Maternal protein-energy supplementation does not affect adolescent blood pressure in The Gambia.

BACKGROUND: Birthweight, and by inference maternal nutrition during pregnancy, is thought to be an important determinant of offspring blood pressure but the evidence base for this in humans is lacking data from randomized controlled trials. METHODS: The offspring from a maternal prenatal protein-energy supplementation trial were enrolled into a follow-up study of chronic disease risk factors including blood pressure. Subjects were 11-17 years of age and blood pressure was measured in triplicate using an automated monitor (Omron 705IT). One-thousand two-hundred sixty seven individuals (71% of potential participants) were included in the analysis. RESULTS: There was no difference in blood pressure between those whose mothers had consumed protein-energy biscuits during pregnancy and those whose mothers had consumed the same supplement post-partum. For systolic blood pressure the intention-to-treat regression coefficient was 0.46 (95% CI: -1.12, 2.04). Mean systolic blood pressure for control children was 110.2 (SD +/- 9.3) mmHg and for intervention children was 110.8 (SD +/- 8.8) mmHg. Mean diastolic blood pressure for control children was 64.7 (SD +/- 7.7) mmHg and for intervention children was 64.6 (SD +/- 7.6) mmHg. CONCLUSIONS: We have found no association between maternal prenatal protein-energy supplementation and offspring blood pressure in adolescence amongst rural Gambians. We found some evidence to suggest that offspring body composition may interact with the effect of maternal supplementation on blood pressure

Supplemental feeding during pregnancy compared with maternal supplementation during lactation does not affect schooling and cognitive development through late adolescence.

BACKGROUND: The long-term impact of early malnutrition on human capital outcomes remains unclear, and existing evidence has come largely from observational studies. OBJECTIVE: We compared the impact of a nutritional supplement given during pregnancy or lactation in rural Gambia on educational performance and cognitive ability in offspring at their maturity. DESIGN: This study was a follow-up of a randomized trial of prenatal high protein and energy supplementation conducted between 1989 and 1994. Subjects were 16-22 y of age at follow-up, and information was collected on schooling achievement and cognitive ability by using the Raven's progressive matrices test, Mill Hill vocabulary test, and forward and backward digit-span tests. RESULTS: A total of 1459 individuals were traced and interviewed and represented 71% of the original cohort and 81% of the surviving cohort. There was no difference in cognitive ability or educational attainment between treatment groups by using any of the methods of assessment. CONCLUSION: We have shown little evidence to support a long-term effect of prenatal protein-energy supplementation compared with supplementation during lactation on cognitive development in rural Gambians. This trial was registered at http://www.controlled-trials.com as ISRCTN72582014

Impact of Environmental Disturbance on the Stability and Benefits of Individual Status within Dominance Hierarchies

Changes in environmental conditions affect social interactions and thus may modify an individual’s competitive ability within a social group. We subjected three-spined sticklebacks, Gasterosteus aculeatus, housed in groups of four individuals, to environmental perturbations to assess the impact on dominance hierarchy stability. Hierarchy stability decreased during increased turbulence or lowered water levels (‘simulated drought’) whereas control hierarchies became more stable in a constant environment. The dominant individual either became more aggressive and remained dominant during the environmental manipulation or was usurped by a lower rank member. Only simulated drought affected rates of aggression where levels of aggression were higher after the water level was dropped which may be the result of an increased encounter rate in these conditions. When there were large size differences between the group members, the dominant individual performed the greatest amount of aggression and ate the largest proportion of food and there was little aggressive behaviour from the lower ranks. In groups of similar-sized individuals, aggression was much higher. The benefit of being dominant was to gain weight over the experimental period whereas ranks 2 and 3 lost weight. The lowest rank, 4, actually gained weight over the experimental period. This study suggests that it would benefit an individual to be dominant, highly aggressive and gain weight or be submissive, avoid aggressive interactions and, by sneakily obtaining access to food, also gain weight. Altering environmental conditions has a profound effect on social behaviour in this study

Investigating the association between urban agriculture and food security, dietary diversity, and nutritional status: A systematic literature review

© 2015 Elsevier Ltd. OBJECTIVE: This literature review seeks to examine the evidence for the association between urban agriculture (UA) and food security, dietary diversity, and nutritional status and clarify the evidence base for its effectiveness at ameliorating some food security challenges faced by urban residents. DESIGN: We searched five databases, five grey literature libraries, and hand-searched reference lists to identify all potentially relevant sources. To be included a paper needed to quantify the impact of UA on food security, dietary diversity, or nutrition status. Papers were screened and quality assessed and data were extracted in duplicate. SETTING: Developing and transitional economies. SUBJECTS: Urban farmers, their households, and communities. RESULTS: We identified 11,192 potentially relevant studies and included 13 papers from 12 unique studies. Studies identified both positive and no associations with UA and food security, and in one study's sub-analysis, negative associations were detected. Weak study designs and methods, incomparable measures, compounded with the finding that food insecure households are more likely to engage in UA, all make interpretations difficult. All studies that measured dietary diversity found a positive association. Most studies found a positive association between engagement in UA and food consumption. Findings for nutritional status were mixed, some showing positive associations for stunting. CONCLUSION: Poor quality and weak study designs made interpretation difficult and the assignment of causation impossible. The evidence base for UA needs to be strengthened before it can be confidently recommended as a strategy to improve urban food security. We did not however, find any evidence to discourage its use

A qualitative geographical information systems approach to explore how older people over 70 years interact with and define their neighbourhood environment.

A growing body of literature explores the relationship between the built environment and health, and the methodological challenges of understanding these complex interactions across the lifecourse. The impact of the neighbourhood environment on health and behaviour amongst older adults has received less attention, despite this age group being potentially more vulnerable to barriers in their surrounding social and physical environment. A qualitative geographical information systems (QGIS) approach was taken to facilitate the understanding of how older people over 70 in 5 UK towns interact with their local neighbourhood. The concept of neighbourhood changed seasonally and over the lifecourse, and was associated with social factors such as friends, family, or community activities, rather than places. Spaces stretched further than the local, which is problematic for older people who rely on variable public transport provision. QGIS techniques prompted rich discussions on interactions with and the meanings of 'place' in older people

Early Invitation to Food And/Or Multiple Micronutrient Supplementation in Pregnancy Does Not Affect Body Composition in Offspring at 54 Months: Follow-Up of the MINImat Randomized Trial, Bangladesh

Growth patterns in early life are associated with later health.The effect of nutrition duringin uterodevelopmenton later body composition is unclear. We evaluated whether prenatal early invitation to food and/or multiplemicronutrient supplementation (MMS) in pregnancy has an effect on offspring body composition at 54 monthsof age. In Maternal and Infant Nutrition Interventions in Matlab trial (ISRCTN16581394) in Bangladesh, 4436pregnant women were randomised into six equally sized groups: double-masked supplementation with capsulesof either 30 mg Fe and 400mg folic acid, or 60 mg Fe and 400mg folic acid, or MMS (15 micronutrients), wascombined with a randomised early invitation (around 9 weeks) or a usual invitation (around 20 weeks) to startfood supplementation (608 kcal 6 days per week). At 54 months, the body composition of the offspring wasassessed by leg-to-leg bioelectrical impedance analysis. Of the 3267 live singletons with birth anthropometry,2290 children were measured at 54 months,representing 70% of the live births.There was no interaction betweenthe food and micronutrient supplementation on body composition outcomes. There were no significant differ-ences in a range of anthropometric and body composition measurements, including weight, height, mid-upperarm circumference, head circumference, skinfold thickness, and fat mass and fat-free mass between the differentprenatal food and micronutrient groups using an intention-to-treat analysis. This analysis shows that earlyinvitation to food supplementation and MMS provided to rural Bangladeshi women during pregnancy did notaffect offspring body composition at 54 months of age

Optimising measurement of health-related characteristics of the built environment: Comparing data collected by foot-based street audits, virtual street audits and routine secondary data sources.

The role of the neighbourhood environment in influencing health behaviours continues to be an important topic in public health research and policy. Foot-based street audits, virtual street audits and secondary data sources are widespread data collection methods used to objectively measure the built environment in environment-health association studies. We compared these three methods using data collected in a nationally representative epidemiological study in 17 British towns to inform future development of research tools. There was good agreement between foot-based and virtual audit tools. Foot based audits were superior for fine detail features. Secondary data sources measured very different aspects of the local environment that could be used to derive a range of environmental measures if validated properly. Future built environment research should design studies a priori using multiple approaches and varied data sources in order to best capture features that operate on different health behaviours at varying spatial scales

Body Composition of Bangladeshi Children: Comparison and Development of Leg-to-Leg Bioelectrical Impedance Equation

The aim of this study was to investigate the validity of the Tanita TBF 300A leg-to-leg bioimpedance analyzer for estimating fat-free mass (FFM) in Bangladeshi children aged 4-10 years and to develop novel prediction equations for use in this population, using deuterium dilution as the reference method. Two hundred Bangladeshi children were enrolled. The isotope dilution technique with deuterium oxide was used for estimation of total body water (TBW). FFM estimated by Tanita was compared with results of deuterium oxide dilution technique. Novel prediction equations were created for estimating FFM, using linear regression models, fitting child's height and impedance as predictors. There was a significant difference in FFM and percentage of body fat (BF%) between methods (p<0.01), Tanita underestimating TBW in boys (p=0.001) and underestimating BF% in girls (p<0.001). A basic linear regression model with height and impedance explained 83% of the variance in FFM estimated by deuterium oxide dilution technique. The best-fit equation to predict FFM from linear regression modelling was achieved by adding weight, sex, and age to the basic model, bringing the adjusted R2 to 89% (standard error=0.90, p<0.001). These data suggest Tanita analyzer may be a valid field-assessment technique in Bangladeshi children when using populationspecific prediction equations, such as the ones developed here

Feeding the Worlth Healthily: the Challenge of Measuring the effects of Agriculture on Health

Agricultural production, food systems and population health are intimately linked. While there is a strong evidence base to inform our knowledge of what constitutes a healthy human diet, we know little about actual food production or consumption in many populations and how developments in the food and agricultural system will affect dietary intake patterns and health. The paucity of information on food production and consumption is arguably most acute in low- and middle-income countries, where it is most urgently needed to monitor levels of under-nutrition, the health impacts of rapid dietary transition and the increasing ‘double burden’ of nutrition-related disease. Food availability statistics based on food commodity production data are currently widely used as a proxy measure of national-level food consumption, but using data from the UK and Mexico we highlight the potential pitfalls of this approach. Despite limited resources for data collection, better systems of measurement are possible. Important drivers to improve collection systems may include efforts to meet international development goals and partnership with the private sector. A clearer understanding of the links between the agriculture and food system and population health will ensure that health becomes a critical driver of agricultural change

An exploratory analysis of hospital discharge summaries across Europe

Hospital discharge summaries play a critical role in ensuring safe and efficient continuity of care, particularly through transmission of key information from secondary to primary. This paper aims to explore whether discharge summaries used in European hospitals are adequate to support continuity of care. ..