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Hackl LS, Karakochuk CD, Mazariegos DI, Jeremiah K, Obeid O, Ravi N, Ayana DA, Varela V, Alayón S, Dary O, Moorthy D. Assessing Accuracy and Precision of Hemoglobin Determination in Venous, Capillary Pool, and Single-Drop Capillary Blood Specimens Using three Different HemoCue® Hb Models: The Multicountry Hemoglobin Measurement (HEME) Study. J Nutr 2024:S0022-3166(24)00168-8. [PMID: 38580209 DOI: 10.1016/j.tjnut.2024.03.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 03/12/2024] [Accepted: 03/15/2024] [Indexed: 04/07/2024] Open
Abstract
BACKGROUND Anemia prevalence estimates reported in population surveys can vary based on the blood specimen source (capillary or venous) and analytic device (hematology autoanalyzers or portable hemoglobinometers) used for hemoglobin (Hb) determination. OBJECTIVES This study aimed to compare accuracy and precision of Hb measurement in three blood specimen types on three models of hemoglobinometers against the results from venous blood from the same individuals measured on automated analyzers (AAs). METHODS This multisite (Cambodia, Ethiopia, Guatemala, Lebanon, Nigeria, and Tanzania) study assessed Hb measurements in paired venous and capillary blood specimens from apparently healthy women (aged 15-49 y) and children (aged 12-59 mo) using three HemoCue® Hb models (201+, 301, and 801). Measurements were compared against reference values: venous blood in hematology AA and adjusted via regression calibration or mean difference in HemoCue® Hb. Venous, capillary pool, and single-drop capillary blood specimens were assessed for accuracy and precision. RESULTS Venous blood measured using HemoCue® Hb 301 exhibited a positive mean error, whereas responses in HemoCue® Hb 201+ and 801 were nondirectional compared with the reference. Adjustment with the reference harmonized mean errors for all devices across study sites to <1.0 g/L using venous blood. Precision was highest for venous blood (±5-16 g/L) in all sites, lowest for single-drop capillary (±9-37 g/L), and intermediate (±9-28 g/L) for capillary pool blood specimen. Imprecision differed across sites, especially with both capillary blood specimens, suggesting different levels of personnel skills. CONCLUSIONS Findings suggest that venous blood is needed for accurate and precise Hb determination. Single-drop capillary blood use should be discouraged owing to high measurement variability. Further research should evaluate the viability and reliability of capillary pool blood for this purpose. Accuracy of HemoCue® Hb devices can be improved via standardization against results from venous blood assessed using AA.
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Affiliation(s)
- Laura S Hackl
- USAID Advancing Nutrition, John Snow Inc., Arlington, VA, USA
| | - Crystal D Karakochuk
- Food, Nutrition and Health, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Dora Inés Mazariegos
- Department of Nutrition and Micronutrients, Institute of Nutrition of Central America and Panama, Calzada Roosevelt, Guatemala
| | - Kidola Jeremiah
- National Institute of Medical Research, Mwanza Research Centre, Mwanza, Tanzania
| | - Omar Obeid
- Department of Nutrition and Food Sciences, Faculty of Agricultural and Food Sciences, American University of Beirut, Riad El-Solh, Beirut, Lebanon
| | | | - Desalegn A Ayana
- School of Medical Laboratory Science, College of Health and Medical Sciences, Haramaya University, Dire Dawa, Ethiopia
| | - Veronica Varela
- USAID Advancing Nutrition, John Snow Inc., Arlington, VA, USA
| | - Silvia Alayón
- USAID Advancing Nutrition, Save the Children US, Arlington, VA, United States
| | - Omar Dary
- Bureau for Global Health, United States Agency for International Development, Washington, DC, United States
| | - Denish Moorthy
- USAID Advancing Nutrition, John Snow Inc., Arlington, VA, USA.
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Vosti S, Baker E, Moorthy D, Mazinga M, Dary O. Firm-Level and Public-Sector Costs Make Small-Scale Maize Flour Fortification Challenging in Uganda. Food Nutr Bull 2024; 45:12-23. [PMID: 38214039 DOI: 10.1177/03795721231223052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2024]
Abstract
BACKGROUND Maize flour in Uganda is milled by hundreds of enterprises, mostly small- (5-20 metric tons [MT]/day) and micro-scale (<5 MT/day) mills or firms. A mandatory maize flour fortification program exists for medium-scale mills (>20 MT/day) and policymakers are considering including smaller-scale millers. OBJECTIVE We estimated the private and public costs of maize flour fortification at different scales and explored their implications for extending the mandatory fortification to include smaller-scale mills. METHODS We used secondary data on the structure of the maize flour market and primary data on milling and fortification costs to estimate mill and regulatory costs at 3 scales of flour production: micro, small, and medium. RESULTS For micro-, small-, and medium-size operations, respectively, operational costs of fortification were US$13, US$9, and US$7 per metric ton (MT) of maize flour, which represented 20%, 16%, and 16% of annual operating costs, and the ratio of fortification equipment cost to mill equipment costs was higher for micro-scale mills (2.7) than for small- (0.38) and medium-scale (0.54) maize mills. Governmental regulatory costs rise if smaller-scale mills are included due to the increased number of facility inspections. CONCLUSIONS Fortification and regulatory costs increase as production scale decreases. Up-front capital costs of fortification would be daunting for micro- and small-scale mills. Medium-scale mills, which supply social protection programs, might be able to manage fortification costs and other challenges. Decision-makers should consider all costs and cost burdens, and the realities of enforcement capabilities before expanding fortification programs to include smaller-scale operations.
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Affiliation(s)
- Stephen Vosti
- Department of Agricultural and Resource Economics, University of California, Davis, Davis, CA, USA
- Institute for Global Nutrition, UC Davis, Davis, CA, USA
| | - Emily Baker
- Strengthening Partnerships, Results, and Innovations in Nutrition Globally project, Arlington, VA, USA
| | | | | | - Omar Dary
- Nutrition and Environmental Health Division, Bureau for Global Health, U.S. Agency for International Development, Washington, DC, USA
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Raiten DJ, Moorthy D, Hackl LS, Dary O. Exploring the Anemia Ecology: A New Approach to an Old Problem. J Nutr 2023; 153 Suppl 1:S1-S6. [PMID: 37778890 PMCID: PMC10797548 DOI: 10.1016/j.tjnut.2023.07.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 02/28/2023] [Accepted: 07/31/2023] [Indexed: 10/03/2023] Open
Abstract
Our ability to identify anemia and all its permutations demands an approach that integrates the key elements of a complex "ecology," which intertwines biology and mechanistic aspects of nutrients with both the health status and underlying factors-physical, economic, social, behavioral, demographic, and environmental. The complexity of anemia demands an ecologic approach that appreciates systems biology, translates sensitive and specific assessment methodologies and interventions, and ultimately improves clinical and public health outcomes. This series of technical papers on anemia by the U.S. Agency for International Development (USAID) Advancing Nutrition Anemia Task Force (ATF) is a first step in translating our ecologic approach to anemia with a view toward balancing research with its translation to effective programs, interventions, and policy. This introductory overview describes the components of our ecologic approach-linking the biology of anemia with its assessment and using the learning from that confluence to devise context-specific interventions. This introductory review briefly discusses the topics that underlie the biology and primary etiologies of anemia and presents a framework for public health assessment of anemia, leading to appropriate public health interventions. The other 3 manuscripts in the supplement provide the details of the arguments laid out in the introduction.
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Affiliation(s)
- Daniel J Raiten
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, United States
| | - Denish Moorthy
- USAID Advancing Nutrition, JSI Research and Training Institute, VA, United States.
| | - Laura S Hackl
- USAID Advancing Nutrition, JSI Research and Training Institute, VA, United States
| | - Omar Dary
- Division of Nutrition and Environmental Health, Office of Maternal and Child Health and Nutrition, Bureau for Global Health, United States Agency for International Development, Washington, DC, United States
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Williams AM, Brown KH, Allen LH, Dary O, Moorthy D, Suchdev PS. Improving Anemia Assessment in Clinical and Public Health Settings. J Nutr 2023; 153 Suppl 1:S29-S41. [PMID: 37778891 PMCID: PMC11002965 DOI: 10.1016/j.tjnut.2023.05.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 03/28/2023] [Accepted: 05/10/2023] [Indexed: 10/03/2023] Open
Abstract
We aim to provide a practical approach to assess anemia and its primary causes, both in clinical settings and in the context of public health programs. Anemia remains a global challenge; thus, to achieve goals for anemia reduction and assess progress, standardized approaches are required for the assessment of anemia and its causes. We first provide a brief review of how to assess anemia, based on hemoglobin concentrations and cutoffs that correspond to age, sex, and physiologic status. Next, we discuss how to assess the likely causes of anemia in different settings. The causes of anemia are classified as non-nutritional (for example, because of infection, inflammation, blood loss, or genetic disorders) or nutrition-specific (for example, because of deficiencies of iron, vitamin A, riboflavin, vitamin B12, or folate). There is an important overlap between these 2 categories, such as the increased likelihood of iron deficiency in the context of inflammation. Given the multifaceted nature of anemia etiology, we introduce a framework for anemia assessment based on the "ecology of anemia," which recognizes its many overlapping causes. This conceptual framework is meant to inform what data on anemia causes may need to be collected in population surveys. The framework has a supporting table with information on the diagnostic tests, biomarkers and proposed cutoffs, characteristics, and feasibility of collecting the myriad information that can help elucidate the anemia etiology. We also provide examples of how this framework can be applied to interpret the anemia risk factor data from population-based surveys that can inform decisions about context-specific interventions. Finally, we present research gaps and priorities related to anemia assessment.
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Affiliation(s)
- Anne M Williams
- Department of Human Nutrition, University of Otago, Dunedin, New Zealand; Nutrition Branch, Centers for Disease Control and Prevention, Atlanta, GA, United States; Emory University, Atlanta, GA, United States.
| | - Kenneth H Brown
- Department of Nutrition and Institute for Global Nutrition, University of California, Davis, CA, United States
| | - Lindsay H Allen
- United States Department of Agriculture, Agricultural Research Service Western Human Nutrition Research Center, Davis, CA, United States
| | - Omar Dary
- Division of Nutrition and Environmental Health, Office of Maternal and Child Health and Nutrition, Bureau for Global Health, United States Agency for International Development, Washington, DC, United States
| | | | - Parminder S Suchdev
- Nutrition Branch, Centers for Disease Control and Prevention, Atlanta, GA, United States; Emory University, Atlanta, GA, United States
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Loechl CU, Datta-Mitra A, Fenlason L, Green R, Hackl L, Itzkowitz L, Koso-Thomas M, Moorthy D, Owino VO, Pachón H, Stoffel N, Zimmerman MB, Raiten DJ. Approaches to Address the Anemia Challenge. J Nutr 2023; 153 Suppl 1:S42-S59. [PMID: 37714779 PMCID: PMC10797550 DOI: 10.1016/j.tjnut.2023.07.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 07/21/2023] [Accepted: 07/31/2023] [Indexed: 09/17/2023] Open
Abstract
Anemia is a multifactorial condition; approaches to address it must recognize that the causal factors represent an ecology consisting of internal (biology, genetics, and health) and external (social/behavioral/demographic and physical) environments. In this paper, we present an approach for selecting interventions, followed by a description of key issues related to the multiple available interventions for prevention and reduction of anemia. We address interventions for anemia using the following 2 main categories: 1) those that address nutrients alone, and, 2) those that address nonnutritional causes of anemia. The emphasis will be on interventions of public health relevance, but we also consider the clinical context. We also focus on interventions at different stages of the life course, with a particular focus on women of reproductive age and preschool-age children, and present evidence on various factors to consider when selecting an intervention-inflammation, genetic mutations, nutrient delivery, bioavailability, and safety. Each section on an intervention domain concludes with a brief discussion of key research areas.
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Affiliation(s)
- Cornelia U Loechl
- Division of Human Health, International Atomic Energy Agency, Vienna, Austria
| | - Ananya Datta-Mitra
- Department of Pathology and Laboratory Medicine, University of California, Davis, Davis, CA, United States
| | - Lindy Fenlason
- Bureau for Global Health, USAID, Washington, DC, United States
| | - Ralph Green
- Department of Pathology and Laboratory Medicine, University of California, Davis, Davis, CA, United States
| | - Laura Hackl
- USAID Advancing Nutrition, John Snow Inc., Arlington, VA, United States
| | - Laura Itzkowitz
- Bureau for Global Health, USAID, Washington, DC, United States
| | - Marion Koso-Thomas
- Eunice Kennedy Shriver National Institute of Child Health and Development, National Institutes of Health, Bethesda, MD, Unites States
| | - Denish Moorthy
- USAID Advancing Nutrition, John Snow Inc., Arlington, VA, United States.
| | | | - Helena Pachón
- Food Fortification Initiative, Emory University, Atlanta, GA, United States
| | - Nicole Stoffel
- Laboratory of Human Nutrition, Department of Health Sciences and Technology, ETH Zurich, Zu¨rich, Switzerland; MRC Human Immunology Unit, MRC Weatherall Institute of Molecular Medicine, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - Michael B Zimmerman
- MRC Human Immunology Unit, MRC Weatherall Institute of Molecular Medicine, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - Daniel J Raiten
- Eunice Kennedy Shriver National Institute of Child Health and Development, National Institutes of Health, Bethesda, MD, Unites States
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6
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Moorthy D, Rowe L. Evaluation of Global Experiences in Large-Scale Double-Fortified Salt Programs. J Nutr 2021; 151:38S-46S. [PMID: 33582783 PMCID: PMC7882358 DOI: 10.1093/jn/nxaa284] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 07/13/2020] [Accepted: 08/27/2020] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Double-fortified salt (DFS) is a vehicle for dual fortification with iron and iodine, to reduce their respective deficiencies. This background article is the third in a series reviewing available research, analyses, and experiences on DFS as an effective delivery vehicle for iron and iodine. OBJECTIVES The objective of this article is to systematically evaluate current programs distributing DFS around the world and catalogue opportunities, risks, and challenges related to programs that incorporate DFS. We carried out a narrative review of DFS programs from around the world with our data sources deriving from a mix of a nonsystematic literature search and interviews with key informants. METHODS We assessed programmatic experience with DFS from social safety net programs in India (from the states of Bihar, Madhya Pradesh, and Uttar Pradesh) and from non-social safety net country programs or projects in Argentina, Cote d'Ivoire, Kenya, Morocco, Nigeria, Philippines, and Sri Lanka. RESULTS Findings revealed color change of the final DFS product was an issue in 9 of the 14 programs or studies reviewed and was the most significant challenge that had a direct impact on consumer acceptance and uptake regardless of type of program (open market or social safety net). Other challenges identified were related to the quality of the salt and lack of DFS formulation standards and regulatory monitoring protocols. CONCLUSIONS DFS programs need to focus on 1) improved technology with better consumer acceptance and better performance when used with lower-quality salt; 2) elucidation and enforcement of DFS formulation quality standards, along with producer incentives; and 3) strong government backing at the policy level. DFS offers a unique opportunity to leverage an almost universally consumed product with the addition of 2 important nutrients missing in many populations. However, program "maturity" will take time with urgent attention needed for quality production.
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Affiliation(s)
- Denish Moorthy
- USAID Advancing Nutrition, John Snow Inc. Research and Training Institute, Arlington, VA, USA
| | - Laura Rowe
- Food Fortification Initiative, Atlanta, GA, USA
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7
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Rappaport AI, Karakochuk CD, Hess SY, Whitehead RD, Namaste SML, Dary O, Parker ME, Neufeld LM, Larson LM, Newton S, Wegmuller R, Moorthy D. Variability in haemoglobin concentration by measurement tool and blood source: an analysis from seven countries. J Clin Pathol 2020; 74:657-663. [PMID: 33023940 DOI: 10.1136/jclinpath-2020-206717] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 07/22/2020] [Accepted: 08/10/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVE We explore factors such as the blood sampling site (capillary vs venous), the equipment (HemoCue vs automated haematology analyser) and the model of the HemoCue device (201+ vs 301) that may impact haemoglobin measurements in capillary and venous blood. METHODS Eleven studies were identified, and bias, concordance and measures of diagnostic performance were assessed within each study. FINDINGS Our analysis included 11 studies from seven countries (Cambodia, India, The Gambia, Ghana, Laos, Rwanda and USA). Samples came from children, men, non-pregnant women and pregnant women. Mean bias ranged from -8.7 to 2.5 g/L in Cambodian women, 6.2 g/L in Laotian children, 2.4 g/L in Ghanaian women, 0.8 g/L in Gambian children 6-23 months and 1.4 g/L in Rwandan children 6-59 months when comparing capillary blood on a HemoCue to venous blood on a haematology analyser. Bias was 8.3 g/L in Indian non-pregnant women and 2.6 g/L in Laotian children and women and 1.5 g/L in the US population when comparing capillary to venous blood using a HemoCue. For venous blood measured on the HemoCue compared with the automated haematology analyser, bias was 5.3 g/L in Gambian pregnant women 18-45 years and 11.3 g/L in Laotian children 6-59 months. CONCLUSION Our analysis found large variability in haemoglobin concentration measured on capillary or venous blood and using HemoCue Hb 201+ or Hb 301 or automated haematology analyser. We cannot ascertain whether the variation is due to differences in the equipment, differences in capillary and venous blood, or factors affecting blood collection techniques.
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Affiliation(s)
- Aviva I Rappaport
- Strengthening Partnerships, Results, and Innovations in Nutrition Globally (SPRING), Arlington, Virginia, USA.,School of Human Nutrition, McGill University, Sainte-Anne-de-Bellevue, Quebec, Canada
| | - Crystal D Karakochuk
- Food, Nutrition, and Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sonja Y Hess
- Institute for Global Nutrition, Department of Nutrition, University of California Davis, Davis, California, USA
| | - Ralph D Whitehead
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Atlanta, Georgia, USA
| | - Sorrel M L Namaste
- The Demographic and Health Survey (DHS) Program, ICF, Rockville, Maryland, USA
| | - Omar Dary
- US Agency for International Development (USAID), Bureau of Global Health, Office of Maternal Child Health and Nutrition, Washington, DC, USA
| | - Megan E Parker
- Maternal, Newborn, Child Health and Nutrition, PATH, Seattle, Washington, USA
| | - Lynnette M Neufeld
- Knowledge Leadership, Global Alliance for Improved Nutrition, Geneva, Switzerland
| | - Leila M Larson
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, South Carolina, USA
| | - Sam Newton
- School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Rita Wegmuller
- GroundWork, Fläsch, Switzerland.,Medical Research Council Unit The Gambia, Keneba, The Gambia
| | - Denish Moorthy
- USAID Advancing Nutrition, John Snow Inc. Research and Training Institute, Arlington, Virginia, USA
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Moorthy D, Merrill R, Namaste S, Iannotti L. The Impact of Nutrition-Specific and Nutrition-Sensitive Interventions on Hemoglobin Concentrations and Anemia: A Meta-review of Systematic Reviews. Adv Nutr 2020; 11:1631-1645. [PMID: 32845972 PMCID: PMC7666908 DOI: 10.1093/advances/nmaa070] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 02/12/2020] [Accepted: 05/21/2020] [Indexed: 11/14/2022] Open
Abstract
Anemia is a multifactorial condition arising from inadequate nutrition, infection, chronic disease, and genetic-related etiologies. Our aim was to assess the impact of nutrition-sensitive and nutrition-specific interventions on hemoglobin (Hb) concentrations and anemia to inform the prioritization and scale-up of interventions to address the multiple causes of anemia. We performed a meta-review synthesis of information by searching multiple databases for reviews published between 1990 and 2017 and used standard methods for conducting a meta-review of reviews, including double independent screening, extraction, and quality assessment. Quantitative pooling and narrative syntheses were used to summarize information. Hb concentration and anemia outcomes were pooled in specific population groups (children aged <5 y, school-age children, and pregnant women). Methodological quality of the systematic reviews was assessed using Assessing the Methodological Quality of Systematic Reviews (AMSTAR) criteria. Of the 15,444 records screened, we identified 118 systematic reviews that met inclusion criteria. Reviews focused on nutrition-specific interventions (96%). Daily and intermittent iron supplementation, micronutrient powders, malaria treatment, use of insecticide-treated nets (ITNs), and delayed cord clamping were associated with increased Hb concentration in children aged <5 y. Among children older than 5 y, daily and intermittent iron supplementation and deworming, and in pregnant women, daily iron-folic acid supplementation, use of ITNs, and delayed cord clamping, were associated with increased Hb concentration. Similar results were obtained for the reduced risk of anemia outcome. This meta-review suggests the importance of nutrition-specific interventions for anemia and highlights the lack of evidence to understand the influence of nutrition-sensitive and multifaceted interventions on the condition.
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Affiliation(s)
| | - Rebecca Merrill
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Sorrel Namaste
- The Demographic and Health Survey Program, ICF, Rockville, MD, USA
| | - Lora Iannotti
- Brown School, Institute for Public Health, Washington University in St Louis, MO, USA
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9
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Karakochuk CD, Hess SY, Moorthy D, Namaste S, Parker ME, Rappaport AI, Wegmüller R, Dary O. Measurement and interpretation of hemoglobin concentration in clinical and field settings: a narrative review. Ann N Y Acad Sci 2019; 1450:126-146. [PMID: 30652320 DOI: 10.1111/nyas.14003] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Revised: 12/16/2018] [Accepted: 12/26/2018] [Indexed: 12/26/2022]
Abstract
Anemia affects over 800 million women and children globally. Defined as a limited or insufficient functional red blood cell supply in peripheral blood, anemia causes a reduced oxygen supply to tissues and can have serious health consequences for women and children. Hemoglobin (Hb) concentration is most commonly measured for anemia diagnosis. Methods to measure Hb are usually invasive (requiring a blood sample); however, advances in diagnostic and clinical chemistry over the past decade have led to the development of new noninvasive methods. Accurate diagnosis at the individual level is important to identify individuals who require treatment. At the population level, anemia prevalence estimates are often the impetus for national nutrition policies or programs. Thus, it is essential that methods for Hb measurement are sensitive, specific, accurate, and reproducible. The objective of our narrative review is to describe the basic principles, advantages, limitations, and quality control issues related to methods of Hb measurement in clinical and field settings. We also discuss other biomarkers and tests that can help to determine the severity and underlying causes of anemia. In conclusion, there are many established and emerging methods to measure Hb concentration, each with their own advantages, limitations, and factors to consider before use.
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Affiliation(s)
- Crystal D Karakochuk
- Food, Nutrition and Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sonja Y Hess
- Department of Nutrition, University of California Davis, Davis, California
| | - Denish Moorthy
- USAID-funded Strengthening Partnerships, Results, and Innovation in Nutrition Globally Project, John Snow Inc., Arlington, Virginia
| | | | - Megan E Parker
- Nutrition Innovation, Maternal Newborn and Child Health and Nutrition, PATH, Seattle, Washington
| | - Aviva I Rappaport
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Rita Wegmüller
- GroundWork, Fläsch, Switzerland.,Medical Research Council Unit the Gambia, Keneba, the Gambia
| | - Omar Dary
- Nutrition Division, Office of Maternal and Child Health and Nutrition, Bureau for Global Health, United States Agency for International Development, Washington, DC
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- Food, Nutrition and Health, University of British Columbia, Vancouver, British Columbia, Canada
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10
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Helbig KL, Mroske C, Moorthy D, Sajan SA, Velinov M. Biallelic loss-of-function variants in DOCK3 cause muscle hypotonia, ataxia, and intellectual disability. Clin Genet 2017; 92:430-433. [PMID: 28195318 DOI: 10.1111/cge.12995] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 02/06/2017] [Accepted: 02/08/2017] [Indexed: 12/30/2022]
Abstract
DOCK3 encodes the dedicator of cytokinesis 3 protein, a member of the DOCK180 family of proteins that are characterized by guanine-nucleotide exchange factor activity. DOCK3 is expressed exclusively in the central nervous system and plays an important role in axonal outgrowth and cytoskeleton reorganization. Dock3 knockout mice exhibit motor deficiencies with abnormal ataxic gait and impaired learning. We report 2 siblings with biallelic loss-of-function variants in DOCK3. Diagnostic whole-exome sequencing (WES) and chromosomal microarray were performed on a proband with severe developmental disability, hypotonia, and ataxic gait. Testing was also performed on the proband's similarly affected brother. A paternally inherited 458 kb deletion in chromosomal region 3p21.2 disrupting the DOCK3 gene was identified in both affected siblings. WES identified a nonsense variant c.382C>G (p.Gln128*) in the DOCK3 gene (NM_004947) on the maternal allele in both siblings. Common features in both affected individuals include severe developmental disability, ataxic gait, and severe hypotonia, which recapitulates the Dock3 knockout mouse phenotype. We show that complete DOCK3 deficiency in humans leads to developmental disability with significant hypotonia and gait ataxia, probably due to abnormal axonal development.
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Affiliation(s)
- K L Helbig
- Division of Clinical Genomics, Ambry Genetics, Aliso Viejo, California
| | - C Mroske
- Division of Clinical Genomics, Ambry Genetics, Aliso Viejo, California
| | - D Moorthy
- The George A. Jervis Clinic, New York State Institute for Basic Research in Developmental Disabilities, Staten Island, New York
| | - S A Sajan
- Division of Clinical Genomics, Ambry Genetics, Aliso Viejo, California
| | - M Velinov
- The George A. Jervis Clinic, New York State Institute for Basic Research in Developmental Disabilities, Staten Island, New York.,Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, New York
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11
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Suri DJ, Moorthy D, Rosenberg IH. The Role of Dairy in Effectiveness and Cost of Treatment of Children With Moderate Acute Malnutrition: A Narrative Review. Food Nutr Bull 2016; 37:176-85. [PMID: 26936209 DOI: 10.1177/0379572116633327] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Dairy is recommended in specially formulated supplementary foods to treat children with moderate acute malnutrition (MAM) but with limited evidence and added cost. OBJECTIVE Review studies of ready-to-use foods (RUFs) versus fortified blended foods (FBFs) to determine whether inclusion of dairy modifies the comparative effectiveness and cost. METHODS We reviewed literature comparing FBF and RUF in treatment of MAM among children younger than 5 years in developing countries. Outcomes of recovery from MAM, weight, and length gain were compared among treatment categories: FBF with dairy (FBF+), FBF without dairy (FBF-), RUF with dairy (RUF+), and RUF without dairy (RUF-). Supplement cost was compared per 500 kcal. RESULTS Eight studies were included. Rations were heterogeneous in energy and type of dairy. Overall, RUF+, RUF-, and FBF+ performed similarly, with higher recovery and weight gain compared with FBF-. RUF+ had higher recovery (in 5 of 6 comparisons), weight gain (4 of 4), and length gain (1 of 4) versus FBF-. The RUF+ had higher recovery (1 of 2) versus FBF+, with no other differences. The RUF- versus FBF+ had no differences (0 of 2). The RUF- had higher recovery (1 of 2), weight gain (2 of 2) versus FBF-. Four studies reported supplement costs, which averaged US$0.15 (FBF-), US$0.18 (FBF+), US$0.18 (RUF-), and US$0.37 (RUF+) per 500 kcal. CONCLUSIONS There is a consistent benefit of FBF that include dairy in treatment of children with MAM. Benefits of dairy in RUF require further investigation. Evidence from rigorous quantitative analysis of existing data, cost-effectiveness, and prospective trials will be essential in determining policy on treatment for children with MAM.
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Affiliation(s)
- Devika J Suri
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA Department of Nutritional Sciences, University of Wisconsin, Madison, WI, USA
| | - Denish Moorthy
- Strengthening Partnerships, Results and Innovations in Nutrition Globally (SPRING) Project, Arlington, VA, USA
| | - Irwin H Rosenberg
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
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12
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Philip D, Buch A, Moorthy D, Scott TM, Parnell LD, Lai CQ, Ordovás JM, Selhub J, Rosenberg IH, Tucker KL, Troen AM. Dihydrofolate reductase 19-bp deletion polymorphism modifies the association of folate status with memory in a cross-sectional multi-ethnic study of adults. Am J Clin Nutr 2015; 102:1279-88. [PMID: 26354538 PMCID: PMC4625589 DOI: 10.3945/ajcn.115.111054] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Accepted: 08/13/2015] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Folate status has been positively associated with cognitive function in many studies; however, some studies have observed associations of poor cognitive outcomes with high folate. In search of an explanation, we hypothesized that the association of folate with cognition would be modified by the interaction of high-folate status with a common 19-bp deletion polymorphism in the dihydrofolate reductase (DHFR) gene. To our knowledge, the cognitive effects of this gene have not been studied previously. OBJECTIVE We examined the association between cognitive outcomes with the 19-bp deletion DHFR polymorphism, folate status, and their interaction with high or normal plasma folate. DESIGN This was a pooled cross-sectional study of the following 2 Boston-based cohorts of community living adults: the Boston Puerto Rican Health Study and the Nutrition, Aging, and Memory in Elders study. Individuals were genotyped for the DHFR 19-bp deletion genotype, and plasma folate status was determined. Cognitive outcomes included the Mini-Mental State Examination, Center for Epidemiologic Studies Depression Scale, and factor scores for the domains of memory, executive function, and attention from a set of cognitive tests. RESULTS The prevalence of the homozygous deletion (del/del) genotype was 23%. In a multivariable analysis, high folate status (>17.8 ng/mL) was associated with better memory scores than was normal-folate status (fourth-fifth quintiles compared with first-third quintiles: β ± SE = -0.22 ± 0.06, P < 0.01). Carriers of the DHFR del/del genotype had worse memory scores (β ± SE = -0.24 ± 0.10, P < 0.05) and worse executive scores (β = -0.19, P < 0.05) than did those with the del/ins and ins/ins genotypes. Finally, we observed an interaction such that carriers of the del/del genotype with high folate had significantly worse memory scores than those of both noncarriers with high-folate and del/del carriers with normal-folate (β-interaction = 0.26 ± 0.13, P < 0.05). CONCLUSIONS This study identifies a putative gene-nutrient interaction that, if confirmed, would predict that a sizable minority carrying the del/del genotype might not benefit from high-folate status and could see a worsening of memory. An understanding of how genetic variation affects responses to high-folate exposure will help weigh risks and benefits of folate supplementation for individuals and public health.
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Affiliation(s)
- Dana Philip
- Nutrition and Brain Health Laboratory, Institute of Biochemistry, Food Science and Nutrition, Robert H Smith Faculty of Agriculture, Food and Environment, The Hebrew University of Jerusalem, Rehovot, Israel
| | - Assaf Buch
- Nutrition and Brain Health Laboratory, Institute of Biochemistry, Food Science and Nutrition, Robert H Smith Faculty of Agriculture, Food and Environment, The Hebrew University of Jerusalem, Rehovot, Israel
| | | | | | | | | | | | | | | | - Katherine L Tucker
- Nutritional Epidemiology Program, Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA; and Department of Clinical Laboratory and Nutritional Sciences at University of Massachusetts, Lowell, MA
| | - Aron M Troen
- Nutrition and Brain Health Laboratory, Institute of Biochemistry, Food Science and Nutrition, Robert H Smith Faculty of Agriculture, Food and Environment, The Hebrew University of Jerusalem, Rehovot, Israel; Neuroscience and Aging Laboratory,
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Hadar N, Raman G, Moorthy D, O'Donnell TF, Thaler DE, Feldmann E, Lau J, Kitsios GD, Dahabreh IJ. Asymptomatic Carotid Artery Stenosis Treated with Medical Therapy Alone: Temporal Trends and Implications for Risk Assessment and the Design of Future Studies. Cerebrovasc Dis 2014; 38:163-73. [DOI: 10.1159/000365206] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2014] [Accepted: 06/11/2014] [Indexed: 11/19/2022] Open
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Raman G, Moorthy D, Hadar N, Dahabreh IJ, O'Donnell TF, Thaler DE, Feldmann E, Lau J, Kitsios GD. Management strategies for asymptomatic carotid stenosis: a systematic review and meta-analysis. Ann Intern Med 2013; 158:676-685. [PMID: 23648949 DOI: 10.7326/0003-4819-158-9-201305070-00007] [Citation(s) in RCA: 103] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Adults with asymptomatic carotid artery stenosis are at increased risk for ipsilateral carotid territory ischemic stroke. PURPOSE To examine comparative evidence on management strategies for asymptomatic carotid stenosis and the incidence of ipsilateral stroke with medical therapy alone. DATA SOURCES MEDLINE, Cochrane Central Register of Controlled Trials, U.S. Food and Drug Administration documents, and review of references through 31 December 2012. STUDY SELECTION Randomized, controlled trials (RCTs) and prospective or retrospective nonrandomized, comparative studies of medical therapy alone, carotid endarterectomy (CEA) plus medical therapy, or carotid artery stenting (CAS) plus medical therapy for adults with asymptomatic carotid stenosis, as well as single-group prospective cohort studies of medical therapy, were reviewed. DATA EXTRACTION Two investigators extracted information on study and population characteristics, results, and risk of bias. DATA SYNTHESIS Forty-seven studies in 56 publications were eligible. The RCTs comparing CAS and CEA were clinically heterogeneous; 1 RCT reported more but not statistically significant ipsilateral stroke events (including any periprocedural stroke) in CAS compared with CEA, whereas another RCT, in a population at high surgical risk for CEA, did not. Three RCTs showed that CEA reduced the risk for ipsilateral stroke (including any periprocedural stroke) compared with medical therapy alone, but these results may no longer be applicable to contemporary clinical practice. No RCT compared CAS versus medical therapy alone. The summary incidence of ipsilateral stroke across 26 cohorts receiving medical therapy alone was 1.68% per year. LIMITATIONS Studies defined asymptomatic status heterogeneously. Participants in RCTs did not receive best-available medical therapy. CONCLUSION Future RCTs of asymptomatic carotid artery stenosis should explore whether revascularization interventions provide benefit to patients treated by best-available medical therapy. PRIMARY FUNDING SOURCE Agency for Healthcare Research and Quality.
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Affiliation(s)
- Gowri Raman
- Tufts Center for Clinical Evidence Synthesis, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA
| | - Denish Moorthy
- Tufts Center for Clinical Evidence Synthesis, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA
| | - Nira Hadar
- Center for Evidence-based Medicine, Brown University, Providence, RI
| | - Issa J Dahabreh
- Center for Evidence-based Medicine, Brown University, Providence, RI
| | | | - David E Thaler
- Department of Neurology, Tufts Medical Center, Boston, MA
| | | | - Joseph Lau
- Center for Evidence-based Medicine, Brown University, Providence, RI
| | - Georgios D Kitsios
- Department of Internal Medicine, Lahey Hospital and Medical Center, Burlington, MA
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15
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Patel K, Moorthy D, Chan JA, Concannon TW, Ratichek SJ, Chung M, Balk EM. High priority future research needs for obstructive sleep apnea diagnosis and treatment. J Clin Sleep Med 2013; 9:395-402. [PMID: 23585757 DOI: 10.5664/jcsm.2600] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES To identify and prioritize future research needs (FRN) topics for diagnosis and treatment of obstructive sleep apnea (OSA). METHODS Twenty-one panel members represented six stake-holder categories: patients and the public, providers; purchasers of health care, payers, policymakers, and principal investigators. Building on a recently completed comparative effectiveness review, stakeholders nominated and discussed potential FRN topics. Stakeholders then nominated their top priority FRN topics based on the Agency for Healthcare Research and Quality Effective Health Care Program Selection Criteria. From these nominations, the highest priority FRN topics were determined and were elaborated upon to include possible study designs to address the topics. RESULTS Thirty-seven topics were discussed and prioritized. The nine highest priority FRN topics included: cost-effectiveness of management strategies, defining age- and sex-specific criteria for OSA, evaluating routine preoperative screening for OSA, evaluating involvement of a sleep medicine specialist in diagnosis of OSA, evaluating clinical prediction rules, assessing the effect of treating sleep disordered breathing and long-term clinical outcomes, comparing treatments for patients who do not tolerate positive airway pressure, evaluating strategies to improve treatment compliance, and evaluating the association between sleep apnea severity and long-term clinical outcomes. CONCLUSIONS While there are numerous specific research questions with low or insufficient strength of evidence for OSA management, OSA patients, their healthcare providers, and society at large would benefit from refocusing research efforts into the prioritized research questions and away from simple comparisons of short-term outcomes between specific interventions.
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Affiliation(s)
- Kamal Patel
- Institute of Clinical Research and Health Policy Studies, Tufts University School of Medicine, Tufts Medical Center, Boston, MA, USA
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16
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Suri D, Moorthy D, Rosenberg I. Systematic Review and Meta‐Analysis of Food‐Based Interventions on Recovery from Moderate Acute Malnutrition in Young Children. FASEB J 2013. [DOI: 10.1096/fasebj.27.1_supplement.lb332] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Devika Suri
- Nevin Scrimshaw International Nutrition FoundationBostonMA
| | | | - Irwin Rosenberg
- Friedman School of Nutrition Science and PolicyTufts UniversityBostonMA
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17
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Moorthy D, Peter I, Scott TM, Parnell LD, Lai CQ, Crott JW, Ordovás JM, Selhub J, Griffith J, Rosenberg IH, Tucker KL, Troen AM. Status of vitamins B-12 and B-6 but not of folate, homocysteine, and the methylenetetrahydrofolate reductase C677T polymorphism are associated with impaired cognition and depression in adults. J Nutr 2012; 142:1554-60. [PMID: 22739363 PMCID: PMC3397340 DOI: 10.3945/jn.112.161828] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The C677T polymorphism of the methylenetetrahydrofolate reductase (MTHFR) gene differs in frequency in various ethnic groups that have differing prevalence of age-related cognitive impairments. We used a series of neuro-psychological tests to examine the association of the MTHFR C677T polymorphism with cognition and depression and also to assess whether genotype modifies the association of folate and homocysteine with these outcomes. This study analyzed pooled cross-sectional data from 2 ethnically diverse cohorts of community-living adults: the Boston Puerto Rican Health Study (n = 939) and the Nutrition, Aging, and Memory in Elders study (n = 1017). Individuals in both cohorts underwent anthropometric and laboratory measurements and dietary and health assessments using validated questionnaires between the years 2003 and 2007. Cognitive outcomes included measures of global cognition [Mini-Mental Status Exam (MMSE)], depression (Center for Epidemiological Studies Depression Scale), and 3 factor scores for the domains of attention, executive function, and memory that were derived from a detailed set of neuropsychological tests. Low plasma vitamin B-12 concentrations were associated with poorer MMSE scores and higher depression scores, and low vitamin B-6 concentrations were associated with lower MMSE and worse attention and executive function in the multivariate analysis. In contrast, MTHFR genotype, folate, and homocysteine were not associated with cognition or depression in either ethnicity-pooled or stratified analysis. The current study did not find evidence of an association between the MTHFR C677T TT genotype and impaired cognition or depression in a population with adequate folate status and a high prevalence of cognitive impairment and depression.
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Affiliation(s)
- Denish Moorthy
- Neuroscience and Aging Laboratory, Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA, USA.
| | - Inga Peter
- Department of Genetics and Genomic Sciences, Mount Sinai School of Medicine, New York, NY
| | - Tammy M. Scott
- Neuroscience and Aging Laboratory,Department of Psychiatry, and
| | | | | | | | | | - Jacob Selhub
- Vitamin Metabolism Laboratory, Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA
| | - John Griffith
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA; and
| | | | | | - Aron M. Troen
- Neuroscience and Aging Laboratory,Institute of Biochemistry, Food Science and Nutrition, Robert H. Smith Faculty of Agriculture, Food and Environment, The Hebrew University of Jerusalem, Rehovot, Israel,To whom correspondence should be addressed. E-mail:
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18
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Troen AM, Scott TM, D'Anci KE, Moorthy D, Dobson B, Rogers G, Weiner DE, Levey AS, Dallal GE, Jacques PF, Selhub J, Rosenberg IH. Cognitive dysfunction and depression in adult kidney transplant recipients: baseline findings from the FAVORIT Ancillary Cognitive Trial (FACT). J Ren Nutr 2011; 22:268-276.e3. [PMID: 22153382 DOI: 10.1053/j.jrn.2011.07.009] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2010] [Revised: 06/07/2011] [Accepted: 07/11/2011] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE Hyperhomocysteinemia and B-vitamin deficiency may be treatable risk factors for cognitive impairment and decline. Hyperhomocysteinemia, cognitive impairment, and depression are all common in individuals with kidney disease, including kidney transplant recipients. Accordingly, we assessed the prevalence of cognitive impairment and depressive symptoms in transplant recipients and their association with kidney function, plasma total homocysteine, and B-vitamin concentrations. SETTING Cross-sectional analysis of baseline data from the Folic Acid for Vascular Outcome Reduction In Transplantation (FAVORIT) Ancillary Cognitive Trial (FACT), which included 183 participants in FAVORIT who underwent detailed neuropsychological assessment before the study intervention. RESULTS The mean age was 54.0 ± 9.5 years (range: 7 to 386 months). Men comprised 55.2% of the cohort, and the mean time between the current transplant and cognitive testing was 7.0 ± 5.8 years. Twenty-four percent of participants reported neurological or psychiatric complaints, and 30% exhibited symptoms of mild to severe depression. Testing revealed evidence of significant and selective deficits in this population: 33% performed more than 1 standard deviation (SD) below normed means on a memory test, 58% fell lower than 1 SD below the norms on a test of attention and mental processing speed, and 33% to 42% fell lower than 1 SD below the norms on several tests of executive function. Lower estimated glomerular filtration rate and lower folate were associated with poorer performance on tests of memory and executive function. CONCLUSIONS These observations confirm previous reports of mood and cognitive impairments in adult kidney transplant recipients. Further research is needed to determine the benefit of B-vitamin supplementation and other interventions in this patient population.
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Affiliation(s)
- Aron M Troen
- Nutrition and Neurocognition Laboratory, Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, Massachusetts; Vitamin Metabolism and Aging Laboratory, Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, Massachusetts; Institute of Biochemistry, Food Science and Nutrition, The Robert H. Smith Faculty of Agriculture, Food and Environment, The Hebrew University of Jerusalem, Rehovot, Israel.
| | - Tammy M Scott
- Department of Psychiatry, Tufts Medical Center, Tufts School of Medicine, Boston, Massachusetts; Nutrition and Neurocognition Laboratory, Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, Massachusetts
| | - Kristen E D'Anci
- Nutrition and Neurocognition Laboratory, Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, Massachusetts
| | - Denish Moorthy
- Nutrition and Neurocognition Laboratory, Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, Massachusetts
| | - Beverly Dobson
- Nutrition and Neurocognition Laboratory, Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, Massachusetts
| | - Gail Rogers
- Nutritional Epidemiology Laboratory, Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, Massachusetts
| | - Daniel E Weiner
- Division of Nephrology, Tufts Medical Center, Tufts School of Medicine, Boston, Massachusetts
| | - Andrew S Levey
- Division of Nephrology, Tufts Medical Center, Tufts School of Medicine, Boston, Massachusetts
| | - Gerard E Dallal
- Biostatistics Laboratory, Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, Massachusetts
| | - Paul F Jacques
- Nutritional Epidemiology Laboratory, Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, Massachusetts
| | - Jacob Selhub
- Vitamin Metabolism and Aging Laboratory, Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, Massachusetts
| | - Irwin H Rosenberg
- Nutrition and Neurocognition Laboratory, Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, Massachusetts
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19
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Trikalinos TA, Moorthy D, Chung M, Yu WW, Lee J, Lichtenstein AH, Lau J. Concordance of randomized and nonrandomized studies was unrelated to translational patterns of two nutrient-disease associations. J Clin Epidemiol 2011; 65:16-29. [PMID: 22047889 DOI: 10.1016/j.jclinepi.2011.07.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2011] [Accepted: 07/09/2011] [Indexed: 02/07/2023]
Abstract
OBJECTIVE There are several examples in nutrition of discordance between the results of observational studies and randomized controlled trials (RCTs). We hypothesized that this discordance is attributable to differences in the translational paths of nutrient-disease associations. Translational paths can be assessed using citation analysis. STUDY DESIGN AND SETTING We compared the characteristics of citation networks using examples, where RCTs and observational studies agreed (long-chain n-3 polyunsaturated fatty acids [n-3 PUFA]) or disagreed (vitamin E). We performed systematic reviews in each example, constructed citation networks, and compared them with respect to the number of articles and citation relationships between them, as well as the distribution of articles' hub and authority scores. RESULTS For n-3 PUFA, meta-analyses of 14 RCTs and 10 observational studies both suggested that higher intake was associated with lower cardiovascular mortality. For vitamin E, the meta-analysis of 14 RCTs excluded a clinically significant effect, whereas 14 observational studies reported a significant inverse association. The respective citation networks consisted of 392 (n-3 PUFA) and 351 (vitamin E) articles. No differences between the characteristics of the two networks were identified. There was no evidence that the observational studies predated RCTs in the translational process in either example. CONCLUSION In the two examples, citation network characteristics do not predict concordance in the results of observational studies and RCTs.
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Affiliation(s)
- Thomas A Trikalinos
- Center for Clinical Evidence Synthesis, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Box #63, 800 Washington Street, Boston, MA 02111, USA.
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Abstract
This article reviews the role of nutrition in Crohn's disease, one of the inflammatory bowel diseases. In addition to presenting a comprehensive review of the state-of-the-evidence on nutritional risks and nutritional therapies in Crohn's disease, and making specific nutrient recommendations, this article includes a list of Web-based resources, including websites, blogs, newsletters, and multimedia podcasts that can be utilized by patients and healthcare providers alike to learn more about the etiology, pathophysiology, and nutritional management of Crohn's disease.
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Affiliation(s)
- Denish Moorthy
- Nutrition and Neurocognition Laboratory, Human Nutrition Research Center on Aging, Tufts University, Boston, Massachusetts, USA
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Moorthy D, Patro BK, Das BC, Sankar R, Karmakar MG, Pandav CS. Tracking progress towards sustainable elimination of iodine deficiency disorders in Orissa. Indian J Public Health 2007; 51:211-215. [PMID: 18232159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023] Open
Abstract
OBJECTIVE To assess the status of iodine deficiency in the population of Orissa and track progress of the elimination efforts. METHODS A community based field survey was conducted. Data was collected using quantitative and qualitative research methods. Standard internationally recommended protocol and methodology was followed. Thirty clusters were selected using population proportionate to size sampling technique. School children aged 6 to 12 years were selected as target group. Goiter prevalence, urinary iodine excretion in the target group and iodine content of the salt at household were used as outcome variables. RESULTS A total of 1200 children were studied. The total goiter rate was found to be 8.0%, of which 7.6% were grade I and 0.4% was grade-II goiter. The median urinary iodine excretion was found to be 85.4 microg/L and 32.2% of the subjects had urinary iodine levels less than 50 microg/L. Estimation of iodine content by titration method revealed that in only 45% of households salt was found to be adequately iodised. (Salt with iodine level 15 ppm). CONCLUSION Iodine deficiency continues to be a public health problem in Orissa and the need to accelerate efforts to iodine sufficiency cannot be overemphasized.
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Abstract
OBJECTIVES To assess the status of the iodine deficiency in the population of Bihar and track progress of the elimination efforts. METHODS A community based field survey was conducted. Using quantitative and qualitative research methods, data was collected by following internationally recommended protocol and methodology. Thirty clusters were selected using population proportionate to size technique. School age children (6 to 12 years) were the target group studied. Urinary iodine in target children and iodine content of salt at households were the indicators used. RESULTS Total of 1169 children were studied. The median urinary iodine concentration was found to be 85.6 microg/L. Urinary iodine concentration was less than 50 microg/L in 31.5% of the subjects. Only 40.1% of the household salt samples were found to be adequately iodised as determined by titration method (> or =15 ppm iodine). CONCLUSIONS Study results show existence of iodine deficiency in the state. There is need to accelerate our efforts to achieve iodine sufficiency and this should be done on a war-footing.
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Affiliation(s)
- R Sankar
- Centre for Community Medicine, All India Institute of Medical Sciencs, New Delhi/Nutrition, UNICEF, Bihar and Micronutrient Cell, Government of Bihar, India.
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Anand K, Baridalyne N, Moorthy D, Kapoor SK, Sankar R, Pandav CS. Ethical issues in public health policy. Natl Med J India 2002; 15:97-100. [PMID: 12044125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
Ethics in public health policy is given the least importance and rarely discussed. Resolving ethical issues in public health is often an arduous task as these are complicated and require careful handling. Using four case studies, we discuss issues pertaining to pertussis and brain damage, water fluoridation and dental caries, infection with the human immunodeficiency virus and the right to marriage, and the debate surrounding universal salt iodization. The core issue in all these examples pertains to the relevance of ethics in public health policy.
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Affiliation(s)
- K Anand
- Centre for Community Medicine, All India Institute of Medical Sciences, Ansari Nagar, New Delhi
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Kumar R, Sharma S, Marwah A, Moorthy D, Dhanwal D, Malhotra A. Ectopic goiter masquerading as submandibular gland swelling: a case report and review of the literature. Clin Nucl Med 2001; 26:306-9. [PMID: 11290889 DOI: 10.1097/00003072-200104000-00005] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Ectopic thyroid glands generally occur in the midline as a result of abnormal median migration, and their presence lateral to the midline is rare. A 12-year-old boy had a swelling in the left submandibular region that imaging techniques showed to be an ectopic thyroid gland, although no thyroid tissue was seen in the normal location. Only eight cases of lateral aberrant thyroid tissue have been reported. The importance of being aware of the possibility of ectopic thyroid tissue as a submandibular region swelling has an important bearing on disease management. A pertinent review of the literature and its management is included.
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Affiliation(s)
- R Kumar
- Department of Nuclear Medicine, All India Institute of Medical Sciences Campus, New Delhi.
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Moorthy D, Sood A, Ahluwalia A, Kumar R, Pandey RM, Pandav CS, Karmarkar MG, Padhy AK. Radioiodine kinetics and thyroid function following the universal salt iodization policy. Natl Med J India 2001; 14:71-4. [PMID: 11396321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
BACKGROUND Universal salt iodization was introduced in Delhi in 1989. The present study quantifies the change in iodine kinetics as a result of this. The previous values were reported 10-30 years earlier, when Delhi was iodine deficient. METHODS Thirty subjects (18 men and 12 women, 17-48 years of age) who were residents of Delhi and had no thyroid disorder, were recruited from our outpatient clinic in 1999. The 24-hour urinary excretion of iodine and the iodine content of salt consumed at home by these subjects were estimated. Kinetic studies of iodine using radiotracer 131I were done to determine thyroid iodine clearance, renal iodine clearance, percentage uptake and absolute iodine uptake by the thyroid gland, and plasma inorganic iodine. RESULTS The median 24-hour urinary iodine excretion was 341.3 micrograms. The mean (SD) thyroid uptake of radioactive iodine was 4.9 (2.3)% at 2 hours and 19.1 (8.0)% at 24 hours. The median calculated plasma inorganic iodine was 1.36 micrograms/dl, absolute iodine intake 6.5 micrograms/hour and thyroid iodine clearance was 4.8 ml/minute (geometric means 1.68 micrograms/dl, 8.5 micrograms/hour and 8.1 ml/minute, respectively). The serum thyroid hormones and thyroid stimulating hormone were within normal limits. CONCLUSION Compared to the values reported 10-30 years ago when the population was iodine deficient, the present urinary iodine excretion, plasma inorganic iodine and absolute iodine intake have increased, while the percentage thyroid uptake of iodine ingested and thyroid clearance have decreased. The lack of change in the serum thyroid hormone levels after 10 years of universal salt iodization indicates that iodine consumption has had no adverse effect on thyroid function in these normal individuals. These changes are consistent with the increase in iodine consumption. Since the iodine ingestion in a community may change with time, assessment of iodine kinetics should be done periodically in different regions of the country.
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Affiliation(s)
- D Moorthy
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
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Abstract
We report the case of a young girl with diabetes mellitus whose insulin syringe needle broke and became embedded in subcutaneous tissue.
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Affiliation(s)
- A Sood
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi.
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Affiliation(s)
- R Kumar
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi.
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