of this generation and the next. Estimating the burden of malnutrition at a population level is fundamental to targeting interventions and measuring progress over time, and for adolescents, we usually depend on survey data and the 2007 WHO Growth Reference to do so. There is substantial risk of misguided conclusions regarding adolescent prevalence estimates, however, when underlying methodological limitations of the indicators and reference are not adequately considered. We use national prevalence estimates among girls and young women 10-22 y of age from the 2014 State of Food Security and Nutrition in Bangladesh report as an example to demonstrate that determining the true prevalence of undernutrition, overweight, and obesity is complicated by racial/ethnic variation across populations in timing of the adolescent growth spurt, growth potential, and body build. Further challenging the task are inherent limitations of the body mass index as an indicator of thinness and adiposity, and cutoffs that poorly distinguish a well-nourished population from a malnourished one. We provide recommendations for adolescent nutrition policy and program decision-making, emphasizing the importance of 1) critically interpreting indicators and distributions by age when using the 2007 WHO Growth Reference; 2) examining what is happening before and after adolescence, when interpretation of anthropometry is more straightforward, as well as trends over time; and 3) complementing anthropometry with other information, particularly dietary intake. Finally, we advocate that nutrition researchers prioritize exploration of better methods to predict peak height velocity, for development of standardized indicators to measure dietary quality among adolescents, and for studies that will illuminate causal paths so that we can effectively improve adolescent dietary intake and nutritional status.
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Affiliation(s)
| | - Ty Beal
- Global Alliance for Improved Nutrition (GAIN), Geneva, Switzerland
- Department of Environmental Science and Policy, University of California, Davis, CA
| | | | - Edward A Frongillo
- Center for Research in Nutrition and Health Disparities, Arnold School of Public Health, University of South Carolina, Columbia, SC
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38
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Stein AD. Perspective: Growing Up or Growing Out: Growth Faltering in Early Childhood and Subsequent Risk of Overweight. Adv Nutr 2019; 10:557-562. [PMID: 31305909 PMCID: PMC6628840 DOI: 10.1093/advances/nmz030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 01/22/2019] [Accepted: 03/07/2019] [Indexed: 11/14/2022] Open
Affiliation(s)
- Aryeh D Stein
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA,Address correspondence to ADS (e-mail: )
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39
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Leroy JL, Frongillo EA. Perspective: What Does Stunting Really Mean? A Critical Review of the Evidence. Adv Nutr 2019; 10:196-204. [PMID: 30801614 PMCID: PMC6416038 DOI: 10.1093/advances/nmy101] [Citation(s) in RCA: 148] [Impact Index Per Article: 29.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 07/24/2018] [Accepted: 10/30/2018] [Indexed: 01/05/2023] Open
Abstract
The past decade has seen an unprecedented increase in attention to undernutrition, and drastically reducing child stunting has become a global development objective. The strong focus on linear growth retardation and stunting has enabled successful advocacy for nutrition, but with this focus has come some confusion and misunderstanding about the meaning of linear growth retardation and stunting among researchers, donors, and agencies active in nutrition. Motivated by the belief that a sharp focus will further accelerate progress in reducing undernutrition, we critically reviewed the evidence. The global attention to stunting is based on the premise that any intervention aimed at improving linear growth will subsequently lead to improvements in the correlates of linear growth retardation and stunting. Current evidence and understanding of mechanisms does not support this causal thinking, with 2 exceptions: linear growth retardation is a cause of difficult births and poor birth outcomes. Linear growth retardation is associated with (but does not cause) delayed child development, reduced earnings in adulthood, and chronic diseases. We thus propose distinguishing 2 distinctly different meanings of linear growth retardation and stunting. First, the association between linear growth retardation (or stunting) and other outcomes makes it a useful marker. Second, the causal links with difficult births and poor birth outcomes make linear growth retardation and stunting outcomes of intrinsic value. In many cases a focus on linear growth retardation and stunting is not necessary to improve the well-being of children; in many other cases, it is not sufficient to reach that goal; and for some outcomes, promoting linear growth is not the most cost-efficient strategy. We appeal to donors, program planners, and researchers to be specific in selecting nutrition outcomes and to target those outcomes directly.
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Affiliation(s)
- Jef L Leroy
- Poverty, Health, and Nutrition Division, International Food Policy Research Institute, Washington, DC
| | - Edward A Frongillo
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, SC
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40
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Abstract
PURPOSE OF REVIEW Despite targeted interventions, an estimated 150.8 million children under 5 years globally are still stunted, of which more than half live in Asia and more than one-third live in Africa. This review summarizes our current knowledge regarding how longitudinal bone growth is regulated by nutritional intake in the developing world. Dietary macronutrients and micronutrients necessary for growth are also briefly reviewed. RECENT FINDINGS Recent advances include investigations of nutritionally sensitive regulators of growth as well as prospective evaluations of the role of specific dietary components on growth in order to better assess their impact. SUMMARY Further investigation is required to understand how nutrition impacts growth, the mechanisms underlying stunting and to optimize therapeutic strategies for children who are at risk for growth attenuation or are stunted in low and middle-income countries (LMICs).
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Affiliation(s)
- Jasreena K Nijjar
- Division of Pediatric Endocrinology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Diane Stafford
- Division of Pediatric Endocrinology, Lucille Packard Children's Hospital and Stanford Medical School, Stanford, Palo Alto, California, USA
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41
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Sinai T, Goldberg MR, Nachshon L, Amitzur-Levy R, Yichie T, Katz Y, Monsonego-Ornan E, Elizur A. Reduced Final Height and Inadequate Nutritional Intake in Cow's Milk-Allergic Young Adults. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2018; 7:509-515. [PMID: 30529059 DOI: 10.1016/j.jaip.2018.11.038] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 11/22/2018] [Accepted: 11/26/2018] [Indexed: 01/10/2023]
Abstract
BACKGROUND Growth impairment was previously described in milk-allergic children but was not examined in adults on reaching final height. OBJECTIVES To investigate the dietary intake and final stature of young adults with IgE-mediated cow's milk allergy (IgE-CMA) as compared with nonallergic controls. METHODS Eighty-seven patients with IgE-CMA, median age 19.5 years (interquartile range [IQR], 17.3-22.7), and 36 control participants without food allergies, median age 22.7 years (IQR, 18.9-26.1), were studied. Anthropometric and nutritional data were collected. Age and gender z-scores were determined according to the Centers for Disease Control and Prevention growth charts. Nutrient intake assessment was based on dietary records. Individuals with conditions or treatments affecting bone metabolism or growth, other than asthma, were excluded. RESULTS Mean values of height z-scores were significantly reduced in CMA subjects compared with controls (-0.64 ± 0.9 vs -0.04 ± 0.7, P = .001). In contrast, no differences were found between the 2 groups in weight and body mass index z-scores. Patients with CMA had significantly lower intake of protein, and several essential vitamins (A, B12, and riboflavin) and minerals (calcium, potassium, phosphorus, magnesium, and zinc) compared with controls (P < .05), but the intakes of calories, carbohydrate, and fat were not significantly different between the 2 groups. Differences between actual and expected (based on midparental height) height z-scores were comparable in CMA subjects with or without asthma and between those with and without additional food allergies. CONCLUSIONS Young adults who have CMA from infancy are at risk of not reaching their growth potential. Growth and nutritional monitoring and appropriate dietary intervention are of particular importance in these at-risk individuals.
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Affiliation(s)
- Tali Sinai
- The School of Nutritional Sciences, The Hebrew University of Jerusalem, Rehovot, Israel
| | - Michael R Goldberg
- Institute of Allergy, Immunology, and Pediatric Pulmonology, Yitzhak Shamir Medical Center, Zerifin, Israel
| | - Liat Nachshon
- Institute of Allergy, Immunology, and Pediatric Pulmonology, Yitzhak Shamir Medical Center, Zerifin, Israel
| | - Roni Amitzur-Levy
- Institute of Allergy, Immunology, and Pediatric Pulmonology, Yitzhak Shamir Medical Center, Zerifin, Israel
| | - Tamar Yichie
- Institute of Allergy, Immunology, and Pediatric Pulmonology, Yitzhak Shamir Medical Center, Zerifin, Israel
| | - Yitzhak Katz
- Institute of Allergy, Immunology, and Pediatric Pulmonology, Yitzhak Shamir Medical Center, Zerifin, Israel
| | - Efrat Monsonego-Ornan
- The School of Nutritional Sciences, The Hebrew University of Jerusalem, Rehovot, Israel
| | - Arnon Elizur
- Institute of Allergy, Immunology, and Pediatric Pulmonology, Yitzhak Shamir Medical Center, Zerifin, Israel; Department of Pediatrics, Yitzhak Shamir Medical Center, Zerifin, Israel.
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Yamashita T, Iwase A, Sakai H, Terasaki H, Sakamoto T, Araie M. Differences of body height, axial length, and refractive error at different ages in Kumejima study. Graefes Arch Clin Exp Ophthalmol 2018; 257:371-378. [DOI: 10.1007/s00417-018-4192-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 11/10/2018] [Accepted: 11/15/2018] [Indexed: 10/27/2022] Open
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Tessema M, Gunaratna NS, Brouwer ID, Donato K, Cohen JL, McConnell M, Belachew T, Belayneh D, De Groote H. Associations among High-Quality Protein and Energy Intake, Serum Transthyretin, Serum Amino Acids and Linear Growth of Children in Ethiopia. Nutrients 2018; 10:E1776. [PMID: 30453477 PMCID: PMC6266228 DOI: 10.3390/nu10111776] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 11/05/2018] [Accepted: 11/09/2018] [Indexed: 12/17/2022] Open
Abstract
Limited evidence is available on the associations of high-quality protein and energy intake, serum transthyretin (TTR), serum amino acids and serum insulin-like growth factor-1 (IGF-1) with linear growth of young children. Data collected during the baseline of a randomized control trial involving rural Ethiopian children aged 6⁻35 months (n = 873) were analyzed to evaluate the associations among height/length-for-age z-scores, dietary intakes, and these biomarkers (i.e., serum level of TTR, IGF-1, tryptophan and lysine, and inflammation). The prevalence of stunting was higher for children >23 months (38%) than ≤23 months (25%). The prevalence of inflammation was 35% and of intestinal parasites 48%. Three-quarters of the children were energy deficient, and stunted children had lower daily energy intake that non-stunted children (p < 0.05). Intakes of tryptophan, protein, and energy, and serum levels of tryptophan and IGF-1 were positively correlated with the linear growth of children. Controlling for inflammation, intestinal parasites, and sociodemographic characteristics, daily tryptophan (b = 0.01, p = 0.001), protein (b = 0.01, p = 0.01) and energy (b = 0.0003, p = 0.04) intakes and serum TTR (b = 2.58, p = 0.04) and IGF-1 (b = 0.01, p = 0.003) were positively associated with linear growth of children. Linear growth failure in Ethiopian children is likely associated with low quality protein intake and inadequate energy intake. Nutrition programs that emphasize improved protein quantity and quality and energy intake may enhance the linear growth of young children and need to be further investigated in longitudinal and interventional studies.
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Affiliation(s)
- Masresha Tessema
- Division of Human Nutrition, Wageningen University, 6700 AA Wageningen, The Netherlands.
- Ethiopian Public Health Institute, Gulele Sub City, P.O. Box 1242, Addis Ababa, Ethiopia.
- Human Nutrition Unit, Jimma University, P.O. Box 378, Jimma, Ethiopia.
| | - Nilupa S Gunaratna
- Department of Nutrition Science and Public Health Graduate Program, Purdue University, West Lafayette, IN 47907, USA.
| | - Inge D Brouwer
- Division of Human Nutrition, Wageningen University, 6700 AA Wageningen, The Netherlands.
| | - Katherine Donato
- Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA.
| | - Jessica L Cohen
- Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA.
| | | | - Tefera Belachew
- Human Nutrition Unit, Jimma University, P.O. Box 378, Jimma, Ethiopia.
| | - Demissie Belayneh
- International Maize and Wheat Improvement Centre (CIMMYT), P.O. Box 5689, Addis Ababa, Ethiopia.
| | - Hugo De Groote
- International Maize and Wheat Improvement Centre (CIMMYT), P.O. Box 1041-00621, Nairobi, Kenya.
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Christian P, Smith ER. Adolescent Undernutrition: Global Burden, Physiology, and Nutritional Risks. ANNALS OF NUTRITION AND METABOLISM 2018; 72:316-328. [PMID: 29730657 DOI: 10.1159/000488865] [Citation(s) in RCA: 166] [Impact Index Per Article: 27.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 03/12/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND Adolescents, comprised of 10-19 year olds, form the largest generation of young people in our history. There are an estimated 1.8 billion adolescents in the world, with 90% residing in low- and middle-income countries. The burden of disease among adolescents has its origins in infectious and injury-related causes, but nutritional deficiencies, suboptimal linear growth, and undernutrition are major public health problems, even as overweight may be on the rise in many contexts. Summary and Key Messages: Girls are most vulnerable to the influences of cultural and gender norms, which often discriminate against them. Dietary patterns and physical activity, in addition to schooling and countervailing social norms for early marriage, influence health and nutritional well-being of adolescents. Nutrient requirements - -including those for energy, protein, iron, calcium, and -others - increase in adolescence to support adequate growth and development. In settings where dietary intakes are suboptimal, anemia and micronutrient deficiencies are high. Endocrine factors are essential for promoting normal adolescent growth and are sensitive to undernutrition. Growth velocity increases during puberty when peak height velocity occurs and catch-up is possible; in girls, about 15-25% of adult height is attained. A premature pregnancy can halt linear growth and increase the risk of adverse birth outcomes. Research is needed to fill the huge data gaps related to nutrition and growth during adolescence, in addition to testing interventions during this second window of opportunity to enhance growth and development, improve human capital, and to end the intergenerational cycle of growth failure.
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Affiliation(s)
- Parul Christian
- Bill and Melinda Gates Foundation, Seattle, Washington, USA.,Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Emily R Smith
- Bill and Melinda Gates Foundation, Seattle, Washington, USA.,Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, Massachusetts, USA
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Blumberg JB, Cena H, Barr SI, Biesalski HK, Dagach RU, Delaney B, Frei B, Moreno González MI, Hwalla N, Lategan-Potgieter R, McNulty H, van der Pols JC, Winichagoon P, Li D. The Use of Multivitamin/Multimineral Supplements: A Modified Delphi Consensus Panel Report. Clin Ther 2018; 40:640-657. [DOI: 10.1016/j.clinthera.2018.02.014] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Revised: 02/19/2018] [Accepted: 02/23/2018] [Indexed: 12/13/2022]
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46
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Larson LM, Martorell R, Bauer PJ. A Path Analysis of Nutrition, Stimulation, and Child Development Among Young Children in Bihar, India. Child Dev 2018. [PMID: 29529358 PMCID: PMC6174960 DOI: 10.1111/cdev.13057] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Nutrition plays an important role in the development of a child, particularly in low‐ and middle‐income countries where malnutrition is often widespread. The relation between diet, hemoglobin, nutritional status, motor development, stimulation and mental development was examined in a cross‐sectional sample of 1,079 children 12–18 months of age living in rural Bihar, India. Path analysis revealed associations between (a) length‐for‐age z‐scores and motor development, standardized β (β) = .285, p < .001, and (b) motor and all mental development outcomes (language: β = .422; personal‐social: β = .490; memory: β = .139; and executive function: β = .072, all p < .001). Additionally, stimulation was significantly associated with language scores and hemoglobin concentration with memory. These findings inform interventions aimed at improving child development in Northern India.
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Agapova SE, Stephenson KB, Divala O, Kaimila Y, Maleta KM, Thakwalakwa C, Ordiz MI, Trehan I, Manary MJ. Additional Common Bean in the Diet of Malawian Children Does Not Affect Linear Growth, but Reduces Intestinal Permeability. J Nutr 2018; 148:267-274. [PMID: 29490090 DOI: 10.1093/jn/nxx013] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 10/18/2017] [Indexed: 01/26/2023] Open
Abstract
Background Chronic malnutrition, as manifested by linear growth faltering, is pervasive among rural African children. Improvements in complementary feeding may decrease the burden of environmental enteric dysfunction (EED) and thus improve growth in children during the critical first 1000 d of development. Objective We tested the hypothesis that systematically including common bean or cowpea into complementary feeding would reduce EED and growth faltering among children in rural Malawi. Methods This was a double-blind clinical trial in which children 12-23 mo of age were randomly assigned to receive complementary feeding with 1 of 3 foods: roasted cowpea or common bean flour, or an isoenergetic amount of corn-soy blend as a control food for 48 wk. Children aged 12-23 mo received 155 kcal/d and thereafter until 35 mo received 200 kcal/d. The primary outcomes were change in length-for-age z score (LAZ) and improvements in a biomarker of EED, the percentage of lactulose (%L) excreted as part of the lactulose:mannitol dual-sugar absorption test. Anthropometric measurements and urinary %L excretion were compared between the 2 intervention groups and the control group separately with the use of linear mixed model analyses for repeated measures. Results A total of 331 children completed the clinical trial. Compliance with the study interventions was excellent, with >90% of the intervention flour consumed as intended. No significant effects on LAZ, change in LAZ, or weight-for-length z score were observed due to either intervention legume, compared to the control. %L was reduced with common bean consumption (effect estimate was -0.07 percentage points of lactulose, P = 0.0007). The lactulose:mannitol test was not affected by the legume intervention. Conclusion The addition of common bean to complementary feeding of rural Malawian children during the second year of life led to an improvement in a biomarker of gut health, although this did not directly translate into improved linear growth. This trial was registered at clinicaltrials.gov as NCT02472301.
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Affiliation(s)
| | | | - Oscar Divala
- School of Public Health and Family Medicine and Department of Paediatrics, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Yankho Kaimila
- School of Public Health and Family Medicine and Department of Paediatrics, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Kenneth M Maleta
- School of Public Health and Family Medicine and Department of Paediatrics, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Chrissie Thakwalakwa
- School of Public Health and Family Medicine and Department of Paediatrics, College of Medicine, University of Malawi, Blantyre, Malawi
| | - M Isabel Ordiz
- Department of Pediatrics, Washington University, St Louis, MO
| | - Indi Trehan
- Department of Pediatrics, Washington University, St Louis, MO.,Department of Paediatrics, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Mark J Manary
- Department of Pediatrics, Washington University, St Louis, MO.,School of Public Health and Family Medicine and Department of Paediatrics, College of Medicine, University of Malawi, Blantyre, Malawi.,Children's Nutrition Research Center, Baylor College of Medicine, Houston, TX
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48
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Reynolds SA, Andersen C, Behrman J, Singh A, Stein AD, Benny L, Crookston BT, Cueto S, Dearden K, Georgiadis A, Krutikova S, Fernald LC. Disparities in children's vocabulary and height in relation to household wealth and parental schooling: A longitudinal study in four low- and middle-income countries. SSM Popul Health 2017; 3:767-786. [PMID: 29302614 PMCID: PMC5742640 DOI: 10.1016/j.ssmph.2017.08.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 08/07/2017] [Accepted: 08/21/2017] [Indexed: 01/28/2023] Open
Abstract
Children from low socio-economic status (SES) households often demonstrate worse growth and developmental outcomes than wealthier children, in part because poor children face a broader range of risk factors. It is difficult to characterize the trajectories of SES disparities in low- and middle-income countries because longitudinal data are infrequently available. We analyze measures of children's linear growth (height) at ages 1, 5, 8 and 12y and receptive language (Peabody Picture Vocabulary Test) at ages 5, 8 and 12y in Ethiopia, India, Peru and Vietnam in relation to household SES, measured by parental schooling or household assets. We calculate children's percentile ranks within the distributions of height-for-age z-scores and of age- and language-standardized receptive vocabulary scores. We find that children in the top quartile of household SES are taller and have better language performance than children in the bottom quartile; differences in vocabulary scores between children with high and low SES are larger than differences in the height measure. For height, disparities in SES are present by age 1y and persist as children age. For vocabulary, SES disparities also emerge early in life, but patterns are not consistent across age; for example, SES disparities are constant over time in India, widen between 5 and 12y in Ethiopia, and narrow in this age range in Vietnam and Peru. Household characteristics (such as mother's height, age, and ethnicity), and community fixed effects explain most of the disparities in height and around half of the disparities in vocabulary. We also find evidence that SES disparities in height and language development may not be fixed over time, suggesting opportunities for policy and programs to address these gaps early in life.
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Affiliation(s)
- Sarah A. Reynolds
- School of Public Health, University of California, Berkeley, CA, USA
| | - Chris Andersen
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Jere Behrman
- School of Arts and Sciences, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Aryeh D. Stein
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Liza Benny
- Young Lives, Department of International Development, University of Oxford, UK
| | | | - Santiago Cueto
- Group for the Analysis of Development and Pontificia Universidad Católica del Perú, Lima, Peru
| | | | - Andreas Georgiadis
- Young Lives, Department of International Development, University of Oxford, UK
| | | | - Lia C.H. Fernald
- School of Public Health, University of California, Berkeley, CA, USA
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49
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Taylor RM, Fealy SM, Bisquera A, Smith R, Collins CE, Evans TJ, Hure AJ. Effects of Nutritional Interventions during Pregnancy on Infant and Child Cognitive Outcomes: A Systematic Review and Meta-Analysis. Nutrients 2017; 9:E1265. [PMID: 29156647 PMCID: PMC5707737 DOI: 10.3390/nu9111265] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Revised: 11/06/2017] [Accepted: 11/13/2017] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Epidemiological studies have demonstrated that folate, iodine and iron intake during pregnancy impacts on foetal brain development and cognitive function. However, in human studies, the relationship with other dietary nutrients is less clear. OBJECTIVE This systematic review aims to critically appraise the current literature and meta-analyses results from nutritional interventions during pregnancy that aimed to optimise infant and child cognitive outcomes. DESIGN Ten electronic databases were searched for articles published up to August 2017. The search was limited to articles published in English. Randomised controlled trials (RCTs) testing the impact of any nutritional intervention (dietary counselling, education, nutrient supplementation, fortified foods and/or foods) during pregnancy on cognitive outcomes of children (<10 years old). Two independent reviewers assessed study eligibility and quality using the American Dietetic Association quality criteria checklist for primary research. Standardised mean differences were used for nine cognitive domains to measure effects for meta-analyses. RESULTS A total of 34 RCTs were included (21 studies included children aged less than 35 months, 10 studies included children aged 36-60 months and 3 studies included children aged 61-119 months). The types of nutritional interventions included nutrient supplements, whole foods, fortified foods and nutrition education. The following nine cognition outcomes: attention, behaviour, crystallised intelligence, fluid intelligence, global cognition, memory, motor skills, visual processing, and problem solving were not significantly impacted by nutritional interventions, although 65% of studies conducted post-hoc data analyses and were likely to be underpowered. Although, long chain polyunsaturated fatty acids (LCPUFA) supplementation was associated with a marginal increase in crystallised intelligence (Effect size (ES): 0.25; 95% confidence interval (95% CI): -0.04, 0.53), the effect was not statistically significant (p = 0.09), with significant study heterogeneity (p = 0.00). CONCLUSIONS LCPUFA supplementation may be associated with an improvement in child crystallised intelligence, however further research is warranted. The remaining eight cognition domains were not significantly impacted by maternal nutritional interventions.
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Affiliation(s)
- Rachael M Taylor
- Priority Research Centre for Reproductive Science, University of Newcastle, Callaghan, NSW 2308, Australia.
- Faculty of Health and Medicine, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308, Australia.
- Hunter Medical Research Institute, 1 Kookaburra Circuit, New Lambton Heights, NSW 2305, Australia.
| | - Shanna M Fealy
- Faculty of Health and Medicine, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308, Australia.
- Faculty of Health and Medicine, School of Nursing & Midwifery, University of Newcastle, Callaghan, NSW 2308, Australia.
| | - Alessandra Bisquera
- Hunter Medical Research Institute, 1 Kookaburra Circuit, New Lambton Heights, NSW 2305, Australia.
- Clinical Research Design IT and Statistical Support (CReDITSS) Unit, Hunter Medical Research Institute, 1 Kookaburra Circuit, New Lambton Heights, NSW 2305, Australia.
| | - Roger Smith
- Priority Research Centre for Reproductive Science, University of Newcastle, Callaghan, NSW 2308, Australia.
- Faculty of Health and Medicine, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308, Australia.
- Hunter Medical Research Institute, 1 Kookaburra Circuit, New Lambton Heights, NSW 2305, Australia.
| | - Clare E Collins
- Hunter Medical Research Institute, 1 Kookaburra Circuit, New Lambton Heights, NSW 2305, Australia.
- Faculty of Health and Medicine, School of Health Sciences, University of Newcastle, Callaghan, NSW 2308, Australia.
- Priority Research Centre in Physical Activity and Nutrition, University of Newcastle, Callaghan, NSW 2308, Australia.
| | - Tiffany-Jane Evans
- Hunter Medical Research Institute, 1 Kookaburra Circuit, New Lambton Heights, NSW 2305, Australia.
- Clinical Research Design IT and Statistical Support (CReDITSS) Unit, Hunter Medical Research Institute, 1 Kookaburra Circuit, New Lambton Heights, NSW 2305, Australia.
| | - Alexis J Hure
- Faculty of Health and Medicine, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308, Australia.
- Hunter Medical Research Institute, 1 Kookaburra Circuit, New Lambton Heights, NSW 2305, Australia.
- Priority Research Centre for Gender, Health and Ageing, University of Newcastle, Callaghan, NSW 2308, Australia.
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