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Chung HW, Chen JC, Chen HL, Ko FY, Ho SY. Developing a practical neurodevelopmental prediction model for targeting high-risk very preterm infants during visit after NICU: a retrospective national longitudinal cohort study. BMC Med 2024; 22:68. [PMID: 38360711 PMCID: PMC10870669 DOI: 10.1186/s12916-024-03286-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 02/05/2024] [Indexed: 02/17/2024] Open
Abstract
BACKGROUND Follow-up visits for very preterm infants (VPI) after hospital discharge is crucial for their neurodevelopmental trajectories, but ensuring their attendance before 12 months corrected age (CA) remains a challenge. Current prediction models focus on future outcomes at discharge, but post-discharge data may enhance predictions of neurodevelopmental trajectories due to brain plasticity. Few studies in this field have utilized machine learning models to achieve this potential benefit with transparency, explainability, and transportability. METHODS We developed four prediction models for cognitive or motor function at 24 months CA separately at each follow-up visits, two for the 6-month and two for the 12-month CA visits, using hospitalized and follow-up data of VPI from the Taiwan Premature Infant Follow-up Network from 2010 to 2017. Regression models were employed at 6 months CA, defined as a decline in The Bayley Scales of Infant Development 3rd edition (BSIDIII) composite score > 1 SD between 6- and 24-month CA. The delay models were developed at 12 months CA, defined as a BSIDIII composite score < 85 at 24 months CA. We used an evolutionary-derived machine learning method (EL-NDI) to develop models and compared them to those built by lasso regression, random forest, and support vector machine. RESULTS One thousand two hundred forty-four VPI were in the developmental set and the two validation cohorts had 763 and 1347 VPI, respectively. EL-NDI used only 4-10 variables, while the others required 29 or more variables to achieve similar performance. For models at 6 months CA, the area under the receiver operating curve (AUC) of EL-NDI were 0.76-0.81(95% CI, 0.73-0.83) for cognitive regress with 4 variables and 0.79-0.83 (95% CI, 0.76-0.86) for motor regress with 4 variables. For models at 12 months CA, the AUC of EL-NDI were 0.75-0.78 (95% CI, 0.72-0.82) for cognitive delay with 10 variables and 0.73-0.82 (95% CI, 0.72-0.85) for motor delay with 4 variables. CONCLUSIONS Our EL-NDI demonstrated good performance using simpler, transparent, explainable models for clinical purpose. Implementing these models for VPI during follow-up visits may facilitate more informed discussions between parents and physicians and identify high-risk infants more effectively for early intervention.
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Affiliation(s)
- Hao Wei Chung
- Division of Neonatology, Department of Pediatrics, Kaohsiung Medical University Chung-Ho Memorial Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Biological Science and Technology, National Yang Ming Chiao Tung University, Hsinchu, Taiwan
- Department of Pediatrics, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Center for Big Data Research, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ju-Chieh Chen
- Department of Biological Science and Technology, National Yang Ming Chiao Tung University, Hsinchu, Taiwan
| | - Hsiu-Lin Chen
- Division of Neonatology, Department of Pediatrics, Kaohsiung Medical University Chung-Ho Memorial Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Respiratory Therapy, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Fang-Yu Ko
- Department of Biological Science and Technology, National Yang Ming Chiao Tung University, Hsinchu, Taiwan
| | - Shinn-Ying Ho
- Department of Biological Science and Technology, National Yang Ming Chiao Tung University, Hsinchu, Taiwan.
- Institute of Bioinformatics and Systems Biology, National Yang Ming Chiao Tung University, Hsinchu, Taiwan.
- Center for Intelligent Drug Systems and Smart Bio-Devices, National Yang Ming Chiao Tung University, Hsinchu, Taiwan.
- College of Health Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan.
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Becker M, Fehr K, Goguen S, Miliku K, Field C, Robertson B, Yonemitsu C, Bode L, Simons E, Marshall J, Dawod B, Mandhane P, Turvey SE, Moraes TJ, Subbarao P, Rodriguez N, Aghaeepour N, Azad MB. Multimodal machine learning for modeling infant head circumference, mothers' milk composition, and their shared environment. Sci Rep 2024; 14:2977. [PMID: 38316895 PMCID: PMC10844250 DOI: 10.1038/s41598-024-52323-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 01/17/2024] [Indexed: 02/07/2024] Open
Abstract
Links between human milk (HM) and infant development are poorly understood and often focus on individual HM components. Here we apply multi-modal predictive machine learning to study HM and head circumference (a proxy for brain development) among 1022 mother-infant dyads of the CHILD Cohort. We integrated HM data (19 oligosaccharides, 28 fatty acids, 3 hormones, 28 chemokines) with maternal and infant demographic, health, dietary and home environment data. Head circumference was significantly predictable at 3 and 12 months. Two of the most associated features were HM n3-polyunsaturated fatty acid C22:6n3 (docosahexaenoic acid, DHA; p = 9.6e-05) and maternal intake of fish (p = 4.1e-03), a key dietary source of DHA with established relationships to brain function. Thus, using a systems biology approach, we identified meaningful relationships between HM and brain development, which validates our statistical approach, gives credence to the novel associations we observed, and sets the foundation for further research with additional cohorts and HM analytes.
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Affiliation(s)
- Martin Becker
- International Milk Composition (IMiC) Consortium, Winnipeg, Canada
- Stanford University, Stanford, 94305, USA
| | - Kelsey Fehr
- International Milk Composition (IMiC) Consortium, Winnipeg, Canada
- Manitoba Interdisciplinary Lactation Centre (MILC), Winnipeg, Canada
- Children's Hospital Research Institute of Manitoba, Winnipeg, Canada
- University of Manitoba, Winnipeg, R3E3P4, Canada
| | - Stephanie Goguen
- International Milk Composition (IMiC) Consortium, Winnipeg, Canada
- Manitoba Interdisciplinary Lactation Centre (MILC), Winnipeg, Canada
- Children's Hospital Research Institute of Manitoba, Winnipeg, Canada
- University of Manitoba, Winnipeg, R3E3P4, Canada
| | - Kozeta Miliku
- University of Toronto, Toronto, M5S 1A8, Canada
- McMaster University, Hamilton, M5S 1A8, Canada
| | | | | | - Chloe Yonemitsu
- University of California, San Diego, La Jolla, CA, 92093, USA
| | - Lars Bode
- International Milk Composition (IMiC) Consortium, Winnipeg, Canada
- University of California, San Diego, La Jolla, CA, 92093, USA
| | | | | | | | | | - Stuart E Turvey
- University of British Columbia and British Columbia Children's Hospital, Vancouver, V5Z4H4, Canada
| | | | - Padmaja Subbarao
- University of Toronto, Toronto, M5S 1A8, Canada
- McMaster University, Hamilton, M5S 1A8, Canada
- SickKids, Toronto, M5G 0A4, Canada
| | - Natalie Rodriguez
- International Milk Composition (IMiC) Consortium, Winnipeg, Canada
- Manitoba Interdisciplinary Lactation Centre (MILC), Winnipeg, Canada
- Children's Hospital Research Institute of Manitoba, Winnipeg, Canada
- University of Manitoba, Winnipeg, R3E3P4, Canada
| | - Nima Aghaeepour
- International Milk Composition (IMiC) Consortium, Winnipeg, Canada.
- Stanford University, Stanford, 94305, USA.
| | - Meghan B Azad
- International Milk Composition (IMiC) Consortium, Winnipeg, Canada.
- Manitoba Interdisciplinary Lactation Centre (MILC), Winnipeg, Canada.
- Children's Hospital Research Institute of Manitoba, Winnipeg, Canada.
- University of Manitoba, Winnipeg, R3E3P4, Canada.
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Piper JD, Mazhanga C, Mapako G, Mapurisa I, Mashedze T, Munyama E, Mwapaura M, Chidhanguro D, Mpofu E, Mutasa B, Gladstone MJ, Wells JC, Langhaug LF, Tavengwa NV, Ntozini R, Prendergast AJ. Characterising school-age health and function in rural Zimbabwe using the SAHARAN toolbox. PLoS One 2023; 18:e0285570. [PMID: 37167268 PMCID: PMC10174535 DOI: 10.1371/journal.pone.0285570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 04/26/2023] [Indexed: 05/13/2023] Open
Abstract
INTRODUCTION We developed the School-Age Health, Activity, Resilience, Anthropometry and Neurocognitive (SAHARAN) toolbox to address the shortage of school-age assessment tools that combine growth, physical and cognitive function. Here we present i) development, acceptability and feasibility of the SAHARAN toolbox; ii) characteristics of a pilot cohort; and iii) associations between the domains measured in the cohort. METHODS Growth was measured with anthropometry, knee-heel length and skinfold thicknesses. Bioimpedance analysis measured lean mass index and phase angle. Cognition was assessed using the mental processing index, derived from the Kaufman Assessment Battery for Children version 2, a fine motor finger-tapping task, and School Achievement Test (SAT). Physical function combined grip strength, broad jump and the 20m shuttle-run test to produce a total physical score. A caregiver questionnaire was performed in parallel. RESULTS The SAHARAN toolbox was feasible to implement in rural Zimbabwe, and highly acceptable to children and caregivers following some minor modifications. Eighty children with mean (SD) age 7.6 (0.2) years had mean height-for-age (HAZ) and weight-for-age Z-scores (WAZ) of -0.63 (0.81) and -0.55 (0.85), respectively. Lean mass index and total skinfold thicknesses were related to WAZ and BMI Z-score, but not to HAZ. Total physical score was associated with unit rises in HAZ (1.29, 95% CI 0.75, 1.82, p<0.001), and lean mass index (0.50, 95% CI 0.16, 0.83, p = 0.004), but not skinfold thicknesses. The SAT was associated with unit increases in the mental processing index and child socioemotional score. The caregiver questionnaire identified high levels of adversity and food insecurity. CONCLUSIONS The SAHARAN toolbox provided a feasible and acceptable holistic assessment of child growth and function in mid-childhood. We found clear associations between growth, height-adjusted lean mass and physical function, but not cognitive function. The SAHARAN toolbox could be deployed to characterise school-age growth, development and function elsewhere in sub-Saharan Africa.
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Affiliation(s)
- Joe D. Piper
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
- Blizard Institute, Queen Mary University of London, London, United Kingdom
| | - Clever Mazhanga
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Gloria Mapako
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Idah Mapurisa
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Tsitsi Mashedze
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Eunice Munyama
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Marian Mwapaura
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | | | - Eddington Mpofu
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Batsirai Mutasa
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Melissa J. Gladstone
- Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom
| | - Jonathan C. Wells
- Population Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Lisa F. Langhaug
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Naume V. Tavengwa
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Robert Ntozini
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Andrew J. Prendergast
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
- Blizard Institute, Queen Mary University of London, London, United Kingdom
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Al-Saleh I, Elkhatib R, Alnuwaysir H, Aldhalaan H, Alismail E, Binmanee A, Hawari A, Alhazzani F, Jabr MB, Mohamed G. Exposure of preterm neonates receiving total parenteral nutrition to phthalates and its impact on neurodevelopment at the age of 2 months. Sci Rep 2023; 13:6969. [PMID: 37117441 PMCID: PMC10141929 DOI: 10.1038/s41598-023-33715-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 04/18/2023] [Indexed: 04/30/2023] Open
Abstract
This prospective study assessed the exposure to phthalates of preterm neonates who received total parenteral nutrition (TPN) during their stay in the neonatal intensive care unit (NICU) and the risk of neurodevelopment delays at the age of 2 months. Our study recruited 33 preterm neonates who required TPN upon NICU admission. Urine samples for analyzing phthalate metabolites were obtained at admission and then daily until the last day of receiving TPN. Phthalates in the daily TPN received by the preterm neonates were analyzed. The neurodevelopment of the neonates was assessed using the Ages and Stages Questionnaire Edition 3 (ASQ-3). Diethyl phthalate and butyl benzyl phthalate were found in all TPN samples, while 27% and 83% contained dibutyl phthalate and di-(2-ethylhexyl) phthalate (DEHP), respectively. Yet, the daily dose of each phthalate that our preterm neonates received from TPN was much lower than the recommended tolerable limit. Urinary levels of monobenzyl phthalate and four metabolites of DEHP [i.e., mono-(2-ethylhexyl) phthalate (MEHP), mono-(2-ethyl-5-hydroxyhexyl) phthalate, mono-(2-ethyl-5-oxohexyl) phthalate (MEOHP), and mono-(2-ethyl-5-carboxypentyl) phthalate (MECPP)] and the sum of four DEHP metabolites (∑4DEHP) increased significantly in preterm neonates before discharge. However, these levels were not correlated with their phthalate parent compounds in TPN, suggesting other sources of exposure in the NICU. At 2 months, we found that urinary levels of mono-iso-butyl phthalate (MiBP), MECPP, MEHP, and ∑4DEHP were inversely related to fine motor skills. After adjusting for head circumference, the inverse relationships remained significant, suggesting direct effects from phthalates. Given the extreme vulnerability of our population, it is critical to minimize exposure to phthalates during their NICU stay.
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Affiliation(s)
- Iman Al-Saleh
- King Faisal Specialist Hospital and Research Centre, Environmental Health Program (MBC#03), P.O. Box: 3354, Riyadh, 11211, Saudi Arabia.
| | - Rola Elkhatib
- King Faisal Specialist Hospital and Research Centre, Environmental Health Program (MBC#03), P.O. Box: 3354, Riyadh, 11211, Saudi Arabia
| | - Hissah Alnuwaysir
- King Faisal Specialist Hospital and Research Centre, Environmental Health Program (MBC#03), P.O. Box: 3354, Riyadh, 11211, Saudi Arabia
| | - Hesham Aldhalaan
- Center for Autism Research, King Faisal Specialist Hospital and Research Centre, P.O. Box: 3354, Riyadh, 11211, Saudi Arabia
| | - Eiman Alismail
- Center for Autism Research, King Faisal Specialist Hospital and Research Centre, P.O. Box: 3354, Riyadh, 11211, Saudi Arabia
| | - Abdulaziz Binmanee
- Neonatal Critical Care Section, Department of Pediatrics, King Faisal Specialist Hospital and Research Centre, P.O. Box: 3354, Riyadh, 11211, Saudi Arabia
| | - Amal Hawari
- Neonatal Critical Care Section, Department of Pediatrics, King Faisal Specialist Hospital and Research Centre, P.O. Box: 3354, Riyadh, 11211, Saudi Arabia
| | - Fahad Alhazzani
- Neonatal Critical Care Section, Department of Pediatrics, King Faisal Specialist Hospital and Research Centre, P.O. Box: 3354, Riyadh, 11211, Saudi Arabia
| | - Mohammad Bin Jabr
- Neonatal Critical Care Section, Department of Pediatrics, King Faisal Specialist Hospital and Research Centre, P.O. Box: 3354, Riyadh, 11211, Saudi Arabia
| | - Gamal Mohamed
- Biostatistics, Epidemiology and Scientific Computing Department, King Faisal Specialist Hospital and Research Centre, P.O. Box: 3354, Riyadh, 11211, Saudi Arabia
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Alois CI, Luntz A. Recognizing and managing hydrocephalus in children. JAAPA 2023; 36:18-26. [PMID: 36913610 DOI: 10.1097/01.jaa.0000921260.32212.39] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
Abstract
ABSTRACT Hydrocephalus is one of the most common indications for pediatric neurosurgical intervention and is associated with the need for lifelong monitoring. All clinicians should be familiar with the complications that may arise throughout life in these patients so that they can provide timely intervention. This article focuses on the assessment of hydrocephalus, the appropriate diagnostic workup and differential diagnoses, and evidence-based surgical treatments and associated outcomes.
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Affiliation(s)
- Corinne I Alois
- Corinne I. Alois is an assistant professor in the PA program at St. John's University in Jamaica, N.Y., an adjunct faculty member in the PA program at Pace University-Lenox Hill Hospital in New York City, and an adjunct research faculty member at St. Elizabeth University in Morristown, N.J. At the time this article was written, Allison Luntz was a student in the PA program at St. John's University. She now is in the PA surgical residency program at Yale University School of Medicine/Norwalk (Conn.) Hospital. The authors have disclosed no potential conflicts of interest, financial or otherwise
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Impact of Neonatal Body (Dis)Proportionality Determined by the Cephalization Index (CI) on Gross Motor Development in Children with Down Syndrome: A Prospective Cohort Study. CHILDREN (BASEL, SWITZERLAND) 2022; 10:children10010013. [PMID: 36670564 PMCID: PMC9856915 DOI: 10.3390/children10010013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 12/14/2022] [Accepted: 12/15/2022] [Indexed: 12/24/2022]
Abstract
Background: Children with Down syndrome (DS) lag behind typical children in the acquisition of developmental milestones, which could differ depending on body proportionality. We aimed to determine the difference in the acquisition of developmental milestones in children with DS with a disproportionate cephalization index (CI) compared to a proportionate CI. We created a motor development model that predicted milestone acquisition times. Methods: In this 20-year prospective cohort study, 47 children with DS aged 3 months to 5 years, followed up to 2020, were grouped according to the ratio of head circumference to birth weight (HC/BW) or CI into proportionate (CI < 1.1) and disproportionate (CI ≥ 1.1). We used a modified Munich Functional Developmental Diagnostic Scale that was assessed for reliability and content validity (Levene’s test and discriminant analysis) to determine 28 motor milestones. Linear regression was used to predict time to milestone acquisition, controlling for sex, maternal age, and birth weight. Results: Compared to proportionate CI, children with disproportionate CI were delayed in the milestone acquisition of a prone position by 2.81 months, standing before walking by 1.29 months, and a supine position by 1.61 months. Both groups required more time to reach standing after the acquisition of independent walking, but children with disproportionate CI reached those milestones later (4.50 vs. 4.09 months, p < 0.001). Conclusion: Children with disproportionate CI acquired milestones in a predictable order but slower than those with a proportionate CI. Our findings support the need to classify the degree of motor developmental delay in children with DS into unique functional groups rather than rely on clinicians’ arbitrary descriptions of the timing of developmental delays in children with DS.
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Zhu Z, Shen J, Zhu Y, Wang L, Qi Q, Wang X, Li C, Andegiorgish AK, Elhoumed M, Cheng Y, Dibley MJ, Zeng L. Head circumference trajectories during the first two years of life and cognitive development, emotional, and behavior problems in adolescence: a cohort study. Eur J Pediatr 2022; 181:3401-3411. [PMID: 35802207 DOI: 10.1007/s00431-022-04554-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 06/28/2022] [Accepted: 07/01/2022] [Indexed: 11/26/2022]
Abstract
UNLABELLED The associations of early-life head circumference (HC) with child neurodevelopmental and mental health among generally healthy population remain unclear. We aimed to examine the associations of early-life HC trajectories with cognitive development and emotional and behavioral problems in adolescence and to identify the HC growth-sensitive period. We conducted a prospective, community-based birth cohort study in rural western China, and 745 adolescents aged 10-14 years were followed between June and December 2016. We assessed their HC eight times during the first 2 years of life and their adolescent cognitive, emotional, and behavioral outcomes using the Wechsler Intelligence Scale for Children-IV and Youth Self-Report-2001, respectively. We applied group-based trajectory modeling to identify the HC trajectories and conditional growth to derive the HC growth-sensitive periods. We identified five distinct HC trajectories characterized as Start below average-then decrease (7.8% of the sample), Start below average-then increase (6.8%), Start average-then decrease (33%), Consistently average (38%), and Consistently above average (14%). Infants in the trajectory of consistently above average had higher cognitive scores in adolescence compared to those from suboptimal trajectories, with adjusted mean differences ranging from 2.84 to 8.99 points. The conditional gains showed that the HC growth-sensitive period was between 0 and 18 months for child cognition. We found null associations between HC measures and adolescent emotional and behavioral problem scores. CONCLUSION Early-life HC trajectories were associated with adolescent cognitive development. HC may serve as an inexpensive screening tool to monitor child development at risk during the first 18 months, particularly in resource-limited settings. WHAT IS KNOWN • Postnatal head circumference (HC) has been shown to be associated with cognitive development in infants who were born premature and/or fetal growth restriction, while inconsistent associations were reported among generally healthy populations, especially in low- and middle- income countries, challenging its utility in public health practices. WHAT IS NEW • Adolescents in the HC growth trajectory of consistently above average had higher cognitive scores compared to those with other suboptimal trajectories, while null findings were observed for adolescent emotional and behavioral health. • HC may serve as an inexpensive screening tool to monitor child development at risk during the first 18 months of life, particularly in resource-limited settings.
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Affiliation(s)
- Zhonghai Zhu
- Department of Epidemiology and Biostatistics, School of Public Health, Xian Jiaotong University Health Science Center, Xi'an, No.76, Yanta West Road, Xi'an, Shaanxi, 710061, People's Republic of China
| | - Jiali Shen
- Department of Epidemiology and Biostatistics, School of Public Health, Xian Jiaotong University Health Science Center, Xi'an, No.76, Yanta West Road, Xi'an, Shaanxi, 710061, People's Republic of China
| | - Yingze Zhu
- Department of Epidemiology and Biostatistics, School of Public Health, Xian Jiaotong University Health Science Center, Xi'an, No.76, Yanta West Road, Xi'an, Shaanxi, 710061, People's Republic of China
| | - Liang Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Xian Jiaotong University Health Science Center, Xi'an, No.76, Yanta West Road, Xi'an, Shaanxi, 710061, People's Republic of China
| | - Qi Qi
- Department of Epidemiology and Biostatistics, School of Public Health, Xian Jiaotong University Health Science Center, Xi'an, No.76, Yanta West Road, Xi'an, Shaanxi, 710061, People's Republic of China
| | - Xueyao Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Xian Jiaotong University Health Science Center, Xi'an, No.76, Yanta West Road, Xi'an, Shaanxi, 710061, People's Republic of China
| | - Chao Li
- Department of Epidemiology and Biostatistics, School of Public Health, Xian Jiaotong University Health Science Center, Xi'an, No.76, Yanta West Road, Xi'an, Shaanxi, 710061, People's Republic of China
| | - Amanuel Kidane Andegiorgish
- Department of Epidemiology and Biostatistics, School of Public Health, Xian Jiaotong University Health Science Center, Xi'an, No.76, Yanta West Road, Xi'an, Shaanxi, 710061, People's Republic of China
| | - Mohamed Elhoumed
- Department of Epidemiology and Biostatistics, School of Public Health, Xian Jiaotong University Health Science Center, Xi'an, No.76, Yanta West Road, Xi'an, Shaanxi, 710061, People's Republic of China
- National Institute of Public Health Research (INRSP), BP. 695, Nouakchott, Mauritania
| | - Yue Cheng
- Department of Nutrition and Food Safety Research, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, 710061, People's Republic of China
| | - Michael J Dibley
- The Sydney School of Public Health, Faculty of Medicine, The University of Sydney, Sydney, NSW, Australia
| | - Lingxia Zeng
- Department of Epidemiology and Biostatistics, School of Public Health, Xian Jiaotong University Health Science Center, Xi'an, No.76, Yanta West Road, Xi'an, Shaanxi, 710061, People's Republic of China.
- Key Laboratory of Environment and Genes Related to Diseases, Xi'an Jiaotong University, Ministry of Education, Xi'an, Shaanxi, People's Republic of China.
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Smith ME, Cisbani G, Lacombe RJS, Bazinet RP. A Scoping Review of Clinical Studies in Infants Fed Formulas Containing Palm Oil or Palm Olein and Sn-2 Palmitate. J Nutr 2021; 151:2997-3035. [PMID: 34510181 PMCID: PMC8485903 DOI: 10.1093/jn/nxab246] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 05/14/2021] [Accepted: 06/28/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Palmitic acid (PA; 16:0) is added to infant formula in the form of palm oil/palm olein (PO/POL) and stereospecific numbered-2 palmitate (SN2). Several studies have examined the effects of PO/POL and or SN2 in formulas on health outcomes, mainly growth, digestion, and absorption of nutrients. However, the roles of PA, PO/POL, and SN2 on neurodevelopment remains unknown. OBJECTIVES The objective of this scoping review was to map out studies in infants fed formula with PO/POL or SN2 to identify current knowledge on the role of PA in infant nutrition, specifically neurodevelopment. METHODS Data sources, including Medline, Embase, CAB Abstracts, and the Cochrane Database, were searched. Eligible articles were randomized controlled trials (RCTs) and observational studies examining outcomes in term singleton infants fed formula containing PO/POL or SN2. Studies examining preterm infants or infants with infections, mixed-feeding interventions, or outcomes not concerned with PO/POL or SN2 were excluded. Screening and data extraction were performed by 2 independent reviewers, and results were charted into 10 outcome categories. RESULTS We identified 28 RCTs and 2 observational studies. Only 1 RCT examined a neurodevelopmental outcome, reporting infants fed SN2 formula had higher fine motor skill scores compared to those fed a vegetable oil formula with a lower amount of SN2; however, only after adjustment for maternal education and at an earlier, but not a later time point. Anthropometric measures do not appear to be influenced by PO/POL or SN2 within formulas. Alternatively, it was reported that infants fed PO/POL within formulas had a decreased absorption of calcium, total fat, and PA compared to those fed vegetable oil formulas. However, studies were heterogenous, making it difficult to isolate the effects of PO/POL or SN2 in formulas. CONCLUSIONS Our review reiterates the need for future studies to address the effects of PO/POL and SN2 on neurodevelopment in infants. This study is registered at Open Science Framework as osf.io/697he.
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Affiliation(s)
- Mackenzie E Smith
- Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Giulia Cisbani
- Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
| | - R J Scott Lacombe
- Department of Pediatrics, Dell Medical School, The University of Texas at Austin, Austin, TX, USA
| | - Richard P Bazinet
- Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
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Childhood disadvantage, neurocognitive development and neuropsychiatric disorders: Evidence of mechanisms. Curr Opin Psychiatry 2021; 34:306-323. [PMID: 33587493 PMCID: PMC9458466 DOI: 10.1097/yco.0000000000000701] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Children living in socioeconomically disadvantaged households have excess risks of neurodevelopmental and neuropsychiatric problems. The purpose of this review is to synthesize evidence for mechanisms that may contribute to these excess risks. RECENT FINDINGS The majority of the 60 studies included in our review focused on children's neurocognitive development and behavioural problems. About half conducted mediation analyses of factors in the family and neighbourhood environments, including access to resources (e.g. cognitive inputs within the home environment) and exposure to stressors (e.g. negative parenting practices), as well as neurobiological embedding of childhood disadvantage. In addition, many studies conducted moderation analyses of factors that were hypothesized to interact with (i.e. exacerbate or mitigate) the harmful effects of childhood disadvantage. SUMMARY Many of the factors that contribute to the excess risk of neurodevelopmental and neuropsychiatric problems among children in disadvantaged households are potentially modifiable (e.g. cognitively stimulating materials, parental language input, cultural resources, parental stress and psychopathology, negative parenting, neighbourhood violence). If their causality is ultimately established, they could be targets for the prevention and reduction of disparities. The continued search for mechanisms should not detract from work to reduce and hopefully eliminate children's exposure to disadvantage.
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