Publications by authors named "Sophie E Moore"

144 Publications

Breast Milk Micronutrients and Infant Neurodevelopmental Outcomes: A Systematic Review.

Nutrients 2021 Oct 28;13(11). Epub 2021 Oct 28.

Department of Women and Children's Health, King's College London, London SE1 7EH, UK.

Micronutrients are fundamental for healthy brain development and deficiencies during early development can have a severe and lasting impact on cognitive outcomes. Evidence indicates that undernourished lactating individuals may produce breast milk containing lower concentrations of certain vitamins and minerals. Exclusively breastfed infants born to mothers deficient in micronutrients may therefore be at risk of micronutrient deficiencies, with potential implications for neurodevelopment. This systematic review aims to consider current knowledge on the effects of breast milk micronutrients on the developmental outcomes of infants. The databases Medline, Global Health, PsychInfo, Open Grey, and the Web of Science were searched for papers published before February 2021. Studies were included if they measured micronutrients in breast milk and their association with the neurodevelopmental outcomes of exclusively breastfed infants. Also, randomised control trials investigating neurocognitive outcomes following maternal supplementation during lactation were sought. From 5477 initial results, three observational studies were eligible for inclusion. These investigated associations between breast milk levels of vitamin B6, carotenoids, or selenium and infant development. Results presented suggest that pyroxidal, β-carotene, and lycopene are associated with infant neurodevelopmental outcomes. Limited eligible literature and heterogeneity between included papers prevented quantitative synthesis. Insufficient evidence was identified, precluding any conclusions on the relationship between breast milk micronutrients and infant developmental outcomes. Further, the evidence available was limited by a high risk of bias. This highlights the need for further research in this area to understand the long-term influence of micronutrients in breast milk, the role of other breast milk micronutrients in infant neurodevelopmental outcomes, and the impact of possible lactational interventions.
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http://dx.doi.org/10.3390/nu13113848DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8624933PMC
October 2021

The Mothers, Infants, and Lactation Quality (MILQ) Study: A Multi-Center Collaboration.

Curr Dev Nutr 2021 Oct 20;5(10):nzab116. Epub 2021 Sep 20.

Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.

Little valid information is available on human milk nutrient concentrations, especially for micronutrients (MNs), and there are no valid reference values (RVs) across lactation. In this multi-center collaborative study, RVs will be established for human milk nutrients across the first 8.5 mo postpartum. Well-nourished, unsupplemented women in Bangladesh, Brazil, Denmark, and The Gambia ( = 250/site) were recruited during the third trimester of pregnancy. Milk, blood, saliva, urine, and stool samples from mothers and their infants are collected identically at 3 visits (1-3.49, 3.5-5.99, 6.0-8.49 mo postpartum). Milk analyses include macronutrients, selected vitamins, trace elements and minerals, iodine, metabolomics, amino acids, human milk oligosaccharides, and bioactive peptides. We measure milk volume; maternal and infant diets, anthropometry, and morbidity; infant development, maternal genome, and the infant and maternal microbiome. RVs will be constructed based on methods for the WHO Child Growth Standards and the Intergrowth-21st Project. This trial was registered at clinical trials.gov as NCT03254329.
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http://dx.doi.org/10.1093/cdn/nzab116DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8546155PMC
October 2021

Plasma lipids and growth faltering: A longitudinal cohort study in rural Gambian children.

Sci Adv 2021 Sep 17;7(38):eabj1132. Epub 2021 Sep 17.

Core Metabolomics and Lipidomics Laboratory, Wellcome Trust-MRL Institute of Metabolic Science, University of Cambridge, Cambridge, UK.

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http://dx.doi.org/10.1126/sciadv.abj1132DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8448443PMC
September 2021

Aflatoxin Exposure during Early Life Is Associated with Differential DNA Methylation in Two-Year-Old Gambian Children.

Int J Mol Sci 2021 Aug 20;22(16). Epub 2021 Aug 20.

School of Medicine, University of Leeds, Leeds LS2 9JT, UK.

: DNA methylation is an epigenetic control mechanism that may be altered by environmental exposures. We have previously reported that in utero exposure to the mycotoxin and liver carcinogen aflatoxin B1 from the maternal diet, as measured using biomarkers in the mothers' blood, was associated with differential DNA methylation in white blood cells of 6-month-old infants from The Gambia. : Here we examined aflatoxin B1-associated differential DNA methylation in white blood cells of 24-month-old children from the same population ( = 244), in relation to the child's dietary exposure assessed using aflatoxin albumin biomarkers in blood samples collected at 6, 12 and 18 months of age. HM450 BeadChip arrays were used to assess DNA methylation, with data compared to aflatoxin albumin adduct levels using two approaches; a continuous model comparing aflatoxin adducts measured in samples collected at 18 months to DNA methylation at 24 months, and a categorical time-dose model that took into account aflatoxin adduct levels at 6, 12 and 18 months, for comparison to DNA methylation at 24 months. : Geometric mean (95% confidence intervals) for aflatoxin albumin levels were 3.78 (3.29, 4.34) at 6 months, 25.1 (21.67, 29.13) at 12 months and 49.48 (43.34, 56.49) at 18 months of age. A number of differentially methylated CpG positions and regions were associated with aflatoxin exposure, some of which affected gene expression. Pathway analysis highlighted effects on genes involved with with inflammatory, signalling and growth pathways. : This study provides further evidence that exposure to aflatoxin in early childhood may impact on DNA methylation.
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http://dx.doi.org/10.3390/ijms22168967DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8396526PMC
August 2021

Seasonal modulation of antibody response to diphtheria-tetanus-pertussis vaccination in infants: a cohort study in rural Gambia.

BMC Public Health 2021 07 22;21(1):1442. Epub 2021 Jul 22.

Department of Women and Children's Health, King's College London, St Thomas' Hospital, 10th Floor North Wing, London, SE1 7EH, UK.

Background: In rural Gambia, rates of malnutrition and infection are higher during the annual rainy/'hungry' season (June-October) in comparison to the dry/'harvest' season (November-May). The effects of this seasonal pattern on an infant's immune development and their capacity to respond to childhood vaccinations remain unclear. The aim of the current analysis was to determine whether antibody responses to diphtheria-tetanus-pertussis (DTP) vaccinations in infants differ between seasons.

Methods: Infants received the DTP vaccine at 8, 12 and 16 weeks of age and antibody titres were measured in blood samples collected at 12 (n = 710) and 24 (n = 662) weeks of age. Mean DTP antibody titres, adjusted for maternal and infant confounders, were compared by t-tests and the effect sizes of the mean differences were calculated between seasons at mid-gestation (20 weeks gestation) and first vaccination (8 weeks of infant age).

Results: A smaller number of infants received their first vaccination during the rainy/hungry season months compared to the dry/harvest season (n = 224 vs. n = 486). At 12 weeks, infants vaccinated during the rainy/hungry season had lower weight-for-length Z-scores (p = 0.01) and were more likely to be anaemic (p < 0.001). Their mothers, however, were pregnant mostly during the dry/harvest season, had higher weight gain (p < 0.001) and were less likely to be anaemic during pregnancy (p < 0.001). At 12 weeks, infants vaccinated during the rainy/hungry season had significantly higher mean diphtheria, tetanus and pertussis antibody titres; by 62.3, 16.9 and 19.7%, respectively (all, p < 0.001). However, at 24 weeks, they had lower mean anti-diphtheria titres (by 20.6%, p < 0.001) compared with infants vaccinated during the dry/harvest season, and no differences were observed in mean tetanus and pertussis antibody titres by vaccination season.

Conclusions: Infant antibody response to the primary dose of the DTP vaccine was influenced by both season of pregnancy and infancy, although effects were diminished following three doses. Environmental exposures, including nutrition, to both the mother and infant are hypothesised as likely drivers of these seasonal effects.
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http://dx.doi.org/10.1186/s12889-021-11383-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8296693PMC
July 2021

Variation in Human Milk Composition Is Related to Differences in Milk and Infant Fecal Microbial Communities.

Microorganisms 2021 May 27;9(6). Epub 2021 May 27.

Margaret Ritchie School of Family and Consumer Sciences, University of Idaho, Moscow, ID 83844, USA.

Previously published data from our group and others demonstrate that human milk oligosaccharide (HMOs), as well as milk and infant fecal microbial profiles, vary by geography. However, little is known about the geographical variation of other milk-borne factors, such as lactose and protein, as well as the associations among these factors and microbial community structures in milk and infant feces. Here, we characterized and contrasted concentrations of milk-borne lactose, protein, and HMOs, and examined their associations with milk and infant fecal microbiomes in samples collected in 11 geographically diverse sites. Although geographical site was strongly associated with milk and infant fecal microbiomes, both sample types assorted into a smaller number of community state types based on shared microbial profiles. Similar to HMOs, concentrations of lactose and protein also varied by geography. Concentrations of HMOs, lactose, and protein were associated with differences in the microbial community structures of milk and infant feces and in the abundance of specific taxa. Taken together, these data suggest that the composition of human milk, even when produced by relatively healthy women, differs based on geographical boundaries and that concentrations of HMOs, lactose, and protein in milk are related to variation in milk and infant fecal microbial communities.
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http://dx.doi.org/10.3390/microorganisms9061153DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8230061PMC
May 2021

Increasing the availability and utilization of reliable data on population micronutrient (MN) status globally: the MN Data Generation Initiative.

Am J Clin Nutr 2021 09;114(3):862-870

The Micronutrient Forum, Washington, DC, USA.

Micronutrient (MN) deficiencies can produce a broad array of adverse health and functional outcomes. Young, preschool children and women of reproductive age in low- and middle-income countries are most affected by these deficiencies, but the true magnitude of the problems and their related disease burdens remain uncertain because of the dearth of reliable biomarker information on population MN status. The reasons for this lack of information include a limited understanding by policy makers of the importance of MNs for human health and the usefulness of information on MN status for program planning and management; insufficient professional capacity to advocate for this information and design and implement related MN status surveys; high costs and logistical constraints involved in specimen collection, transport, storage, and laboratory analyses; poor access to adequately equipped and staffed laboratories to complete the analyses reliably; and inadequate capacity to interpret and apply this information for public health program design and evaluation. This report describes the current situation with regard to data availability, the reasons for the lack of relevant information, and the steps needed to correct this situation, including implementation of a multi-component MN Data Generation Initiative to advocate for critical data collection and provide related technical assistance, laboratory services, professional training, and financial support.
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http://dx.doi.org/10.1093/ajcn/nqab173DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8408880PMC
September 2021

Maternal Dietary Patterns and Pregnancy Hypertension in Low- and Middle-Income Countries: A Systematic Review and Meta-analysis.

Adv Nutr 2021 Dec;12(6):2387-2400

Department of Pediatrics, BC Children's and Women's Hospital and University of British Columbia, Vancouver, British Columbia, Canada.

Healthy maternal diets can lower the odds of developing pre-eclampsia, a direct and second leading cause of maternal death, globally. However, there is a research gap in low- and middle-income countries (LMIC), which bear a disproportionate burden of these deaths. The objectives of this systematic review were to: 1) evaluate the association between dietary patterns in pregnancy and hypertensive disorders, including pre-eclampsia for pregnant and postpartum women in LMIC, and 2) compile barriers and facilitators to an adequate maternal diet. A systematic search was performed on MEDLINE, Embase, the Cumulative Index to Nursing and Allied Health, Web of Science, Cochrane Central Register of Controlled Trials, African Journals Online, the WHO Regional Databases, 2 trial registries, Google Scholar, and reference lists. Included in the analysis were primary research studies of dietary patterns during pregnancy, with pregnancy hypertension outcome(s), and conducted in LMIC. Included studies were assessed using ROBINS-I risk of bias. Thirteen studies were included, of which 5 studies were included in a meta-analysis (Review Manager 5). Lower odds of pre-eclampsia were associated with adequate (compared with no or low) consumption of vegetables (OR: 0.38; 95% CI: 0.18, 0.80; I2 = 85%; P = 0.01) and adequate (compared with no or low) consumption of fruit (OR: 0.42; 95% CI: 0.24, 0.71; I2 = 79%; P = 0.008). No firm conclusions could be drawn about the impact on pre-eclampsia odds of any of the following during pregnancy: high consumption of meat or grains; a "Western" diet; or alcohol consumption. More LMIC-based research is needed to explore whether the apparent beneficial effects of fruits and vegetables on pre-eclampsia incidence might be enhanced when maternal malnutrition is prevalent, and/or whether other sociodemographic factors might contribute.
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http://dx.doi.org/10.1093/advances/nmab057DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8634459PMC
December 2021

The Role of Nutrition in COVID-19 Susceptibility and Severity of Disease: A Systematic Review.

J Nutr 2021 07;151(7):1854-1878

Medical Research Council (MRC) Unit The Gambia at the London School of Hygiene & Tropical Medicine, Fajara, The Gambia.

Background: Many nutrients have powerful immunomodulatory actions with the potential to alter susceptibility to coronavirus disease 2019 (COVID-19) infection, progression to symptoms, likelihood of severe disease, and survival.

Objective: The aim was to review the latest evidence on how malnutrition across all its forms (under- and overnutrition and micronutrient status) may influence both susceptibility to, and progression of, COVID-19.

Methods: We synthesized information on 13 nutrition-related components and their potential interactions with COVID-19: overweight, obesity, and diabetes; protein-energy malnutrition; anemia; vitamins A, C, D, and E; PUFAs; iron; selenium; zinc; antioxidants; and nutritional support. For each section we provide: 1) a landscape review of pertinent material; 2) a systematic search of the literature in PubMed and EMBASE databases, including a wide range of preprint servers; and 3) a screen of 6 clinical trial registries. All original research was considered, without restriction to study design, and included if it covered: 1) severe acute respiratory syndrome coronavirus (CoV) 2 (SARS-CoV-2), Middle East respiratory syndrome CoV (MERS-CoV), or SARS-CoV viruses and 2) disease susceptibility or 3) disease progression, and 4) the nutritional component of interest. Searches took place between 16 May and 11 August 2020.

Results: Across the 13 searches, 2732 articles from PubMed and EMBASE, 4164 articles from the preprint servers, and 433 trials were returned. In the final narrative synthesis, we include 22 published articles, 38 preprint articles, and 79 trials.

Conclusions: Currently there is limited evidence that high-dose supplements of micronutrients will either prevent severe disease or speed up recovery. However, results of clinical trials are eagerly awaited. Given the known impacts of all forms of malnutrition on the immune system, public health strategies to reduce micronutrient deficiencies and undernutrition remain of critical importance. Furthermore, there is strong evidence that prevention of obesity and type 2 diabetes will reduce the risk of serious COVID-19 outcomes. This review is registered at PROSPERO as CRD42020186194.
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http://dx.doi.org/10.1093/jn/nxab059DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8194602PMC
July 2021

Longitudinal infant fNIRS channel-space analyses are robust to variability parameters at the group-level: An image reconstruction investigation.

Neuroimage 2021 08 26;237:118068. Epub 2021 Apr 26.

Department of Medical Physics and Biomedical Engineering, University College London, London WC1E 6BT, UK.

The first 1000 days from conception to two-years of age are a critical period in brain development, and there is an increasing drive for developing technologies to help advance our understanding of neurodevelopmental processes during this time. Functional near-infrared spectroscopy (fNIRS) has enabled longitudinal infant brain function to be studied in a multitude of settings. Conventional fNIRS analyses tend to occur in the channel-space, where data from equivalent channels across individuals are combined, which implicitly assumes that head size and source-detector positions (i.e. array position) on the scalp are constant across individuals. The validity of such assumptions in longitudinal infant fNIRS analyses, where head growth is most rapid, has not previously been investigated. We employed an image reconstruction approach to analyse fNIRS data collected from a longitudinal cohort of infants in The Gambia aged 5- to 12-months. This enabled us to investigate the effect of variability in both head size and array position on the anatomical and statistical inferences drawn from the data at both the group- and the individual-level. We also sought to investigate the impact of group size on inferences drawn from the data. We found that variability in array position was the driving factor between differing inferences drawn from the data at both the individual- and group-level, but its effect was weakened as group size increased towards the full cohort size (N = 53 at 5-months, N = 40 at 8-months and N = 45 at 12-months). We conclude that, at the group sizes in our dataset, group-level channel-space analysis of longitudinal infant fNIRS data is robust to assumptions about head size and array position given the variability in these parameters in our dataset. These findings support a more widespread use of image reconstruction techniques in longitudinal infant fNIRS studies.
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http://dx.doi.org/10.1016/j.neuroimage.2021.118068DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8285580PMC
August 2021

Identification of methylation changes associated with positive and negative growth deviance in Gambian infants using a targeted methyl sequencing approach of genomic DNA.

FASEB Bioadv 2021 Apr 5;3(4):205-230. Epub 2021 Feb 5.

Department of Pathology University of Cambridge Cambridge UK.

Low birthweight and reduced height gain during infancy (stunting) may arise at least in part from adverse early life environments that trigger epigenetic reprogramming that may favor survival. We examined differential DNA methylation patterns using targeted methyl sequencing of regions regulating gene activity in groups of rural Gambian infants: (a) low and high birthweight (DNA from cord blood ( = 16 and  = 20, respectively), from placental trophoblast tissue ( = 21 and  = 20, respectively), and DNA from peripheral blood collected from infants at 12 months of age ( = 23 and  = 17, respectively)), and, (b) the top 10% showing rapid postnatal length gain (high,  = 20) and the bottom 10% showing slow postnatal length gain (low,  = 20) based on z score change between birth and 12 months of age (LAZ) (DNA from peripheral blood collected from infants at 12 months of age). Using BiSeq analysis to identify significant methylation marks, for birthweight, four differentially methylated regions (DMRs) were identified in trophoblast DNA, compared to 68 DMRs in cord blood DNA, and 54 DMRs in 12-month peripheral blood DNA. Twenty-five DMRs were observed to be associated with high and low length for age (LAZ) at 12 months. With the exception of five loci (associated with two different genes), there was no overlap between these groups of methylation marks. Of the 194 CpG methylation marks contained within DMRs, 106 were located to defined gene regulatory elements (promoters, CTCF-binding sites, transcription factor-binding sites, and enhancers), 58 to gene bodies (introns or exons), and 30 to intergenic DNA. Distinct methylation patterns associated with birthweight between comparison groups were observed in DNA collected at birth (at the end of intrauterine growth window) compared to those established by 12 months (near the infancy/childhood growth transition). The longitudinal differences in methylation patterns may arise from methylation adjustments, changes in cellular composition of blood or both that continue during the critical postnatal growth period, and in response to early nutritional and infectious environmental exposures with impacts on growth and longer-term health outcomes.
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http://dx.doi.org/10.1096/fba.2020-00101DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8019263PMC
April 2021

Comparison of Two Approaches for the Metataxonomic Analysis of the Human Milk Microbiome.

Front Cell Infect Microbiol 2021 25;11:622550. Epub 2021 Mar 25.

Department of Nutrition and Food Science, Complutense University of Madrid, Madrid, Spain.

Recent work has demonstrated the existence of large inter-individual and inter-population variability in the microbiota of human milk from healthy women living across variable geographical and socio-cultural settings. However, no studies have evaluated the impact that variable sequencing approaches targeting different 16S rRNA variable regions may have on the human milk microbiota profiling results. This hampers our ability to make meaningful comparisons across studies. In this context, the main purpose of the present study was to re-process and re-sequence the microbiome in a large set of human milk samples (n = 412) collected from healthy women living at diverse international sites (Spain, Sweden, Peru, United States, Ethiopia, Gambia, Ghana and Kenya), by targeting a different 16S rRNA variable region and reaching a larger sequencing depth. Despite some differences between the results obtained from both sequencing approaches were notable (especially regarding alpha and beta diversities and Proteobacteria representation), results indicate that both sequencing approaches revealed a relatively consistent microbiota configurations in the studied cohorts. Our data expand upon the milk microbiota results we previously reported from the INSPIRE cohort and provide, for the first time across globally diverse populations, evidence of the impact that different DNA processing and sequencing approaches have on the microbiota profiles obtained for human milk samples. Overall, our results corroborate some similarities regarding the microbial communities previously reported for the INSPIRE cohort, but some differences were also detected. Understanding the impact of different sequencing approaches on human milk microbiota profiles is essential to enable meaningful comparisons across studies.

Clinical Trial Registration: www.clinicaltrials.gov, identifier NCT02670278.
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http://dx.doi.org/10.3389/fcimb.2021.622550DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8027255PMC
July 2021

Key genetic variants associated with variation of milk oligosaccharides from diverse human populations.

Genomics 2021 Jul 6;113(4):1867-1875. Epub 2021 Apr 6.

Department of Animal, Veterinary, and Food Sciences, University of Idaho, Moscow, ID 83844, USA. Electronic address:

Human milk oligosaccharides (HMO), the third most abundant component of human milk, are thought to be important contributors to infant health. Studies have provided evidence that geography, stage of lactation, and Lewis and secretor blood groups are associated with HMO profile. However, little is known about how variation across the genome may influence HMO composition among women in various populations. In this study, we performed genome-wide association analyses of 395 women from 8 countries to identify genetic regions associated with 19 different HMO. Our data support FUT2 as the most significantly associated (P < 4.23 to P < 4.5) gene with seven HMO and provide evidence of balancing selection for FUT2. Although polymorphisms in FUT3 were also associated with variation in lacto-N-fucopentaose II and difucosyllacto-N-tetrose, we found little evidence of selection on FUT3. To our knowledge, this is the first report of the use of genome-wide association analyses on HMO.
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http://dx.doi.org/10.1016/j.ygeno.2021.04.004DOI Listing
July 2021

Impact of Maternal Nutritional Supplementation during Pregnancy and Lactation on the Infant Gut or Breastmilk Microbiota: A Systematic Review.

Nutrients 2021 Mar 30;13(4). Epub 2021 Mar 30.

Department of Women and Children's Health, King's College London, London SE1 7EH, UK.

Recent evidence indicates that maternal dietary intake, including dietary supplements, during pregnancy and lactation may alter the infant gut or breastmilk microbiota, with implications for health outcomes in both the mother and infant. To review the effects of maternal nutritional supplementation during pregnancy and lactation on the infant gut or breastmilk microbiota a systematic literature search was conducted. A total of 967 studies published until February 2020 were found, 31 were eligible and 29 randomized control trials were included in the qualitative synthesis. There were 23 studies that investigated the effects of probiotic supplementation, with the remaining studies investigating vitamin D, prebiotics or lipid-based nutrient supplements (LNS). The effects of maternal nutritional supplementation on the infant gut microbiota or breastmilk microbiota were examined in 21 and 12 studies, respectively. Maternal probiotic supplementation during pregnancy and lactation generally resulted in the probiotic colonization of the infant gut microbiota, and although most studies also reported alterations in the infant gut bacterial loads, there was limited evidence of effects on bacterial diversity. The data available show that maternal probiotic supplementation during pregnancy or lactation results in probiotic colonization of the breastmilk microbiota. There were no observed effects between probiotic supplementation and breastmilk bacterial counts of healthy women, however, administration of probiotic to nursing women affected by mastitis was associated with significant reductions in breastmilk loads. Maternal LNS supplementation during pregnancy and lactation increased bacterial diversity in the infant gut, whilst vitamin D and prebiotic supplementation did not alter either infant gut bacterial diversity or counts. Heterogeneity in study design precludes any firm conclusions on the effects of maternal nutritional supplementation during pregnancy and lactation on the infant gut or breastmilk microbiota, warranting further research.
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http://dx.doi.org/10.3390/nu13041137DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8067242PMC
March 2021

Pregnancy-Related Change in pQCT and Bone Biochemistry in a Population With a Habitually Low Calcium Intake.

J Bone Miner Res 2021 07 7;36(7):1269-1280. Epub 2021 May 7.

MRC Nutrition and Bone Health Research Group, University of Cambridge, Cambridge, UK.

In pregnancy, changes in maternal calcium (Ca) economy occur to satisfy fetal Ca demand. It is unclear whether maternal mineral reserves facilitate these requirements and no data exist from sub-Saharan Africa. The aim was to determine skeletal changes with peripheral quantitative computed tomography (pQCT) and bone biochemistry between early second and third trimesters. Pregnant rural Gambians aged 18 to 45 years (n = 467) participating in a trial of antenatal nutritional supplements (ISRCTN49285450) had pQCT scans and blood collections at mean (SD) 14 (3) and 31 (1) weeks' gestation. Outcomes were pQCT: radius/tibia 4% total volumetric bone mineral density (vBMD), trabecular vBMD, total cross-sectional area (CSA), 33%/38% radius/tibia cortical vBMD, bone mineral content (BMC), total CSA; biochemistry: collagen type 1 cross-linked β-C-telopeptide (β-CTX), type 1 procollagen N-terminal (P1NP), parathyroid hormone (PTH), and 1,25(OH) D. Independent t tests tested whether pooled or within-group changes differed from 0. Multiple regression was performed adjusting for age. Data for change are expressed as mean (confidence interval [CI] 2.5, 97.5%). Radius trabecular vBMD, cortical vBMD, and BMC increased by 1.15 (0.55, 1.75)%, 0.41 (0.24, 0.58)%, and 0.47 (0.25, 0.69)%. Tibia total and trabecular vBMD increased by 0.34 (0.15, 0.54)% and 0.46 (0.17, 0.74)%, while tibia cortical vBMD, BMC, and cortical CSA increased by 0.35 (0.26, 0.44)%, 0.55 (0.41, 0.68)% and 0.20 (0.09, 0.31)%, respectively. CTX, PTH, and 1,25(OH) D increased by 23.0 (15.09, 29.29)%, 13.2 (8.44, 19.34)%, and 21.0 (17.67, 24.29)%, while P1NP decreased by 32.4 (-37.19, -28.17)%. No evidence of mobilization was observed in the peripheral skeleton. Resorption, although higher in late versus early gestation, was lower throughout pregnancy compared with non-pregnant non-lactating (NPNL) in the same community. Formation was lower in late pregnancy than in early, and below NPNL levels. This suggests a shift in the ratio of resorption to formation. Despite some evidence of change in bone metabolism, in this population, with habitually low Ca intakes, the peripheral skeleton was not mobilized as a Ca source for the fetus. © 2021 crown copyright . Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR). The article published with the permission of the Controller of HMSO and the Queen's Printer of Scotland..
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http://dx.doi.org/10.1002/jbmr.4295DOI Listing
July 2021

Identification of nutritionally modifiable hormonal and epigenetic drivers of positive and negative growth deviance in rural African fetuses and infants: Project protocol and cohort description.

Gates Open Res 2020 24;4:25. Epub 2020 Feb 24.

Department of Anthropology, University of Colorado, Boulder, CO, 80309, USA.

Growth retardation (stunting, wasting and poor organ development) among children in low-income countries has major short and long-term health consequences yet very little is known about the nutritional and environmental influences on the key hormonal axes regulating child growth in these settings, nor the tempo and timing of faltering episodes. Here we describe the study protocol and provide a cohort description of the Hormonal and Epigenetic Regulators of Growth (HERO-G) study. This prospective cohort study from rural Gambia, West Africa, followed mothers and children longitudinally from pre-conception, through pregnancy, delivery, and to two years of child age A total of 251 eligible mother-infant pairs were recruited into the HERO-G study, with 206 (82%) followed up until two years of age. Women were seen at scheduled antenatal appointments at 20, 28 and 36 weeks of gestation, and at delivery, where possible. Between one week and 12 months of age, infants were visited every second day for collection of detailed anthropometry and morbidity data. Infants identified as about to enter a growth faltering episode at these visits entered a more detailed 20-day protocol, with the collection of dried blood spots, anthropometry and body composition. All infants were seen for scheduled clinic visits at 3, 6, 9, 12, 18 and 24 months of age for clinical examination and venous blood draw. Data from the HERO-G study is being used to explore three major mechanistic pathways influencing growth: 1) genome-wide investigations for signatures of epigenetic effects on any loci that might affect growth; 2) frequent anthropometric measurement coupled with non-invasive monitoring for rapid identification and interrogation of real-time faltering patterns and aetiology; 3) focused measurement of hormones and cytokines that act together in an integrated manner, both and after birth, to coordinate patterns of growth with immune activation, inflammation, and nutritional status.
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http://dx.doi.org/10.12688/gatesopenres.13101.1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7921526PMC
February 2020

Multipathogen Analysis of IgA and IgG Antigen Specificity for Selected Pathogens in Milk Produced by Women From Diverse Geographical Regions: The INSPIRE Study.

Front Immunol 2020 11;11:614372. Epub 2021 Feb 11.

Antigen Discovery Incorporated, Irvine, CA, United States.

Breastfeeding provides defense against infectious disease during early life. The mechanisms underlying this protection are complex but likely include the vast array of immune cells and components, such as immunoglobulins, in milk. Simply characterizing the concentrations of these bioactives, however, provides only limited information regarding their potential relationships with disease risk in the recipient infant. Rather, understanding pathogen and antigen specificity profiles of milk-borne immunoglobulins might lead to a more complete understanding of how maternal immunity impacts infant health and wellbeing. Milk produced by women living in 11 geographically dispersed populations was applied to a protein microarray containing antigens from 16 pathogens, including diarrheagenic , spp. serovar Typhi, , and other pathogens of global health concern, and specific IgA and IgG binding was measured. Our analysis identified novel disease-specific antigen responses and suggests that some IgA and IgG responses vary substantially within and among populations. Patterns of antibody reactivity analyzed by principal component analysis and differential reactivity analysis were associated with either lower-to-middle-income countries (LMICs) or high-income countries (HICs). Antibody levels were generally higher in LMICs than HICs, particularly for and diarrheagenic antigens, although sets of , , and some antigens were more reactive in HICs. Differential responses were typically specific to canonical immunodominant antigens, but a set of nondifferential but highly reactive antibodies were specific to antigens possibly universally recognized by antibodies in human milk. This approach provides a promising means to understand how breastfeeding and human milk protect (or do not protect) infants from environmentally relevant pathogens. Furthermore, this approach might lead to interventions to boost population-specific immunity in at-risk breastfeeding mothers and their infants.
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http://dx.doi.org/10.3389/fimmu.2020.614372DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7905217PMC
July 2021

Effects of Maternal Nutritional Supplements and Dietary Interventions on Placental Complications: An Umbrella Review, Meta-Analysis and Evidence Map.

Nutrients 2021 Jan 30;13(2). Epub 2021 Jan 30.

Department of Pediatrics, University of British Columbia, Vancouver, BC V6H 0B3, Canada.

The placenta is a vital, multi-functional organ that acts as an interface between maternal and fetal circulation during pregnancy. Nutritional deficiencies during pregnancy alter placental development and function, leading to adverse pregnancy outcomes, such as pre-eclampsia, infants with small for gestational age and low birthweight, preterm birth, stillbirths and maternal mortality. Maternal nutritional supplementation may help to mitigate the risks, but the evidence base is difficult to navigate. The primary purpose of this umbrella review is to map the evidence on the effects of maternal nutritional supplements and dietary interventions on pregnancy outcomes related to placental disorders and maternal mortality. A systematic search was performed on seven electronic databases, the PROSPERO register and references lists of identified papers. The results were screened in a three-stage process based on title, abstract and full-text by two independent reviewers. Randomized controlled trial meta-analyses on the efficacy of maternal nutritional supplements or dietary interventions were included. There were 91 meta-analyses included, covering 23 types of supplements and three types of dietary interventions. We found evidence that supports supplementary vitamin D and/or calcium, omega-3, multiple micronutrients, lipid-based nutrients, and balanced protein energy in reducing the risks of adverse maternal and fetal health outcomes. However, these findings are limited by poor quality of evidence. Nutrient combinations show promise and support a paradigm shift to maternal dietary balance, rather than single micronutrient deficiencies, to improve maternal and fetal health. The review is registered at PROSPERO (CRD42020160887).
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http://dx.doi.org/10.3390/nu13020472DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7912620PMC
January 2021

Beyond Reproduction: The "First 1,000 Days" Approach to Nutrition through a Gendered Rights-Based Lens.

Health Hum Rights 2020 Dec;22(2):113-123

Associate Professor at the School of Population and Public Health, Department of Pediatrics, BC Children's and Women's Hospital and University of British Columbia, Vancouver, Canada.

The First 1,000 Days approach highlights the importance of adequate nutrition in early life-from conception to a child's second birthday-for good development and growth throughout the child's life and potentially onto their own offspring. The approach has been highly influential in mobilizing policy attention and resources to improve maternal and infant nutrition in global health and development. This paper undertakes a critical review of this approach from a gendered human rights lens, finding that the theoretical underpinnings implicitly reflect and reproduce gender biases by conceptualizing women within a limited scope of reproduction and child care. We explore the processes of systemic neglect through Pierre Bourdieu's theories on how social structures are reproduced. Understanding theory is important to the governance of global health, how we frame priorities, and how we act on them. Revisiting influential theories is a means of accountability to ensure inclusiveness and to reduce gender and health inequities in research. We argue that a greater focus on women could increase the potential impact of nutrition interventions.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7762907PMC
December 2020

A Novel method for the identification and quantification of weight faltering.

Am J Phys Anthropol 2021 05 1;175(1):282-291. Epub 2021 Jan 1.

Growth and Development Lab, Department of Anthropology, University of Colorado Boulder, Boulder, Colorado, USA.

Objective: We describe a new method for identifying and quantifying the magnitude and rate of short-term weight faltering episodes, and assess how (a) these episodes relate to broader growth outcomes, and (b) different data collection intervals influence the quantification of weight faltering.

Materials And Methods: We apply this method to longitudinal growth data collected every other day across the first year of life in Gambian infants (n = 124, males = 65, females = 59). Weight faltering episodes are identified from velocity peaks and troughs. Rate of weight loss and regain, maximum weight loss, and duration of each episode were calculated. We systematically reduced our dataset to mimic various potential measurement intervals, to assess how these intervals affect the ability to derive information about short-term weight faltering episodes. We fit linear models to test whether metrics associated with growth faltering were associated with growth outcomes at 1 year, and generalized additive mixed models to determine whether different collection intervals influence episode identification and metrics.

Results: Three hundred weight faltering episodes from 119 individuals were identified. The number and magnitude of episodes negatively impacted growth outcomes at 1 year. As data collection interval increases, weight faltering episodes are missed and the duration of episodes is overestimated, resulting in the rate of weight loss and regain being underestimated.

Conclusions: This method identifies and quantifies short-term weight faltering episodes, that are in turn negatively associated with growth outcomes. This approach offers a tool for investigators interested in understanding how short-term weight faltering relates to longer-term outcomes.
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http://dx.doi.org/10.1002/ajpa.24217DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8247282PMC
May 2021

Age-Related Dynamics of Circulating Innate Lymphoid Cells in an African Population.

Front Immunol 2020 2;11:594107. Epub 2020 Dec 2.

Department of Infection Biology, London School of Hygiene and Tropical Medicine, London, United Kingdom.

Innate lymphoid cell (ILC) lineages mirror those of CD4+ T helper cell subsets, producing type 1, 2 and 3 cytokines respectively. Studies in adult human populations have shown contributions of non-cytotoxic ILC to immune regulation or pathogenesis in a wide range of diseases and have prompted investigations of potential functional redundancy between ILC and T helper cell compartments in neonates and children. To investigate the potential for ILC to contribute to immune responses across the human lifespan, we examined the numbers and frequencies of peripheral blood ILC subsets in a cohort of Gambians aged between 5 and 73 years of age. ILC2 were the most abundant peripheral blood ILC subset in this Gambian cohort, while ILC1 were the rarest at all ages. Moreover, the frequency of ILC1s (as a proportion of all lymphocytes) was remarkably stable over the life course whereas ILC3 cell frequencies and absolute numbers declined steadily across the life course and ILC2 frequencies and absolute numbers declined from childhood until the age of approx. 30 years of age. Age-related reductions in ILC2 cell numbers appeared to be partially offset by increasing numbers of total and GATA3+ central memory (CD45RA-CCR7+) CD4+ T cells, although there was also a gradual decline in numbers of total and GATA3+ effector memory (CD45RA-CCR7-) CD4+ T cells. Despite reduced overall abundance of ILC2 cells, we observed a coincident increase in the proportion of CD117+ ILC2, indicating potential for age-related adaptation of these cells in childhood and early adulthood. While both CD117+ and CD117- ILC2 cells produced IL-13, these responses occurred predominantly within CD117- cells. Furthermore, comparison of ILC frequencies between aged-matched Gambian and UK young adults (25-29 years) revealed an overall higher proportion of ILC1 and ILC2, but not ILC3 in Gambians. Thus, these data indicate ongoing age-related changes in ILC2 cells throughout life, which retain the capacity to differentiate into potent type 2 cytokine producing cells, consistent with an ongoing role in immune modulation.
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http://dx.doi.org/10.3389/fimmu.2020.594107DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7738635PMC
June 2021

Acknowledging the gap: a systematic review of micronutrient supplementation in infants under six months of age.

Wellcome Open Res 2020 12;5:238. Epub 2020 Oct 12.

Department of Women and Children's Health, King's College Hospital, London, Westminster Bridge Road, London, SE1 7EH, UK.

: Micronutrient deficiencies remain common worldwide, but the consequences to growth and development in early infancy (under six months of age) are not fully understood. We present a systematic review of micronutrient interventions in term infants under six months of age, with a specific focus on iron supplementation. : We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (Ovid) and Embase (Ovid) from January 1980 through December 2019. Interventions included iron or multiple micronutrients (MMNs). : Of 11,109 records identified, 32 publications from 23 trials were included (18 iron and five MMN supplementation trials). All 23 trials evaluated the effect of supplementation on biochemical outcomes, ten reported on growth, 14 on morbidity and/or mortality and six on neuro-behavioural development. Low- and middle- income countries made up 88% (21/24) of the total trial locations. Meta-analysis was not possible due to extensive heterogeneity in both exposure and outcome measures.  However, these trials indicated that infants less than six months of age benefit biochemically from early supplementation with iron, but the effect of additional nutrients or MMNs, along with the impacts on growth, morbidity and/or mortality, and neuro-behavioural outcomes remain unclear. : Infants less than six months of age appear to benefit biochemically from micronutrient supplementation. However, well-powered randomised controlled trials are required to determine whether routine supplementation with iron or MMNs containing iron should commence before six months of life in exclusively breast-fed infants in low-resource settings.
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http://dx.doi.org/10.12688/wellcomeopenres.16282.1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7713887PMC
October 2020

The missing focus on women's health in the First 1,000 days approach to nutrition.

Public Health Nutr 2021 04 7;24(6):1526-1530. Epub 2020 Oct 7.

Department of Pediatrics, BC Children's and Women's Hospital and University of British Columbia, VancouverV6H 3V4, Canada.

The First 1,000 Days approach highlights the time between conception and a child's second birthday as a critical period where adequate nutrition is essential for adequate development and growth throughout the child's life and potentially onto their own offspring. Based on a review of relevant literature, this commentary explores the First 1,000 Days approach with a maternal lens. While the primary objective of the First 1,000 Days approach to nutrition is to reduce child malnutrition rates, particularly chronic undernutrition in the form of stunting, interventions are facilitated through mothers in terms of promoting healthy behaviours such as exclusive breast-feeding and attention to her nutritional status during pregnancy and lactation. Though these interventions were facilitated through women, women's health indicators are rarely tracked and measured, which we argue represents a missed opportunity to strengthen the evidence base for associations between maternal nutrition and women's health outcomes. Limited evidence on the effects of dietary interventions with pregnant and lactating mothers on women's health outcomes hinders advocacy efforts, which then contributes to lower prioritisation and less research.
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http://dx.doi.org/10.1017/S1368980020003894DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8025082PMC
April 2021

Prevalence estimates of diabetes in pregnancy in a rural, sub-Saharan population.

Diabetes Res Clin Pract 2020 Nov 24;169:108455. Epub 2020 Sep 24.

Department of Women and Children's Health, King's College London, London, UK; MRC Unit The Gambia at the London School of Hygiene and Tropical Medicine, Gambia. Electronic address:

Aims: To determine the prevalence of Hyperglycaemia first Detected in Pregnancy (HDIP) in a cohort of women from rural Gambia and compare the diagnostic ability of capillary blood glucose (CBG) sampling to identify HIP versus laboratory-based analysis of venous plasma glucose (VPG).

Methods: Pregnant women from rural Gambia (N = 251) underwent a 75 g Oral Glucose Tolerance Test (OGTT) at 28-weeks of gestation. Gestational Diabetes Mellitus was assessed as fasting glucose concentration ≥ 5.1-6.9 mmol/L; ≥10.0 mmol/L at 1-h post load; or ≥ 8.5 mmol/L at 2-h post load and Diabetes in Pregnancy as fasting glucose > 7.0 mmol/L.

Results: A total of 199 and 244 women had VPG and CBG measurements respectively, and 198 women had both. 32 women (16.1%) were diagnosed with HDIP using VPG, mostly based on fasting concentrations.

Conclusions: The prevalence of HDIP in rural Gambia was higher than anticipated, emphasising a need for maternal diabetic policy. Based on the current findings, tailored recommendations could include measuring fasting VPG alone when conducting a full OGTT is not feasible. Similarly, CBG may be of value for excluding disease and thereby limiting costly laboratory-based investigations to a select few.
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http://dx.doi.org/10.1016/j.diabres.2020.108455DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7738751PMC
November 2020

The double burden of malnutrition-further perspective.

Lancet 2020 09;396(10254):813

Micronutrient Forum, Washington, DC 20005-3915, USA; Department of Women and Children's Health, King's College London, London, UK; Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, The Gambia.

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http://dx.doi.org/10.1016/S0140-6736(20)31364-7DOI Listing
September 2020

Exploring influences on adolescent diet and physical activity in rural Gambia, West Africa: food insecurity, culture and the natural environment.

Public Health Nutr 2021 11 28;24(16):5277-5287. Epub 2020 Aug 28.

Clinical Ethics and Law (CELS), University of Southampton, Southampton, UK.

Objective: To explore, from the perspectives of adolescents and caregivers, and using qualitative methods, influences on adolescent diet and physical activity in rural Gambia.

Design: Six focus group discussions (FGD) with adolescents and caregivers were conducted. Thematic analysis was employed across the data set.

Setting: Rural region of The Gambia, West Africa.

Participants: Participants were selected using purposive sampling. Four FGD, conducted with forty adolescents, comprised: girls aged 10-12 years; boys aged 10-12 years; girls aged 15-17 years, boys aged 15-17 years. Twenty caregivers also participated in two FGD (mothers and fathers).

Results: All participants expressed an understanding of the association between salt and hypertension, sugary foods and diabetes, and dental health. Adolescents and caregivers suggested that adolescent nutrition and health were shaped by economic, social and cultural factors and the local environment. Adolescent diet was thought to be influenced by: affordability, seasonality and the receipt of remittances; gender norms, including differences in opportunities afforded to girls, and mother-led decision-making; cultural ceremonies and school holidays. Adolescent physical activity included walking or cycling to school, playing football and farming. Participants felt adolescent engagement in physical activity was influenced by gender, seasonality, cultural ceremonies and, to some extent, the availability of digital media.

Conclusions: These novel insights into local understanding should be considered when formulating future interventions. Interventions need to address these interrelated factors, including misconceptions regarding diet and physical activity that may be harmful to health.
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http://dx.doi.org/10.1017/S1368980020002669DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7611936PMC
November 2021

Interactions between the Physical and Social Environments with Adverse Pregnancy Events Related to Placental Disorders-A Scoping Review.

Int J Environ Res Public Health 2020 07 28;17(15). Epub 2020 Jul 28.

Department of Surveying and Geomatics, Midlands State University, P. Bag 9055, Gweru, Zimbabwe.

Background: Due to different social and physical environments across Africa, understanding how these environments differ in interacting with placental disorders will play an important role in developing effective interventions.

Methods: A scoping review was conducted, to identify current knowledge on interactions between the physical and social environment and the incidence of placental disease in Africa.

Results: Heavy metals were said to be harmful when environmental concentrations are beyond critical limits. Education level, maternal age, attendance of antenatal care and parity were the most investigated social determinants.

Conclusions: More evidence is needed to determine the relationships between the environment and placental function in Africa. The results show that understanding the nature of the relationship between social determinants of health (SDH) and placental health outcomes plays a pivotal role in understanding the risk in the heterogenous communities in Africa.
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http://dx.doi.org/10.3390/ijerph17155421DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7432342PMC
July 2020

The Role of Iron in Brain Development: A Systematic Review.

Nutrients 2020 Jul 5;12(7). Epub 2020 Jul 5.

Department of Women and Children's Health, King's College London, London SE1 7EH, UK.

One-third of children falter in cognitive development by pre-school age. Iron plays an important role in many neurodevelopmental processes, and animal studies suggest that iron sufficiency in pregnancy and infancy is particularly important for neurodevelopment. However, it is not clear whether iron deficiency directly impacts developmental outcomes, and, if so, whether impact differs by timing of exposure or developmental domain. We searched four databases for studies on iron deficiency or iron supplementation in pregnancy, or at 0-6 months, 6-24 months, or 2-4 years of age. All studies included neurodevelopmental assessments in infants or children up to 4 years old. We then qualitatively synthesized the literature. There was no clear relationship between iron status and developmental outcomes across any of the time windows or domains included. We identified a large quantity of low-quality studies, significant heterogeneity in study design and a lack of research focused on pregnancy and early infancy. In summary, despite good mechanistic evidence for the role of iron in brain development, evidence for the impact of iron deficiency or iron supplementation on early development is inconsistent. Further high-quality research is needed, particularly within pregnancy and early infancy, which has previously been neglected.
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http://dx.doi.org/10.3390/nu12072001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7400887PMC
July 2020

Periconceptional environment predicts leukocyte telomere length in a cross-sectional study of 7-9 year old rural Gambian children.

Sci Rep 2020 06 15;10(1):9675. Epub 2020 Jun 15.

Genetics and Genomic Medicine Programme, UCL Great Ormond Street Institute of Child Health, London, UK.

Early life exposures are important predictors of adult disease risk. Although the underlying mechanisms are largely unknown, telomere maintenance may be involved. This study investigated the relationship between seasonal differences in parental exposures at time of conception and leukocyte telomere length (LTL) in their offspring. LTL was measured in two cohorts of children aged 2 yrs (N = 487) and 7-9 yrs (N = 218). The association between date of conception and LTL was examined using Fourier regression models, adjusted for age, sex, leukocyte cell composition, and other potential confounders. We observed an effect of season in the older children in all models [likelihood ratio test (LRT) χ² = 7.1, p = 0.03; fully adjusted model]. LTL was greatest in children conceived in September (in the rainy season), and smallest in those conceived in March (in the dry season), with an effect size (LTL peak-nadir) of 0.60 z-scores. No effect of season was evident in the younger children (LRT χ² = 0.87, p = 0.65). The different results obtained for the two cohorts may reflect a delayed effect of season of conception on postnatal telomere maintenance. Alternatively, they may be explained by unmeasured differences in early life exposures, or the increased telomere attrition rate during infancy.
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http://dx.doi.org/10.1038/s41598-020-66729-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7295801PMC
June 2020

Using longitudinal data to understand nutrition and health interactions in rural Gambia.

Authors:
Sophie E Moore

Ann Hum Biol 2020 Mar;47(2):125-131

Department of Women & Children's Health, King's College, London, UK.

: Population-based cohort studies have been pivotal in establishing a number of nutrition-health interactions, especially in high-income settings. Less research is available from low- and middle-income countries due to the lack of detailed longitudinal data.: To describe the use of prospectively collected longitudinal data from the rural West Kiang region of The Gambia to explore nutrition-health interactions in a rural sub-Saharan African context.: Demographic records initiated in 1947, coupled with data on maternal and child health, have been used to explore nutrition-health relationships.: An analysis of the longitudinal demographic data demonstrated a highly significant association between season of birth and infection-related adult mortality in this context. Additionally, using routine data on childhood anthropometry, it has been shown that, despite a significant decline in child undernutrition, rates remain unacceptably high, likely reflecting the very high socio-economic threshold required to eliminate undernutrition.: The foresight to establish demographic data collection over seventy years ago has supported a wealth of novel research within a traditional African context. The availability of detailed clinical records on maternal and child health is helping to unravel the factors driving child undernutrition in rural Africa, and to identify targets for interventions to improve health in this context.
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http://dx.doi.org/10.1080/03014460.2020.1718207DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7287506PMC
March 2020
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