Plant-Based Diets in Children: Secular Trends, Health Outcomes, and a Roadmap for Urgent Practice Recommendations and Research-A Systematic Review

People are increasingly encouraged to reduce animal food consumption and shift towards plant-based diets; however, the implications for children's health are unclear. In this narrative review of research in high-income settings, we summarize evidence on the increasing consumption of plant-based diets in children and update an earlier systematic review regarding their associations with children's health outcomes. The evidence indicates that vegan, but not vegetarian, diets can restrict growth relative to omnivorous children and increase the risk of being stunted and underweight, although the percentage affected is relatively small. Bone mineral content is reduced in vegetarian and, in particular, vegan children, compared to omnivores. Both vegetarian and vegan children who do not use vitamin B12 supplements manifest with B12 deficiency; however, supplementation rectifies this problem. Both vegetarians and vegans have lower concentrations of 25(OH)D if unsupplemented, and lower body iron stores, but usually have normal iron metabolism markers. Both groups are at risk of iodine deficiency, and this might affect thyroid health. Children consuming a vegan diet have a more favorable lipid profile than omnivorous children; however, the results for a vegetarian diet are inconsistent and vary by outcome. Based on the same scientific evidence, national and international dietary recommendations are heterogeneous, with some countries supporting plant-based diets among infants, children, and adolescents, and others discouraging them. We offer a research roadmap, highlighting what is needed to provide adequate evidence to harmonize dietary recommendations for plant-based diets in children. A number of measures should urgently be introduced at international and national levels to improve the safety of their use in children

Increased white matter fibre dispersion and lower IQ scores in adults born preterm

Preterm birth has been associated with altered microstructural properties of the white matter and lower cognitive ability in childhood and adulthood. Due to methodological limitations of the diffusion tensor model, it is not clear whether alterations in myelination or variation in fibre orientation are driving these differences. Novel models applied to multi-shell diffusion imaging have been used to disentangle these effects, but to date this has not been used to study the preterm brain in adulthood. This study investigated whether novel advanced diffusion MRI metrics such as microscopic anisotropy and orientation dispersion are altered in adults born preterm, and whether this was associated with cognitive performance. Seventy-two preterm born participants (37 weeks gestational age) controls (34 males, mean age 30.9 ± 4.0 years) were recruited from the general population. Tensor FA was calculated with FSL, while microscopic FA and orientation dispersion entropy (ODE) were estimated using the Spherical Mean Technique (SMT). Estimated Full Scale IQ (FSIQ), Verbal Comprehension Index (VCI) and Perceptual Reasoning Index (PRI) were obtained from the WASI-II (abbreviated) IQ test. Voxel-wise comparisons using FSL's tract-based spatial statistics were performed to test between-group differences in diffusion MRI metrics as well as within-group associations of diffusion MRI metrics and IQ outcomes. The preterm group had significantly lower FSIQ, VCI and PRI scores. Preterm subjects demonstrated widespread decreases in ODE reflecting increased fibre dispersion, but no differences in microscopic FA. Tensor FA was increased in a small area in the anterior corona radiata. Lower FA values in the preterm population were associated with lower FSIQ and PRI scores. An increase in fibre dispersion in white matter and lower IQ scores after preterm birth exist in adulthood. Advanced diffusion MRI metrics such as the orientation dispersion entropy can be used to monitor white matter alterations across the lifespan in preterm born individuals. Although not significantly different between preterm and term groups, tensor FA values in the preterm group were associated with cognitive outcome

Fright but not fight‐or‐flight: Violent video games elevated stress markers, but did not impact muscle function, memory recall or food intake, in a randomized trial in healthy young men

Objectives: Regular video game playing has been linked with obesity, but the underlying mechanisms remain unclear. Drawing on evolutionary life history theory, we hypothesized that playing violent video games, through activating the stress response, might increase the immediate demand for fuel by muscle and brain tissue, resulting in elevated appetite and food consumption. // Methods: We randomized 71 young adult men to play video games, involving either violent content or nonviolent puzzle-solving, for 1 h. Over this period, we measured stress markers (blood pressure [BP], heart rate, visual-analogue scale [VAS] self-ratings), muscle function (handgrip strength) and cognitive function (memory recall test). Appetite was assessed by VAS, and by food intake using a test-meal after the intervention. Linear mixed-effects models were fitted to assess group effects and group:time effects. // Results: During the intervention, the violent video game group showed elevated systolic BP (∆ = 4.7 mm Hg, 95% CI 1.0, 8.4) and reported feeling more alert but less calm or happy. They showed no difference in grip strength or memory recall. They reported lower feelings of “fullness” but consumed similar food-energy during the test-meal. // Conclusions: Although playing a video game with violent content elevated physiological and perceived stress markers compared with a nonviolent game, this was not associated with markers of altered fuel distribution toward two tissues (muscle and brain) that contribute to the “fight-or-flight” response. Rather than more energy being allocated to the brain overall, energy may have been reallocated within the brain. This may explain why there was no compensatory increase in energy intake in the violent video game group

Socio-economic impacts of the COVID-19 pandemic on new mothers and associations with psychosocial wellbeing: Findings from the UK COVID-19 New Mum online observational study (May 2020-June 2021)

Studies have reported unequal socio-economic impacts of the COVID-19 pandemic and associated restrictions in the UK, despite support packages. It is unclear how women with young children, a vulnerable group economically and psychosocially, havebeen impacted by income and employment pandemic changes, and how this is associated with psychosocial wellbeing. Using the UK COVID-19 New Mum online survey of women with children = £45,000/yr; p<0.001). Expenses impacts were associated with greater risk of partner business stopped/shut down (RRR:27.6/9.8/14.5 for rent/food/essentials [p<0.001 vs. no impact on employment]) or being made unemployed (RRR:15.2/9.5/13.5 [p<0.001]). A greater expenses impact was associated with higher (unhealthy) maternal psychosocial wellbeing score (coef:0.9/1.4/1.3 for moderate-major impact on rent/food/essentials vs. no impact [p<0.001]). The pandemic increased financial insecurity and associated poorer psychosocial wellbeing in new mothers. This is concerning given their pre-existing greater risk of poorer mental health and the implications for breastfeeding and child health and development. These findings reflect highlight the need for the UK government to assess shortfalls of implemented pandemic support policies and the provision of catch-up and better support for vulnerable groups such as new mothers, to avoid increasing socio-economic inequalities and the burden of poor maternal mental health and subsequent negative impacts on child wellbeing

Exclusive Breastfeeding and Developmental and Behavioral Status in Early Childhood

Breastfeeding during infancy may have beneficial effects on various developmental outcomes in childhood. In this study, exclusively breastfed infants were randomly assigned to receive complementary foods from the age of 4 months in addition to breast milk (CF, n = 60), or to exclusively breastfeed to 6 months (EBF, n = 59). At 18 months and again at 30–35 months of age, the children were evaluated with the Parent’s Evaluation of Developmental Status questionnaire (PEDS) and the Brigance Screens-II. The parents completed the PEDS questionnaire at both time intervals and the children underwent the Brigance Screens-II at 30–35 months. At 30–35 months, no significant differences were seen in developmental scores from the Brigance screening test (p = 0.82). However, at 30–35 months a smaller percentage of parents in group CF (2%) had concerns about their children’s gross motor development compared to those in group EBF (19%; p = 0.01), which remained significant when adjusted for differences in pre-randomization characteristics (p = 0.03). No sustained effect of a longer duration of exclusive breastfeeding was seen on selected measures of developmental and behavioral status at 18 months, although at 30–35 months, a smaller percentage of parents of children introduced to complementary foods at four months of age expressed concerns about their gross motor development

Core data necessary for reporting clinical trials on nutrition in infancy

Abstract not availableBerthold Koletzko, Mary Fewtrell, Robert Gibson, Johannes B. van Goudoever, Olle Hernell, Raanan Shamir, Hania Szajewsk

Aluminum exposure from parenteral nutrition in preterm infants: bone health at 15-year follow-up

Background: Aluminum has known neurotoxicity and may impair short-term bone health. In a randomised trial we showed reduced neurodevelopmental scores in preterm infants previously exposed to aluminum from parenteral nutrition solutions. Here, in the same cohort, we test the hypothesis that neonatal aluminum exposure also adversely affects long-term bone health, as indicated by reduced bone mass. Methods: Bone area (BA) and bone mineral content (BMC) of lumbar spine, hip and whole body were measured with Dual X-ray Absorptiometry (DXA) in 13-15yr olds who were born preterm and randomly assigned standard or aluminum-depleted parenteral nutrition (PN) solutions during the neonatal period. Results: 59 subjects (32% of survivors) were followed. Those randomised to standard PN solution had lower lumbar spine BMC; apparently explained by a concomitant decrease in bone size. In non-randomised analyses, subjects exposed to neonatal aluminum intakes above the median (55mcg/kg) had lower hip BMC (by 7.6% (95% CI 0.21 to 2.38; p=0.02)), independent of bone (or body) size. Conclusion: Neonates exposed to parenteral aluminum may have reduced lumbar spine and hip bone mass during adolescence, potential risk factors for later osteoporosis and hip fracture. These findings need confirmation in larger, more detailed studies. Nevertheless, given our previous finding of adverse developmental outcome in these subjects, and the sizeable number of contemporary infants undergoing intensive neonatal care who are still exposed to aluminum via parenteral feeding solutions, the potential adverse long term consequences of early aluminum exposure now deserve renewed attention

Do maternal grandmothers influence breastfeeding duration and infant nutrition? Evidence from Merida, Mexico

Objectives: Breast-feeding is sensitive to somatic, hormonal, behavioral and psychological components of maternal capital. However, through grandmothering, older women may also influence breast-feeding by transferring informational resources to their daughters. We hypothesized that mothers with prolonged instrumental support from their own mother are more likely to have received advice and to have favorable attitudes/practices regarding breastfeeding, compared to those lacking such support, with implications for the grandchild's somatic capital. Methods: We recruited 90 mother-infant dyads (52 with grandmaternal support, 38 without) in Merida, Yucatan, Mexico. All children were first-borns, aged ~2 years. Anthropometry and body composition were assessed. Data on grandmother's breastfeeding advice and maternal breastfeeding duration were obtained by questionnaire. Maternal attitudes to breast-feeding were assessed using the Iowa Infant Feeding Attitude Scale. Results: Women with instrumental support were more likely to have received grandmaternal advice during pregnancy/infancy on exclusive breast-feeding duration (60% vs. 37%, p = 0.033) and the type of first complementary food (81% vs. 47%, p = 0.001). However, women with support had a less favorable attitude to breastfeeding than those without and breastfed their children for less time (median 5 vs. 10.5 months, p = 0.01). No group differences were found in children's length, weight, skinfolds or lean mass z-score. Discussion: Although grandmothers providing instrumental support provided advice regarding breastfeeding, their attitudes may reflect issues beyond nutritional health. Advice of maternal grandmothers did not promote extended breastfeeding, however the differences in breastfeeding attitudes were not associated with the children's nutritional status. Grandmothers should be included in public health interventions promoting breastfeeding

Effects of relaxation interventions during pregnancy on maternal mental health, and pregnancy and newborn outcomes: A systematic review and meta-analysis

Background: Stress during pregnancy is detrimental to maternal health, pregnancy and birth outcomes and various preventive relaxation interventions have been developed. This systematic review and meta-analysis aimed to evaluate their effectiveness in terms of maternal mental health, pregnancy and birth outcomes. // Method: The protocol for this review is published on PROSPERO with registration number CRD42020187443. A systematic search of major databases was conducted. Primary outcomes were maternal mental health problems (stress, anxiety, depression), and pregnancy (gestational age, labour duration, delivery mode) and birth outcomes (birth weight, Apgar score, preterm birth). Randomized controlled trials or quasi-experimental studies were eligible. Meta-analyses using a random-effects model was conducted for outcomes with sufficient data. For other outcomes a narrative review was undertaken. // Result: We reviewed 32 studies comprising 3,979 pregnant women aged 18 to 40 years. Relaxation interventions included yoga, music, Benson relaxation, progressive muscle relaxation (PMR), deep breathing relaxation (BR), guided imagery, mindfulness and hypnosis. Intervention duration ranged from brief experiment (~10 minutes) to 6 months of daily relaxation. Meta-analyses showed relaxation therapy reduced maternal stress (-4.1 points; 95% Confidence Interval (CI): -7.4, -0.9; 9 trials; 1113 participants), anxiety (-5.04 points; 95% CI: -8.2, -1.9; 10 trials; 1965 participants) and depressive symptoms (-2.3 points; 95% CI: -3.4, -1.3; 7 trials; 733 participants). Relaxation has also increased offspring birth weight (80 g, 95% CI: 1, 157; 8 trials; 1239 participants), explained by PMR (165g, 95% CI: 100, 231; 4 trials; 587 participants) in sub-group analysis. In five trials evaluating maternal physiological responses, relaxation therapy optimized blood pressure, heart rate and respiratory rate. Four trials showed relaxation therapy reduced duration of labour. Apgar score only improved significantly in two of six trials. One of three trials showed a significant increase in birth length, and one of three trials showed a significant increase in gestational age. Two of six trials examining delivery mode showed significantly increased spontaneous vaginal delivery and decreased instrumental delivery or cesarean section following a relaxation intervention. // Discussion: We found consistent evidence for beneficial effects of relaxation interventions in reducing maternal stress, improving mental health, and some evidence for improved maternal physiological outcomes. In addition, we found a positive effect of relaxation interventions on birth weight and inconsistent effects on other pregnancy or birth outcomes. High quality adequately powered trials are needed to examine impacts of relaxation interventions on newborns and offspring health outcomes. // Conclusion: In addition to benefits for mothers, relaxation interventions provided during pregnancy improved birth weight and hold some promise for improving newborn outcomes; therefore, this approach strongly merits further research