Ernæring og vekst blant svært premature barn i Norge : En studie en 127 premature barn med fødselsvekt < 1500 gram

Bakgrunn: Årlig fødes gjennomsnittlig 900 barn i Norge med svært lav fødselsvekt (<1500 g). I løpet av de siste 30 årene har overlevelsen til denne gruppen premature blitt betydelig bedret. Dette skyldes økt kunnskap om den medisinske og ernæringsmessige behandlingen både før, under og etter svangerskapet. Det finnes ingen nasjonale retningslinjer for ernæring til premature. Det finnes imidlertid europeiske og amerikanske anbefalinger. Studier fra utlandet tyder på at en stor andel barn blir veksthemmet, såkalt ”small for gestational age” (SGA), mens de er inneliggende på sykehus. Formål: Hovedformålet med studien er å beskrive inntak av næringsstoffer blant premature mens de er innlagt på sykehus, og sammenlikne dette med gjeldende anbefalinger. Vi ønsker også å kartlegge veksten blant premature, samt å undersøke hvorvidt det er en sammenheng mellom inntak av næringsstoffer og utvikling av veksthemming blant denne gruppen barn i norske sykehus. Vi vil også kartlegge plasmanivå av fettløselige vitaminer blant premature barn og sammenligne med referanseverdier. Metode: 127 premature barn med fødselsvekt < 1500 gram deltok i studien. Ved innsyn i journaler fikk vi data om næringsinntak, vekst og diagnoser. Næringsstoffinntak ble beregnet i kostbergningssystemet KBS (utviklet ved Avdeling for ernæringsvitenskap, UiO). Vekst og diagnoser ble lagt inn i en Access database. Alle data ble statistisk behandlet i statistikkprogrammet SPSS. Inntaksdata, vekstdata og målte plasmaverdier av fettløselige vitaminer ble sammenlignet med anbefalinger og referanseområder. Resultater: Premature barn har et lavt inntak av energi, protein og kalsium, og et høyt inntak av vitamin K, vitamin E og jern i forhold til internasjonale anbefalinger. Ukene direkte etter fødsel og ukene før utskrivning er de periodene av sykehusoppholdet der barna er mest utsatt for mangelfull tilførsel av energi og protein. Andel barn som er 10 små for gestasjonsalder (SGA) øker i løpet av sykehusoppholdet fra 33 % ved fødsel til 55 % ved utskrivning. Barn med lavest inntak av energi og protein har økt risiko for å være SGA ved utskrivning. Plasmanivå av vitamin A var lavt ved en ukes alder, og sank i løpet av oppholdet tiltross for høyt inntak. Plasmanivå av vitamin D var lavt ved en ukes alder og økte i løpet av sykehusoppholdet slik at nivået var over øvre referansegrense ved utskrivning. Plasmanivå av vitamin K var svært høyt ved en ukes alder, men sank i løpet av sykehusoppholdet. Plasmanivå av fettløselige vitaminer blant premature barn tilsvarer ikke nivå funnet blant fullbårne friske barn eller referansenivåer og det ble funnet relativt store endringer i nivå under sykehusoppholdet. Konklusjon: Studien har avdekket store avvik mellom faktisk og anbefalt inntak av næringsstoffer, og at en stor del premature barn utvikler veksthemming i løpet av sykehusoppholdet. Det er behov for mer forskning om ernæringsbehandling til premature barn < 1500 gram i sykehuset for å sikre optimal ernæring og om mulig forhindre at barna blir SGA ved utskrivning

Unlocking the potential for achievement of the UN Sustainable Development Goal 2 – “Zero Hunger” - in Africa: Targets, strategies, synergies and challenges

Background: The UN Sustainable Development Goal (SDG) 2 (‘Zero Hunger’) aims to end all forms of hunger and malnutrition by 2030. Thus, a range of different strategies are needed to facilitate the achievement of SDG 2 to overcome challenges and enable synergies between various SDG targets. Objective: The aim of this review is to highlight Africa’s progress toward SDG 2, including targets, strategies, synergies and challenges. Methods: We scrutinized published research articles in peer-reviewed journals, UN reports and in-country Africa reports (between 2015 and 2020) that were relevant to the current topic. Results: Several hunger indicators are showing slow progress or even deterioration in Africa. The prevalence of undernourishment in the general population was 19.1% in 2019 and is expected to increase to 25.7% by 2030. Improvements in child stunting in several regions in Africa are slow, especially in sub-Saharan Africa where about 34% of under-fives were stunted in 2012 and 31% in 2019. In Eastern Africa, stunting prevalence decreased from 38% in 2012 to 34% in 2019. Major drivers of hunger are poor governance and state fragility, war and conflicts, increasing inequality, weak economic development, climate change, biodegradation – and now lately the Covid 19 pandemic – factors that all increase food insecurity. Conclusion: Africa is off track to reach SDG – ‘Zero Hunger’ – by 2030. Current efforts and progress are insufficient. Africa must champion the SDG agenda on a national, regional and global level to facilitate synergies to unlock the potential for reaching ‘Zero Hunger’ throughout the continent.publishedVersio

Cognitive development among children in a low-income setting: Cost-effectiveness analysis of a maternal nutrition education intervention in rural Uganda

Inadequate nutrition and insufficient stimulation in early childhood can lead to long-term deficits in cognitive and social development. Evidence for policy and decision-making regarding the cost of delivering nutrition education is lacking in low and middle-income countries (LMIC). In rural Uganda, we conducted a cluster-randomized controlled trial (RCT) examining the effect of a maternal nutrition education intervention on developmental outcomes among children aged 6–8 months. This intervention led to significantly improved cognitive scores when the children reached the age of 20–24 months. When considering the potential for this intervention’s future implementation, the desired effects should be weighed against the increased costs. This study therefore aimed to assess the cost-effectiveness of this education intervention compared with current practice. Health outcome data were based on the RCT. Cost data were initially identified by reviewing publications from the RCT, while more detailed information was obtained by interviewing researchers involved in processing the intervention. This study considered a healthcare provider perspective for an 18-months’ time horizon. The control group was considered as the current practice for the future large-scale implementation of this intervention. A cost-effectiveness analysis was performed, including calculations of incremental cost-effectiveness ratios (ICERs). In addition, uncertainty in the results was characterized using one-way and probabilistic sensitivity analyses. The ICER for the education intervention compared with current practice was USD 16.50 per cognitive composite score gained, with an incremental cost of USD 265.79 and an incremental cognitive composite score of 16.11. The sensitivity analyses indicated the robustness of these results. The ICER was sensitive to changes in cognitive composite score and the cost of personnel. The education intervention can be considered cost-effective compared with the current practice. The outcome of this study, including the cost analysis, health outcome, cost-effectiveness, and sensitivity analysis, can be useful to inform policymakers and stakeholders about effective resource allocation processes in Uganda and possibly other LMIC.publishedVersio

The association of urine markers of iodine intake with development and growth among children in rural Uganda: A secondary analysis of a randomised education trial

publishedVersio

Model selection reveals the butyrate-producing gut bacterium Coprococcus eutactus as predictor for language development in three-year-old rural Ugandan children

Introduction: The metabolic activity of the gut microbiota plays a pivotal role in the gut-brain axis through the effects of bacterial metabolites on brain function and development. In this study we investigated the association of gut microbiota composition with language development of 3-year-old rural Ugandan children. Methods: We studied the language ability in 139 children of 36 months in our controlled maternal education intervention trial to stimulate children’s growth and development. The dataset includes 1170 potential predictors, including anthropometric and cognitive parameters at 24 months, 542 composition parameters of the children’s gut microbiota at 24 months and 621 of these parameters at 36 months. We applied a novel computationally efficient version of the all-subsets regression methodology and identified predictors of language ability of 36-months-old children scored according to the Bayley Scales of Infant and Toddler Development (BSID-III). Results: The best three-term model, selected from more than 266 million models, includes the predictors Coprococcus eutactus at 24 months of age, Bifidobacterium at 36 months of age, and language development at 24 months. The top 20 four-term models, selected from more than 77 billion models, consistently include C. eutactus abundance at 24 months, while 14 of these models include the other two predictors as well. Mann–Whitney U tests suggest that the abundance of gut bacteria in language non-impaired children (n = 78) differs from that in language impaired children (n = 61). While anaerobic butyrate-producers, including C. eutactus, Faecalibacterium prausnitzii, Holdemanella biformis, Roseburia hominis are less abundant, facultative anaerobic bacteria, including Granulicatella elegans, Escherichia/Shigella and Campylobacter coli, are more abundant in language impaired children. The overall predominance of oxygen tolerant species in the gut microbiota was slightly higher in the language impaired group than in the non-impaired group (P = 0.09). Conclusion: Application of the all-subsets regression methodology to microbiota data established a correlation between the relative abundance of the anaerobic butyrate-producing gut bacterium C. eutactus and language development in Ugandan children. We propose that the gut redox potential and the overall bacterial butyrate-producing capacity in the gut are important factors for language development.publishedVersio

Child saliva microbiota and caries: a randomized controlled maternal education trial in rural Uganda

Throne Holst Foundation and the Centre for Global Health at the University of Oslo’s Research ExceLlence and Innovation in Global HealTh (RELIGHT) programmepublishedVersio

Nutrition, hygiene and stimulation education for impoverished mothers in rural Uganda: Effect on maternal depression symptoms and their associations to child development outcomes

Optimal nutrition improves child development, and impaired development is associated with maternal depression symptoms, in particular in low resource settings. In this follow-up of an open cluster-randomized education trial, we examined its effects among mothers in rural Uganda on their depression symptoms and the association of these symptoms to child development. The education comprised complementary feeding, stimulation, and hygiene. We assessed 77 intervention mothers and 78 controls using Beck Depression Inventory-II (BDI-II) and Center for Epidemiologic Studies Depression Scale (CES-D) scores. Child development was assessed with Bayley Scales of Infant and Toddler Development-III (BSID-III) composite scores for cognitive, language and motor development. Compared to controls, the intervention reduced depression symptoms’ scores with mean (95% CI) differences: −8.26 (−11.49 to −1.13, p = 0.0001) and −6.54; (−8.69 to −2.99, p = 0.004) for BDI II at 20–24 and 36 months, respectively. Similar results were obtained with CES-D. There was a negative association of BDI-II scores and BSID-III cognitive and language scores at 20–24 (p = 0.01 and 0.008, respectively) and 36 months (p = 0.017 and 0.001, respectively). CES-D associations with BSID-III cognitive and language scores showed similar trends. BSID-III motor scores were associated with depression scores at 36 months for both BDI-II and CES-D (p = 0.043 and 0.028, respectively). In conclusion, the group education was associated with reduced maternal depression scores. Moreover, the depression scores were inversely associated with child cognitive and language development outcomes

Nutrition, hygiene and stimulation education for impoverished mothers in rural Uganda: Effect on maternal depression symptoms and their associations to child development outcomes

Optimal nutrition improves child development, and impaired development is associated with maternal depression symptoms, in particular in low resource settings. In this follow-up of an open cluster-randomized education trial, we examined its effects among mothers in rural Uganda on their depression symptoms and the association of these symptoms to child development. The education comprised complementary feeding, stimulation, and hygiene. We assessed 77 intervention mothers and 78 controls using Beck Depression Inventory-II (BDI-II) and Center for Epidemiologic Studies Depression Scale (CES-D) scores. Child development was assessed with Bayley Scales of Infant and Toddler Development-III (BSID-III) composite scores for cognitive, language and motor development. Compared to controls, the intervention reduced depression symptoms’ scores with mean (95% CI) differences: −8.26 (−11.49 to −1.13, p = 0.0001) and −6.54; (−8.69 to −2.99, p = 0.004) for BDI II at 20–24 and 36 months, respectively. Similar results were obtained with CES-D. There was a negative association of BDI-II scores and BSID-III cognitive and language scores at 20–24 (p = 0.01 and 0.008, respectively) and 36 months (p = 0.017 and 0.001, respectively). CES-D associations with BSID-III cognitive and language scores showed similar trends. BSID-III motor scores were associated with depression scores at 36 months for both BDI-II and CES-D (p = 0.043 and 0.028, respectively). In conclusion, the group education was associated with reduced maternal depression scores. Moreover, the depression scores were inversely associated with child cognitive and language development outcomes

Unlocking the potential for achievement of the UN Sustainable Development Goal 2 – “Zero Hunger” - in Africa: Targets, strategies, synergies and challenges

Background: The UN Sustainable Development Goal (SDG) 2 (‘Zero Hunger’) aims to end all forms of hunger and malnutrition by 2030. Thus, a range of different strategies are needed to facilitate the achievement of SDG 2 to overcome challenges and enable synergies between various SDG targets. Objective: The aim of this review is to highlight Africa’s progress toward SDG 2, including targets, strategies, synergies and challenges. Methods: We scrutinized published research articles in peer-reviewed journals, UN reports and in-country Africa reports (between 2015 and 2020) that were relevant to the current topic. Results: Several hunger indicators are showing slow progress or even deterioration in Africa. The prevalence of undernourishment in the general population was 19.1% in 2019 and is expected to increase to 25.7% by 2030. Improvements in child stunting in several regions in Africa are slow, especially in sub-Saharan Africa where about 34% of under-fives were stunted in 2012 and 31% in 2019. In Eastern Africa, stunting prevalence decreased from 38% in 2012 to 34% in 2019. Major drivers of hunger are poor governance and state fragility, war and conflicts, increasing inequality, weak economic development, climate change, biodegradation – and now lately the Covid 19 pandemic – factors that all increase food insecurity. Conclusion: Africa is off track to reach SDG – ‘Zero Hunger’ – by 2030. Current efforts and progress are insufficient. Africa must champion the SDG agenda on a national, regional and global level to facilitate synergies to unlock the potential for reaching ‘Zero Hunger’ throughout the continent