Water, Sanitation and Hygiene: Interventions and Diarrhoea - A Systematic Review and Meta-analysis

This paper provides a formal systematic review and meta-analysis examining the evidence of the effectiveness of interventions intended to reduce illness through improvements in drinking water, sanitation facilities and hygiene practices. The comprehensive literature search and bibliographic review shows that in developing countries, water quality interventions, specifically point-of-use treatment, reduced diarrhea illness levels, but this effect was mainly seen with the provision of household connections and use of water without household storage. Hygiene interventions, especially those promoting hand-washing, were effective. Only limited data were available for sanitation interventions, but these suggested effectiveness in reducing diarrhea. Multifactorial interventions consisting of water supply, sanitation and hygiene education acted to reduce diarrhea but were not more effective than individual interventions

Is slower early growth beneficial for long-term cardiovascular health?

Background - Accelerated neonatal growth increases the later propensity to cardiovascular disease (CVD) in animals, whereas slower growth is thought to have a beneficial effect. To test this hypothesis in humans, we measured flow-mediated endothelium-dependent dilation (FMD) in a population subject to slower early growth and in healthy controls.Methods and Results - High-resolution vascular ultrasound was used to measure the change in brachial artery diameter in response to reactive hyperemia in adolescents age 13 to 16 years who were either part of a cohort born preterm and followed up prospectively (n = 216) or controls born at term ( n = 61). Greater weight gain or linear growth in the first 2 weeks postnatally was associated with lower FMD at adolescence ( regression coefficient, - 0.026-mm change in mean arterial diameter per 100-g increase in weight; 95% CI, - 0.040 to - 0.012 mm; P = 0.0003) independent of birthweight and potential confounding factors. Mean FMD in the half of the preterm population with the lowest rates of early growth was higher than in both the half with the greatest growth ( P = 0.001) and subjects born at term ( P = 0.03).Conclusions - FMD was 4% lower in adolescents with the highest compared with the lowest rate of weight gain in the first 2 weeks after birth, a substantial negative effect similar to that for insulin-dependent diabetes mellitus or smoking in adults. Our findings are consistent with the adverse effects of accelerated neonatal growth on long-term cardiovascular health and suggest that postnatal growth patterns could explain the previously reported association between birthweight and later CVD

Iron Status at Age 6 Months in Colombian Infants Exclusively Breast-fed for 4-5 Versus 6 Months.

BACKGROUND: The optimal age for introducing complementary feeding to breast-fed infants may differ depending on the setting. Prolonged exclusive breastfeeding (EBF) protects against infection but may increase the risk of iron deficiency (ID)/anaemia (IDA) in vulnerable infants. AIM: To compare haemoglobin (Hb), serum ferritin (SF)), anaemia (Hb  2500 g), all EBF for ≥4 months. RESULTS: 108 infants (54% boys) were recruited; 46% EBF for 4-5mo, 54% EBF at 6mo. Prevalence of anaemia, ID and IDA was 20%, 10% and 5%, with no significant difference between EBF4-5 and EBF6 groups. In multivariate models, anaemia/ID were predicted by greater weight gain from 0-6 mo, and anaemia also by caesarean delivery; Hb was lower in infants with higher intake of cows' milk; SF was lower in boys and those with greater weight gain. EBF4-5 versus EBF6 was not a significant predictor of any outcome. CONCLUSION: Anaemia and ID were common at 6 months but were not affected by EBF for 4-5 versus 6 months, suggesting 6 months EBF is safe in this population. However, further research is required to examine effects on later iron status. The findings highlight the need to emphasise avoidance of cow's milk before 12 months

Influence of leptin on arterial distensibility - A novel link between obesity and cardiovascular disease?

Background-The mechanisms by which obesity increases the risk of atherosclerotic cardiovascular disease (CVD) are poorly understood. In experimental models, leptin, a hormone produced by adipose tissue, has been shown adversely to affect vascular health. Therefore, we tested the hypothesis that high leptin concentrations are associated with lower arterial distensibility, an index of circulatory function relevant to the atherosclerotic process.Methods and Results-Noninvasive, high-resolution, vascular ultrasound was used to measure brachial artery distensibility in 294 healthy adolescents (aged 13 to 16 years) who had a broad range of body mass indexes. Fat mass was measured by bioelectric impedance analysis; fasting serum leptin concentration by radioimmunoassay; and lipid profile, fasting insulin, glucose, and C-reactive protein concentrations by standard laboratory techniques. Higher leptin concentrations were associated with impaired arterial distensibility (regression coefficient, -1.3% change in arterial distension per 10% increase in leptin; 95% CI, -1.9% to -0.8%; P<0.001). This association was independent of fat mass, blood pressure, and C-reactive protein, fasting insulin, or LDL cholesterol concentrations.Conclusions-Elevation in leptin was associated with impaired vascular function, independent of the metabolic and inflammatory disturbances associated with obesity. Our observations are consistent with data from experimental models and suggest that high leptin concentration is an important mechanism for the adverse influence of body fatness on CVD

Adaptation of New Colombian Food-based Complementary Feeding Recommendations using Linear Programming.

To use Linear Programming (LP) analyses to adapt New Complementary Feeding Guidelines (NCFg) designed for infants aged 6-12 month (m) living in poor socioeconomic circumstances in Bogota to ensure dietary adequacy for young children aged 12-23 m. A secondary data analysis was performed using dietary and anthropometric data collected from 12 m old infants (n = 72) participating in a randomised controlled trial. LP analyses were performed to identify nutrients whose requirements were difficult to achieve using local foods as consumed; and to test and compare the NCFg and alternative food-based recommendations (FBRs) on the basis of dietary adequacy, for 11 micronutrients, at the population level. Thiamine recommended nutrient intakes for these young children could not be achieved given local foods as consumed. NCFg focusing only on meat, fruits, vegetables and breast milk ensured dietary adequacy at the population level for only 4 micronutrients, increasing to 8/11 modelled micronutrients when the FBRs promoted legumes, dairy, vitamin-A rich vegetables and chicken giblets. None of the FBRs tested ensured population-level dietary adequacy for thiamine, niacin and iron unless a fortified infant food was recommended. This study demonstrated the value of using LP to adapt NCFg for a different age group than the one for which they were designed. Our analyses suggest that to ensure dietary adequacy for 12-23 m olds these adaptions should include legumes, dairy products, vitamin A rich vegetables, organ meat and a fortified food

Nutrition challenges ahead

The breakout session ‘Nutrition challenges ahead’ was held at the EFSA 2nd Scientific Conference ‘Shaping the Future of Food Safety, Together’ (Milan, Italy, 14–16 October 2015) to address the main problems in the area of nutrition to be faced in the 21st Century, both at a global and individual level. The nutrition challenges ahead are diverse and depend on agricultural, socioeconomic and individual factors. At a global level, food security, food sustainability and decreasing the impact of food production on climate change are of paramount importance. Decreasing the prevalence of obesity and related disorders, which may coexist with selected micronutrient deficiencies, is a major challenge for wealthy countries; for developing countries and rural food systems, fighting protein–energy malnutrition and micronutrient deficiencies is a priority. Diets based on a wide variety of nutrient-rich local plant foods (e.g. fruits, vegetables, whole grain cereals, vegetable oils, nuts) that contain moderate amounts of animal protein (preferably in the form of fish) and are low in saturated and trans-fatty acids, added sugars and sodium, are healthy, nutritious, sustainable and climate friendly. Creating an environment where such diets are also economically advantageous and convenient may be a part of a global solution to these nutritional challenges. Individuals, however, are unique regarding their genetic background, gut microbiota and health status. In addition, nutrition may already play a role in the development (and prevention) of disease very early in life. Thus, additional health benefits could be achieved by tailoring nutritional strategies to particular population subgroups or even individuals on the basis of current and future knowledge about the relationship between nutrients, genes, the microbiome and health. New technologies and food innovation may help in finding novel foods fit for purpose

Assessing the impact of drinking water and sanitation on diarrhoeal disease in low- and middle-income settings: Systematic review and meta-regression

Objective: To assess the impact of inadequate water and sanitation on diarrhoeal disease in low- and middle-income settings. Methods: The search strategy used Cochrane Library, MEDLINE & PubMed, Global Health, Embase and BIOSIS supplemented by screening of reference lists from previously published systematic reviews, to identify studies reporting on interventions examining the effect of drinking water and sanitation improvements in low- and middle-income settings published between 1970 and May 2013. Studies including randomised controlled trials, quasi-randomised trials with control group, observational studies using matching techniques and observational studies with a control group where the intervention was well defined were eligible. Risk of bias was assessed using a modified Ottawa-Newcastle scale. Study results were combined using meta-analysis and meta-regression to derive overall and intervention-specific risk estimates. Results: Of 6819 records identified for drinking water, 61 studies met the inclusion criteria, and of 12 515 records identified for sanitation, 11 studies were included. Overall, improvements in drinking water and sanitation were associated with decreased risks of diarrhoea. Specific improvements, such as the use of water filters, provision of high-quality piped water and sewer connections, were associated with greater reductions in diarrhoea compared with other interventions. Conclusions: The results show that inadequate water and sanitation are associated with considerable risks of diarrhoeal disease and that there are notable differences in illness reduction according to the type of improved water and sanitation implemented

Death within 8 years after childhood convulsive status epilepticus:a population-based study

The risk of long-term mortality and its predictors following convulsive status epilepticus in childhood are uncertain. We report mortality within 8 years after an episode of convulsive status epilepticus, and investigate its predictors from a paediatric, prospective, population-based study from north London, UK. In the current study, we followed-up a cohort previously ascertained during a surveillance study of convulsive status epilepticus in childhood. After determining the survival status of the cohort members, we defined cause of death as that listed on their death certificates. We estimated a standardized mortality ratio to compare mortality in our cohort with that expected in the reference population. Multivariable Cox regression analysis was used to investigate any association between the clinical and demographic factors at the time of status epilepticus and subsequent risk of death. The overall case fatality was 11% (95% confidence interval 7.5–16.2%); seven children died within 30 days of their episode of convulsive status epilepticus and 16 during follow-up. The overall mortality in our cohort was 46 times greater than expected in the reference population, and was predominantly due to higher mortality in children who had pre-existing clinically significant neurological impairments when they had their acute episode of convulsive status epilepticus. Children without prior neurological impairment who survived their acute episode of convulsive status epilepticus were not at a significantly increased risk of death during follow-up. There were no deaths in children following prolonged febrile convulsions and idiopathic convulsive status epilepticus. A quarter of deaths during follow-up were associated with intractable seizures/convulsive status epilepticus, and the rest died as a complication of their underlying medical condition. On regression analysis, presence of clinically significant neurological impairments prior to convulsive status epilepticus was the only independent risk factor for mortality. In conclusion, there is a high risk of death within 8 years following childhood convulsive status epilepticus but most deaths are not seizure related. Presence of pre-existing clinically significant neurological impairments at the time of convulsive status epilepticus is the main risk factor for mortality within 8 years after the acute episode. The attributable role of convulsive status epilepticus on mortality remains uncertain, but appears less than is generally perceived