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Kwon D, Knorr DA, Wiley KS, Young SL, Fox MM. Association of pica with cortisol and inflammation among Latina pregnant women. Am J Hum Biol 2024; 36:e24025. [PMID: 38050975 PMCID: PMC11062838 DOI: 10.1002/ajhb.24025] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 11/14/2023] [Accepted: 11/17/2023] [Indexed: 12/07/2023] Open
Abstract
Pica, the urge to consume items generally not considered food, such as dirt, raw starch, and ice, are particularly common among pregnant women. However, the biology of pica in pregnancy is not well understood. Therefore, this study aimed to assess how pica relates to endocrine stress and immune biomarkers in a cohort of pregnant Latina women in Southern California. Thirty-four women completed a structured pica questionnaire. Maternal urinary cortisol and plasma cytokine levels were measured between 21 and 31 weeks' gestation. Associations between pica during pregnancy and biomarkers were assessed using linear regression models adjusting for gestational age. Twelve (35.3%) of the pregnant women reported pica (geophagy and amylophagy) during pregnancy. In multivariate models, those who engaged in pica had higher levels of cortisol (β: 0.37, 95% CI: 0.01, 0.073) and lower levels of IL-1β (β: -0.06, 95% CI: -0.11, -0.02), IL-8 (β: -0.30, 95% CI: -0.56, -0.05), IL-21 (β: -0.35, 95% CI: -0.63, -0.08), and type-1 inflammation composite (β: -0.29, 95% CI: -0.44, -0.14) than women who did not engage in pica. These results suggest that biological stress and immune response differ for women with pica compared to those without. This study suggests novel physiological covariates of pica during pregnancy. Further research is needed to better understand the mechanisms and temporality underlying the observed associations between pica and endocrine and immune biomarkers.
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Affiliation(s)
- Dayoon Kwon
- Department of Epidemiology, University of California, Los Angles, California, USA
| | - Delaney A Knorr
- Department of Anthropology, University of California, Los Angles, California, USA
| | - Kyle S Wiley
- Department of Anthropology, University of California, Los Angles, California, USA
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angles, California, USA
| | - Sera L Young
- Department of Anthropology, Northwestern University, Evanston, Illinois, USA
| | - Molly M Fox
- Department of Anthropology, University of California, Los Angles, California, USA
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angles, California, USA
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Sousa R, Cunha F, Abreu J, Cunha N. A Rare Presentation of Pica Disorder in Soap Ingestion Variant: Case Report and Review. J Nerv Ment Dis 2024; 212:117-119. [PMID: 38290104 DOI: 10.1097/nmd.0000000000001716] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Abstract
ABSTRACT Pica indicates the persistent ingestion of inedible substances over a period of at least 1 month, being discordant to the individual's cognitive development level and not directly attributable to cultural or social normative practices. The literature suggests that the prevalence of pica varies significantly according to the social and clinical context. It can co-occur with psychiatric disorders, with its etiology being poorly understood and most likely multifactorial. In this article, we report the case of a patient in her 50s with a clinical setting compatible with soap ingestion variant of pica disorder. In addition to the variety of ingested substances, pica can be associated with heterogeneous behavior, mainly of the obsessive-compulsive spectrum. Despite recent research, this condition is still a target of much speculation. This is a very rare and challenging presentation of a soap ingestion variant of pica with very few similar cases described to date.
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Affiliation(s)
- Rui Sousa
- Department of Psychiatry, Centro Hospitalar Tondela-Viseu, Viseu, Portugal
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Papini NM, Bulik CM, Chawner SJRA, Micali N. Prevalence and recurrence of pica behaviors in early childhood within the ALSPAC birth cohort. Int J Eat Disord 2024; 57:400-409. [PMID: 38097525 PMCID: PMC10922868 DOI: 10.1002/eat.24111] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 11/26/2023] [Accepted: 11/26/2023] [Indexed: 12/26/2023]
Abstract
OBJECTIVE The present study examined prevalence and correlates of pica behaviors during childhood using data from the Avon Longitudinal Study of Parents and Children (ALSPAC) study. METHOD Data on 10,109 caregivers from the ALSPAC study who reported pica behavior at 36, 54, 65, 77, and 115 months on their child were included. Autism was obtained through clinical and education records, while DD was derived from the Denver Developmental Screening Test. RESULTS A total of 312 parents (3.08%) reported pica behaviors in their child. Of these, 19.55% reported pica at least at two waves (n = 61). Pica was most common at 36 months (N = 226; 2.29%) and decreased as children aged. A significant association was found between pica and autism at all five waves (p < .001). There was a significant relationship between pica and DD, with individuals with DD more likely to experience pica than those without DD at 36 (p = .01), and 54 (p < .001), 65 (p = .04), 77 (p < .001), and 115 months (p = .006). Exploratory analyses examined pica behaviors with broader eating difficulties and child body mass index. DISCUSSION This study enhances understanding of childhood pica behaviors, addressing a significant gap in knowledge. Pica occurrence in the general population is poorly understood due to few epidemiological studies. Findings from the present study indicate pica is an uncommon behavior in childhood; however, children with DD or autism may benefit from pica screening and diagnosis between ages 36 and 115 months. Children who exhibit undereating, overeating, and food fussiness may also engage in pica behaviors.
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Affiliation(s)
- Natalie M. Papini
- Department of Health Sciences, Northern Arizona University, Flagstaff, Arizona, USA
- Center of Excellence for Eating Disorders (CEED), University of North Carolina, Chapel Hill, North Carolina, USA
- Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK
| | - Cynthia M. Bulik
- Department of Psychiatry, University of North Carolina, Chapel Hill, USA
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Nutrition, University of North Carolina, Chapel Hill, USA
| | - Samuel J. R. A. Chawner
- Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK
| | - Nadia Micali
- Eating Disorders Research Unit, Psychiatric Centre Ballerup, Capital Region of Denmark Mental Health Services, Copenhagen, Denmark
- Great Ormond Street Institute of Child Health, University College London, London, UK
- Institute of Biological Psychiatry, Psychiatric Center Sct. Hans, Capital Region of Denmark Mental Health Services, Copenhagen, Denmark
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Rasool M, Jawad M, Noman SK, Ejerish M. Causes and management of Pica disorder among central Iraqi peoples. Pol Merkur Lekarski 2024; 52:226-232. [PMID: 38642359 DOI: 10.36740/merkur202402112] [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] [Subscribe] [Scholar Register] [Indexed: 04/22/2024]
Abstract
OBJECTIVE Aim: To find the causes and factors behind the Pica disorder, which helps in early diagnosis and appropriate treatments.. PATIENTS AND METHODS Materials and Methods: A retrospective cross-section study was carried out between July 1, 2022, and April 20, 2023, enrolling 300 patients from different provinces of central and south Iraq with Pica disease whose diagnosis depended on specialized physicians according to WHO guidelines. The participants were following up for three to six months in private clinics. RESULTS Results: 92.4% of the patients were female, and 41% of patients were under 20 years old, with low ferritin, HB, and vitamin D levels (80% of cases), and these markers showed a negative correlation with the number of Pica. Chowing of ice and clay were the common types of Pica, which represent about 30% each, while 34% of cases had multiple types, which had signs and symptoms of fever, palpitation, vomiting, abdominal pain, paleness, headaches, and hair loss. Six-month flows were better than three months. CONCLUSION Conclusions: Pica was a disorder that could lead to behavior and emotional abnormalities that caused the patients to eat some things that were eaten by healthy people. This may be, as concluded from our results, due to reduced levels of ferritin, hemoglobin (Hb), and vitamin D that caused these psychological problems.
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Ezemenahi SI, Adinma E, Nworah AV, Obi-Nwosu AL, Ezemenahi SC. Prevalence of Pica amongst Pregnant Women attending Antenatal Clinic of a Tertiary Clinic in South-East, Nigeria. West Afr J Med 2023; 40:982-988. [PMID: 37768267] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2023]
Abstract
BACKGROUND The eating of non-food substances during pregnancy is called pica. It is commonly practised by pregnant women worldwide, including in Nigeria, and has been reported to have a mixed impact on their health. AIM This study sought to determine the prevalence of pica amongst pregnant women attending the antenatal clinic in Nnamdi Azikiwe University Teaching Hospital (NAUTH), Anambra State, South East, Nigeria. MATERIALS AND METHODS After obtaining approval from the Ethics And Research Committees in Nnamdi Azikiwe University Teaching Hospital, a cross-sectional survey of 326 consenting pregnant women who met the eligibility criteria was conducted. They were selected by systematic random sampling from 5th September to 5th of November 2022. Data was obtained by interview-based questionnaires and analyzed using the statistical package for Social Sciences (SPSS) version 25.0. The level of significance for this study was set at P < 0.05 for all analyses. RESULTS The prevalence of pica among this population was 25.8%, and their mean age was 29.3 ± 4.8. The majority identified smell 45 (53.6%) and taste 40 (47.6%) as the reasons for pica practice. Geophagy dominated other forms of pica as white clay was the most consumed item 60 (72.6%). CONCLUSION This study showed that pica practice was common among pregnant women in this study and geophagy was the dominant form of pica. There is a need to step up health education on the effects of pica in pregnancy.
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Affiliation(s)
- S I Ezemenahi
- Department of Family Medicine, Nnamdi Azikiwe University, Awka, Nigeria. , Tel 08033940938
| | - E Adinma
- Department of Community Medicine, Nnamdi Azikiwe University Awka, Nigeria
| | - A V Nworah
- Department of Community Medicine, Nnamdi Azikiwe University Awka, Nigeria
| | - A L Obi-Nwosu
- Department of Family Medicine, Nnamdi Azikiwe University, Awka, Nigeria. , Tel 08033940938
| | - S C Ezemenahi
- Department of Medicine, America University of Barbados, Barbados
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Gerontidis A, Grammatikopoulou MG, Tzimos C, Gkiouras K, Taousani E, Athanasiadis L, Goulis DG. Effectors of Pregorexia and Emesis among Pregnant Women: A Pilot Study. Nutrients 2022; 14:nu14245275. [PMID: 36558433 PMCID: PMC9785442 DOI: 10.3390/nu14245275] [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: 10/31/2022] [Revised: 12/06/2022] [Accepted: 12/07/2022] [Indexed: 12/14/2022] Open
Abstract
During pregnancy, women tend to improve their lifestyle habits and refine their dietary intake. Quite often, however, these dietary improvements take an unhealthy turn, with orthorexia nervosa (ON) practices being apparent. The aim of the present pilot cross-sectional study was to assess the prevalence of ON tendencies and the incidence of pica and record diet practices in a sample of pregnant women. A total of 157 pregnant women were recruited through private practice gynecologists during the first months of 2021. Nutrition-related practices were recorded, orthorexic tendencies were assessed using the translated and culturally adapted Greek version of the ORTO-15 questionnaire, pica practices were evaluated with a binary question and nausea and emesis during pregnancy (NVP) was evaluated using the translated modified Pregnancy-Unique Quantification of Emesis and Nausea (mPUQE). Only two women reported pica tendencies, with ice and snow being the consumed items. The majority (61.1%) of women reported improving their diet since conception was achieved. Folic acid and iron oral nutrient supplements (ONS) were reportedly consumed by the majority of participants (87.9% and 72.6%, respectively) and 9.6% reported using herbal medicine products. The ORTO-15 score was reduced with tertiary education attainment, ART conception, being in the third trimester of pregnancy, consumption of folic acid and MV supplements and was only increased among women who were at their first pregnancy. The majority of participants experienced severe NVP and the remaining experienced moderate NVP. NVP was associated with lower hemoglobin levels, lack of supplementary iron intake, avoidance of gluten-containing foods, as well as with increased gestational weight gain. The results highlight the need to screen pregnant women for disturbed eating behaviors and nutrition-related problems, in order to ensure a healthy pregnancy outcome.
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Affiliation(s)
- Alexandros Gerontidis
- Department of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, GR-56429 Thessaloniki, Greece
| | - Maria G. Grammatikopoulou
- Department of Rheumatology and Clinical Immunology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Biopolis, GR-41110 Larissa, Greece
- Correspondence: (M.G.G.); (D.G.G.)
| | - Christos Tzimos
- Northern Greece Statistics Directorate, Hellenic Statistical Authority, 218 Delfon Str., GR-54646 Thessaloniki, Greece
| | - Konstantinos Gkiouras
- Department of Rheumatology and Clinical Immunology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Biopolis, GR-41110 Larissa, Greece
| | - Eleftheria Taousani
- Department of Midwifery, Faculty of Health Sciences, International Hellenic University, Alexander Campus, GR-57400 Thessaloniki, Greece
- Unit of Reproductive Endocrinology, 1st Department of Obstetrics and Gynecology, Medical School, Faculty of Health Sciences, Aristotle University of Thessaloniki, 76 Agiou Pavlou Street, GR-54629 Thessaloniki, Greece
| | - Loukas Athanasiadis
- 3rd Department of Psychiatry, Medical School, Aristotle University of Thessaloniki, 76 Agiou Pavlou Street, GR-54629 Thessaloniki, Greece
| | - Dimitrios G. Goulis
- Unit of Reproductive Endocrinology, 1st Department of Obstetrics and Gynecology, Medical School, Faculty of Health Sciences, Aristotle University of Thessaloniki, 76 Agiou Pavlou Street, GR-54629 Thessaloniki, Greece
- Correspondence: (M.G.G.); (D.G.G.)
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Narh CT, Dzamalala CP, Mmbaga BT, Menya D, Mlombe Y, Finch P, Nyakunga G, Schüz J, McCormack V. Geophagia and risk of squamous cell esophageal cancer in the African esophageal cancer corridor: Findings from the ESCCAPE multicountry case-control studies. Int J Cancer 2021; 149:1274-1283. [PMID: 34004024 PMCID: PMC8411422 DOI: 10.1002/ijc.33688] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 03/31/2021] [Revised: 05/03/2021] [Accepted: 05/04/2021] [Indexed: 02/06/2023]
Abstract
Geophagia, the intentional practice of consuming soil, occurs across the African esophageal cancer corridor, particularly during pregnancy. We investigated whether this practice is linked to endemic esophageal squamous cell carcinoma (ESCC) in this region. We conducted ESCC case-control studies in Tanzania, Malawi and Kenya. Cases were patients with incident histologically/clinically confirmed ESCC and controls were hospital patients/visitors without digestive diseases. Participants were asked if they had ever eaten soil (never/regularly/pregnancy-only). Odds ratios (OR) are adjusted for sex, age, tobacco, alcohol, country, religion and marital status. Overall, 934 cases (Malawi 535, Tanzania 304 and Kenya females 95) and 995 controls provided geophagia information. Among controls, ever-geophagia was common in women (Malawi 49%, Kenya 43% and Tanzania 29%) but not in men (10% Malawi, <1% Tanzania). In women, ESCC ORs were 1.25 (95% CI: 0.70, 2.22) for regular versus never geophagia and 0.88 (95% CI: 0.64, 1.22) for pregnancy-only versus never. Findings were stronger based on comparisons of cases with hospital visitor controls and were null using hospital patients as controls. In conclusion, geophagia is too rare to contribute to the male ESCC burden in Africa. In women, the practice is common but we did not find consistent evidence of a link to ESCC. The study cannot rule out selection bias masking modest effects. Physical effects of geophagia do not appear to have a large impact on overall ESCC risk. Research with improved constituent-based geophagia exposure assessment is needed.
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Affiliation(s)
- Clement T. Narh
- Branch of Environment and Lifestyle EpidemiologyInternational Agency for Research on Cancer (IARC)LyonFrance
- School of Public HealthUniversity of Health and Allied SciencesHohoeGhana
| | | | - Blandina T. Mmbaga
- Kilimanjaro Clinical Research InstituteMoshiTanzania
- Kilimanjaro Christian Medical CentreMoshiTanzania
| | - Diana Menya
- School of Public HeathMoi UniversityEldoretKenya
| | | | - Peter Finch
- College of MedicineUniversity of MalawiBlantyreMalawi
| | | | - Joachim Schüz
- Branch of Environment and Lifestyle EpidemiologyInternational Agency for Research on Cancer (IARC)LyonFrance
| | - Valerie McCormack
- Branch of Environment and Lifestyle EpidemiologyInternational Agency for Research on Cancer (IARC)LyonFrance
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Abstract
Pica is the developmentally inappropriate consumption of non-nutritive items for at least one month. Pica can lead to many adverse outcomes, but the exact pathophysiology of pica is unknown or variable across populations. Several studies have evidenced that there is a high prevalence of pica among youth with sickle cell disease (SCD). However, the lack of knowledge regarding the correlates of pica contributes to overlooking the condition, inaccurate diagnoses, and a lack of evidence-based treatments once pica is identified. This review examines the literature to develop a biopsychosocial model of pica in SCD. Elucidating the potential relationships among the proposed biological, psychological, and social factors, and pica will inform our understanding of this phenomenon in pediatric SCD and may guide future research and clinical recommendations.
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Affiliation(s)
- Nikita Rodrigues
- Department of Psychology, Georgia State University, Atlanta, GA, USA.
- , Washington, DC, USA.
| | - Sharon Shih
- Department of Psychology, Georgia State University, Atlanta, GA, USA
| | - Lindsey L Cohen
- Department of Psychology, Georgia State University, Atlanta, GA, USA
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Liu H, Burns RT, Spencer BR, Page GP, Mast AE. Demographic, clinical, and biochemical predictors of pica in a large cohort of blood donors. Transfusion 2021; 61:2090-2098. [PMID: 33913181 PMCID: PMC8571648 DOI: 10.1111/trf.16409] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 02/22/2021] [Revised: 03/29/2021] [Accepted: 03/29/2021] [Indexed: 12/27/2022]
Abstract
BACKGROUND Pica is characterized as repeatedly eating or chewing a non-nutritious substance including, but not limited to ice, clay and dirt, starch, raw pasta, chalk, coal, paint, or paper. Pica symptoms can be intense and addiction-like and disrupt quality of life. It is strongly linked to iron deficiency. Since substantial iron loss occurs during blood donation, blood donors may be susceptible to development of pica behaviors. METHODS We investigated demographic, clinical, hematological, and biochemical factors associated with pica using univariable and multivariable logistic regression analysis in a cohort of 11,418 racially diverse blood donors. Pica was defined by questionnaire responses as consuming at least 8 oz of ice daily and/or consumption of non-ice substances regardless of the amount and frequency. RESULTS Pica was present in 2.2% of the donors. The sensitivity and specificity of pica in iron-deficient donors were 36% and 82%, respectively. Lower ferritin (p = .001), non-Asian race (p < .001), higher red cell distribution width (p < .001), younger age, and restless legs syndrome (p = .008) were independently associated with pica. Female sex is associated with iron deficiency but was not an independent predictor of pica suggesting that iron deficient males and females were equally susceptible to the development of pica behaviors. Donors with normal ferritin levels also reported pica, reinforcing the role of non-iron related factors in its presentation. CONCLUSIONS We have identified demographic, clinical, and biochemical predictors of pica that help identify those most at risk for developing pica behaviors, and thereby assist in its clinical diagnosis and treatment.
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Affiliation(s)
- Hefei Liu
- Blood Research Institute, Versiti, Milwaukee, Wisconsin, USA
- Department of Medicine, Medical College of Wisconsin, Wauwatosa, Wisconsin, USA
| | - Robert T. Burns
- Blood Research Institute, Versiti, Milwaukee, Wisconsin, USA
| | - Bryan R. Spencer
- Department of Scientific Affairs, American Red Cross, Dedham, Massachusetts, USA
| | - Grier P. Page
- BioStatEpi, RTI International, Atlanta, Georgia, USA
| | - Alan E. Mast
- Blood Research Institute, Versiti, Milwaukee, Wisconsin, USA
- Department of Cell Biology, Neurobiology and Anatomy, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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Fields VL, Soke GN, Reynolds A, Tian LH, Wiggins L, Maenner M, DiGuiseppi C, Kral TVE, Hightshoe K, Ladd-Acosta C, Schieve LA. Association between pica and gastrointestinal symptoms in preschoolers with and without autism spectrum disorder: Study to Explore Early Development. Disabil Health J 2020; 14:101052. [PMID: 33358227 DOI: 10.1016/j.dhjo.2020.101052] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 10/16/2020] [Accepted: 12/09/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Pica, the repeated ingestion of nonfood items, can result in gastrointestinal (GI) outcomes. Children with autism spectrum disorder (ASD) and other developmental disabilities (DDs) are disproportionately affected by both pica and GI symptoms. Study of the inter-relationship between pica, GI symptoms, and ASD/DD is limited. OBJECTIVE/HYPOTHESIS We assessed associations between pica and GI symptoms in preschool-aged children with and without ASD and other (non-ASD) DDs in the Study to Explore Early Development. METHODS Our sample included children with ASD (n = 1244), other DDs (n = 1593), and population (POP) controls (n = 1487). Data to define final case-control status, pica, and GI symptoms were from standardized developmental assessments/questionnaires. Prevalence ratios, adjusted for sociodemographic factors (aPRs), and 95% confidence intervals were derived from modified Poisson regression. RESULTS Within each group (ASD, DD, POP) and for the total sample, pica was associated with vomiting (aPR for total sample 2.6 [1.7, 4.0]), diarrhea (1.8 [1.4, 2.2]), and loose stools (1.8 [1.4, 2.2]). In the DD group, pica was associated with constipation (1.4 [1.03, 1.9]) and pain on stooling (1.8 [1.2, 2.6]). In analyses of the subgroup without pica, increases in GI symptoms were still evident in the ASD and DD groups compared to POP group. CONCLUSION These findings highlight an important adverse effect of pica, GI symptoms, in children with and without ASD and DDs; nonetheless, pica does not fully explain the increased risk for GI symptoms among children with ASD and DDs. These findings inform the specialized healthcare needs of children with ASD and other DDs.
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Affiliation(s)
- Victoria L Fields
- Epidemic Intelligence Service Officer, Centers for Disease Control and Prevention, USA; National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Gnakub N Soke
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Ann Reynolds
- Department of Pediatrics, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Lin H Tian
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Lisa Wiggins
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Matthew Maenner
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Carolyn DiGuiseppi
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Tanja V E Kral
- School of Nursing and Perelman School of Medicine, Department of Biobehavioral Health Sciences, University of Pennsylvania, Philadelphia, PA, USA
| | - Kristina Hightshoe
- Department of Psychiatry, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | | | - Laura A Schieve
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Abstract
OBJECTIVES The aim of this study was to investigate the relationship between anthropometric characteristics and both geophagy and cognitive function of children. STUDY DESIGN The study prospectively followed singleton children whose mothers participated in the MiPPAD clinical trial in Allada, Benin, from birth to age 12 months. Anthropometric measurements were taken at birth and 9 and 12 months. Wasting, stunting and underweight were defined as weight-for-length, length-for-age and weight-for-age Z-scores less than -2, respectively. Cognitive and motor functions were assessed using the Mullen Scales of Early Learning. Parent-reported geophageous habits of children were collected when the children were 12 months. Multiple linear and logistic regressions were used to analyse the data. RESULTS A total of 632 children (49.7% girls) were involved in the study. Stunting, wasting and underweight were observed in 14.1%, 13.6% and 17.7%, respectively, at 9 months and 17.3%, 12.7% and 17.2%, respectively, at 12 months. The prevalence of geophagy among the children was 48.2%. Impaired growth at 9 and 12 months was consistently associated with low cognitive and gross motor (GM) score. Children stunted at 9 months had lower GM scores at 12 months compared with their non-stunted peers (β = -3.48, 95% confidence interval -6.62 to -0.35). CONCLUSIONS Stunting, wasting and underweight are associated with cognitive and GM deficits in infants. In this setting, impaired growth was not associated with geophagy. Further research evaluating geophagy and growth prospectively and concurrently from birth to 36 months is needed.
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Affiliation(s)
- Michael O Mireku
- School of Psychology, University of Lincoln, Lincoln, UK
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London W2 1PG, UK
| | - Michel Cot
- Mère et Enfant Face aux Infections Tropicales, Institut de Recherche pour le Développement (IRD), Paris, France
- Faculté des Sciences Pharmaceutiques et Biologiques, PRES Sorbonne Paris Cité, Université Paris Descartes, Paris, France
| | | | - Florence Bodeau-Livinec
- Département Méthodes Quantitatives en Santé Publique, Ecole des Hautes Etudes en Santé Publique, Saint-Denis, France
- Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in Pregnancy, Inserm UMR 1153, Paris Descartes University, Paris, France
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Konlan KD, Abdulai JA, Konlan KD, Amoah RM, Doat A. Practices of pica among pregnant women in a tertiary healthcare facility in Ghana. Nurs Open 2020; 7:783-792. [PMID: 32257266 PMCID: PMC7113508 DOI: 10.1002/nop2.451] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 01/03/2020] [Indexed: 01/31/2023] Open
Abstract
Aim This study assessed the practice of pica among pregnant women in the Ho Teaching Hospital. Design Descriptive cross-sectional. Methods Systematic sampling technique was used to recruit 286 pregnant women. Questionnaire was used to collect data. Data entered into Statistical Package for Social Sciences for analysis. Result Of the 286 pregnant women, 21.2% and 17.8% considered white clay and ice respectively as nutritious. Prevalence of pica was 47.5%, while 44.9% of pregnant women who practised pica reported they feel uncomfortable when they do not eat pica as 63.3% considered intake of pica as harmful. Among women who received education against pica practice, 49.4% have ever taken pica as 50.9% of them with education on effects of pica were currently engaged in the activity (χ2 = 1.93 p = .17). Conclusion Health professionals, especially midwives must intensify education on effects of pica among pregnant women.
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Affiliation(s)
- Kennedy Diema Konlan
- Department of Public Health NursingSchool of Nursing and MidwiferyUniversity of Health and Allied SciencesHoGhana
| | | | | | - Roberta Mensima Amoah
- Department of Public HealthSchool of Allied SciencesUniversity for Development StudiesTamaleGhana
| | - Abdul‐Razak Doat
- Nursing and Midwifery Training CollegeTamaleGhana
- Tehran University of Medical SciencesTehranIran
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13
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Kambunga SN, Candeias C, Hasheela I, Mouri H. Review of the nature of some geophagic materials and their potential health effects on pregnant women: some examples from Africa. Environ Geochem Health 2019; 41:2949-2975. [PMID: 30977022 DOI: 10.1007/s10653-019-00288-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 03/27/2019] [Indexed: 05/25/2023]
Abstract
The voluntary human consumption of soil known as geophagy is a global practice and deep-rooted in many African cultures. The nature of geophagic material varies widely from the types to the composition. Generally, clay and termite mound soils are the main materials consumed by geophagists. Several studies revealed that gestating women across the world consume more soil than other groups for numerous motives. These motivations are related to medicinal, cultural and nutrients supplementation. Although geophagy in pregnancy (GiP) is a universal dynamic habit, the highest prevalence has been reported in African countries such as Kenya, Ghana, Rwanda, Nigeria, Tanzania, and South Africa. Geophagy can be both beneficial and detrimental. Its health effects depend on the amount and composition of the ingested soils, which is subjective to the geology and soil formation processes. In most cases, the negative health effects concomitant with the practice of geophagy eclipse the positive effects. Therefore, knowledge about the nature of geophagic material and the health effects that might arise from their consumption is important.
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Affiliation(s)
- Selma N Kambunga
- Department of Geology, University of Johannesburg, Johannesburg, South Africa
| | - Carla Candeias
- GeoBioTec, Geosciences Department, University of Aveiro, Aveiro, Portugal
- EpiUnit, Public Health Institute, University of Porto, Porto, Portugal
| | - Israel Hasheela
- Environmental and Engineering Geology Division, Geological Survey of Namibia, Windhoek, Namibia
| | - Hassina Mouri
- Department of Geology, University of Johannesburg, Johannesburg, South Africa.
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Caillet P, Poirier M, Grall-Bronnec M, Marchal E, Pineau A, Pintas C, Carton V, Jolliet P, Winer N, Victorri-Vigneau C. High prevalence of kaolin consumption in migrant women living in a major urban area of France: A cross-sectional investigation. PLoS One 2019; 14:e0220557. [PMID: 31365572 PMCID: PMC6668907 DOI: 10.1371/journal.pone.0220557] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Accepted: 07/18/2019] [Indexed: 11/25/2022] Open
Abstract
Geophagia is a feeding behavior involving the regular intake of soil, including clay-like kaolin. Frequent in Africa, kaolin consumption is associated with heavy metal intoxication, iron and other micronutrient deficiencies, geohelminth infection and inactivation of concomitantly taken drugs. It is expected that this practice would be imported into an asylum country during the immigration process. To confirm this hypothesis, a single center, cross-sectional study was conducted at the University Hospital of Nantes, France, whose main objective was to assess whether the prevalence of kaolin consumers was high in a migrant population living in a large French metropolitan area (the city of Nantes). Each woman consulting for the first time at the Medical and Psychosocial Gynecology Obstetric Unit during the inclusion period ranging from January 1, 2017, to July 1, 2017, was asked for consent to be included in the study. The main outcome was the proportion of positive answers regarding consumption of kaolin within the last twelve months, with its 95% confidence interval (CI). A logistic regression was performed to identify drivers of consumption, and a clustering approach was conducted to identify profiles of consumers. A total of 284 women were included in the study, of whom 110 (38.7%) were pregnant. Our main finding was a 14.1% (95% CI: 10.5–18.6) prevalence of clay consumers. Second, the characteristic most strongly associated with consumption was Central or West Africa origin (adjusted Odds Ratio (aOR) = 52.7; 95% CI: 13.7–202.2). Finally, 60% of consumers showed signs of addictive-like phenomena, and three profiles were identified, depicting a continuum of patients in regard to their control over their kaolin consumption. Our results suggest that kaolin consumption is frequent in particular subpopulations of migrants. This warrants further study of the clinical consequences of kaolin consumption and its associated addictive-like symptoms.
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Affiliation(s)
- Pascal Caillet
- Department of Clinical Pharmacology, University Hospital of Nantes, Nantes, France
- * E-mail:
| | - Maud Poirier
- Department of Gynecology and Obstetrics, University Hospital of Nantes, Nantes, France
| | - Marie Grall-Bronnec
- Department of Addictology and Psychiatry, University Hospital of Nantes, Nantes, France
- SPHERE U1246 Unit, University of Nantes, University of Tours, INSERM, Nantes, France
| | - Edouard Marchal
- Department of Clinical Pharmacology, University Hospital of Nantes, Nantes, France
| | - Alain Pineau
- Department of Clinical Pharmacology, University Hospital of Nantes, Nantes, France
| | - Catherine Pintas
- Department of Gynecology and Obstetrics, University Hospital of Nantes, Nantes, France
| | - Véronique Carton
- Department of Gynecology and Obstetrics, University Hospital of Nantes, Nantes, France
| | - Pascale Jolliet
- Department of Clinical Pharmacology, University Hospital of Nantes, Nantes, France
- SPHERE U1246 Unit, University of Nantes, University of Tours, INSERM, Nantes, France
| | - Norbert Winer
- Department of Gynecology and Obstetrics, University Hospital of Nantes, Nantes, France
- INRA, UMR 1280, Physiology of Nutritional Adaptations, University of Nantes, IMAD, Nantes, France
| | - Caroline Victorri-Vigneau
- Department of Clinical Pharmacology, University Hospital of Nantes, Nantes, France
- SPHERE U1246 Unit, University of Nantes, University of Tours, INSERM, Nantes, France
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Chung EO, Mattah B, Hickey MD, Salmen CR, Milner EM, Bukusi EA, Brashares JS, Young SL, Fernald LCH, Fiorella KJ. Characteristics of Pica Behavior among Mothers around Lake Victoria, Kenya: A Cross-Sectional Study. Int J Environ Res Public Health 2019; 16:E2510. [PMID: 31337101 PMCID: PMC6679355 DOI: 10.3390/ijerph16142510] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 07/08/2019] [Accepted: 07/10/2019] [Indexed: 11/16/2022]
Abstract
Background: Pica, the craving and purposeful consumption of nonfoods, is poorly understood. We described the prevalence of pica among women on Mfangano Island, Kenya, and examined sociodemographic and health correlates. Methods: Our cross-sectional study included 299 pregnant or postpartum women in 2012. We used a 24-h recall to assess pica, defined as consumption of earth (geophagy), charcoal/ash, or raw starches (amylophagy) and built multivariable logistic regression models to examine sociodemographic and health correlates of pica. Results: Eighty-one women (27.1%) engaged in pica in the previous 24 h, with 59.3% reporting amylophagy and 56.8% reporting geophagy, charcoal, and/or ash consumption. The most common substances consumed were raw cassava (n = 30, 36.6%), odowa, a chalky, soft rock-like earth (n = 21, 25.6%), and soil (n = 17, 20.7%). Geophagy, charcoal, and/or ash consumption was negatively associated with breastfeeding (OR = 0.38, 95% CI: 0.18-0.81), and amylophagy was associated with pregnancy (OR = 4.31, 95% CI: 1.24-14.96). Pica was more common within one of six study regions (OR = 3.64, 95% CI: 1.39-9.51). We found no evidence of an association between food insecurity and pica. Conclusion: Pica was a common behavior among women, and the prevalence underscores the need to uncover its dietary, environmental, and cultural etiologies.
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Affiliation(s)
- Esther O Chung
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, McGavran-Greenberg Hall, CB #7435, Chapel Hill, NC 27599-7435, USA.
| | - Brian Mattah
- Ekialo Kiona Research Dept, Organic Health Response, Mbita, P.O. Box 224-40305, Kenya
| | - Matthew D Hickey
- Division of HIV, Infectious Disease, and Global Medicine, Department of Medicine, UCSF, 1001 Potrero Ave, San Francisco, CA 94110, USA
| | - Charles R Salmen
- Ekialo Kiona Research Dept, Organic Health Response, Mbita, P.O. Box 224-40305, Kenya
- Department of Family Medicine and Community Health, University of Minnesota, 5516 Delaware St SE, Minneapolis, MN 55455, USA
| | - Erin M Milner
- Bureau for Global Health, USAID, Washington, DC 20001, USA
| | - Elizabeth A Bukusi
- Centre for Microbiology Research, Kenya Medical Research Institute, Hospital Road, Nairobi 00100, Kenya
| | - Justin S Brashares
- Department of Environmental Science, Policy, and Management, University of California, Berkeley, 130 Mulford Hall #3114, Berkeley, CA 94720, USA
| | - Sera L Young
- Department of Anthropology, Northwestern University, 1810 Hinman Avenue, Evanston, IL 60208, USA
| | - Lia C H Fernald
- Division of Community Health Sciences, School of Public Health, University of California, Berkeley, 2121 Berkeley Way, Room 5302, Berkeley, CA 94720-7360, USA
| | - Kathryn J Fiorella
- Master of Public Health Program, Department of Population Medicine and Diagnostic Sciences, Cornell University, S2-004 Shurman Hall, Ithaca, NY 14853, USA
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Vofo BN, Vofo GVFN, Fonge BA, Nsagha DS, Egbe TO, Assob JCN. High umbilical cord blood lead levels and "calabar chalk" consumption amongst pregnant women in two hospitals in Cameroon. Pan Afr Med J 2019; 33:109. [PMID: 31489087 PMCID: PMC6711677 DOI: 10.11604/pamj.2019.33.109.13999] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Accepted: 05/02/2019] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION "Calabar chalk" is a lead-laden pica mostly consumed by pregnant women worldwide as a remedy for morning sickness. This clay material has been shown to have lead levels of up to 40mg per kilogram. Meanwhile blood lead levels, even at doses less than 10μg/dl will be toxic to humans and even worse-off to the fetus as it crosses the placenta. We, therefore, sort to determine the prevalence of "Calabar chalk" consumption amongst pregnant women and if it translates to higher umbilical cord blood lead levels. METHODS We carried out a cross-sectional study by prospectively and consecutively enrolling 300 pregnant women from December 2014 through February 2015. A questionnaire was administered to ascertain "Calabar chalk" consumption. The levels of lead in the umbilical cord blood of 51 participants of each group of those who consumed and didn't consume "Calabar chalk" were measured by spectrometry and compared using the T-test (p<0.05). RESULTS The prevalence of "Calabar chalk" consumption was 43.33%. This was mostly consumed during pregnancy only (46.34%), with higher rates observed amongst primigravidas. The mean umbilical blood lead levels amongst those who consumed and those who did not consume "Calabar chalk" was 39.19μg/dl and 25.33μg/dl respectively (P=0.111). CONCLUSION The prevalence of "Calabar chalk" consumption was high in the pregnant women population. The overall umbilical cord blood lead levels were extremely high in both consumers and non-consumers. We recommend health education and chelation therapy to be considered.
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Affiliation(s)
- Brice Nguedia Vofo
- Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of Buea, South West Region, Cameroon
| | | | - Beatrice Ambo Fonge
- Department of Botany, Faculty of Science, University of Buea, South West Region, Cameroon
| | - Dickson Shey Nsagha
- Department of Public Health and Hygiene, Faculty of Health Sciences, University of Buea, South West Region, Cameroon
| | - Thomas Obinchemti Egbe
- Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of Buea, South West Region, Cameroon
| | - Jules Clement Nguedia Assob
- Department of Medical Laboratory Sciences, Faculty of Health Sciences, University of Buea, South West Region, Cameroon
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Abstract
BACKGROUND Calcium is a major nutrient implicated in pregnancy-induced hypertension (PIH). Aside dietary sources, geophagia has been reported to provide calcium needed to prevent PIH. These soils are shown to contain significant amount of heavy metals which have been associated with hypertension. OBJECTIVE The aim of this study was to determine the relationship between geophagia and PIH, assess the dietary intakes and health of participants. METHODS This study was a case-control involving 30 women with PIH and 70 normotensive pregnant women. RESULTS Geophagia was not significantly associated with PIH. Women with PIH practicing geophagia recorded significantly low levels of haemoglobin, calcium and ferritin. Hypertensives recorded impaired fasting blood glucose (5.77±1.71mmol/L, p=0.051), higher levels of urea (3.60±1.29 mmol/L, p=0.000) and creatinine (382.67±11.66 µmol/L, p=0.000). Percentage intakes of macronutrients for normotensives were within the Adequate Macronutrient Distribution Range and PIH group recorded higher intakes of carbohydrate (72.75±16.16 %), lower protein (9.77±5.61 %) and fat (17.15±11.99%). Dietary calcium intakes in both groups were lower than recommended (< 1,000 mg/day). CONCLUSION In this study, geophagia during pregnancy is not directly associated with PIH but is detrimental to maternal health. The pregnant women in this study had considerably low intakes of energy and nutrients. There is a need for measures to ensure adequate maternal nutrition for a positive health and pregnancy outcomes.
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Affiliation(s)
- Deborah Sakua Sackey
- Department of Biochemistry and Biotechnology, College of Science, Kwame Nkrumah. University of Science and Technology, Kumasi, Ghana
| | - Christopher Larbie
- Department of Biochemistry and Biotechnology, College of Science, Kwame Nkrumah. University of Science and Technology, Kumasi, Ghana
| | - Faustina O Mensah
- Department of Biochemistry and Biotechnology, College of Science, Kwame Nkrumah. University of Science and Technology, Kumasi, Ghana
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18
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Hartmann AS, Poulain T, Vogel M, Hiemisch A, Kiess W, Hilbert A. Prevalence of pica and rumination behaviors in German children aged 7-14 and their associations with feeding, eating, and general psychopathology: a population-based study. Eur Child Adolesc Psychiatry 2018; 27:1499-1508. [PMID: 29675593 DOI: 10.1007/s00787-018-1153-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 04/02/2018] [Indexed: 12/23/2022]
Abstract
Despite potentially severe medical consequences of pica and rumination disorder (RD), little is known about their prevalence and association with other psychopathology in childhood. As a part of a larger population-based study, 804 children aged 7-14 years and their parents were asked about their experience of pica and RD behaviors, and associated eating, feeding and general psychopathology. A total of 12.31 and 11.49% of the participants reported having engaged in pica or RD behaviors, respectively, at least once. Recurring pica or RD behaviors had been experienced by 4.98 and 1.49% of the participants, respectively. The behaviors showed a significant but small correlation with one another (r = 0.28, p < 0.01). Correlations with symptoms of avoidant/restrictive food intake disorder (ARFID) were significant but small (pica: r = 0.18, RD: r = 0.27, both p < 0.01). Prevalence rates of recurring pica behavior were significantly increased if recurring RD was present (58.33%), and also vice versa (17.50%). The prevalence rates of recurrent pica and RD behaviors were also increased in the presence of an ARFID diagnosis (both behaviors 12.0%). However, correlations with restraint and eating, weight, and shape concern were non-significant (all p > 0.05). Additionally, RD behavior was positively correlated with emotional and conduct problems (r = 0.15 and 0.22, both p < 0.01), and both behaviors were negatively correlated with prosocial behavior (r = - 0.10 and - 0.09, both p < 0.05). Our findings underscore the clinical significance of pica and RD behaviors. More research is warranted on both disorders and their association and relation with ARFID to deepen the understanding of their presentation and to ascertain diagnostic validity.
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Affiliation(s)
- Andrea S Hartmann
- Institute of Psychology, Department of Human Sciences, Osnabrück University, Knollstrasse 15, 49069, Osnabrück, Germany.
| | - Tanja Poulain
- LIFE Leipzig Research Center for Civilization Diseases, University of Leipzig, Philipp-Rosenthal-Strasse 27, 04103, Leipzig, Germany
- Center for Pediatric Research, Hospital for Children and Adolescents, University of Leipzig Medical Center, Liebigstrasse 20a, 04103, Leipzig, Germany
| | - Mandy Vogel
- LIFE Leipzig Research Center for Civilization Diseases, University of Leipzig, Philipp-Rosenthal-Strasse 27, 04103, Leipzig, Germany
- Center for Pediatric Research, Hospital for Children and Adolescents, University of Leipzig Medical Center, Liebigstrasse 20a, 04103, Leipzig, Germany
| | - Andreas Hiemisch
- LIFE Leipzig Research Center for Civilization Diseases, University of Leipzig, Philipp-Rosenthal-Strasse 27, 04103, Leipzig, Germany
- Center for Pediatric Research, Hospital for Children and Adolescents, University of Leipzig Medical Center, Liebigstrasse 20a, 04103, Leipzig, Germany
| | - Wieland Kiess
- LIFE Leipzig Research Center for Civilization Diseases, University of Leipzig, Philipp-Rosenthal-Strasse 27, 04103, Leipzig, Germany
- Center for Pediatric Research, Hospital for Children and Adolescents, University of Leipzig Medical Center, Liebigstrasse 20a, 04103, Leipzig, Germany
| | - Anja Hilbert
- Department of Medical Psychology and Medical Sociology, Department of Psychosomatic Medicine and Psychotherapy, Integrated Research and Treatment Center Adiposity Diseases, University of Leipzig Medical Center, Philipp-Rosenthal-Strasse 27, 04103, Leipzig, Germany
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Ngole-Jeme VM, Ekosse GIE, Songca SP. An analysis of human exposure to trace elements from deliberate soil ingestion and associated health risks. J Expo Sci Environ Epidemiol 2018; 28:55-63. [PMID: 27924816 DOI: 10.1038/jes.2016.67] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Revised: 10/13/2016] [Accepted: 10/25/2016] [Indexed: 06/06/2023]
Abstract
Fifty-seven samples of soils commonly ingested in South Africa, Swaziland, Democratic Republic of Congo (DRC), and Togo were analyzed for the concentrations of arsenic (As), cadmium (Cd), cobalt (Co), chromium (Cr), copper (Cu), lead (Pb), manganese (Mn), nickel (Ni), and zinc (Zn) and their bioaccessibility in the human gastrointestinal tract. Bioaccessibility values were used to calculate daily intake, and hazard quotient of each trace element, and chronic hazard index (CHI) of each sample. Carcinogenic risk associated with As and Ni exposure were also calculated. Mean pseudo-total concentrations of trace elements in all samples were 7.2, 83.3, 77.1, 15.4, 28.6, 24.9, 56.1, 2.8, and 26.5 mg/kg for As, Cr, Mn, Co, Ni, Cu, Zn, Cd, and Pb, respectively. Percent bioaccessibility of Pb (13-49%) and Zn (38-56%) were highest among trace elements studied. Average daily intake values were lower than their respective reference doses for ell elements except for Pb in selected samples. Samples from DRC presented the highest health risks associated with trace element exposure with most of the samples having CHI values between 0.5 and 1.0. Some samples had higher than unacceptable values of carcinogenic risk associated with As and Ni exposure. Results indicate low trace element exposure risk from ingesting most of the soil samples.
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Affiliation(s)
- Veronica M Ngole-Jeme
- Department of Environmental Sciences, School of Environmental Sciences, College of Agriculture and Environmental Sciences, University of South Africa, Florida 1710, Roodepoort, South Africa
| | - Georges-Ive E Ekosse
- Directorate of Research and Innovation, University of Venda, Private Bag X5050, Thohoyandou, Limpopo Province 0950, South Africa
| | - Sandile P Songca
- Office of the Deputy Vice Chancellor, Teaching and Learning, University of Zululand, Private Bag X1001, KwaDlangezwa 3886, KwaZulu-Natal, South Africa
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20
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Gundacker C, Kutalek R, Glaunach R, Deweis C, Hengstschläger M, Prinz A. Geophagy during pregnancy: Is there a health risk for infants? Environ Res 2017; 156:145-147. [PMID: 28342960 DOI: 10.1016/j.envres.2017.03.028] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Revised: 03/17/2017] [Accepted: 03/17/2017] [Indexed: 05/04/2023]
Abstract
Prenatal lead exposure is a public health concern. Geophagy, the practice of soil eating, is documented for pregnant women of sub-Saharan Africa to treat pregnancy-related malaise. The soils however can contain substantial amounts of lead. In an exploratory study on 48 mother-child pairs in the Democratic Republic of Congo, we found striking site-specific differences in prenatal lead exposure, i.e., higher lead levels at Kisangani than at Isiro. Kisangani women consumed 1/ more often soil during the first trimester of pregnancy as well as 2/ a different type of soil compared to Isiro women (P<0.05). We conclude geophagy may be a potential source of prenatal lead exposure.
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Affiliation(s)
- Claudia Gundacker
- Institute of Medical Genetics, Center of Pathobiochemistry and Genetics, Medical University of Vienna, Vienna, Austria
| | - Ruth Kutalek
- Department of Social and Preventive Medicine, Center for Public Health, Medical University of Vienna, Kinderspitalgasse 15, A-1090 Vienna, Austria.
| | - Rosina Glaunach
- Department of General Practice and Family Medicine, Center for Public Health, Medical University of Vienna, Vienna, Austria
| | - Coloman Deweis
- Department of General Practice and Family Medicine, Center for Public Health, Medical University of Vienna, Vienna, Austria
| | - Markus Hengstschläger
- Institute of Medical Genetics, Center of Pathobiochemistry and Genetics, Medical University of Vienna, Vienna, Austria
| | - Armin Prinz
- Department of General Practice and Family Medicine, Center for Public Health, Medical University of Vienna, Vienna, Austria
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21
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Ardeshirian KA, Howarth DA. Esperance pica study. Aust Fam Physician 2017; 46:243-248. [PMID: 28376581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND Pica, the eating of non-foods, occurs particularly in children and pregnant women. It has been observed in communities all over the world. Pica is associated with iron deficiency and, in some environments, lead poisoning. This is the first time a study has assessed the prevalence of pica in Australia. METHODS The study assessed the prevalence of pica in an Australian rural community, using a questionnaire given to parents of 223 children aged 2-10 years attending the five general practice surgeries in the shire. RESULTS The prevalence of non-ice pica in the study group was 9.4%, and 3.6% of this group ate soil. DISCUSSION The presence of pica should alert the treating clinician to consider iron deficiency and, in the case of polluted environments, lead exposure.
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Nafil H, Tazi I, Mahmal L. [Prevalence of pica in iron deficiency anemia in Marrakech (Morocco)]. Med Sante Trop 2015; 25:273-275. [PMID: 26103958 DOI: 10.1684/mst.2013.0199] [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] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
INTRODUCTION Pica is an eating disorder, defined by long-term ingestion of non-nutritive substances. PURPOSE To determine the frequency of pica in patients with iron deficiency anemia and to describe the population with both iron deficiency anemia and pica. PATIENTS AND METHODS This retrospective study examined records from the department of hematology at the Mohammed VI University Hospital Center in Marrakech of all adult patients seen from January 1, 2005, through December 31, 2010 who met both criteria. Results: During the 6-year study period, 320 patients with iron deficiency anemia were seen: 256 women and 64 men (sex-ratio F/M: 4). The prevalence of pica among the patients with iron deficiency anemia was 17.5% (56/320). All the patients with pica were women, for a prevalence of 21.8% (56/256); their average age was 23 years; 40 were white (71.4%) and 16 black (28.6%). The clinical signs were primarily pallor (100%) and asthenia (100%). The mean level of hemoglobin was 7.6 g/dL and of ferritin, 6.4 mg/L. Geophagia was the most common form of pica (75%). Iron supplementation induced regression of pica in 64.3% of patients. CONCLUSION Our study shows a high prevalence of pica in patients with iron deficiency anemia.
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Affiliation(s)
- H Nafil
- Service d'hématologie, CHU Mohammed VI, Amerchiche, 40000 Marrakech, Maroc, Université Cadi Ayyad, Maroc
| | - I Tazi
- Service d'hématologie, CHU Mohammed VI, Amerchiche, 40000 Marrakech, Maroc, Université Cadi Ayyad, Maroc
| | - L Mahmal
- Service d'hématologie, CHU Mohammed VI, Amerchiche, 40000 Marrakech, Maroc, Université Cadi Ayyad, Maroc
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Aloni MN, Lecerf P, Lê PQ, Heijmans C, Huybrechts S, Devalck C, Azzi N, Ngalula-Mujinga M, Ferster A. Is Pica under-reported in children with sickle cell disease? A pilot study in a Belgian cohort. ACTA ACUST UNITED AC 2014; 20:429-32. [PMID: 25494639 DOI: 10.1179/1607845414y.0000000219] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
BACKGROUND For centuries, writers have recorded their observations on pica. Nevertheless the association of pica with sickle cell disease (SCD) was poorly documented. METHODS Cross-sectional evaluation performed on SCD children and caregivers attending the outpatient clinic who were invited to complete questionnaires assessing behavior of pica. RESULTS Out of 55 sickle cell children, 31(56.4%) reported practicing pica regularly. Substances ingested by patients covered a broad spectrum. Compared with the non-pica group, subjects who reported pica were younger and had lower hemoglobin (8.3 g/dl (7.6-9.7) vs. 9.1 g/dl (7.9-10.5): P < 0.01). The level of ferritin, zinc, copper, and lead was similar between the pica and non-pica groups (P > 0.05). Discussion In this series, there are many substances consumed by SCD children and adolescents, and we did not find an occurrence of similar substances among this select group. Pica children were younger and more anemic than non-pica patients. CONCLUSION This study suggests that pica remains an unknown and under-reported clinical problem in children with SCD and seems to be related to the severity of anemia. The next step of this project aims to clarify causal mechanisms for pica and its association with SCD in a larger population.
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Uchida T, Kawati Y. [Pagophagia in iron deficiency anemia]. Rinsho Ketsueki 2014; 55:436-439. [PMID: 24850454] [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: 06/03/2023]
Abstract
The relationship between pagophagia (ice pica) and iron deficiency anemia was studied. All 81 patients with iron deficiency anemia defined as hemoglobin <12.0 g/dl and ferritin level <12 ng/ml were interviewed about their habits of eating ice or other non-food substances. Pagophagia was defined as compulsive and repeated ingestion of at least one tray of ice or ice eating which was relieved after iron administration. Pagophagia was present in 13 patients (16.0%). All patients who received oral iron were periodically assessed employing a questionnaire on pagophagia and laboratory data. Iron therapy can cure the pagophagia earlier than hemoglobin recovery and repair of tissue iron deficiency. Although the pathogenesis of pagophagia is unclear, a biochemical approach involving the central nervous system might elucidate the mechanism underlying these abnormal behaviors.
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Sumbele IU, Ngole VM, Ekosse GIE. Influence of physico-chemistry and mineralogy on the occurrence of geohelminths in geophagic soils from selected communities in the Eastern Cape, South Africa, and their possible implication on human health. Int J Environ Health Res 2013; 24:18-30. [PMID: 23574040 DOI: 10.1080/09603123.2013.782600] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Geophagic soils from selected communities in Eastern Cape, South Africa were characterised to determine their properties and geohelminth content. The soils were coarse-textured with cation exchange capacity values ranging from 6.35 to 18.94 cmol (+)/kg. Quartz was the dominant mineral in the samples with SiO2, Al2O3, and Fe2O3(t) having the highest concentrations among major element oxides. The soil properties, mineralogical composition, and low amounts of particle binding substances may favour the survival of geohelminth ova in the soils. Seven of the samples contained at least one of the following geohelminths: Ascaris lumbricoides, Trichuris trichiura, Necator americanus, Ancylostoma duodenale and Strongyloides stercoralis. The presence of these geohelminths in the soils was attributed to agricultural and sanitary practices inherent in the communities and the soil properties. Communities need to be sensitised on the importance of safe sanitary and animal husbandry practices to reduce the prevalence of helminth infection among geophagists.
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Affiliation(s)
- Irene U Sumbele
- a Faculty of Science, Department of Zoology and Animal Physiology , University of Buea , Buea , Cameroon
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Abrahams PW, Davies TC, Solomon AO, Trow AJ, Wragg J. Human geophagia, calabash chalk and undongo: mineral element nutritional implications. PLoS One 2013; 8:e53304. [PMID: 23308189 PMCID: PMC3538771 DOI: 10.1371/journal.pone.0053304] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2012] [Accepted: 11/30/2012] [Indexed: 11/30/2022] Open
Abstract
The prime aim of our work is to report and comment on the bioaccessible concentrations – i.e., the soluble content of chemical elements in the gastrointestinal environment that is available for absorption – of a number of essential mineral nutrients and potentially harmful elements (PHEs) associated with the deliberate ingestion of African geophagical materials, namely Calabash chalk and Undongo. The pseudo-total concentrations of 13 mineral nutrients/PHEs were quantified following a nitric-perchloric acid digestion of nine different Calabash chalk samples, and bioaccessible contents of eight of these chemical elements were determined in simulated saliva/gastric and intestinal solutions obtained via use of the Fed ORganic Estimation human Simulation Test (FOREhST) in vitro procedure. The Calabash chalk pseudo-total content of the chemical elements is often below what may be regarded as average for soils/shales, and no concentration is excessively high. The in vitro leachate solutions had concentrations that were often lower than those of the blanks used in our experimental procedure, indicative of effective adsorption: lead, a PHE about which concern has been previously raised in connection with the consumption of Calabash chalk, was one such chemical element where this was evident. However, some concentrations in the leachate solutions are suggestive that Calabash chalk can be a source of chemical elements to humans in bioaccessible form, although generally the materials appear to be only a modest supplier: this applies even to iron, a mineral nutrient that has often been linked to the benefits of geophagia in previous academic literature. Our investigations indicate that at the reported rates of ingestion, Calabash chalk on the whole is not an important source of mineral nutrients or PHEs to humans. Similarly, although Undongo contains elevated pseudo-total concentrations of chromium and nickel, this soil is not a significant source to humans for any of the bioaccessible elements investigated.
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Affiliation(s)
- Peter W Abrahams
- Institute of Geography and Earth Sciences, Aberystwyth University, Ceredigion, United Kingdom.
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Golden CD, Rasolofoniaina BJR, Benjamin R, Young SL. Pica and amylophagy are common among Malagasy men, women and children. PLoS One 2012; 7:e47129. [PMID: 23082143 PMCID: PMC3474809 DOI: 10.1371/journal.pone.0047129] [Citation(s) in RCA: 17] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2012] [Accepted: 09/10/2012] [Indexed: 11/19/2022] Open
Abstract
Pica, the craving and purposive consumption of non-food substances, is of public health concern for its potential deleterious and salubrious health consequences. However, neither its prevalence nor demographic correlates have been well characterized. Therefore, we conducted the first population-based study of pica and amylophagy in Madagascar. From February to December 2009, we surveyed pica and amylophagy behaviors in a random sample of 760 individuals >5 years in 167 households among two ethnic groups in 16 villages in the Makira Protected Area of Madagascar. Of the 760 individuals interviewed, 62.5% were children (5–11 years), 5.4% were adolescents (12–16 years), and 35.1% were adults (≥17 years). Thirteen non-food items were reported being consumed. Across the entire population in the prior year, the prevalence of geophagy was 53.4%, of amylophagy, 85.2%, and of other pica substances (e.g. charcoal, chalk) was 19.0%. The prevalence of these behaviors was not higher during pregnancy. These findings differ from previous studies in terms of the higher overall prevalence of these behaviors, the high prevalence among men, and the absence of any peak in behaviors during pregnancy. However, there are two categories of substances that elevate our estimates but fall outside the strict definition of pica as a craving: 1) substances consumed for self-medication and 2) substances viewed as food, such as all amylophagic substances in this case. Our results suggest that population-based studies of pica should include males of all ages. Further, the prevalence of the behavior underscores the importance of understanding the etiology and health consequences of these ingestive behaviors (Abstract S1).
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Khosrof Ben Jaafar S, Aouidet A, Gharbi N. Pica, parasites and anemia among women from 15 to 49 years of age in Tunisia. Tunis Med 2012; 90:502-505. [PMID: 22693103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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Doyle JR, Blais JM, White PA. A survey of the traditional food consumption that may contribute to enhanced soil ingestion in a Canadian First Nation community. Sci Total Environ 2012; 424:104-109. [PMID: 22459881 DOI: 10.1016/j.scitotenv.2012.02.044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2011] [Revised: 02/19/2012] [Accepted: 02/20/2012] [Indexed: 05/31/2023]
Abstract
Soil ingestion rates in the order of 400 mg d(-1) have been proposed and considered plausible for use in human health risk assessments (HHRA) of Aboriginal populations and justified by qualitative assessments of the traditional subsistence activities that could enhance soil ingestion. The purpose of this study was to assess and document the subsistence activities and food consumption practiced by a First Nation Community living in a wilderness community in Canada to allow for a comparison with the previous qualitative assessments of Aboriginal populations and a quantitative mass balance tracer element study of the community conducted concurrently. An ethno-cultural survey was conducted of the Xeni Gwet'in First Nations community living in the Nemiah Valley, approximately 230 km west of Williams Lake, British Columbia. The community diet was observed to consist mainly of fish and big game, and was supplemented by berries and roots. Outdoor cultural gatherings, hunting and food gathering trips and sporting events, with their attendant potential for enhanced soil exposure, were observed to be an important facet of community life. The survey concluded that a significant portion of the Xeni Gwet'in practise a lifestyle similar to the subsistence lifestyles of other indigenous communities, where soil exposure scenarios in the order of hundreds of mg d(-1) have been proposed.
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Affiliation(s)
- J R Doyle
- Chemical and Environmental Toxicology Program, University of Ottawa, Ottawa, Canada.
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Doyle JR, Blais JM, Holmes RD, White PA. A soil ingestion pilot study of a population following a traditional lifestyle typical of rural or wilderness areas. Sci Total Environ 2012; 424:110-20. [PMID: 22459882 DOI: 10.1016/j.scitotenv.2012.02.043] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2011] [Revised: 02/19/2012] [Accepted: 02/20/2012] [Indexed: 05/19/2023]
Abstract
The relatively few soil ingestion studies underpinning the recommended soil ingestion rates for contaminated site human health risk assessments (HHRAs) that have been conducted to date assessed soil ingestion in children living in urban or suburban areas of the United States, and to a lesser extent, Europe. However, the lifestyle of populations living in North American urban and suburban environments is expected to involve limited direct contact with soil. Conversely, many populations, such as indigenous and Aboriginal peoples residing in rural and wilderness areas of North America and worldwide, participate in activities that increase the frequency of direct contact with soil. Qualitative exposure of Aboriginal populations inhabiting wilderness areas suggest that high levels of soil ingestion may occur that are many times greater than those recommended by regulatory agencies for use in HHRAs. Accordingly, a study of subjects selected from a wilderness community in Canada was conducted using mass balance tracer methods to estimate soil ingestion and the results compared with previous soil ingestion studies and regulatory guidelines for the soil ingestion rates used in HHRA of contaminated sites. A pilot study of 7 subjects living in the Nemiah Valley of British Columbia was conducted over a 3-week period. The mean soil ingestion rate estimated in this study using the 4 elemental tracers with the lowest food-to-soil ratios (i.e., Al, Ce, La, Si), was observed to be approximately 75 mg d(-1) (standard deviation 120 mg d(-1)), the median soil ingestion rate was 50 mg d(-1), and the 90th percentile was 211 mg d(-1). These soil ingestion rate estimates are higher than the soil ingestion estimates currently recommended for HHRAs of adults, and higher than those obtained in most previous studies of adults. However, the estimates are lower than the earlier qualitative assessments of subsistence lifestyles.
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Affiliation(s)
- J R Doyle
- Chemical and Environmental Toxicology Program, University of Ottawa, Ottawa, Canada.
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Karadaş C, Kara D. In vitro gastro-intestinal method for the assessment of heavy metal bioavailability in contaminated soils. Environ Sci Pollut Res Int 2011; 18:620-628. [PMID: 21046270 DOI: 10.1007/s11356-010-0404-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2010] [Accepted: 10/11/2010] [Indexed: 05/30/2023]
Abstract
INTRODUCTION Balya and its associated villages which is a town of the Balikesir region of Turkey have very rich zinc, lead, and manganese mines. These mines have been operating since the thirteenth century and now there is heavy metal contamination in both the soil and natural waters in these areas. MATERIALS AND METHODS Soils were collected from Sarı su, Enverpaşa, and Hastanetepe which are in Balya town and Kadıköy, Kaşıkcı, Müstecap, Patlak, Çakallar, and Bengiler which are the villages near Balya and the mine areas. Nine trace analytes (As, Ba, Cd, Cr, Cu, Mn, Ni, Pb, and Zn) were determined using an acid extraction procedure as well as from PBET in vitro gastro-intestinal experiments using ICP-OES. RESULTS AND DISCUSSION The results showed that high As, Ba, Pb, Zn, and Cd concentrations were found in these soils. The amounts ingested by pica behavior of children at the rate of 10 g day(-1) are calculated using the results of in vitro intestinal bio-accessibility experiments. CONCLUSION The results showed that the amount of As, Pb, Ba, and Cd levels ingested by pica behavior are substantially higher than tolerable daily intake values in most of the soils. When normal ingestion is taken into account, the tolerable daily limits are only exceeded for one element (Pb) and even then, only at two sites.
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Affiliation(s)
- Cennet Karadaş
- Department of Chemistry, Art and Science Faculty, Balikesir University, 10100, Balikesir, Turkey
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Kutalek R, Wewalka G, Gundacker C, Auer H, Wilson J, Haluza D, Huhulescu S, Hillier S, Sager M, Prinz A. Geophagy and potential health implications: geohelminths, microbes and heavy metals. Trans R Soc Trop Med Hyg 2010; 104:787-95. [PMID: 20889178 DOI: 10.1016/j.trstmh.2010.09.002] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2010] [Revised: 09/01/2010] [Accepted: 09/01/2010] [Indexed: 11/17/2022] Open
Affiliation(s)
- Ruth Kutalek
- Medical University of Vienna, Center for Public Health, Department of General Practice and Family Medicine, Unit Ethnomedicine and International Health, Waehringerstrasse 25, 1090 Vienna, Austria.
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Ashworth M, Hirdes JP, Martin L. The social and recreational characteristics of adults with intellectual disability and pica living in institutions. Res Dev Disabil 2009; 30:512-520. [PMID: 18789647 DOI: 10.1016/j.ridd.2008.07.010] [Citation(s) in RCA: 21] [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] [Subscribe] [Scholar Register] [Received: 07/21/2008] [Accepted: 07/27/2008] [Indexed: 05/26/2023]
Abstract
This paper reports on the social life of adults with intellectual disability (ID) who engage in pica behaviour (i.e., ingestion of non-food items). Secondary analyses were conducted on the population of adults residing in Ontario's three remaining specialized institutions for persons with ID (N=1008); 220 individuals (21.8%) had pica. All persons were assessed using the interRAI Intellectual Disability assessment, a comprehensive and standardized instrument that supports person-centered service planning. A series of logistic regression models were used to evaluate the relationship between pica and various indicators of social relationships and activities, while controlling for a set of covariates. Pica was significantly associated with increased likelihood of not having a strong and supportive relationship with family, lack of social contact, absence of participation in activities of long-standing interest, absence of involvement in a day program, as well as lack of involvement in recreational activities; though it was not related to interpersonal conflict. Attention should be equally paid to the social correlates of pica rather than solely concentrate on its health risks. Implications for the community supports needed to ensure the successful transition of persons with pica from institutional to community settings is also discussed.
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Affiliation(s)
- Melody Ashworth
- Department of Human Development and Applied Psychology, Ontario Institute for Studies in Education, University of Toronto, 252 Bloor Street West, Toronto, Ontario, Canada.
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Tobiasson M, Alyass B, Söderlund S, Birgegård G. High prevalence of restless legs syndrome among patients with polycytemia vera treated with venesectio. Med Oncol 2009; 27:105-7. [PMID: 19225914 DOI: 10.1007/s12032-009-9180-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2009] [Accepted: 02/03/2009] [Indexed: 11/26/2022]
Abstract
In order to examine whether symptoms of iron deficiency anemia are due to the iron deficiency itself or the associated anemia, 34 patients with polycytemia vera (PV) treated with venesectio, who had iron deficiency but normal hemoglobin (Hb) levels, were given a questionnaire covering symptoms of iron deficiency including the international RLS-scale and the Fact-fatigue quality of life scale (QoL). We found a prevalence of pica of 11.7%, mouth paresthesias of 5.8% and rest-less legs 29.6% (RLS "normal" prevalence 10%). Thus, the prevalence of RLS is significantly higher in our population. We also saw a significant difference in QoL between patients with and without RLS (P = 0.015) and QoL correlated with the severity of RLS (R = 0.85). In conclusion, RLS seems to be a frequent and serious problem for PV patients treated with venesectio according to standard guidelines.
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Abstract
Food cravings, aversions and pica are common during pregnancy and may have a significant input on pregnancy progress and outcome. A study was carried out to determine the frequency and duration of pronounced dietary cravings, aversions and pica during pregnancy among 204 pregnant and lactating women attending two health facilities in Dar es Salaam City, Tanzania. Nausea and vomiting were reported by 82.8% of all women of which 43.2% experienced severe nausea alone, 9.5% severe vomiting alone and 35.5% experienced severe vomiting and nausea. Mild cases of each of the symptoms either occurring alone or both of them occurring together were also reported. Both behaviours were observed more in <3 months of pregnancy. The proportions of women with dietary cravings, aversions, and pica were 73.5%, 70.1% and 63.7% of all women respectively. More women (70.1%) experienced both food cravings and aversions than either symptom alone. Foods craved most were meat (23.3%), mangoes (22.7%), yoghurt (20.0%) oranges (20.0%), plantain (15.3%) and soft drinks (13.3%). Foods avoided most were rice (36.4%), meat (36.4%) and fish (30.8%). Eggs, beans, tea and stiff porridge were also avoided. Reasons given for avoiding foods were unpleasant smell/taste (10.3%), to reduce nausea (11.8%), no particular reason (58.3%) and dislike by foetus (belief) (3.9%). Pica was experienced by 63.7%% of the women and soil, ice and ash were the most commonly non-food substances eaten. The frequency of nausea and vomiting was highest in the early months of pregnancy and most women experienced the symptoms during morning hours. Craving in most women was more intense in the first trimesters. Most women craved for meat and sour and savoury foods, and avoided rice, meat and fish. Soil consumption was the pica observed in most women. Since aversions and cravings are closely linked to dietary intake of pregnant woman understanding these behaviours is important in addressing maternal nutrition.
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Affiliation(s)
- C N M Nyaruhucha
- Sokoine University of Agriculture, Department of Food Science and Technology, P.O .Box 3006, Morogoro, Tanzania.
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Louw VJ, du Preez P, Malan A, van Deventer L, van Wyk D, Joubert G. Pica and food craving in adult patients with iron deficiency in Bloemfontein, South Africa. S Afr Med J 2007; 97:1069-1071. [PMID: 18250914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023] Open
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Gonyea J. Pica--do you know what your patients are eating? Nephrol Nurs J 2007; 34:230-1. [PMID: 17486956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
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Abstract
BACKGROUND In the literature pica is reported to be prevalent in pregnant women. Most studies have focused on less privileged populations, but is pica prevalent among privileged pregnant women? METHODS 100,000 pregnant women in the Danish National Birth Cohort were asked about pica in a food frequency questionnaire mailed in gestation week 25. RESULTS The response rate of the questionnaire was 70% of Danish National Birth Cohort participants. Only 14 women reported to have eaten substances that were clearly not foods, i.e. 0.02% had pica in this cohort of well nourished Danish women. CONCLUSION It seems that, in privileged populations, pica is more a myth than a reality.
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Affiliation(s)
- Tina Broby Mikkelsen
- Maternal Nutrition Group, Danish Epidemiology Science Centre, Statens Serum Institut, Artillerivej 5, Copenhagen S, DK-2300, Denmark.
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Abstract
The paper reports epidemiological and phenomenological investigations of aberrant eating among 347 pre-adolescent children in court-ordered foster and kinship care, in New South Wales, Australia. A quarter of children displayed clinically significant aberrant eating problems, with no evidence of gender or age effects. Two distinct patterns were identified. The first is a pattern of excessive eating and food acquisition and maintenance behaviors without concurrent obesity (termed Food maintenance syndrome), resembling the behavioral correlates of Hyperphagic Short Stature (Psychosocial Dwarfism). Various data suggest this pattern is primarily triggered by acute stress, including maltreatment in care, against a background of complex psychopathology and developmental disabilities. The second is a cluster of pica-type eating behaviors that correlates with self-injurious behavior, and is closely associated with developmental disabilities. The paper includes recommendations for clinicians working with pre-adolescent children in care.
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Affiliation(s)
- Michael Tarren-Sweeney
- School of Education, University of Canterbury, Private Bag 4800, Christchurch, 8020, New Zealand.
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Viguria Padilla F, Miján de la Torre A. [Pica: the portrait of a little known clinical entity]. NUTR HOSP 2006; 21:557-66. [PMID: 17044601] [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: 05/12/2023] Open
Abstract
Pica is a eating disorder, of the eating behavior in childhood. It is defined as the persistent intake of non-nutritional substances for at least one month, in an inappropriate way from an evolutionary perspective, and provided that its practice is not culturally banned. Many animal species, including primates, have this behavior. Documented from antiquity, in most cases it has been considered a symptom of another related disorder rather than as independent condition. Its prevalence is unknown. It is mainly described in mentally disabled people, pregnant women, autism, mentally ill patients, children, and others. The ingestion of earth, ice, starch, ropes, wood, and other products has been observed, although some authors also include the obsessive and reiterative consumption of eatable substances. Geophagia is considered a cultural phenomenon, although sometimes may lead to disease, and an form of paleomedicine or paleonutrition. The etiology of pica is unknown and it has no markers. Sensitive, digestive, nutritional, psychological, and psychiatric factors have been implicated in its origin and maintenance. Although the morbimortality is unknown and difficult to study, we may highlight intoxications, parasitic diseases, and surgical abdomen with serious complications. Finally, as in other eating behavior disorders, the global management of this entity requires a coordinated intervention of different health care professionals.
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Affiliation(s)
- F Viguria Padilla
- Centro Atención Minusválidos Psíquicos (CAMP) Fuentes Blancas, Gerencia Servicios Sociales, Junta Castilla y León, Burgos
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Abstract
BACKGROUND Intellectually-disabled patients with acute abdominal conditions are susceptible to late diagnosis and adverse outcome due to impaired communication, altered behaviour, neurological impairment, associated congenital anomalies, variable reaction to pain and drugs and various difficulties in perioperative management. The present study aims to present the experience of surgery for acute abdominal conditions in intellectually-disabled patients. Various difficulties encountered during the management are highlighted and measures to overcome these problems are discussed. METHODS A prospective descriptive population study was performed through the prospective collection of data on consecutive intellectually-disabled adults operated for acute abdominal conditions over a 5-year period. Study parameters included demographic details, clinical presentation, diagnostic modalities, operative findings and outcome in terms of morbidity and mortality. RESULTS Of 19 men and three women with a mean age of 28.3 years, anorexia, vomiting, and increasing abdominal distension were the most common presenting features. History of pica was available in 36.4% of patients. Intestinal obstruction, acute appendicitis, volvulus and pseudo-obstruction of the colon were the most frequently encountered conditions. Postoperative morbidity and mortality were 33 and 23%, respectively. CONCLUSION Intellectually-disabled patients demand particular clinical expertise owing to various difficulties inherent to their mental and physical disabilities. Short history, anorexia, vomiting and abdominal distension should make the clinician aware of the possibility of an acute abdominal condition. History of pica should be considered a serious clinical correlate. A high index of clinical suspicion, intensive perioperative care and low threshold for an early operation are recommended to reduce the higher morbidity and mortality figures.
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Affiliation(s)
- Kamran Khalid
- Department of Surgery, King Saud University Unit, Riyadh Medical Complex, Riyadh, Kingdom of Saudi Arabia.
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Luoba AI, Geissler PW, Estambale B, Ouma JH, Magnussen P, Alusala D, Ayah R, Mwaniki D, Friis H. Geophagy among pregnant and lactating women in Bondo District, western Kenya. Trans R Soc Trop Med Hyg 2005; 98:734-41. [PMID: 15485704 DOI: 10.1016/j.trstmh.2004.01.009] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2003] [Revised: 01/15/2004] [Accepted: 01/15/2004] [Indexed: 11/26/2022] Open
Abstract
Geophagy was studied among 827 pregnant women in western Kenya, during and after pregnancy. The women were recruited at a gestational age of 14-24 weeks and followed-up to 6 months post-partum. The median age (range) of the women was 23 years and median parity 2. At recruitment, 378 were eating earth, of which most (65%) reported earth-eating before pregnancy. The preferred type of earth eaten was soft stone, known locally as odowa (54.2%) and earth from termite mounds (42.8%). The prevalence remained high during pregnancy, and then declined to 34.5% and 29.6% at 3 and 6 months post-partum respectively (P < 0.001). The mean daily earth intake was 44.5 g during pregnancy, which declined to 25.5 g during lactation (P < 0.001). A random sample of 204 stools was collected from the women and analysed for silica content as a tracer for earth-eating. The mean silica content was 2.1% of the dry weight of stool. Geophagous women had a higher mean silica content than the non-geophagous ones (3.1% vs. 1.4%, P < 0.001). Faecal silica and reported geophagy were strongly correlated (P < 0.001).
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Affiliation(s)
- Alfred I Luoba
- Divison of Vector-Borne Diseases, Ministry of Health, Kisumu, Kenya
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Abstract
BACKGROUND Up to 70% of young Nigerian children have been reported to have blood lead concentrations > or =10 microg/dl. AIMS To better elucidate risk factors for lead toxicity among Nigerian families with children at risk for lead toxicity. METHODS Two geographic wards in Jos, Nigeria were selected for study, one previously reported to have a high mean blood lead level (37 (SD 13) microg/dl) and one with a lower mean blood lead level (17 (SD 10) microg/dl) in young children. Data pertaining to potential risk factors for lead exposure were collected from children and adults in 34 households. RESULTS The mean (SD) blood lead concentration of 275 subjects, aged 3 weeks to 90 years, was 8.7 (5.7) microg/dl (range 1-34 microg/dl); 92 (34%) had concentrations > or =10 microg/dl. In multivariate analysis, an age of 5 years and under, flaking house paint, residence near a gasoline seller, male gender, increasing maternal and paternal education, and use of a lead ore eye cosmetic were independently associated with greater blood lead concentration. Vehicle ownership was associated with reduced lead concentration. Compared with the low-lead ward, residence in the high-lead ward remained significantly associated with greater lead values, indicating that additional factors likely contribute to lead exposure. CONCLUSION Although the cause of increased lead levels in Jos appears to be multi-factorial, several remediable sources contribute to lead exposure in Nigeria.
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Affiliation(s)
- N J Wright
- Las Vegas Clinic for Children and Youth, 501 7th Street, Las Vegas, New Mexico 87701, USA
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Kettaneh A, Eclache V, Fain O, Sontag C, Uzan M, Carbillon L, Stirnemann J, Thomas M. Pica and food craving in patients with iron-deficiency anemia: a case-control study in France. Am J Med 2005; 118:185-8. [PMID: 15694906 DOI: 10.1016/j.amjmed.2004.07.050] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2004] [Accepted: 07/09/2004] [Indexed: 11/20/2022]
Affiliation(s)
- Adrien Kettaneh
- Department of Internal Medicine, Hôpital Jean Verdier, Bondy, France.
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Kushner RF, Gleason B, Shanta-Retelny V. Reemergence of pica following gastric bypass surgery for obesity: a new presentation of an old problem. ACTA ACUST UNITED AC 2004; 104:1393-7. [PMID: 15354156 DOI: 10.1016/j.jada.2004.06.026] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Abstract Pica, the compulsive ingestion of nonnutritive substances, has been a fascinating and poorly understood phenomenon for centuries. Pagophagia, or ice eating, is one of the most common forms of pica and is closely associated with the development of iron-deficiency anemia. Although this condition has been well described among pregnant women and malnourished children, particularly in developing countries, it has not been previously reported to occur following gastric bypass surgery for treatment of severe obesity. This article presents two cases of women who experienced a recurrence of pagophagia following gastric bypass surgery, along with an updated review of the literature.
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Affiliation(s)
- Robert F Kushner
- Northwestern University Feinberg School of Medicine, Wellness Institute, Northwestern Memorial Hospital, 150 East Huron, Chicago, IL 60611, USA
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Garg M, Shaver MJ, Easom A. Pica. An underappreciated cause of electrolyte abnormalities. Nephrol News Issues 2004; 18:28-9, 33. [PMID: 15125162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Affiliation(s)
- Manish Garg
- University of Arkansas for Medical Sciences (UAMS), Little Rock, USA
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Nchito M, Geissler PW, Mubila L, Friis H, Olsen A. Effects of iron and multimicronutrient supplementation on geophagy: a two-by-two factorial study among Zambian schoolchildren in Lusaka. Trans R Soc Trop Med Hyg 2004; 98:218-27. [PMID: 15049460 DOI: 10.1016/s0035-9203(03)00045-2] [Citation(s) in RCA: 80] [Impact Index Per Article: 4.0] [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: 11/23/2022] Open
Abstract
Geophagy has been associated with iron deficiency and anaemia, but no causal relationship has been established. To clarify this, we conducted a two-by-two factorial randomised, controlled trial on the effect of iron and multimicronutrient supplementation on geophagy in Zambian schoolchildren in Lusaka, from February to December 2001. Of the 406 children, 212 (52.2%) were girls and the mean (range) age was 10.2 (7-15) years. Geophagy was reported by 302 (74.4%) and more often in girls than in boys (80.2 vs. 67.7%, P = 0.007). The mean (range) daily earth intake was 25.2 (1-200) g. Geophageous children had more often geophageous relatives than non-geophageous children (79.5 vs. 1.9%, P < 0.001). Geophageous children had lower serum ferritin (20.5 vs. 25.0 microg/l, P = 0.032) but not haemoglobin (Hb) (129.2 vs. 130.4 g/l, P = 0.59), than non-geophageous. Among those with Hb < 130 g/l, geophageous children had significantly higher prevalence (53.7 vs. 30.6%, P = 0.024) of Ascaris lumbricoides infection than non-geophageous. The prevalence of geophagy (74.4 to 51.6%) and the intake of earth (25.3 to 15.0 g/day) declined (P = 0.001 and P < 0.001, respectively) among the 220 (54.2%) children followed-up. In bivariate analysis, non-iron supplementation reduced the prevalence of geophagy more than iron supplementation did, but this was not confirmed in the multiple logistic regression analysis. Multimicronutrients had no effect on either geophagy prevalence or earth intake. Geophagy was prevalent and associated with iron deficiency, but iron supplementation had no effects on geophageous behaviour. Geophagy could be a copied behaviour and the association between geophagy and iron deficiency due to impaired iron absorption following earth eating.
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Affiliation(s)
- Mbiko Nchito
- The Department of Biological Sciences, University of Zambia, Lusaka, Zambia.
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López LB, Ortega Soler CR, de Portela MLPM. [Pica during pregnancy: a frequently underestimated problem]. Arch Latinoam Nutr 2004; 54:17-24. [PMID: 15332352] [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: 04/30/2023]
Abstract
Pica is the compulsive intake of non-nutritive substances such as earth, clay, chalk, soap and ice. The most common forms of pica are geophagia or the intake of earth and pagophagia or the intake of ice. The description of this peculiar phenomenon dates back to the Greco-Roman civilization. Its prevalence during pregnancy is generally underestimated. Published data reveal a prevalence of between 8% and 65%. Investigations from Latin America indicate a prevalence of 23% to 44%. It is not clear yet which are the causes that predispose to pica, but they are frequently associated with anemia or iron deficiency during pregnancy. Its diagnosis, which only consists in questioning pregnant women, is generally omitted during prenatal care, probably because health professionals have no knowledge about this disorder. The identification of pica in pregnant women could contribute to the detection of a risk group where it is necessary to implement strategies as regards both the evaluation and the nutritional education.
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Feely E, Garavan C, Kelleher K. Dead cattle, lead and child health. Ir Med J 2003; 96:232-4. [PMID: 14653373] [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: 04/27/2023]
Abstract
This study was carried out as part of a larger interagency investigation in response to concerns about human health following the death of three cattle from lead poisoning in an old lead mining area in Silvermines, Tipperary. Its aim was to screen for lead toxicity in the local child population. Screening consisted of measurement of blood lead concentrations and the completion of questionnaires regarding exposure to lead and general health. Pre-school and primary school children resident in four surrounding district electoral divisions (DEDs) were specifically targeted. One out of 334 (0.3%) children screened had an elevated blood lead concentration. The geometric mean lead concentration was 2.6 microg/dl which is below the intervention lead concentration of 10 microg/dl recommended by the CDC. The mean lead concentration in those aged under three years was statistically significantly higher than in those aged three years and over (3.4 microg/dl vs 2.5 microg/dl; p=0.000581). No specific health problems were identified by the questionnaires. This study concluded that the elevated environmental lead levels which were demonstrated by other agencies involved in this investigation are not currently being transferred to children. It recommends further blood screening of children in the area and ongoing education to minimise the risk of lead toxicity in the area in the future.
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Affiliation(s)
- E Feely
- Department of Public Health, Mid-Western Health Board, 31-33 Catherine St, Limerick.
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50
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Abstract
PURPOSE To discover the prevalence of pica, the documentation of pica on medical records, and any relationship of pica to pregnancy outcomes in rural socioeconomically disadvantaged pregnant women. STUDY DESIGN AND METHODS Prospective, descriptive, correlational investigation with 128 women who sought prenatal care from two rural community health agencies. Demographic and sociocultural variables, pica practices, pica substances ingested, and pregnancy outcomes were collected. RESULTS Thirty-eight percent of these pregnant women practiced pica. African-American women reported practicing pica more often than other ethnicities. Substances ingested included ice (>1 cup/day), freezer frost, laundry starch, cornstarch, clay dirt, and baked clay dirt. Polypica (ingestion of more than one substance) was practiced by 11 women. Women practicing pica were more likely to have been underweight prior to pregnancy, and smoked fewer cigarettes. Women reporting daily pica practice were significantly more likely to have lower prenatal hematocrits than women who did not practice pica, or who practiced pica less frequently than daily. No specific pregnancy complication was associated with the practice of pica. CLINICAL IMPLICATIONS Pica exists, and might be more common than healthcare providers assume. Although this study did not show specific pregnancy complications associated with pica, other studies have shown anemia and lead poisoning among women who practice pica. It is not clear that patients volunteer information about pica, so it would be helpful if nurses queried patients at each prenatal visit regarding pica practice. Discussion of pica practices should be based on a nonjudgmental model, for pica may have strong cultural implications, and may be practiced for cultural reasons unknown to the nurse.
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Affiliation(s)
- Robin Webb Corbett
- School of Nursing, East Carolina University, Rivers Building, Greenville, NC 27858, USA.
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