Does prenatal micronutrient supplementation improve children's mental development? A systematic review

<p>Abstract</p> <p>Background</p> <p>Although maternal nutrient status influences all aspects of fetal development including the brain, the impact of micronutrient supplementation on the baby's mental function is a topic of debate. This systematic review assesses the effect of single and multiple micronutrient supplementation during pregnancy on offspring mental development.</p> <p>Methods</p> <p>Eleven electronic literature databases were searched using key terms of various combinations and filter string terms. Reference lists of articles selected for review were scanned for citations fitting the same inclusion criteria. Each stage of the literature retrieval and review process was conducted independently by two reviewers. The CONSORT checklist was used to assess study quality.</p> <p>Results</p> <p>A total of 1316 articles were retrieved from the electronic database search, of which 18 met the inclusion criteria and were evaluated. The selected studies were randomized controlled trials published from 1983 to 2010, with high variance in sample size, intervention type, and outcome measures. The median CONSORT score was 15 (range 12 - 19). Due to inconsistent interventions and outcome measures among the studies, no conclusive evidence was found that enhancing the intrauterine environment through micronutrient supplementation was associated with child mental development in a number of dimensions. There was some evidence to support n-3 fatty acids or multi-micronutrients having some positive effect on mental development, but the evidence for single nutrients was much weaker.</p> <p>Conclusions</p> <p>The study of children's mental outcomes as a function of prenatal supplementation is still relatively new, but the results of this systematic review suggest that further work with multiple micronutrients and/or n-3 fatty acids should be conducted.</p

An insight into ancient aeolian processes and post‐Noachian aqueous alteration in Gale crater, Mars, using ChemCam geochemical data from the Greenheugh capping unit

Aeolian processes have shaped and contributed to the geological record in Gale crater, Mars, long after the fluviolacustrine system existed ∼3 Ga ago. Understanding these aeolian deposits, particularly those which have been lithified and show evidence for aqueous alteration, can help to constrain the environment at their time of deposition and the role of liquid water later in Mars’ history. The NASA Curiosity rover investigated a prominent outcrop of aeolian sandstone within the Stimson formation at the Greenheugh pediment as part of its investigation of the Glen Torridon area. In this study, we use geochemical data from ChemCam to constrain the effects of aeolian sedimentary processes, sediment provenance, and diagenesis of the sandstone at the Greenheugh pediment, comparing the Greenheugh data to the results from previous Stimson localities situated 2.5 km north and >200 m lower in elevation. Our results, supported by mineralogical data from CheMin, show that the Stimson formation at the Greenheugh pediment was likely sourced from an olivine-rich unit that may be present farther up the slopes of Gale crater’s central mound. Our results also suggest that the Greenheugh pediment Stimson formation was cemented by surface water runoff such as that which may have formed Gediz Vallis. The lack of alteration features in the Stimson formation at the Greenheugh pediment relative to those of the Emerson and Naukluft plateaus suggests that groundwater was not as available at this locality compared to the others. However, all sites share diagenesis at the unconformity

Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019

Background: In an era of shifting global agendas and expanded emphasis on non-communicable diseases and injuries along with communicable diseases, sound evidence on trends by cause at the national level is essential. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) provides a systematic scientific assessment of published, publicly available, and contributed data on incidence, prevalence, and mortality for a mutually exclusive and collectively exhaustive list of diseases and injuries. Methods: GBD estimates incidence, prevalence, mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) due to 369 diseases and injuries, for two sexes, and for 204 countries and territories. Input data were extracted from censuses, household surveys, civil registration and vital statistics, disease registries, health service use, air pollution monitors, satellite imaging, disease notifications, and other sources. Cause-specific death rates and cause fractions were calculated using the Cause of Death Ensemble model and spatiotemporal Gaussian process regression. Cause-specific deaths were adjusted to match the total all-cause deaths calculated as part of the GBD population, fertility, and mortality estimates. Deaths were multiplied by standard life expectancy at each age to calculate YLLs. A Bayesian meta-regression modelling tool, DisMod-MR 2.1, was used to ensure consistency between incidence, prevalence, remission, excess mortality, and cause-specific mortality for most causes. Prevalence estimates were multiplied by disability weights for mutually exclusive sequelae of diseases and injuries to calculate YLDs. We considered results in the context of the Socio-demographic Index (SDI), a composite indicator of income per capita, years of schooling, and fertility rate in females younger than 25 years. Uncertainty intervals (UIs) were generated for every metric using the 25th and 975th ordered 1000 draw values of the posterior distribution. Findings: Global health has steadily improved over the past 30 years as measured by age-standardised DALY rates. After taking into account population growth and ageing, the absolute number of DALYs has remained stable. Since 2010, the pace of decline in global age-standardised DALY rates has accelerated in age groups younger than 50 years compared with the 1990–2010 time period, with the greatest annualised rate of decline occurring in the 0–9-year age group. Six infectious diseases were among the top ten causes of DALYs in children younger than 10 years in 2019: lower respiratory infections (ranked second), diarrhoeal diseases (third), malaria (fifth), meningitis (sixth), whooping cough (ninth), and sexually transmitted infections (which, in this age group, is fully accounted for by congenital syphilis; ranked tenth). In adolescents aged 10–24 years, three injury causes were among the top causes of DALYs: road injuries (ranked first), self-harm (third), and interpersonal violence (fifth). Five of the causes that were in the top ten for ages 10–24 years were also in the top ten in the 25–49-year age group: road injuries (ranked first), HIV/AIDS (second), low back pain (fourth), headache disorders (fifth), and depressive disorders (sixth). In 2019, ischaemic heart disease and stroke were the top-ranked causes of DALYs in both the 50–74-year and 75-years-and-older age groups. Since 1990, there has been a marked shift towards a greater proportion of burden due to YLDs from non-communicable diseases and injuries. In 2019, there were 11 countries where non-communicable disease and injury YLDs constituted more than half of all disease burden. Decreases in age-standardised DALY rates have accelerated over the past decade in countries at the lower end of the SDI range, while improvements have started to stagnate or even reverse in countries with higher SDI. Interpretation: As disability becomes an increasingly large component of disease burden and a larger component of health expenditure, greater research and developm nt investment is needed to identify new, more effective intervention strategies. With a rapidly ageing global population, the demands on health services to deal with disabling outcomes, which increase with age, will require policy makers to anticipate these changes. The mix of universal and more geographically specific influences on health reinforces the need for regular reporting on population health in detail and by underlying cause to help decision makers to identify success stories of disease control to emulate, as well as opportunities to improve. Funding: Bill & Melinda Gates Foundation. © 2020 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licens

Dietary Intakes and Supplement Use in Pre-Adolescent and Adolescent Canadian Athletes

Young athletes experience numerous dietary challenges including growth, training/competition, unhealthy food environments, and travel. The objective was to determine nutrient intakes and supplement use in pre-adolescent and adolescent Canadian athletes. Athletes (n = 187) aged 11–18 years completed an on-line 24-h food recall and dietary supplement questionnaire. Median energy intake (interquartile range) varied from 2159 kcal/day (1717–2437) in 11–13 years old females to 2905 kcal/day (2291–3483) in 14–18 years old males. Carbohydrate and protein intakes were 8.1 (6.1–10.5); 2.4 (1.6–3.4) in males 11–13 years, 5.7 (4.5–7.9); 2.0 (1.4–2.6) in females 11–13 years, 5.3 (4.3–7.4); 2.0 (1.5–2.4) in males 14–18 y and 4.9 (4.4–6.2); 1.7 (1.3–2.0) in females 14–18 years g/kg of body weight respectively. Median vitamin D intakes were below the recommended dietary allowance (RDA) and potassium was below the adequate intake (AI) for all athlete groups. Females 14–18 years had intakes below the RDA for iron 91% (72–112), folate 89% (61–114) and calcium 84% (48–106). Multivitamin-multiminerals, vitamin C, vitamin D, vitamin-enriched water, protein powder, sport foods, fatty acids, probiotics, and plant extracts were popular supplements. Canadian pre-adolescent and adolescent athletes could improve their dietary intakes by focusing on food sources of calcium, vitamin D, potassium, iron, and folate. With the exceptions of vitamin D and carbohydrates during long exercise sessions, supplementation is generally unnecessary

Evaluation of congruence among dietary supplement use and motivation for supplementation in young, Canadian athletes

BACKGROUND: Dietary supplement use is endemic in young athletes; however, it is unclear if their choices are congruent with their motivation for supplementation and the established benefits of the dietary supplements. The aim of this study was to evaluate the relationships between dietary supplement use and self-reported rationale in young athletes. METHODS: Canadian athletes (n = 567; 11-25 years; 76 % club or provincial level, 24 % national or higher) completed a questionnaire designed to assess supplementation patterns and motivation for supplementation. Chi square tests examined associations between dietary supplements and self-reported rationale for use. RESULTS: Vitamin and mineral supplements, including vitamin-enriched water, were associated with several health- and performance- related reasons (p < 0.001). Branched chain amino acids (BCAA) and glutamine were linked to improving diet and immune function (p < 0.01), but were more strongly associated with performance reasons, as were performance foods (protein powder, sport bars, sport gels, etc.). Plant extracts and fatty acids were primarily associated with health reasons, particularly immune support (p < 0.001). CONCLUSIONS: Congruencies exist between performance rationales and supplementation for common ergogenic aids, however, less so for vitamin and mineral supplements, vitamin-enriched water, and plant extracts. Incongruences were found between fatty acids, protein supplements, vitamin and mineral supplements, vitamin-enriched water, and plant extracts and health motivators for supplementation. Educational interventions are essential to ensure young athletes are using dietary supplements safely and effectively.Canadian Foundation for Dietetic ResearchYe

Dietary Intakes and Supplement Use in Pre-Adolescent and Adolescent Canadian Athletes

Publisher's PDFYoung athletes experience numerous dietary challenges including growth, training/competition, unhealthy food environments, and travel. The objective was to determine nutrient intakes and supplement use in pre-adolescent and adolescent Canadian athletes. Athletes (n = 187) aged 11-18 years completed an on-line 24-h food recall and dietary supplement questionnaire. Median energy intake (interquartile range) varied from 2159 kcal/day (1717-2437) in 11-13 years old females to 2905 kcal/day (2291-3483) in 14-18 years old males. Carbohydrate and protein intakes were 8.1 (6.1-10.5); 2.4 (1.6-3.4) in males 11-13 years, 5.7 (4.5-7.9); 2.0 (1.4-2.6) in females 11-13 years, 5.3 (4.3-7.4); 2.0 (1.5-2.4) in males 14-18 y and 4.9 (4.4-6.2); 1.7 (1.3-2.0) in females 14-18 years g/kg of body weight respectively. Median vitamin D intakes were below the recommended dietary allowance (RDA) and potassium was below the adequate intake (AI) for all athlete groups. Females 14-18 years had intakes below the RDA for iron 91% (72-112), folate 89% (61-114) and calcium 84% (48-106). Multivitamin-multiminerals, vitamin C, vitamin D, vitamin-enriched water, protein powder, sport foods, fatty acids, probiotics, and plant extracts were popular supplements. Canadian pre-adolescent and adolescent athletes could improve their dietary intakes by focusing on food sources of calcium, vitamin D, potassium, iron, and folate. With the exceptions of vitamin D and carbohydrates during long exercise sessions, supplementation is generally unnecessary.University of Delaware, Department of Behavioral Health and Nutritio

Multi-scale habitat selection and foraging ecology of the eurasian hoopoe (Upupa epops) in pine plantations

Bird conservation can be challenging in landscapes with high habitat turnover such as planted forests, especially for species that require large home ranges and juxtaposition of diVerent habitats to complete their life cycle. The eurasian hoopoe (Upupa epops) has declined severely in western Europe but is still abundant in south-western France. We studied habitat selection of hoopoes in pine plantation forests using a multi-scale survey, including point-counts at the landscape level and radio-tracking at the home-range scale. We quantiWed habitat use by systematically observing bird behaviour and characterized foraging sites according to micro-habitat variables and abundance of the main prey in the study area, the pine processionary moth (Thaumetopoea pityocampa). At the landscape scale, hoopoes selected habitat mosaics of high diversity, including deciduous woods and hedgerows as main nesting sites. At the home-range scale, hoopoes showed strong selection for short grassland vegetation along sand tracks as main foraging habitats. Vegetation was signiWcantly shorter and sparser at foraging sites than random, and foraging intensity appeared to be signiWcantly correlated with moth winter nest abundance. Hoopoe nesting success decreased during the three study years in line with processionary moth abundance. Thus, we suggest that hoopoes need complementation between foraging and breeding habitats to establish successfully in pine plantations. Hoopoe conservation requires the maintenance of adjacent breeding (deciduous woods) and foraging habitats (short swards adjacent to plantation edges), and consequently depends on the maintenance of habitat diversity at the landscape scale

Global burden of 87 risk factors in 204 countries and territories, 1990–2019 : a systematic analysis for the Global Burden of Disease Study 2019

Background: Rigorous analysis of levels and trends in exposure to leading risk factors and quantification of their effect on human health are important to identify where public health is making progress and in which cases current efforts are inadequate. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 provides a standardised and comprehensive assessment of the magnitude of risk factor exposure, relative risk, and attributable burden of disease. Methods: GBD 2019 estimated attributable mortality, years of life lost (YLLs), years of life lived with disability (YLDs), and disability-adjusted life-years (DALYs) for 87 risk factors and combinations of risk factors, at the global level, regionally, and for 204 countries and territories. GBD uses a hierarchical list of risk factors so that specific risk factors (eg, sodium intake), and related aggregates (eg, diet quality), are both evaluated. This method has six analytical steps. (1) We included 560 risk–outcome pairs that met criteria for convincing or probable evidence on the basis of research studies. 12 risk–outcome pairs included in GBD 2017 no longer met inclusion criteria and 47 risk–outcome pairs for risks already included in GBD 2017 were added based on new evidence. (2) Relative risks were estimated as a function of exposure based on published systematic reviews, 81 systematic reviews done for GBD 2019, and meta-regression. (3) Levels of exposure in each age-sex-location-year included in the study were estimated based on all available data sources using spatiotemporal Gaussian process regression, DisMod-MR 2.1, a Bayesian meta-regression method, or alternative methods. (4) We determined, from published trials or cohort studies, the level of exposure associated with minimum risk, called the theoretical minimum risk exposure level. (5) Attributable deaths, YLLs, YLDs, and DALYs were computed by multiplying population attributable fractions (PAFs) by the relevant outcome quantity for each age-sex-location-year. (6) PAFs and attributable burden for combinations of risk factors were estimated taking into account mediation of different risk factors through other risk factors. Across all six analytical steps, 30 652 distinct data sources were used in the analysis. Uncertainty in each step of the analysis was propagated into the final estimates of attributable burden. Exposure levels for dichotomous, polytomous, and continuous risk factors were summarised with use of the summary exposure value to facilitate comparisons over time, across location, and across risks. Because the entire time series from 1990 to 2019 has been re-estimated with use of consistent data and methods, these results supersede previously published GBD estimates of attributable burden. Findings: The largest declines in risk exposure from 2010 to 2019 were among a set of risks that are strongly linked to social and economic development, including household air pollution; unsafe water, sanitation, and handwashing; and child growth failure. Global declines also occurred for tobacco smoking and lead exposure. The largest increases in risk exposure were for ambient particulate matter pollution, drug use, high fasting plasma glucose, and high body-mass index. In 2019, the leading Level 2 risk factor globally for attributable deaths was high systolic blood pressure, which accounted for 10·8 million (95% uncertainty interval [UI] 9·51–12·1) deaths (19·2% [16·9–21·3] of all deaths in 2019), followed by tobacco (smoked, second-hand, and chewing), which accounted for 8·71 million (8·12–9·31) deaths (15·4% [14·6–16·2] of all deaths in 2019). The leading Level 2 risk factor for attributable DALYs globally in 2019 was child and maternal malnutrition, which largely affects health in the youngest age groups and accounted for 295 million (253–350) DALYs (11·6% [10·3–13·1] of all global DALYs that year). The risk factor burden varied considerably in 2019 between age groups and locations. Among children aged 0–9 years, the three leading detailed risk factors for attributable DALYs were all related to malnutrition. Iron deficiency was the leading risk factor for those aged 10–24 years, alcohol use for those aged 25–49 years, and high systolic blood pressure for those aged 50–74 years and 75 years and older. Interpretation: Overall, the record for reducing exposure to harmful risks over the past three decades is poor. Success with reducing smoking and lead exposure through regulatory policy might point the way for a stronger role for public policy on other risks in addition to continued efforts to provide information on risk factor harm to the general public. Funding: Bill & Melinda Gates Foundation.Peer reviewe

Global burden of 87 risk factors in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019

Background: Rigorous analysis of levels and trends in exposure to leading risk factors and quantification of their effect on human health are important to identify where public health is making progress and in which cases current efforts are inadequate. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 provides a standardised and comprehensive assessment of the magnitude of risk factor exposure, relative risk, and attributable burden of disease. Methods: GBD 2019 estimated attributable mortality, years of life lost (YLLs), years of life lived with disability (YLDs), and disability-adjusted life-years (DALYs) for 87 risk factors and combinations of risk factors, at the global level, regionally, and for 204 countries and territories. GBD uses a hierarchical list of risk factors so that specific risk factors (eg, sodium intake), and related aggregates (eg, diet quality), are both evaluated. This method has six analytical steps. (1) We included 560 risk–outcome pairs that met criteria for convincing or probable evidence on the basis of research studies. 12 risk–outcome pairs included in GBD 2017 no longer met inclusion criteria and 47 risk–outcome pairs for risks already included in GBD 2017 were added based on new evidence. (2) Relative risks were estimated as a function of exposure based on published systematic reviews, 81 systematic reviews done for GBD 2019, and meta-regression. (3) Levels of exposure in each age-sex-location-year included in the study were estimated based on all available data sources using spatiotemporal Gaussian process regression, DisMod-MR 2.1, a Bayesian meta-regression method, or alternative methods. (4) We determined, from published trials or cohort studies, the level of exposure associated with minimum risk, called the theoretical minimum risk exposure level. (5) Attributable deaths, YLLs, YLDs, and DALYs were computed by multiplying population attributable fractions (PAFs) by the relevant outcome quantity for each age-sex-location-year. (6) PAFs and attributable burden for combinations of risk factors were estimated taking into account mediation of different risk factors through other risk factors. Across all six analytical steps, 30 652 distinct data sources were used in the analysis. Uncertainty in each step of the analysis was propagated into the final estimates of attributable burden. Exposure levels for dichotomous, polytomous, and continuous risk factors were summarised with use of the summary exposure value to facilitate comparisons over time, across location, and across risks. Because the entire time series from 1990 to 2019 has been re-estimated with use of consistent data and methods, these results supersede previously published GBD estimates of attributable burden. Findings: The largest declines in risk exposure from 2010 to 2019 were among a set of risks that are strongly linked to social and economic development, including household air pollution; unsafe water, sanitation, and handwashing; and child growth failure. Global declines also occurred for tobacco smoking and lead exposure. The largest increases in risk exposure were for ambient particulate matter pollution, drug use, high fasting plasma glucose, and high body-mass index. In 2019, the leading Level 2 risk factor globally for attributable deaths was high systolic blood pressure, which accounted for 10·8 million (95% uncertainty interval [UI] 9·51–12·1) deaths (19·2% [16·9–21·3] of all deaths in 2019), followed by tobacco (smoked, second-hand, and chewing), which accounted for 8·71 million (8·12–9·31) deaths (15·4% [14·6–16·2] of all deaths in 2019). The leading Level 2 risk factor for attributable DALYs globally in 2019 was child and maternal malnutrition, which largely affects health in the youngest age groups and accounted for 295 million (253–350) DALYs (11·6% [10·3–13·1] of all global DALYs that year). The risk factor burden varied considerably in 2019 between age groups and locations. Among children aged 0–9 years, the three leading detailed risk factors for attributable DALYs were all related to malnutrition. Iron deficiency was the leading risk factor for those aged 10–24 years, alcohol use for those aged 25–49 years, and high systolic blood pressure for those aged 50–74 years and 75 years and older. Interpretation: Overall, the record for reducing exposure to harmful risks over the past three decades is poor. Success with reducing smoking and lead exposure through regulatory policy might point the way for a stronger role for public policy on other risks in addition to continued efforts to provide information on risk factor harm to the general public. Funding: Bill & Melinda Gates Foundation