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Mejía Toro C, Carriedo A, Pérez Tamayo EM, Crosbie E. Barriers to Overcoming Child Hunger and Malnutrition: Applying a Human Rights Approach to Improve Policy and Action. Int J Public Health 2023; 68:1605969. [PMID: 37711158 PMCID: PMC10498992 DOI: 10.3389/ijph.2023.1605969] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 08/06/2023] [Indexed: 09/16/2023] Open
Abstract
Objective: Analyze key barriers to achieving children's right to food under Colombia's food and nutrition security policies and programs. Methods: A literature review was conducted along with 17 semi-structured expert interviews. The law framework on the right to food was applied to analyze findings. Results: Four key barriers were found. First, a reductionist approach prevails in the political narrative. This focuses on ensuring personal food access overlooking societal and environmental impacts. Second, the implementation of policies and programs is passed on to third parties, preventing civic participation and accountability. Third, there are insufficient national data sources and indicators to monitor the impact of interventions and funding. Fourth, program implementation is unequal and inadequate, which inadvertently supports illicit economies that thrive on conditions of hunger and poverty. Conclusion: Children's food and nutrition are reliant on organizations that focus on personal food supply without strengthening civic participation. Strengthening participation requires a human rights approach. International organizations can help the government to engage communities in policy and program improvement and oversight.
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Affiliation(s)
- Carolina Mejía Toro
- Department of Noncommunicable Diseases and Mental Health, Pan American Health Organization/World Health Organization, Washington, DC, United States
- Bureau for Humanitarian Assistance, United States Agency for International Development, Washington, DC, United States
- World Public Health Nutrition Association, Peacehaven, United Kingdom
| | - Angela Carriedo
- World Public Health Nutrition Association, Peacehaven, United Kingdom
- Department of Health, University of Bath, Bath, United Kingdom
| | | | - Eric Crosbie
- School of Public Health, University of Nevada, Reno, Reno, NV, United States
- Ozmen Institute for Global Studies, University of Nevada Reno, Reno, NV, United States
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Monfared V, Salehian A, Nikniaz Z, Ebrahimpour-Koujan S, Faghfoori Z. The effect of zinc supplementation on anthropometric measurements in healthy children over two years: a systematic review and meta-analysis. BMC Pediatr 2023; 23:414. [PMID: 37612628 PMCID: PMC10464267 DOI: 10.1186/s12887-023-04249-x] [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: 04/24/2023] [Accepted: 08/16/2023] [Indexed: 08/25/2023] Open
Abstract
BACKGROUND Zinc deficiency is one of the most important micronutrient deficiencies in children that can affect the children's growth pattern. In this regard, different studies were conducted to assess the effect of zinc supplementation on growth patterns in healthy children. To the best of our knowledge, no systematic review has summarized the results of these studies. So, in the present study, we systematically reviewed the result of the studies that assessed the effect of zinc supplementation on anthropometric parameters in healthy, over 2-year-old children. METHODS A systematic search was carried out in PubMed, Scopus, and Web of Science from inception to November 2021. Data were pooled using the random-effects method and were expressed as weighted mean difference (WMD) and 95% confidence intervals (CI). RESULTS The pooled results of eight studies, including 1586 participants, showed that zinc supplementation significantly increases height [(WMD): 0.9, 95% CI: (0.27, 1.52), p < 0.001], weight [(WMD): 0.51, 95% CI: (0.06, 0.97), p < 0.001], height for age (HAZ) [(WMD): 0.07, 95% CI: (0.03, 0.10), p < 0.001]. Also, meta-regression analysis did not reveal any significant association between dose and duration of intervention and anthropometric parameters. CONCLUSION The present study demonstrates the beneficial effects of zinc supplementation on weight, height, and HAZ.
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Affiliation(s)
- Vahid Monfared
- Student Research Committee, Semnan University of Medical Sciences, Semnan, Iran
| | - Adel Salehian
- Student Research Committee, Semnan University of Medical Sciences, Semnan, Iran
| | - Zeinab Nikniaz
- Liver and gastrointestinal diseases research center, Tabriz University of medical sciences, Tabriz, Iran
| | - Soraiya Ebrahimpour-Koujan
- Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Zeinab Faghfoori
- Food Safety Research Center (salt), Semnan University of Medical Sciences, Semnan, ZIP Code: 3581793563, Iran.
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Blaine RE, Blaine KP, Cheng K, Banuelos C, Leal A. Priorities, barriers, and facilitators for nutrition-related care for autistic children: a qualitative study comparing interdisciplinary health professional and parent perspectives. Front Pediatr 2023; 11:1198177. [PMID: 37650046 PMCID: PMC10465129 DOI: 10.3389/fped.2023.1198177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 06/27/2023] [Indexed: 09/01/2023] Open
Abstract
Introduction Children with autism spectrum disorder often face nutrition-related challenges, such as food selectivity, gastrointestinal issues, overweight and obesity, and inadequate nutrient intake. However, the role of routine nutrition-related screening or care by interdisciplinary health professionals is not well understood. This study aimed to compare the beliefs of health professionals with those of parents of autistic children regarding high-priority nutrition-related challenges, barriers and facilitators to care, and desired education and resources related to nutrition for autistic children. Participants Interdisciplinary health professionals (n = 25) (i.e., pediatricians, occupational therapists, speech-language pathologists, board certified behavior analysts, registered dietitians) and parents of autistic children (n = 22). Methods The study used semi-structured phone interviews, which were recorded, transcribed, verified, and double-coded using the Framework Method. Results Thematic analysis of transcripts revealed that while health professionals and parents of autistic children shared some perspectives on nutrition-related challenges and care, they also had distinct viewpoints. Parents emphasized the importance of addressing food selectivity, behavioral eating challenges, sensory issues, and sleep disturbances affecting appetite. Both groups acknowledged the need for tailored support, access to an interdisciplinary care team, and reasonable expectations. Some health professionals perceived parents as lacking motivation or the ability to make changes. In contrast, many parents felt that health professionals lacked the knowledge and motivation to take nutrition or growth concerns seriously. Health professionals acknowledged that their lack of knowledge or capacity to provide nutrition education or referrals was a common barrier to care, particularly given limited community resources. Discussion Health professionals who serve autistic children are motivated to address nutrition-related challenges but lack resources related to nutrition. To promote better health outcomes for autistic children, professionals should identify and support parent motivations around nutrition-related care. Both groups expressed interest in accessing autism-specific resources for education, referral, and screening guidance. Future research could explore the development of healthcare training models that improve the competency of health professionals in providing nutrition care and referral for autistic children.
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Affiliation(s)
- Rachel E. Blaine
- Department of Family and Consumer Sciences, California State University, Long Beach, CA, United States
| | - Kevin P. Blaine
- Research Institute, Children’s Hospital of Orange County, Orange, CA, United States
| | - Katie Cheng
- Department of Family and Consumer Sciences, California State University, Long Beach, CA, United States
| | - Cynthia Banuelos
- Department of Family and Consumer Sciences, California State University, Long Beach, CA, United States
| | - Aaron Leal
- Department of Family and Consumer Sciences, California State University, Long Beach, CA, United States
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Liu Q, Lu W, Bai C, Xu C, Ye M, Zhu Y, Yao L. Cadmium, arsenic, and mineral nutrients in rice and potential risks for human health in South China. Environ Sci Pollut Res Int 2023:10.1007/s11356-023-27857-7. [PMID: 37246182 DOI: 10.1007/s11356-023-27857-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 05/19/2023] [Indexed: 05/30/2023]
Abstract
Rice (Oryza sativa L.) is one of the most important staple food crops worldwide. For people fed on rice, toxic elements cadmium (Cd) and arsenic (As) and mineral nutrients in rice are pivotal to evaluate potential risks of harmful element intake and malnutrition. We collected rice samples of 208 cultivars (83 inbred and 125 hybrid) from fields in South China and determined Cd, As, As species, and mineral elements in brown rice. Chemical analysis shows that the average content of Cd and As in brown rice were 0.26 ± 0.32 and 0.21 ± 0.08 mg·kg-1, respectively. Inorganic As (iAs) was the dominative As species in rice. Rice Cd and iAs in 35.1% and 52.4% of the 208 cultivars exceeded rice Cd and iAs limits, respectively. Significant variations of rice subspecies and regions were found for Cd, As, and mineral nutrients in rice (P < 0.05). Inbred rice had lower As uptake and more balanced mineral nutrition than hybrid species. Significant correlation was observed between Cd, As versus mineral elements like Ca, Zn, B, and Mo (P < 0.05). Health risk assessment indicates that high risks of non-carcinogenic and carcinogenic of Cd and iAs, and malnutrition, in particular Ca, protein and Fe deficiencies, might be caused by rice consumption in South China.
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Affiliation(s)
- Qinghui Liu
- College of Natural Resources and Environment, South China Agricultural University, Guangzhou, 510642, China
| | - Weisheng Lu
- College of Natural Resources and Environment, South China Agricultural University, Guangzhou, 510642, China
| | - Cuihua Bai
- College of Natural Resources and Environment, South China Agricultural University, Guangzhou, 510642, China
- Guangdong Provincial Key Laboratory of Agricultural & Rural Pollution Abatement and Environmental Safety, College of Natural Resources and Environment, South China Agricultural University, Guangzhou, 510642, People's Republic of China
| | - Congzhuo Xu
- College of Natural Resources and Environment, South China Agricultural University, Guangzhou, 510642, China
| | - Maozhi Ye
- College of Natural Resources and Environment, South China Agricultural University, Guangzhou, 510642, China
| | - Yongcong Zhu
- College of Natural Resources and Environment, South China Agricultural University, Guangzhou, 510642, China
| | - Lixian Yao
- College of Natural Resources and Environment, South China Agricultural University, Guangzhou, 510642, China.
- Guangdong Provincial Key Laboratory of Agricultural & Rural Pollution Abatement and Environmental Safety, College of Natural Resources and Environment, South China Agricultural University, Guangzhou, 510642, People's Republic of China.
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Gsoellpointner M, Eibensteiner F, Thanhaeuser M, Ristl R, Jilma B, Berger A, Haiden N. Effects of early introduction of solid foods on nutrient intake in preterm infants during their 1st year of life: a secondary outcome analysis of a prospective, randomized intervention study. Front Nutr 2023; 10:1124544. [PMID: 37275631 PMCID: PMC10232899 DOI: 10.3389/fnut.2023.1124544] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 04/21/2023] [Indexed: 06/07/2023] Open
Abstract
Very low birth weight (VLBW) infants have higher nutritional needs even after hospital discharge. However, data concerning current nutrient intakes at different time points after the introduction of solid foods and whether dietary reference values are being met are scarce. To adress this issue, this secondary analysis of a prospective, two-arm interventional study in 177 VLBW infants 21 investigates dietary intake comparing early and late (early: 10-12 weeks corrected for gestational age, late: 16-18 weeks corrected for gestational age) introduction of standardized complementary food during the first year of life. Nutritional intake was assessed using self-reported monthly 3-day dietary records from 3 until 12 months, corrected for gestational age. The time point of the introduction of solid foods did not influence nutrient intake, but the early introduction of solids tended toward a higher proportional intake of protein and carbohydrates and a lower intake of fat as a percentage of total energy) during the 1st year of life, corrected for gestational age. The results of this study indicate that this standardized feeding concept was sufficient for zinc, calcium, and phosphorus intake. However, dietary iron and vitamin D intakes did not meet the recommendations. Thus, prolonged iron supplementation should be considered beyond the introduction of meat and vitamin D supplementation at least until 12 months, corrected for gestational age. Trial registration number ClinicalTrials.gov: NCT01809548.
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Affiliation(s)
| | - Fabian Eibensteiner
- Department of Pediatrics and Adolescent Medicine, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Margarita Thanhaeuser
- Department of Pediatrics and Adolescent Medicine, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Robin Ristl
- Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - Bernd Jilma
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Angelika Berger
- Department of Pediatrics and Adolescent Medicine, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Nadja Haiden
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
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Freitas-Costa NC, Andrade P, Normando P, Salvatte Nunes KS, Raymundo CE, Ribeiro de Castro IR, Maria de Aquino Lacerda E, Farias DR, Kac G. Association of development quotient with nutritional status of vitamins B6, B12, and folate in 6-59-month-old children: Results from the Brazilian National Survey on Child Nutrition (ENANI-2019). Am J Clin Nutr 2023:S0002-9165(23)47384-4. [PMID: 37105522 DOI: 10.1016/j.ajcnut.2023.04.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 03/28/2023] [Accepted: 04/19/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND Vitamins B6, B12, and folate are essential for the formation and maintenance of the human brain, but studies evaluating these vitamins with early childhood development (ECD) in children under five are limited and controversial. OBJECTIVE To evaluate the association between vitamins B6, B12, and folate concentrations/status and ECD. METHODS Data regarding 6,520 children aged 6-59 months (from the Brazilian National Survey on Child Nutrition [ENANI-2019]) were analyzed. ECD was assessed using the Survey of Well-being of Young Children's milestones questionnaire. Vitamin B6 concentration (nmol/L) was classified according to the tertile of the distribution and with the cutoff <20 nmol/L. Folate concentrations >45.3 nmol/L were classified as high, and vitamin B12 <150 pmol/L as deficient. The graded response model was used to estimate developmental age, and the developmental quotient (DQ) was calculated as the developmental age divided by chronological age. Multiple linear regression models were adjusted for confounders. RESULTS The DQ mean (95% confidence interval) for Brazilian children was 0.99 (0.97-1.01). Children aged 6-23 months (1.13 [1.10-1.16]) had a higher DQ mean than those aged 24-35 (0.99 [0.95-1.03]) and 36-59 months (0.89 [0.86-0.92]). Child age was inversely associated with DQ (β=-0.007; p<0.001). An interaction between child age and vitamin B12 deficiency in the DQ (β=-0.005; p<0.001) indicated that, in children aged 36-59 months, the DQ was markedly lower in children with B12 deficiency than in those without B12 deficiency. Vitamin B6 concentrations were directly associated with the DQ (β=0.0004; p=0.031) among children aged 24-59 months in the adjusted model. No association was observed between folate status and DQ. CONCLUSIONS In Brazil, the DQ is lower among older children, and those with vitamin B12 deficiency. Vitamin B6 status was directly associated with the DQ in children aged 24-59 months.
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Affiliation(s)
- Nathalia Cristina Freitas-Costa
- Nutritional Epidemiology Observatory, Institute of Nutrition Josué de Castro, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Pedro Andrade
- Institute of Applied Economic Research, Rio de Janeiro, Brazil
| | - Paula Normando
- Nutritional Epidemiology Observatory, Institute of Nutrition Josué de Castro, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Keronlainy Silva Salvatte Nunes
- Nutritional Epidemiology Observatory, Institute of Nutrition Josué de Castro, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Carlos Eduardo Raymundo
- Institute of Collective Health, School of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Elisa Maria de Aquino Lacerda
- Nutritional Epidemiology Observatory, Institute of Nutrition Josué de Castro, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Dayana Rodrigues Farias
- Nutritional Epidemiology Observatory, Institute of Nutrition Josué de Castro, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Gilberto Kac
- Nutritional Epidemiology Observatory, Institute of Nutrition Josué de Castro, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.
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Perez-Plazola M, Diaz J, Stewart CP, Arnold CD, Caswell BL, Lutter CK, Werner ER, Maleta K, Turner J, Prathibha P, Liu X, Gyimah E, Iannotti L. Plasma mineral status after a six-month intervention providing one egg per day to young Malawian children: a randomized controlled trial. Sci Rep 2023; 13:6698. [PMID: 37095119 PMCID: PMC10125967 DOI: 10.1038/s41598-023-33114-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 04/07/2023] [Indexed: 04/26/2023] Open
Abstract
Mineral deficiencies are common in children living in low-resource areas. Eggs are a rich source of essential nutrients and have been shown to improve growth in young children, although little is known about their impact on mineral status. Children aged 6-9 months (n = 660) were randomized to receive either one egg/day for 6-months or no intervention. Anthropometric data, dietary recalls, and venous blood were collected at baseline and 6-months follow-up. Quantification of plasma minerals (n = 387) was done using inductively coupled plasma-mass spectroscopy. Difference-in-difference mean plasma mineral concentrations was determined from baseline and follow-up values and assessed between groups by intention-to-treat using ANCOVA regression models. Prevalence of zinc deficiency was 57.4% at baseline and 60.5% at follow-up. Mean difference (MD) of plasma magnesium, selenium, copper, and zinc levels were not different between groups. Plasma iron concentrations were significantly lower in the intervention compared to the control group (MD = - 9.29; 95% CI: - 15.95, - 2.64). Zinc deficiency was widely prevalent in this population. Mineral deficiencies were not addressed with the egg intervention. Further interventions are needed to improve the mineral status of young children.
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Affiliation(s)
| | - Jenna Diaz
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Washington University School of Medicine in St. Louis, 660 South Euclid Avenue, Campus, Box 8208, St. Louis, MO, 63110, USA.
| | - Christine P Stewart
- Institute for Global Nutrition, Department of Nutrition, University of California Davis, Davis, USA
| | - Charles D Arnold
- Institute for Global Nutrition, Department of Nutrition, University of California Davis, Davis, USA
| | - Bess L Caswell
- Institute for Global Nutrition, Department of Nutrition, University of California Davis, Davis, USA
- Western Human Nutrition Research Center, U.S. Department of Agriculture, Agricultural Research Service,, Davis, USA
| | - Chessa K Lutter
- International Development Group, RTI International US, Triangle Park, USA
| | - E Rochelle Werner
- Institute for Global Nutrition, Department of Nutrition, University of California Davis, Davis, USA
| | - Kenneth Maleta
- School of Global and Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Jay Turner
- Division of Engineering Education Energy, Environmental Energy and Chemical Engineering, Washington University in St. Louis, St. Louis, USA
| | - Pradeep Prathibha
- Division of Engineering Education Energy, Environmental Energy and Chemical Engineering, Washington University in St. Louis, St. Louis, USA
| | - Xuan Liu
- Division of Engineering Education Energy, Environmental Energy and Chemical Engineering, Washington University in St. Louis, St. Louis, USA
| | - Emmanuel Gyimah
- Institute for Public Health, Washington University in St. Louis, St. Louis, USA
| | - Lora Iannotti
- Institute for Public Health, Washington University in St. Louis, St. Louis, USA
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Mrimi EC, Palmeirim MS, Minja EG, Long KZ, Keiser J. Correlation of Cytokines with Parasitic Infections, Undernutrition and Micronutrient Deficiency among Schoolchildren in Rural Tanzania: A Cross-Sectional Study. Nutrients 2023; 15:nu15081916. [PMID: 37111135 PMCID: PMC10145041 DOI: 10.3390/nu15081916] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 04/11/2023] [Accepted: 04/13/2023] [Indexed: 04/29/2023] Open
Abstract
Malnutrition and parasitic infections are often interconnected in a vicious cycle. Malnutrition can lead to changes in immune response, which may affect cytokine concentrations and potentially increase susceptibility to infections. In turn, parasitic infections can exacerbate malnutrition by impairing nutrient absorption. This cross-sectional study aimed to explore this interplay. Schoolchildren aged 6-12 years living in rural Tanzania (n = 120) provided blood, stool and urine samples to determine the relationship between cytokine concentrations (interleukin 4 (IL-4), interferon gamma (IFNγ) and interleukin 17A (IL-17A)), parasitic infections, undernutrition and micronutrient deficiency adjusting for sex, age, inflammatory markers, socioeconomic status and school categories. All schoolchildren had a normal blood cell count. The concentration of IL-4 was significantly higher in schoolchildren diagnosed with stunting, Schistosoma mansoni infection, a high C-reactive protein concentration, nausea, poor housing and increasing age. The concentration of IFNγ was associated with Plasmodium falciparum and Entamoeba histolytica/Entamoeba dispar/Entamoeba moshkovskii infections, vitamin A deficiency, attending the most remote schools and low socioeconomic status. Our study confirms a potential relationship between cytokine concentrations and parasitic infections, malnutrition and low socioeconomic status. A better understanding of long-term effects of parasitic infections and malnutrition on the immune function could help in designing tailored and effective interventions.
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Affiliation(s)
- Emmanuel C Mrimi
- Swiss Tropical and Public Health Institute, 4123 Allschwil, Switzerland
- University of Basel, 4001 Basel, Switzerland
- Ifakara Health Institute, Morogoro P.O. Box 53, Tanzania
| | - Marta S Palmeirim
- Swiss Tropical and Public Health Institute, 4123 Allschwil, Switzerland
- University of Basel, 4001 Basel, Switzerland
| | - Elihaika G Minja
- Swiss Tropical and Public Health Institute, 4123 Allschwil, Switzerland
- University of Basel, 4001 Basel, Switzerland
- Ifakara Health Institute, Morogoro P.O. Box 53, Tanzania
| | - Kurt Z Long
- Swiss Tropical and Public Health Institute, 4123 Allschwil, Switzerland
- University of Basel, 4001 Basel, Switzerland
| | - Jennifer Keiser
- Swiss Tropical and Public Health Institute, 4123 Allschwil, Switzerland
- University of Basel, 4001 Basel, Switzerland
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Vlaardingerbroek H, Joustra SD, Oostdijk W, de Bruin C, Wit JM. Assessment of Nutritional Status in the Diagnostic Evaluation of the Child with Growth Failure. Horm Res Paediatr 2023; 97:11-21. [PMID: 37054683 DOI: 10.1159/000530644] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 03/23/2023] [Indexed: 04/15/2023] Open
Abstract
Current clinical guidelines provide information about the diagnostic workup of children with growth failure. This mini-review focuses on the nutritional assessment, which has received relatively little attention in such guidelines. The past medical history, in particular a low birth size and early feeding problems, can provide information that can increase the likelihood of nutritional deficits or several genetic causes. The current medical history should include a dietary history and can thereby reveal a poorly planned or severely restricted diet, which can be associated with nutritional deficiencies. Children on a vegan diet should receive various nutritional supplements, but insufficient compliance has been reported in one-third of cases. While proper use of nutritional supplements in children consuming a vegan diet appears to be associated with normal growth and development, insufficient intake of supplements may impede growth and bone formation. Physical examination and analysis of height and weight over time can help differentiating between endocrine causes, gastrointestinal disorders, psychosocial problems, or underlying genetic conditions that prevent adequate nutritional intake. Laboratory screening should be part of the workup in every child with short stature, and further laboratory tests can be indicated if warranted by the dietary history, especially in children on a poorly planned vegan diet.
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Affiliation(s)
- Hester Vlaardingerbroek
- Division of Paediatric Endocrinology, Department of Paediatrics, Willem-Alexander Children's Hospital, Leiden University Medical Centre, Leiden, The Netherlands
| | - Sjoerd D Joustra
- Division of Paediatric Endocrinology, Department of Paediatrics, Willem-Alexander Children's Hospital, Leiden University Medical Centre, Leiden, The Netherlands
| | - Wilma Oostdijk
- Division of Paediatric Endocrinology, Department of Paediatrics, Willem-Alexander Children's Hospital, Leiden University Medical Centre, Leiden, The Netherlands
| | - Christiaan de Bruin
- Division of Paediatric Endocrinology, Department of Paediatrics, Willem-Alexander Children's Hospital, Leiden University Medical Centre, Leiden, The Netherlands
| | - Jan M Wit
- Division of Paediatric Endocrinology, Department of Paediatrics, Willem-Alexander Children's Hospital, Leiden University Medical Centre, Leiden, The Netherlands
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Acosta P, Rojas-Humpire R, Newball-Noriega EE, Morales-García WC, Saintila J, Ruiz Mamani PG, Huancahuire-Vega S. Dietary practices and nutritional status of children served in a social program for surrogate mothers in Colombia. BMC Nutr 2023; 9:26. [PMID: 36747251 PMCID: PMC9901049 DOI: 10.1186/s40795-023-00685-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 01/31/2023] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Dietary practices are acquired in the family context and in turn can affect the health of family members, especially the nutritional status of children. The objective of this study was to determine the relationship between nutritional status and feeding practices in children from foster families served by the SOS Children's Villages program in Cartagena, Colombia. METHODS The study had a cross-sectional design. Through a non-probabilistic purposive sampling, 139 children from 0 to 5 years of age from the SOS Children's Villages Cartagena program were involved. The sociodemographic background of the participants was recorded and the nutritional status of the children was evaluated through anthropometric and biochemical measurements. Dietary practices were measured by means of a standardized questionnaire. Analyses were performed with Poisson regression models with robust variance. These regression models provided prevalence ratios (PR) with their respective 95% confidence intervals (95%CI). RESULTS Among dietary practices, it was observed that most families eat together at home (63.3%), watch television when they eat (55.4%), and have dietary norms (80.6%). Consumption of plant foods was predominantly high, especially vegetables (86.3%), fruits (92.1%), cereals (84.9%), root vegetables, and bananas (93.5%). Consumption < 4 times/week of soft drinks and industrialized juices increases 14.3 times the probability of low weight-for-height in the study population compared to the group that does not consume them. On the other hand, watching television while eating (PR: 2.82, 95%CI 1.32-4.69) and consumption of sweet snacks (PR: 2.24, 95%CI 1.03-4.87) increased the probability of low height-for-age; while having eaten norms at home decreased the probability of low height-for-age in the study population by 50%. CONCLUSION It is necessary to develop and implement interventions such as preventive measures and early diagnosis of inappropriate feeding behaviors to ensure adequate nutritional status among children under 5 years of age.
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Affiliation(s)
- Patricia Acosta
- Aldeas Infantiles SOS Colombia, Programa Cartagena, Bolívar, Colombia
| | - Ricardo Rojas-Humpire
- grid.441893.30000 0004 0542 1648Departamento de Ciencias Básicas, Escuela de Medicina Humana, Facultad de Ciencias de La Salud, Universidad Peruana Unión, Lima, Perú ,grid.441893.30000 0004 0542 1648Grupo de Investigación P53, Escuela de Medicina Humana, Facultad de Ciencias de La Salud, Universidad Peruana Unión, Carretera Central Km 19, Ñaña, Lima 15, Peru
| | - Edda E. Newball-Noriega
- grid.441893.30000 0004 0542 1648Departamento de Ciencias Básicas, Escuela de Medicina Humana, Facultad de Ciencias de La Salud, Universidad Peruana Unión, Lima, Perú ,grid.441893.30000 0004 0542 1648Grupo de Investigación P53, Escuela de Medicina Humana, Facultad de Ciencias de La Salud, Universidad Peruana Unión, Carretera Central Km 19, Ñaña, Lima 15, Peru
| | - Wilter C. Morales-García
- grid.441893.30000 0004 0542 1648Unidad de Salud Pública Escuela de Posgrado, Universidad Peruana Unión, Lima, Perú
| | - Jacksaint Saintila
- grid.441720.40000 0001 0573 4474Escuela de Medicina Humana, Universidad Señor de Sipán, Chiclayo, Perú
| | - Percy G. Ruiz Mamani
- grid.441740.20000 0004 0542 2122Facultad de Ciencias de La Salud, Universidad Privada San Juan Bautista, Lima, Perú
| | - Salomón Huancahuire-Vega
- grid.441893.30000 0004 0542 1648Departamento de Ciencias Básicas, Escuela de Medicina Humana, Facultad de Ciencias de La Salud, Universidad Peruana Unión, Lima, Perú ,grid.441893.30000 0004 0542 1648Grupo de Investigación P53, Escuela de Medicina Humana, Facultad de Ciencias de La Salud, Universidad Peruana Unión, Carretera Central Km 19, Ñaña, Lima 15, Peru
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Miyake K, Mochizuki K, Kushima M, Shinohara R, Horiuchi S, Otawa S, Akiyama Y, Ooka T, Kojima R, Yokomichi H, Yamagata Z, Yamazaki S, Ohya Y, Kishi R, Yaegashi N, Hashimoto K, Mori C, Ito S, Yamagata Z, Inadera H, Nakayama T, Iso H, Shima M, Kurozawa Y, Suganuma N, Kusuhara K, Katoh T. Maternal protein intake in early pregnancy and child development at age 3 years. Pediatr Res 2023:10.1038/s41390-022-02435-8. [PMID: 36624288 DOI: 10.1038/s41390-022-02435-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 08/15/2022] [Accepted: 09/20/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND The current study aimed to assess the association between low maternal protein intake during pregnancy and child developmental delay at age 3 years. METHODS This research used data obtained from the Japan Environment and Children's Study. In total, we analyzed 77,237 mother-child pairs. Dietary intake was assessed using the Food Frequency Questionnaire. Developmental outcomes at age 3 years were evaluated with the Japanese version of the Ages and Stages Questionnaire, Third Edition. A multivariate logistic regression analysis was performed to assess the association between maternal protein intake during pregnancy and child development delays at age 3 years. RESULTS Based on the protein-to-total energy intake ratio during early pregnancy, the participants were categorized into three groups: <9.39% (>2 standard deviation below the mean), the severely low protein (SLP) group; 9.39-<13%, the low protein group; and ≥13%, the normal protein group. After adjusting for potential confounding factors, SLP intake was found to be significantly correlated with a higher risk of developmental delay according to the communication, fine motor and problem-solving skill domains. CONCLUSIONS SLP intake caused by inadequate diet during early pregnancy was associated with a higher risk of child developmental delay at age 3 years. IMPACT Animal studies have shown that maternal protein restriction during pregnancy and lactation causes abnormal brain development among offspring. Birth cohort studies to date have not assessed the effects of maternal low protein exposure during pregnancy on child development. Severely low protein intake during early pregnancy was associated with a higher risk of child developmental delay at age 3 years. Since nutritional imbalance in early pregnancy affects not only fetal growth but also postnatal neurodevelopment, nutritional management before pregnancy is considered important.
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Affiliation(s)
- Kunio Miyake
- Department of Health Sciences, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi, Chuo, Yamanashi, Japan.
| | - Kazuki Mochizuki
- Department of Local Produce and Food Sciences, Faculty of Life and Environmental Sciences, University of Yamanashi, Kofu, Yamanashi, Japan
| | - Megumi Kushima
- Center for Birth Cohort Studies, University of Yamanashi, Chuo, Yamanashi, Japan
| | - Ryoji Shinohara
- Center for Birth Cohort Studies, University of Yamanashi, Chuo, Yamanashi, Japan
| | - Sayaka Horiuchi
- Center for Birth Cohort Studies, University of Yamanashi, Chuo, Yamanashi, Japan
| | - Sanae Otawa
- Center for Birth Cohort Studies, University of Yamanashi, Chuo, Yamanashi, Japan
| | - Yuka Akiyama
- Department of Health Sciences, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi, Chuo, Yamanashi, Japan
| | - Tadao Ooka
- Department of Health Sciences, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi, Chuo, Yamanashi, Japan
| | - Reiji Kojima
- Department of Health Sciences, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi, Chuo, Yamanashi, Japan
| | - Hiroshi Yokomichi
- Department of Health Sciences, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi, Chuo, Yamanashi, Japan
| | - Zentaro Yamagata
- Department of Health Sciences, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi, Chuo, Yamanashi, Japan.,Center for Birth Cohort Studies, University of Yamanashi, Chuo, Yamanashi, Japan
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Kozioł K, Kazek B, Sikora D, Brzóska A, Paprocka J, Emich-Widera E. A Dialogue in the Medical Perspective—Body Mass and Nutritional Status Disorders during the Development Period. Children 2022; 9:children9091360. [PMID: 36138668 PMCID: PMC9498126 DOI: 10.3390/children9091360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 08/23/2022] [Accepted: 08/31/2022] [Indexed: 11/16/2022]
Abstract
Eating disorders among children and youth are a serious social problem. The time of development is the starting point in shaping eating patterns. Proper nutrition provides the basis for psychophysical development. A knowledgeable pediatrician can improve society’s health by engaging parents and, later, the child or youth. We offer knowledge on the nutrition basics and the commonly available tools to assess the nutritional status. We will discuss the characteristics of eating and body mass disorders in developing children. We will provide information on the warning signals of eating and body mass disorders and recommend prophylaxis. The reader will be familiarized with the motivational dialogue as an effective control tool for the discussed health issues.
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Affiliation(s)
- Karolina Kozioł
- Department of Pediatric Neurology, Faculty of Medical Sciences, Medical University of Silesia, 40-752 Katowice, Poland
- Department of Pediatrics and Pediatric Endocrinology, Faculty of Medical Sciences, Medical University of Silesia, 40-752 Katowice, Poland
| | - Beata Kazek
- Child Development Support Center “Persevere”, 40-583 Katowice, Poland
| | - Dorota Sikora
- Specialty Diagnostics and Therapy Services, 43-200 Pszczyna, Poland
| | - Anna Brzóska
- Child Development Support Center “Persevere”, 40-583 Katowice, Poland
| | - Justyna Paprocka
- Department of Pediatric Neurology, Faculty of Medical Sciences, Medical University of Silesia, 40-752 Katowice, Poland
- Correspondence:
| | - Ewa Emich-Widera
- Department of Pediatric Neurology, Faculty of Medical Sciences, Medical University of Silesia, 40-752 Katowice, Poland
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13
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Amaya-Castellanos C, Gamboa-Delgado EM, Santacruz-Chasoy E, Pelcastre-Villafuerte BE. Loss of ancestral food practices and perception of its effect on children's health among Inga indigenous grandmothers, Nariño, Colombia. BMC Public Health 2022; 22:1452. [PMID: 35907810 PMCID: PMC9338638 DOI: 10.1186/s12889-022-13828-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 06/06/2022] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE Novel foods and dietary practices, a lack of available land, and displacement by armed conflict have affected the ancestral food traditions practiced by the Inga community in Aponte, in Nariño, Colombia. These factors have led to problems with food security and malnutrition, which have impacted the growth and development of children. Therefore, this study is aimed at identifying the changes in ancestral food practices reported by Inga grandmothers, and the possibility of recuperating them in order to improve children's health. METHOD A qualitative study was conducted that included 24 mothers with children under five years old and 25 grandmothers in nine Inga communities. Participants were recruited using snowball sampling. Free listing was used to identify changes in food patterns, and semi-structured interviews were conducted with 20 grandmothers to delve deeper into the subject. A translator of the Inga language facilitated communication, and the Inga researcher validated the translation using audio recordings. Each interview was transcribed and categorized for the purpose of analysis, using the NVivo 12 software. RESULTS Free lists showed changes from a corn-based to a rice-based diet and a wide variety of non-ancestral food products. According to the grandmothers, "tiendas" have replaced traditional foods with those that are easy to prepare, which are attractive to mothers as well as to the children because of their flavor. Ancestral practices such as grinding, peeling, and log cooking are being abandoned. Government programs and daycare have incorporated new food that compete with traditional ones, with no clear evidence of an intercultural approach. Added to this is the dismissal by young mothers of the knowledge held by their grandmothers, which hinders the continuation of traditions. CONCLUSIONS The findings suggest that it is necessary to prevent the loss of the Inga food culture, and policies need to be created that promote and protect ancestral knowledge and that help to regain the value of the "chagra" farming system, with the support of elders, authorities who are recognized by the community, and government technicians, as recommended by the grandmothers who participated in this study.
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Affiliation(s)
- Claudia Amaya-Castellanos
- Departamento de Salud Pública, Escuela de Medicina, Universidad Industrial de Santander, Carrera 32 #29-31, Bucaramanga, Colombia. .,Medical Anthropology Research Center, Universitat Rovira i Virgili, Tarragona, Catalunya, Spain.
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14
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Bai G, Parkash A, Kumar V, Das K, Akhtar U, . A. Effectiveness of Ready-to-Use Therapeutic Food Among Children With Protein-Calorie Malnutrition
. Cureus 2022; 14:e25872. [PMID: 35876746 PMCID: PMC9292467 DOI: 10.7759/cureus.25872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/12/2022] [Indexed: 12/01/2022] Open
Abstract
Background Malnutrition develops when there is an inadequacy of one or more than one macronutrient for optimum body functioning. This study was designed to determine the effectiveness of ready-to-use therapeutic food (RUTF) in children with protein-calorie malnutrition (PCM) in terms of weight gain and mid-upper arm circumference (MUAC) improvement. Methodology This prospective observational study was done at The Department of Pediatrics, National Institute of Child Health, Karachi, Pakistan from 1st January 2021 to 31st December 2021. A total of 159 children of either gender between six and 59 months of age and diagnosed with PCM were included. All children participating in the study were asked to come back for a follow-up every two weeks until they are 12 weeks old. Outcomes were measured in terms of comparison of weight gain and MUAC at baseline and after 12 weeks of RUTF. Results Of the 159 children, 94 (59.1%) were female. The mean age was 16.8±9.2 months, and 88 (55.3%) children were aged between six to 12 months. The mean body weight was 6.8±9.7 kg. The mean MUAC was calculated to be 116±9.1 mm. There were 121 (76.1%) children who had severe acute malnutrition. One hundred and thirty-one children completed the planned 12-week of follow-up using RUTF in this study, so they were included in the final analysis. Body weight increased significantly from baseline to 12-weeks after RUTF (6.8±1.7 kg vs. 7.6±1.2kg, p<0.0001). Likewise, MUAC also increased from baseline to 12 weeks after RUTF (116.0±9.1 mm vs. 127.2±8.2 mm, p<0.0001). Conclusion The RUTF was found to significantly improve weight gain and MUAC among children aged between six to 60 months with PCM during a period of 12-weeks. Early diagnosis and timely intervention can improve outcomes among children with PCM. Community-based interventions can be aimed to improve the nutritional status of children in a developing country like Pakistan.
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Suhett LG, Juvanhol LL, Silva MA, Ribeiro SAV, Hermsdorff HHM, Shivappa N, Hébert JR, de Novaes JF. Interaction effect between breakfast skipping and sedentary behavior in the dietary inflammatory potential in Brazilian schoolchildren. Nutrition 2022; 102:111749. [DOI: 10.1016/j.nut.2022.111749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 05/04/2022] [Accepted: 05/19/2022] [Indexed: 10/18/2022]
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Mbunga BK, Engebretsen IMS, Strand TA, Gjengdal ELF, Akilimali PZ, Langfjord MM, Tugirimana PL, Mapatano MA. Distribution and Determinants of Serum Zinc, Copper, and Selenium Levels among Children under Five Years from Popokabaka, Democratic Republic of Congo: A Cross-Sectional Study. Nutrients 2022; 14. [PMID: 35277041 DOI: 10.3390/nu14030683] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Revised: 01/31/2022] [Accepted: 02/03/2022] [Indexed: 01/27/2023] Open
Abstract
Information about essential trace elements among children in many African countries, including the Democratic Republic of Congo (DRC), is limited. We aimed to measure the distribution and determinants of serum zinc (Zn), copper (Cu), and selenium (Se) concentrations in a representative sample of children under five years old. We conducted a community-based cross-sectional study in Popokabaka, DRC. Blood samples were drawn from 412 children. The serum concentrations of minerals were measured using inductively coupled plasma−mass spectrometry. The median concentrations (P25−P75) of Zn, Cu, and Se were 61.9 µg/dL (52.8−70.2), 145.5 (120.0−167.0) µg/dL and 5.3 (4.3−6.3) µg/dL. The CRP-adjusted prevalence of serum Se deficiency was 84.1% (95% confidence interval [CI] 81.4−87.0) and of Zn deficiency was 64.6% (95% CI 59.8−69.1%). Only a few children were Cu deficient [1.5% (0.6−3.2)]. Evidence of inflammation (C-reactive protein, >5 mg/L) was associated with a lower Se concentration and higher Cu concentration. Furthermore, serum Se concentration was positively associated with linear growth. The average Cu/Zn molar ratio (2:1) was twice that recommended. Children in western Popokabaka had higher Zn and Se levels than their eastern neighbors. Zinc and selenium deficiencies are common among children in Popokabaka and require attention and prioritization.
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Esaryk EE, Reynolds SA, Fernald LC, Jones AD. Crop diversity is associated with higher child diet diversity in Ethiopia, particularly among low-income households, but not in Vietnam. Public Health Nutr 2021; 24:5857-68. [PMID: 34528505 DOI: 10.1017/S1368980021003281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES To examine associations of household crop diversity with school-aged child dietary diversity in Vietnam and Ethiopia and mechanisms underlying these associations. DESIGN We created a child diet diversity score (DDS) using data on seven food groups consumed in the last 24 h. Generalised estimating equations were used to model associations of household-level crop diversity, measured as a count of crop species richness (CSR) and of plant crop nutritional functional richness (CNFR), with DDS. We examined effect modification by household wealth and subsistence orientation, and mediation by the farm's market orientation. SETTING Two survey years of longitudinal data from the Young Lives cohort. PARTICIPANTS Children (aged 5 years in 2006 and 8 years in 2009) from rural farming households in Ethiopia (n 1012) and Vietnam (n 1083). RESULTS There was a small, positive association between household CNFR and DDS in Ethiopia (CNFR-DDS, β = 0·13; (95 % CI 0·07, 0·19)), but not in Vietnam. Associations of crop diversity and child diet diversity were strongest among poor households in Ethiopia and among subsistence-oriented households in Vietnam. Agricultural earnings positively mediated the crop diversity-diet diversity association in Ethiopia. DISCUSSION Children from households that are poorer and those that rely more on their own agricultural production for food may benefit most from increased crop diversity.
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Castro IRRD, Normando P, Alves-Santos NH, Bezerra FF, Citelli M, Pedrosa LDFC, Jordão Junior AA, Lira PICD, Kurscheidt FA, Silva PRPD, Salvatte K, Lacerda EMDA, Anjos LAD, Boccolini CS, Kac G. Methodological aspects of the micronutrient assessment in the Brazilian National Survey on Child Nutrition (ENANI-2019): a population-based household survey. CAD SAUDE PUBLICA 2021; 3737:e00301120. [PMID: 34495100 DOI: 10.1590/0102-311x00301120] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Accepted: 05/28/2021] [Indexed: 11/21/2022] Open
Abstract
This article aims to present methodological aspects on the collection, analyses, coverage, challenges, and the lessons learned from laboratory assessment of micronutrients on the Brazilian National Survey on Child Nutrition (ENANI-2019). This is a household survey on a probability sample of children under five years of age from 123 Brazilian municipalities in all 26 states and the Federal District. Blood samples were drawn by venipuncture at the homes of children 6 to 59 months of age. This procedure was performed by experienced phlebotomists from the laboratories located in the selected municipalities and scheduled in advance. Blood and serum levels were measured for biomarkers of nutritional status, using the services of a clinical test laboratory with nationwide coverage, for the following micronutrients: iron (hemoglobin and ferritin), zinc, selenium, folic acid, and vitamins A, B1, B6, B12, D, and E. C-reactive protein was analyzed as a marker of inflammation. A barcode identifier was used to track the blood samples and to link the biochemical test results to the other data collected in the survey. A total of 14,558 children were studied. Of the 12,598 eligible children, 8,829 (70.1%) had blood samples drawn. Of the total number of children who had samples drawn, 91.8% (n = 8,025) have results for at least nine of the 12 analyses performed. Coverage of the analysis varied from 95% (for vitamins A and E) to 84.2% (for folic acid). Aliquots of whole blood and serum were stored in a biorepository for future analyses. The results of this pioneering study in the country will back the formulation and, when necessary, the reorientation of public policies in food and nutrition.
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Affiliation(s)
| | - Paula Normando
- Instituto de Nutrição Josué de Castro, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brasil
| | - Nadya Helena Alves-Santos
- Instituto de Nutrição Josué de Castro, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brasil
| | | | - Marta Citelli
- Instituto de Nutrição, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brasil
| | | | | | | | | | | | - Keronlainy Salvatte
- Instituto de Nutrição Josué de Castro, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brasil
| | | | - Luiz Antonio Dos Anjos
- Departamento de Nutrição Social, Universidade Federal Fluminense, Rio de Janeiro, Brasil
| | - Cristiano Siqueira Boccolini
- Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | - Gilberto Kac
- Instituto de Nutrição Josué de Castro, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brasil
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Saleem J, Zakar R, Bukhari GMJ, Naz M, Mushtaq F, Fischer F. Effectiveness of Ready-to-Use Therapeutic Food in Improving the Developmental Potential and Weight of Children Aged under Five with Severe Acute Malnourishment in Pakistan: A Pretest-Posttest Study. Int J Environ Res Public Health 2021; 18:ijerph18179060. [PMID: 34501649 PMCID: PMC8430796 DOI: 10.3390/ijerph18179060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 08/13/2021] [Accepted: 08/26/2021] [Indexed: 11/21/2022]
Abstract
The objective of this study was to assess whether the standard therapy of ready-to-use therapeutic food in the treatment of uncomplicated severe acute malnutrition (SAM) is effective in improving developmental potential and weight gain in children aged under five years. A multicenter pretest-posttest study was conducted among 91 children aged under five with uncomplicated SAM in Pakistan. Study participants completed their eight weeks’ therapy of ready-to-use therapeutic food according to the World Health Organization’s (WHO) standard guidelines. The study outcome was the proportion of children with improved developmental potential in all domains in comparison with the pretreatment status and children gaining >15% of their baseline weight; mean weight-for-height/length z-score after completing eight weeks’ therapy of ready-to-use therapeutic food. The Denver Development Screening Tool II was used for developmental screening. Significant changes (p < 0.05) were observed for developmental status milestones in terms of gross motor, fine motor, and personal/social milestones, as well as language and global development milestones. There was a strong positive correlation (r = 0.961) between initial weight and weight at the last visit (p < 0.001). Ready-to-use therapeutic food is effective in improving development potential as well as promoting weight gain in children aged under five with uncomplicated SAM if provided according to WHO guidelines.
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Affiliation(s)
- Javeria Saleem
- Department of Public Health, University of the Punjab, Lahore 54590, Pakistan; (J.S.); (R.Z.)
| | - Rubeena Zakar
- Department of Public Health, University of the Punjab, Lahore 54590, Pakistan; (J.S.); (R.Z.)
| | - Gul Mehar Javaid Bukhari
- Department of Community Medicine, Federal Medical and Dental College, Islamabad 44000, Pakistan;
| | - Mahwish Naz
- Department of Primary and Secondary Health, Government of Punjab, Lahore 54000, Pakistan;
| | - Faisal Mushtaq
- Department of Biostatistics, Institute of Public Health, Lahore 54000, Pakistan;
| | - Florian Fischer
- Institute of Public Health, Charité—Universitätsmedizin Berlin, 10117 Berlin, Germany
- Institute of Gerontological Health Services and Nursing Research, Ravensburg-Weingarten University of Applied Sciences, 88250 Weingarten, Germany
- Correspondence:
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Saleem J, Zakar R, Mushtaq F, Bukhari GMJ, Fischer F. Comparative analysis of developmental profile between normal and severe acute malnourished under-five children in Pakistan: a multicentre cross-sectional study. BMJ Open 2021; 11:e048644. [PMID: 34389574 PMCID: PMC8365806 DOI: 10.1136/bmjopen-2021-048644] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES This study aims to compare the developmental profile of severe acute malnourished (SAM) and normal under-five children and to find sociodemographic determinants accountable for their developmental disabilities. SETTING We conducted a multi-centre cross-sectional study in three basic health units and one rural health centre in Pakistan. PARTICIPANTS 200 children (SAM and healthy) aged 6-59 months. PRIMARY AND SECONDARY MEASURES We screened for nutritional status and clinical complications. Children underwent for developmental assessment by Denver Development Screening Tool II. A pretested structured questionnaire on sociodemographic characteristics and nutrition was used for collecting data about determinants of developmental delay. RESULTS We observed statistically significant differences in anthropometric measurements among SAM compared with normal nourished in weight, height, mid-upper arm circumference and weight-for-height z-scores. SAM serves as a significant risk factors (p<0.001) for delayed personal or social development (69% vs 11%; OR (95% CI)=18.01 (8.45 to 38.37)), delayed fine motor development (39% vs 8%; OR (95% CI)=7.35 (3.22 to 16.81)), delayed language development (32% vs 8%; OR (95% CI)=5.41 (2.35 to 12.48)), delayed gross motor development (34% vs 10%; OR (95% CI)=4.64 (2.14 to 10.05)) and delayed global development (66% vs 20%; OR (95% CI)=7.77 (4.09 to 14.74)). Applying logistic regression, personal or social development (p<0.001) and language development (p<0.05), under-five siblings was a risk factor, while among gross motor development, mother's educational status (p<0.05) was a significant risk factor for developmental delay. CONCLUSIONS Our analysis indicates that children with malnutrition have a high frequency of developmental delays. Missing maternal education and a higher number of under-five siblings are also potential risk factors for developmental delay.
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Affiliation(s)
- Javeria Saleem
- Department of Public Health, Institute of Social and Cultural Studies, University of the Punjab, Lahore, Pakistan
| | - Rubeena Zakar
- Department of Public Health, Institute of Social and Cultural Studies, University of the Punjab, Lahore, Pakistan
| | | | | | - Florian Fischer
- Institute of Public Health, Charité Universitätsmedizin Berlin, Berlin, Germany
- Institute of Gerontological Health Services and Nursing Research, University of Applied Sciences Ravensburg-Weingarten, Weingarten, Germany
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Saleem J, Zakar R, Bukhari GMJ, Fatima A, Fischer F. Developmental delay and its predictors among children under five years of age with uncomplicated severe acute malnutrition: a cross-sectional study in rural Pakistan. BMC Public Health 2021; 21:1397. [PMID: 34266406 PMCID: PMC8281691 DOI: 10.1186/s12889-021-11445-w] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 07/01/2021] [Indexed: 11/26/2022] Open
Abstract
Background In developing countries, malnutrition in children and developmental delays are two major challenges for public health. To achieve the vision of the Sustainable Development Goals from the broader perspective of child health, early identification of developmental delays and timely intervention are crucial. The aim of this study is to assess the prevalence of suspected developmental delay and their predictors in children under the age of 5 years with uncomplicated severe acute malnutrition in rural areas of Pakistan. Methods A multicentre cross-sectional study was conducted among 185 children with uncomplicated severe acute malnutrition. We screened children aged 6–59 months for their nutritional status and clinical complications. Children fulfilling the inclusion criteria underwent the Denver Development Screening Tool II (DDST-II). The children’s global developmental profile was calculated according to the established protocols of DDST-II, which are based on four important domains of development: personal and social behaviour, language, gross motor adaptive skills and fine motor adaptive skills. A pretested questionnaire was used to collect data on socio-demographic and nutritional factors for assessing predictors of developmental delay, which were analysed using a multivariate logistic regression model. Results Out of 177 children with severe acute malnutrition, 69 (38.9%) had normal global development and 108 (61.1%) had delayed global development. Significant associations were found between global developmental delay and younger children (6–24 months vs. 25–59 months; AOR = 4.53, 95% CI: 1.56–13.10, p < 0.01), children who were not exclusively breastfed (AOR = 3.07, 95% CI: 1.24–7.56, p = 0.01), and a history of contact with a tuberculosis smear-positive adult (AOR = 2.67, 95% CI: 1.30–5.49, p < 0.01). Conclusion About two thirds of the study participants showed delayed or unstable global development. Thus, according to DDST-II-established protocols, there is a high prevalence of suspected developmental delay among children under the age of five years with uncomplicated severe acute malnutrition in rural areas of Pakistan. Children in their first 2 years of life were at particularly high risk due to insufficient breastfeeding. This emphasizes the need to provide adequate infrastructure and information to parents for the prevention of developmental delay in remote areas.
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Affiliation(s)
- Javeria Saleem
- Department of Public Health, Institute of Social and Cultural Studies, University of the Punjab, Lahore, Pakistan
| | - Rubeena Zakar
- Department of Public Health, Institute of Social and Cultural Studies, University of the Punjab, Lahore, Pakistan
| | | | - Aneela Fatima
- Pakistan Council of Scientific and Industrial Research, Islamabad, Pakistan
| | - Florian Fischer
- Institute of Public Health, Charité - Universitätsmedizin Berlin, Berlin, Germany. .,Institute of Gerontological Health Services and Nursing Research, Ravensburg-Weingarten University of Applied Sciences, Weingarten, Germany.
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22
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Nguyen PH, Young MF, Tran LM, Khuong LQ, Duong TH, Nguyen HC, Truong TV, DiGirolamo AM, Martorell R, Ramakrishnan U. Preconception micronutrient supplementation positively affects child intellectual functioning at 6 y of age: A randomized controlled trial in Vietnam. Am J Clin Nutr 2021; 113:1199-1208. [PMID: 33668050 PMCID: PMC8106753 DOI: 10.1093/ajcn/nqaa423] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 12/14/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Although there is growing evidence on the role of preconception nutrition for birth outcomes, very few studies have evaluated the long-term effects of nutrition interventions during the preconception period on offspring cognitive outcomes. OBJECTIVE We evaluate the impact of preconception weekly multiple micronutrients (MMs) or iron and folic acid (IFA) supplementation compared with folic acid (FA) alone on offspring intellectual functioning at age 6-7 y. METHODS We followed 1599 offspring born to women who participated in a double-blinded randomized controlled trial of preconception supplementation in Vietnam. Women received weekly supplements containing either 2800 μg FA only, 60 mg iron and 2800 μg FA, or MMs (15 micronutrients including IFA) from baseline until conception, followed by daily prenatal IFA supplements until delivery. We used the Wechsler Intelligence Scale for Children to measure full-scale IQ (FSIQ) and 4 related domains of intellectual functioning [Verbal Comprehension Index (VCI), Perceptual Reasoning Index (PRI), Working Memory Index (WMI), and Processing Speed Index (PSI) scores] at 6-7 y. Group comparisons were done using ANOVA tests for all children and the subgroup born to women who consumed the supplements ≥26 wk before conception (per-protocol analyses). RESULTS The final sample with data at 6-7 y (n = 1321) was similar for baseline maternal and offspring birth characteristics and age at follow-up by treatment group. Compared with the offspring in the FA group, those in the MM group had higher FSIQ (β = 1.7; 95% CI: 0.1, 3.3), WMI (β = 1.7; 95% CI: 0.2, 3.2), and PSI (β = 2.5; 95% CI: 0.9, 4.1). Similar findings were observed in the per-protocol analyses. There were no significant differences by treatment group for VCI and PRI. CONCLUSIONS Preconception supplementation with MMs improved certain domains of intellectual functioning at age 6-7 y compared with FA. These findings suggest the potential for preconception micronutrient interventions to have long-term benefits for offspring cognition.
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Affiliation(s)
- Phuong H Nguyen
- International Food Policy Research Institute, Washington, DC, USA.,Thai Nguyen University of Pharmacy and Medicine, Thai Nguyen, Vietnam
| | | | - Lan Mai Tran
- Thai Nguyen National Hospital, Thai Nguyen, Vietnam
| | | | - Thai Hong Duong
- Thai Nguyen University of Pharmacy and Medicine, Thai Nguyen, Vietnam.,Thai Nguyen National Hospital, Thai Nguyen, Vietnam
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23
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Adoko MC, Olum S, Elolu S, Ongeng D. Addition of Orange-Fleshed Sweet Potato and Iron-Rich Beans Improves Sensory, Nutritional and Physical Properties But Reduces Microbial Shelf Life of Cassava-Based Pancake ( Kabalagala) Designed for Children 2-5 Years Old. Journal of Culinary Science & Technology 2021. [DOI: 10.1080/15428052.2021.1911899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Melas Cayrol Adoko
- Department of Food Science and Postharvest Technology, Gulu University, Gulu, Uganda
| | - Solomon Olum
- Department of Food Science and Postharvest Technology, Gulu University, Gulu, Uganda
| | - Samuel Elolu
- Department of Food Science and Postharvest Technology, Gulu University, Gulu, Uganda
| | - Duncan Ongeng
- Department of Food Science and Postharvest Technology, Gulu University, Gulu, Uganda
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24
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Pedroso J, Herkrath FJ, Buccini G, Venancio SI, Pérez-Escamilla R, Gubert MB. Maternal Mental Health Mediates the Relationship Between Household Food Insecurity and Early Child Development in Brazil. Food Nutr Bull 2021; 42:77-90. [PMID: 33878902 DOI: 10.1177/0379572120987815] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Optimal early child development (ECD) is fundamental for every child to achieve their developmental potential and thrive. Household food insecurity (HFI) is a risk factor for suboptimal development, but there is still a need to better understand the pathways that explain this relationship. OBJECTIVE To evaluate whether maternal mental health and infant's diet mediate the association between HFI and ECD using structural equation modeling. METHODS Cross-sectional study with 474 mother-infant dyads. Mothers answered a questionnaire that evaluated variables through validated instruments. Structural equation modeling analyses were conducted to obtain standardized effects (β) and bias-corrected 95% CI, enabling comparisons between the magnitude of the effects. The following observed variables were included: HFI, ECD, consumption of a healthy and diverse diet, the presence of a partner in the household, wanted pregnancy, and current breastfeeding. Latent variables were included to evaluate mental health, poverty, and neonatal health. RESULTS Poor maternal mental health mediated the relationship between HFI and ECD (β = -.05), but a healthy and diverse diet was not a mediator in this relationship. Poverty was related to lower development scores directly (β = .21) and indirectly (β = .02). Not having a partner (β = .05) and having an unwanted pregnancy (β = .02) predicted indirectly lower development scores. CONCLUSIONS Poor maternal mental health mediates the relationship between HFI and ECD, and ECD is influenced by poverty, single motherhood, and unwanted pregnancy through different pathways. Therefore, public policies and interventions that aim to promote an optimal ECD should also approach these aspects.
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Affiliation(s)
- Jéssica Pedroso
- 28127University of Brasilia, Brasilia, Distrito Federal, Brazil
| | | | - Gabriela Buccini
- Department of Environmental and Occupational Health, University of Nevada, Las Vegas, USA
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25
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儿童喂养问题的评估工具及其研究进展. Zhongguo Dang Dai Er Ke Za Zhi 2021; 23. [PMID: 33840418 DOI: 10.7499/j.issn.1008-8830.2011061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
As one of the most important non-nutritional factors associated with children's growth and development, feeding problems in children are getting more and more attention from medical professionals and guardians. The evaluation of feeding problems has developed from the single-factor and descriptive research in the past to the multi-factor and analytical research at present, and thus a good quantitative analysis system is increasingly important for researchers. However, the development of localized quantitative analysis tools remains a weak link in this field. Therefore, it is a research hotspot to develop child feeding assessment scales and questionnaires with high reliability, validity, and operability in combination with China's cultural background and eating habits and provide effective assessment tools for feeding problems in Chinese children. Through classification based on research mode and screening, this article reviews the research findings in the field of child feeding, so as to provide a basis for future research.
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26
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Madzorera I, Ghosh S, Wang M, Fawzi W, Isanaka S, Hertzmark E, Namirembe G, Bashaasha B, Agaba E, Turyashemererwa F, Webb P, Duggan C. Prenatal dietary diversity may influence underweight in infants in a Ugandan birth-cohort. Matern Child Nutr 2021; 17:e13127. [PMID: 33595899 PMCID: PMC8189249 DOI: 10.1111/mcn.13127] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 11/06/2020] [Accepted: 12/02/2020] [Indexed: 12/18/2022]
Abstract
Growth faltering in early childhood is prevalent in many low resource countries. Poor maternal dietary diversity during pregnancy has been linked with increased risk of fetal growth failure and adverse birth outcomes but may also influence subsequent infant growth. Our aim is to assess the role of prenatal maternal dietary diversity in infant growth in rural Uganda. Data from 3291 women and infant pairs enrolled in a birth cohort from 2014 to 2016 were analysed (NCT04233944). Maternal diets were assessed using dietary recall in the second or third trimesters of pregnancy. Maternal dietary diversity scores (DDS) were calculated using the FAO Minimum Dietary Diversity for Women (MDD‐W). Cox regression models were used to evaluate associations of the DDS with the incidence of underweight, stunting and wasting in infants from 3 to 12 months, adjusting for confounding factors. The median DDS for women was low, at 3.0 (interquartile range 3.0–4.0), relative to the threshold of consuming five or more food groups daily. Infants of women in highest quartile of DDS (diverse diets) were less likely to be underweight (adjusted hazard ratio: 0.70, 95% confidence interval: 0.61, 0.80) compared with infants of women in Quartile 1 (p for trend <0.001) in models controlling for maternal factors. There was no significant association between DDS and stunting or wasting. Our findings suggest a relationship between higher maternal dietary diversity and lower risk of underweight in infancy. These findings suggest that programmes to improve infant growth could additionally consider strengthening prenatal dietary diversity to improve child outcomes globally.
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Affiliation(s)
- Isabel Madzorera
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, Massachusetts, USA
| | - Shibani Ghosh
- Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, USA.,USAID Feed the Future Innovation Lab for Nutrition, Tufts University, Boston, Massachusetts, USA
| | - Molin Wang
- Departments of Epidemiology and Biostatistics, Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Wafaie Fawzi
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, Massachusetts, USA.,Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, Massachusetts, USA
| | - Sheila Isanaka
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, Massachusetts, USA.,Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, Massachusetts, USA
| | - Ellen Hertzmark
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, Massachusetts, USA
| | - Grace Namirembe
- Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, USA
| | - Bernard Bashaasha
- Department of Agribusiness and Natural Resource Economics, College of Agricultural and Environmental Sciences, Makerere University, Kampala, Uganda
| | - Edgar Agaba
- USAID Feed the Future Innovation Lab for Nutrition, Tufts University, Boston, Massachusetts, USA
| | - Florence Turyashemererwa
- Department of Agribusiness and Natural Resource Economics, College of Agricultural and Environmental Sciences, Makerere University, Kampala, Uganda
| | - Patrick Webb
- Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, USA.,USAID Feed the Future Innovation Lab for Nutrition, Tufts University, Boston, Massachusetts, USA
| | - Christopher Duggan
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, Massachusetts, USA.,Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, Massachusetts, USA
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Santos HO, Genario R, Macedo RCO, Pareek M, Tinsley GM. Association of breakfast skipping with cardiovascular outcomes and cardiometabolic risk factors: an updated review of clinical evidence. Crit Rev Food Sci Nutr 2020; 62:466-474. [PMID: 32935557 DOI: 10.1080/10408398.2020.1819768] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
"Eat breakfast like a king, lunch like a prince and dinner like a pauper" (Adelle Davis, 1904-1974) is a concept that appears to align with some contemporary evidence concerning the appropriate proportioning of daily meals. At the same time, with the popular and scientific dissemination of the concepts of intermittent fasting and time-restricted feeding, well-controlled clinical trials have emerged showing the safety or even possible benefits of skipping breakfast. In this comprehensive literature review, we discuss recent evidence regarding breakfast intake, cardiovascular outcomes and cardiovascular risk markers. Overall, breakfast omission appears to be associated with a higher risk for atherosclerotic and adverse cardiovascular outcomes. However, caution should be employed when deciphering these data as many complex, unmeasured confounders may have contributed. Unfortunately, long-term randomized, clinical trials with detailed dietary control that have assessed clinical outcomes are sparse. Notwithstanding the observational findings, current trials conducted so far-albeit apparently smaller number-have shown that breakfast addition in subjects who do not habitually consume this meal may increase body weight, particularly fat mass, through caloric excess, whereas skipping breakfast may be a feasible strategy for some people aiming for calorie restriction. To date, definitive benefits of breakfast omission or consumption are not supported by the best evidence-based research, and the question of whether skipping breakfast per se is causally associated with cardiovascular outcomes remains unresolved.
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Affiliation(s)
- Heitor O Santos
- School of Medicine, Federal University of Uberlandia (UFU), Uberlandia, Minas Gerais, Brazil
| | | | | | - Manan Pareek
- Department of Cardiology, North Zealand Hospital, Hilleroed, Denmark.,Department of Internal Medicine, Yale New Haven Hospital, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Grant M Tinsley
- Department of Kinesiology and Sport Management, Texas Tech University, Lubbock, Texas, USA
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Olgac A, İnci A, Okur İ, Biberoğlu G, Oğuz D, Ezgü FS, Kasapkara ÇS, Aktaş E, Tümer L. Beneficial Effects of Modified Atkins Diet in Glycogen Storage Disease Type IIIa. Ann Nutr Metab 2020; 76:233-241. [DOI: 10.1159/000509335] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 06/07/2020] [Indexed: 11/19/2022]
Abstract
<b><i>Introduction:</i></b> Glycogen storage disease Type III (GSD III) is an autosomal recessive disease caused by the deficiency of glycogen debranching enzyme, encoded by the AGL gene. Two clinical types of the disease are most prevalent: GSD IIIa involves the liver and muscle, whereas IIIb affects only the liver. The classical dietetic management of GSD IIIa involves prevention of fasting, frequent feeds with high complex carbohydrates in small children, and a low-carb-high-protein diet in older children and adults. Recently, diets containing high amount of fat, including ketogenic and modified Atkins diet (MAD), have been suggested to have favorable outcome in GSD IIIa. <b><i>Methods:</i></b> Six patients, aged 3–31 years, with GSD IIIa received MAD for a duration of 3–7 months. Serum glucose, transaminases, creatine kinase (CK) levels, capillary ketone levels, and cardiac parameters were followed-up. <b><i>Results:</i></b> In all patients, transaminase levels dropped in response to MAD. Decrease in CK levels were detected in 5 out of 6 patients. Hypoglycemia was evident in 2 patients but was resolved by adding uncooked cornstarch to diet. <b><i>Conclusion:</i></b> Our study demonstrates that GSD IIIa may benefit from MAD both clinically and biochemically.
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29
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Moody EC, Colicino E, Wright RO, Mupere E, Jaramillo EG, Amarasiriwardena C, Cusick SE. Environmental exposure to metal mixtures and linear growth in healthy Ugandan children. PLoS One 2020; 15:e0233108. [PMID: 32413070 PMCID: PMC7228047 DOI: 10.1371/journal.pone.0233108] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 11/04/2019] [Accepted: 04/28/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Stunting is an indicator of poor linear growth in children and is an important public health problem in many countries. Both nutritional deficits and toxic exposures can contribute to lower height-for-age Z-score (HAZ) and stunting (HAZ < -2). OBJECTIVES In a community-based cross-sectional sample of 97 healthy children ages 6-59 months in Kampala, Uganda, we examined whether exposure to Pb, As, Cd, Se, or Zn were associated with HAZ individually or as a mixture. METHODS Blood samples were analyzed for a mixture of metals, which represent both toxins and essential nutrients. The association between HAZ and metal exposure was tested using multivariable linear regression and Weighted Quantile Sum (WQS) regression, which uses mixtures of correlated exposures as a predictor. RESULTS There were 22 stunted children in the sample, mean HAZ was -0.74 (SD = 1.84). Linear regression showed that Pb (β = -0.80, p = 0.021) and Se (β = 1.92, p = 0.005) were significantly associated with HAZ. The WQS models separated toxic elements with a presumed negative effect on HAZ (Pb, As, Cd) from essential nutrients with presumed positive effect on HAZ (Se and Zn). The toxic mixture was significantly associated with lower HAZ (β = -0.47, p = 0.03), with 62% of the effect from Pb. The nutrient WQS index did not reach statistical significance (β = -0.47, p = 0.16). DISCUSSION Higher blood lead and lower blood selenium level were both associated with lower HAZ. The significant associations by linear regression were reinforced by the WQS models, although not all associations reached statistical significance. These findings suggest that healthy children in this neighborhood of Kampala, Uganda, who have a high burden of toxic exposures, may experience detrimental health effects associated with these exposures in an environment where exposure sources are not well characterized.
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Affiliation(s)
- Emily C. Moody
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Elena Colicino
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Robert O. Wright
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Ezekiel Mupere
- Department of Paediatrics & Child Health, Mulago Hospital, Kampala, Uganda
| | - Ericka G. Jaramillo
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Chitra Amarasiriwardena
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Sarah E. Cusick
- Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota, United States of America
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30
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Hannan N, Steel A, McMillan SS, Tiralongo E. Health Service Use and Treatment Choices for Pediatric Eosinophilic Esophagitis: Findings From a Cross-Sectional Survey of Australian Carers. Front Pediatr 2020; 8:147. [PMID: 32363170 PMCID: PMC7180181 DOI: 10.3389/fped.2020.00147] [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] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 03/16/2020] [Indexed: 01/09/2023] Open
Abstract
Objectives: The incidence and the prevalence of eosinophilic esophagitis (EoE) are increasing, and healthcare utilization among children with EoE is high. This study provides novel insights into the health services and the treatments, including complementary medicines (CMs), used by carers to manage their children's EoE as well as the carers' beliefs and attitudes toward these treatments. Methods: A national cross-sectional online survey was conducted in Australia between September 2018 and February 2019. The survey included questions about health service and treatment utilization, health insurance and government support, health-related quality of life of children with EoE and their carers, views and attitudes toward CM use, and perceived efficacy of treatment. Results: The survey was completed by 181 carers (96.6% of whom were mothers) of EoE children. Most children (91.2%, n = 165) had seen a medical doctor for their EoE, and almost half had consulted with a CM practitioner (40.3%, n = 73). Pharmaceuticals (n = 156, 86.2%) were the most commonly used treatment option, followed by dietary changes (n = 142, 78.5%), CM products (n = 109, 60.2%), and CM therapies (n = 42, 23.2%). Most children received care from numerous practitioners on multiple occasions, indicating a substantial financial and treatment-related burden. Conclusions: A variety of practitioners are involved in the care of children with EoE, and a high rate of CM use warrants further attention to ensure that appropriate treatment is provided. Carer involvement and guidance, combined with individual practitioner expertise, referrals, and collaboration between providers, is essential to successfully navigate this complex disease and provide adequate care for these patients.
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Affiliation(s)
- Nicole Hannan
- School of Pharmacy and Pharmacology, Griffith University, Southport, QLD, Australia
| | - Amie Steel
- Faculty of Health, Australian Research Centre in Complementary and Integrative Medicine, University of Technology Sydney, Ultimo, NSW, Australia
| | - Sara S McMillan
- School of Pharmacy and Pharmacology, Griffith University, Southport, QLD, Australia
| | - Evelin Tiralongo
- School of Pharmacy and Pharmacology, Griffith University, Southport, QLD, Australia
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Abstract
The WHO recommends exclusive breastfeeding of infants for the first 6 mo of life (EBF-6). We reviewed the evidence behind concerns related to this recommendation. The risk of iron deficiency among EBF-6 infants can be significantly reduced if delayed cord clamping is performed in all newborns. At the moment there is no population-level evidence indicating that exclusive breastfeeding for 6 mo compared with <6 mo increases the risk of developing food allergies. Mild to moderate maternal undernutrition may reduce amounts of some nutrients in breast milk but does not directly diminish milk volume. Persistent reports of insufficient milk by women globally are likely to be the result of lack of access to timely lactation counseling and social support rather than primary biological reasons. All newborns should have their growth, hydration status, and development carefully monitored. In instances where formula supplementation is required, it should be done under the guidance of a qualified provider taking into account that early introduction of breast-milk supplements is a risk factor for early termination of exclusive breastfeeding and any breastfeeding. We found no evidence to support changes to the EBF-6 public health recommendation, although variability in inter-infant developmental readiness is recognized. We suggest that infant and young feeding guidelines make clear that complementary foods should be introduced at around 6 mo of age, taking infant developmental readiness into account.
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Affiliation(s)
| | | | | | - Ellen Piwoz
- Bill & Melinda Gates Foundation, Seattle, WA
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32
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Chakrabarti A, Eiden M, Morin-Rivron D, Christinat N, Monteiro JP, Kaput J, Masoodi M. Impact of multi-micronutrient supplementation on lipidemia of children and adolescents. Clin Nutr 2019; 39:2211-2219. [PMID: 31677804 DOI: 10.1016/j.clnu.2019.09.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Revised: 09/24/2019] [Accepted: 09/24/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Micronutrient supplementation has been extensively explored as a strategy to improve health and reduce risk of chronic diseases. Fat-soluble vitamins like A and E with their antioxidant properties and mechanistic interactions with lipoproteins, have potentially a key impact on lipid metabolism and lipidemia. OBJECTIVE The impact of micronutrients on lipid metabolism requires further investigation including characterization of plasma lipidome following supplementation and any cause-effect on circulating lipids. DESIGN In this study, we elucidate the effect and associations of a multi-micronutrient intervention in Brazilian children and teens with lipoprotein alterations and lipid metabolism. RESULTS Our analysis suggests a combination of short and long-term impact of supplementation on lipid metabolism, potentially mediated primarily by α-tocopherol (vitamin E) and retinol (vitamin A). Among the lipid classes, levels of phospholipids, lysophospholipids, and cholesterol esters were impacted the most along with differential incorporation of stearic, palmitic, oleic and arachidonic acids. Integrated analysis with proteomic data suggested potential links to supplementation-mediated alterations in protein levels of phospholipases and pyruvate dehydrogenase kinase 1 (PDK1). CONCLUSIONS Associations between the observed differences in lipidemia, total triglyceride, and VLDL-cholesterol levels suggest that micronutrients may play a role in reducing these risk factors for cardiovascular disease in children. This would require further investigation.
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Affiliation(s)
| | - Michael Eiden
- Lipid Metabolism, Nestlé Research, EPFL Innovation Park, 1015, Switzerland; Eidea Bioscience Ltd., Cambridge, United Kingdom
| | | | - Nicolas Christinat
- Lipid Metabolism, Nestlé Research, EPFL Innovation Park, 1015, Switzerland
| | - Jacqueline P Monteiro
- Department of Pediatrics and Department of Health Sciences, Ribeirão Preto Medical School, University of São Paulo, Bandeirantes Avenue, 3900, Ribeirão Preto, 14049-900, Brazil
| | - Jim Kaput
- Nestlé Research, EPFL Innovation Park, 1015, Lausanne, Switzerland
| | - Mojgan Masoodi
- Lipid Metabolism, Nestlé Research, EPFL Innovation Park, 1015, Switzerland; Institute of Clinical Chemistry, Inselspital, Bern University Hospital, Bern, Switzerland.
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Balasuriya CND, Larose TL, Mosti MP, Evensen KAI, Jacobsen GW, Thorsby PM, Stunes AK, Syversen U. Maternal serum retinol, 25(OH)D and 1,25(OH)2D concentrations during pregnancy and peak bone mass and trabecular bone score in adult offspring at 26-year follow-up. PLoS One 2019; 14:e0222712. [PMID: 31557195 DOI: 10.1371/journal.pone.0222712] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 09/05/2019] [Indexed: 12/19/2022] Open
Abstract
Background Vitamin A and D deficiency is prevalent in pregnant women worldwide. Both vitamins are involved in fetal skeletal development. A positive association between maternal vitamin D levels and offspring bone mineral density (BMD) at adulthood has been observed. The impact of maternal vitamin A status in pregnancy on offspring peak bone mass remains unclear. Method and findings Forty-one mother-child pairs were recruited from a population-based prospective cohort study in Trondheim, Norway, where pregnant women were followed from gestational week 17. Their term-born infants were followed from birth (1986–88). Regression analyses were performed for vitamin A (retinol), 25-hydroxyvitamin D [25(OH)D] and 1,25-dihydroxyvitamin D [1,25(OH)2D] in maternal serum (gestational weeks 17, 33, 37) and cord blood. Offspring BMD and spine trabecular bone score (TBS), a measure of bone quality, were analyzed by dual x-ray absorptiometry at 26 years. Average levels during pregnancy of retinol, 25(OH)D and 1,25(OH)2D were 1.66 (0.32) μmol/L, 59.0 (20.6) nmol/L, and 251.3 (62.4) pmol/L, respectively. 1,25(OH)2D levels were similar in those with 25(OH)D levels <30 and >75 nmol/L. After adjustment for maternal age, BMI, smoking, and education, and offspring birth weight, maternal serum retinol was positively associated with offspring spine BMD [mean change 30.8 (CI 7.6, 54.0) mg/cm2 per 0.2 μmol/L retinol], and with offspring TBS, although non-significant (p = 0.08). No associations were found between maternal 25(OH)D and 1,25(OH)2D levels and offspring bone parameters. Vitamin levels in cord blood were not associated with offspring BMD or TBS. Conclusions This is the first study to show an association between maternal vitamin A status and offspring peak bone mass. Our findings may imply increase future risk for osteoporotic fracture in offspring of mothers with suboptimal vitamin A level. No associations were observed between 25(OH)D and 1,25(OH)2D and offspring BMD.
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Huiracocha-Tutiven L, Orellana-Paucar A, Abril-Ulloa V, Huiracocha-Tutiven M, Palacios-Santana G, Blume S. Child Development and Nutritional Status in Ecuador. Glob Pediatr Health 2019; 6:2333794X18821946. [PMID: 30719492 PMCID: PMC6348541 DOI: 10.1177/2333794x18821946] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Revised: 11/01/2018] [Accepted: 11/08/2018] [Indexed: 12/17/2022] Open
Abstract
We assessed the development, nutritional status, and complementary feeding of 12- to 23-month-old children from Cuenca, Ecuador in 2013. Ecuador, an upper-middle-income country, developed a child policy in accordance with World Health Organization (WHO) guidelines. We collected cross-sectional survey data. Child development was assessed using the Integrated Management of Childhood Illness Guide–2011. The nutritional status was defined with WHO Child Growth Standards−2006. We investigated nutrient density, WHO Infant and Young Child Feeding Indicators, and nutrient supplementation intake of the complementary feeding. In all, 11.7% of children had “possible developmental delay,” stunting was identified in 29.4% of the children, and 25.3% faced overnutrition (overweight risk/overweight/obesity). The complementary feeding composition can be summarized as having adequate fat, high energy (MJ/day) and protein, and low iron and zinc. Children with “possible developmental delay” received less iron (P < .05) than children with normal development. Overall, 30.4% of children had minimum dietary diversity. A total of 47.7% of children received nutrient supplementation. This epidemiological profile of infants remains a challenge for Ecuador’s health programs.
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Affiliation(s)
| | | | | | | | | | - Stuart Blume
- Vrije Universiteit Amsterdam, Amsterdam, Netherlands
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Pilz S, Zittermann A, Obeid R, Hahn A, Pludowski P, Trummer C, Lerchbaum E, Pérez-López FR, Karras SN, März W. The Role of Vitamin D in Fertility and during Pregnancy and Lactation: A Review of Clinical Data. Int J Environ Res Public Health 2018; 15:E2241. [PMID: 30322097 DOI: 10.3390/ijerph15102241] [Citation(s) in RCA: 82] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 09/29/2018] [Accepted: 09/29/2018] [Indexed: 12/19/2022]
Abstract
Vitamin D deficiency is common and there exists a huge gap between recommended dietary vitamin D intakes and the poor vitamin D supply in the general population. While vitamin D is important for musculoskeletal health, there are accumulating data suggesting that vitamin D may also be important for fertility, pregnancy outcomes and lactation. Significant changes in vitamin D metabolism during pregnancy such as increased production of the “active vitamin D hormone” calcitriol support the important role of vitamin D in this setting. Observational studies show that vitamin D deficiency is a risk marker for reduced fertility and various adverse pregnancy outcomes and is associated with a low vitamin D content of breast milk. Meta-analyses of randomized controlled trials (RCTs) document that physiological vitamin D supplementation during pregnancy is safe and improves vitamin D and calcium status, thereby protecting skeletal health. Although certain RCTs and/or meta-analyses reported some other beneficial effects, it is still not clear whether vitamin D supplementation improves fertility or decreases the risk of adverse pregnancy outcomes such as low birth weight, pre-eclampsia and neonatal mortality, or reduces wheeze/asthma in the infants. Nevertheless, vitamin D supplementation in pregnant women is frequently required to achieve a sufficient vitamin D status as recommended by nutritional vitamin D guidelines. In this review, we provide an overview of systematic reviews, meta-analyses and large trials reporting clinical data on the role of vitamin D for fertility, pregnancy and lactation.
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