Does early nutrition predict cognitive skills during later childhood? Evidence from two developing countries.

The existing evidence linking early undernutrition to educational outcomes in developing countries is largely focused on assessing its impacts on grade attainment and achievement test scores, with limited evidence on the foundational cognitive skills required to perform well at school. We use unique data collected in Ethiopia and Peru as part of the Young Lives Study to investigate the relationship between early undernutrition and four foundational cognitive skills measured later in childhood, the first two of which measure executive functioning: working memory, inhibitory control, long-term memory, and implicit learning. We exploit the rich longitudinal data available to control for potential confounders at the household and individual level and for time-invariant community characteristics. We also take advantage of the availability of data for paired-siblings to obtain household fixed-effects estimates. In the latter specification, we find robust evidence that stunting at ~ age 5 is negatively related with executive functions measured years later, predicting reductions in working memory and inhibitory control by 12.6% and 5.8% of a standard deviation. Although the main cohort of Young Lives was around 12 years old when executive functions were measured, complementary results and analysis of the data available for the younger siblings suggest that the impact of stunting on executive functions-specifically, on working memory-starts at an earlier age. Our results shed light on the mechanisms that explain the relationship between early nutrition and school achievement tests suggesting that good nutrition is an important determinant of children's learning capacities.

Quantification and enantiomeric distribution of clenbuterol in several bovine tissues using UHPLC-tandem mass spectrometry: Evaluation of a risk factor associated with meat contamination.

Clenbuterol (Clb) (4-amino-α-[(tert-butylamine) methyl]-3,5-dichlorobenzyl alcohol) is a sympathomimetic agent that exhibits ß2-agonist activity. It is applied as a bronchodilatory, tocolytic, and mucolytic agent and is authorized for clinical management in both human and veterinary therapeutics as a racemic mixture. However, its use is strictly prohibited in animals destined for food production in countries in the European Union and in the United States and Mexico, among many others. The R-(-) enantiomer in clenbuterol stimulates ß2-receptors, whereas the S-(+) enantiomer blocks the effect of ß1-receptors. The aims of this study were to develop a method for detecting and quantifying Clb and its enantiomeric distribution in several bovine tissues. The UHPLC-MS/MS method developed to quantify the target compound at trace levels in these tissues combines high sensitivity with good selectivity and short chromatographic run time. The tissue samples tested were found to contain racemic Clb in concentrations of 5-447 pg g-1 . The enantiomeric analysis of Clb showed that R-(-)-Clb is present at higher concentrations in some tissues, whereas S-(+)-Clb was detected in a ratio of 55/45 in the liver and heart tissues.

Interactions between genetic and lifestyle factors on cardiometabolic disease-related outcomes in Latin American and Caribbean populations: A systematic review.

Introduction: The prevalence of cardiometabolic diseases has increased in Latin American and the Caribbean populations (LACP). To identify gene-lifestyle interactions that modify the risk of cardiometabolic diseases in LACP, a systematic search using 11 search engines was conducted up to May 2022. Methods: Eligible studies were observational and interventional studies in either English, Spanish, or Portuguese. A total of 26,171 publications were screened for title and abstract; of these, 101 potential studies were evaluated for eligibility, and 74 articles were included in this study following full-text screening and risk of bias assessment. The Appraisal tool for Cross-Sectional Studies (AXIS) and the Risk Of Bias In Non-Randomized Studies-of Interventions (ROBINS-I) assessment tool were used to assess the methodological quality and risk of bias of the included studies. Results: We identified 122 significant interactions between genetic and lifestyle factors on cardiometabolic traits and the vast majority of studies come from Brazil (29), Mexico (15) and Costa Rica (12) with FTO, APOE, and TCF7L2 being the most studied genes. The results of the gene-lifestyle interactions suggest effects which are population-, gender-, and ethnic-specific. Most of the gene-lifestyle interactions were conducted once, necessitating replication to reinforce these results. Discussion: The findings of this review indicate that 27 out of 33 LACP have not conducted gene-lifestyle interaction studies and only five studies have been undertaken in low-socioeconomic settings. Most of the studies were cross-sectional, indicating a need for longitudinal/prospective studies. Future gene-lifestyle interaction studies will need to replicate primary research of already studied genetic variants to enable comparison, and to explore the interactions between genetic and other lifestyle factors such as those conditioned by socioeconomic factors and the built environment. The protocol has been registered on PROSPERO, number CRD42022308488. Systematic review registration: https://clinicaltrials.gov, identifier CRD420223 08488.

School environments and obesity: a systematic review of interventions and policies among school-age students in Latin America and the Caribbean.

BACKGROUND: The rapid rise in obesity rates among school children in Latin America and the Caribbean (LAC) could have a direct impact on the region's physical and mental health, disability, and mortality. This review presents the available interventions likely to reduce, mitigate and/or prevent obesity among school children in LAC by modifying the food and built environments within and around schools. METHODS: Two independent reviewers searched five databases: MEDLINE, Web of Science, Cochrane Library, Scopus and Latin American and Caribbean Health Sciences Literature for peer-reviewed literature published from 1 January 2000 to September 2021; searching and screening prospective studies published in English, Spanish and Portuguese. This was followed by data extraction and quality assessment using the Cochrane risk-of-bias tool (RoB 2) and the Risk of Bias in Non-Randomized Studies of Interventions (ROBINS-I), adopting also the PRISMA 2020 guidelines. Due to the heterogeneity of the intervention's characteristics and obesity-related measurements across studies, a narrative synthesis was conducted. RESULTS: A total of 1342 research papers were screened, and 9 studies were included; 4 in Mexico, and 1 each in Argentina, Brazil, Chile, Colombia, and Ecuador. Four studies reported strategies for modifying food provision; four other targeted the built environment, (modifying school premises and providing materials for physical activity); a final study included both food and built environment intervention components. Overall, two studies reported that the intervention was significantly associated with a lower increase over time in BMI/obesity in the intervention against the control group. The remaining studies were non-significant. CONCLUSIONS: Data suggest that school environmental interventions, complementing nutritional and physical education can contribute to reduce incremental childhood obesity trends. However, evidence of the extent to which food and built environment components factor into obesogenic environments, within and around school grounds is inconclusive. Insufficient data hindered any urban/rural comparisons. Further school environmental intervention studies to inform policies for preventing/reducing childhood obesity in LAC are needed.

Enfermedad neumocócica invasiva en pacientes de un hospital pediátrico de Perú, 2017-2020 / Invasive pneumococcal disease in patients from a pediatric hospital in Peru, 2017-2020

El propósito del presente estudio fue describir las características clínicas, serotipos y susceptibilidad antibiótica en pacientes con enfermedad neumocócica invasiva (ENI). Se revisaron las historias clínicas de los pacientes con ENI hospitalizados en el Instituto Nacional de Salud del Niño-Breña (Lima, Perú). Se evaluaron a 29 pacientes. La mediana de edad fue 1,9 años (rango intercuartílico 1 a 4 años). El 51,7% eran mujeres y la forma clínica de la ENI más frecuente fue la bacteriemia en 18 (62,1%) pacientes. El 65,5% tenía el esquema de vacunación completo, según el Ministerio de Salud de Perú. El 82,8% del aislamiento del germen fue de sangre. La resistencia antibiótica fue más frecuente a la eritromicina (55,2%), trimetoprim-sulfametoxazol (48,3%) y penicilina (24,1%). Los serotipos registrados fueron 6C, 19A, 23A y 24F. Un paciente falleció por meningitis. En conclusión, la ENI fue más frecuente en niños de uno a cinco años y en la forma clínica de bacteriemia. Se encontraron cinco serotipos reportados en estudios previos con resistencia a penicilina y eritromicina.

This study aimed to describe the clinical characteristics, serotypes, and antibiotic susceptibility in patients with invasive pneumococcal disease (IPD). The medical records of patients with IPD who were hospitalized at the Instituto Nacional de Salud del Niño-Breña (Lima, Peru) were reviewed. We evaluated 29 patients. The median age was 1.9 years (interquartile range: 1 to 4 years). Of the sample, 51.7% were women and the most frequent clinical form of IPD was bacteremia in 18 (62.1%) patients; 65.5% had a complete vaccination schedule, according to the Peruvian Ministry of Health. Germ isolation was performed from blood samples in 82.8% of patients. Antibiotic resistance to erythromycin (55.2%) was the most frequent, followed by resistance to trimethoprim-sulfamethoxazole (48.3%) and penicillin (24.1%). The isolated serotypes were 6C, 19A, 23A and 24F. One patient died of meningitis. In conclusion, IPD was more frequent in children aged one to five years and the most frequent clinical form was bacteremia. Five serotypes reported in previous studies were found to be resistant to penicillin and erythromycin.

Development of an online food frequency questionnaire and estimation of misreporting of energy intake during the COVID-19 pandemic among young adults in Peru.

Background: The Young Lives longitudinal study switched to remote data collection methods including the adaptation of dietary intake assessment to online modes due to the physical contact restrictions imposed by the COVID-19 pandemic. This study aimed to describe the adaptation process and validation of an online quantitative food frequency questionnaire (FFQ) for Peruvian young adults. Methods: A previously validated face-to-face FFQ for the adult Peruvian population was adapted to be administered through an online self-administered questionnaire using a multi-stage process. Questionnaire development was informed by experts' opinions and pilot surveys. FFQ validity was assessed by estimating misreporting of energy intake (EI) using the McCrory method, and the FFQ reliability with Cronbach alpha. Logistic regressions were used to examine associations of misreporting with sociodemographic, body mass index (BMI), and physical activity covariates. Results: The FFQ was completed by 426 Peruvian young adults from urban and rural areas, among whom 31% were classified as misreporters, with most of them (16.2%) overreporting daily EI. Men had a lower risk of under-reporting and a higher risk of over-reporting (OR = 0.28 and 1.89). Participants without a higher education degree had a lower risk of under-reporting and a higher risk of over-reporting (OR = 2.18 and 0.36, respectively). No major difference in misreporting was found across age groups, areas, studying as the main activity, being physically active or sedentary, or BMI. Results showed good internal reliability for the overall FFQ (Cronbach alpha = 0.82). Conclusion: Misreporting of EI was mostly explained by education level and sex across participants. Other sociodemographic characteristics, physical activity, sedentary behavior, and BMI did not explain the differences in EI misreporting. The adapted online FFQ proved to be reliable and valid for assessing dietary intakes among Peruvian young adults during the COVID pandemic. Further studies should aim at using and validating innovative dietary intake data collection methods, such as those described, for informing public health policies targeting malnutrition in different contexts after the COVID-19 pandemic.

The evolution of young people's mental health during COVID-19 and the role of food insecurity: Evidence from a four low-and-middle-income-country cohort study.

OBJECTIVES: Provide evidence on how young people's mental health has evolved in Low-and-Middle-Income-Countries (LMICs) during the progression of the COVID-19 pandemic. Identify particularly vulnerable groups who report high and/or continuously high rates of mental health issues. STUDY DESIGN: Longitudinal, observational. METHODS: Two consecutive phone-surveys (August-October and November-December 2020) in Ethiopia, India, Peru and Vietnam interviewed around 9000 participants of a 20-year cohort study who grew up in poverty, now aged 19 and 26. Rates of at least mild anxiety/depression measured by GAD-7/PHQ-8 were each compared across countries; between males/females, and food secure/food insecure households. RESULTS: Overall, rates of at least mild anxiety and mild depression significantly decreased between mid and end-2020 in all countries but Ethiopia as COVID-19 infection rates fell. Females report higher rates of anxiety and depression in all countries but Ethiopia, however the gender gap is closing. Young people in food insecure households have not shown consistent improvements in their rates of anxiety and depression. Food insecure households are poorer, and have significantly more children (p < 0.05) except in Ethiopia. CONCLUSION: Food insecurity is negatively associated with young people's mental health and urgent support targeted towards the most vulnerable should be a priority. Further research into increasing rates of mental health issues in Ethiopia is needed.

Invasive pneumococcal disease in patients from a pediatric hospital in Peru, 2017-2020. / Enfermedad neumocócica invasiva en pacientes de un hospital pediátrico de Perú, 2017-2020.

OBJECTIVES.: Motivation for the study: there are few reports describing cases of invasive pneumococcal disease after the introduction of the 13-valent conjugate vaccine in Peru. Main findings: cases of invasive pneumococcal disease are still reported in children, more frequently in children under five years of age. The most frequent clinical form was bacteremia and there was greater antibiotic resistance to erythromycin, trimethoprim-sulfamethoxazole, and penicillin. Implications: our findings suggest the need to maintain epidemiological surveillance of invasive pneumococcal disease and to measure the impact of vaccination against pneumococcus in children. This study aimed to describe the clinical characteristics, serotypes, and antibiotic susceptibility in patients with invasive pneumococcal disease (IPD). The medical records of patients with IPD who were hospitalized at the Instituto Nacional de Salud del Niño-Breña (Lima, Peru) were reviewed. We evaluated 29 patients. The median age was 1.9 years (interquartile range: 1 to 4 years). Of the sample, 51.7% were women and the most frequent clinical form of IPD was bacteremia in 18 (62.1%) patients; 65.5% had a complete vaccination schedule, according to the Peruvian Ministry of Health. Germ isolation was performed from blood samples in 82.8% of patients. Antibiotic resistance to erythromycin (55.2%) was the most frequent, followed by resistance to trimethoprim-sulfamethoxazole (48.3%) and penicillin (24.1%). The isolated serotypes were 6C, 19A, 23A and 24F. One patient died of meningitis. In conclusion, IPD was more frequent in children aged one to five years and the most frequent clinical form was bacteremia. Five serotypes reported in previous studies were found to be resistant to penicillin and erythromycin.

OBJETIVOS.: Motivación para realizar el estudio: existen pocos reportes que describan casos de la enfermedad neumocócica invasiva posterior a la introducción de la vacuna conjugada 13-valente en Perú. Principales hallazgos: aún se reportan casos de enfermedad neumocócica invasiva en niños, con mayor frecuencia en menores de cinco años. La forma clínica más frecuente fue la bacteriemia y hubo mayor resistencia antibiótica a eritromicina, trimetoprim-sulfametoxazol y penicilina. Implicancias: los hallazgos de este estudio sugieren la necesidad de mantener la vigilancia epidemiológica de la enfermedad neumocócica invasiva; además, de medir el impacto de la vacunación contra el neumococo en niños. El propósito del presente estudio fue describir las características clínicas, serotipos y susceptibilidad antibiótica en pacientes con enfermedad neumocócica invasiva (ENI). Se revisaron las historias clínicas de los pacientes con ENI hospitalizados en el Instituto Nacional de Salud del Niño-Breña (Lima, Perú). Se evaluaron a 29 pacientes. La mediana de edad fue 1,9 años (rango intercuartílico 1 a 4 años). El 51,7% eran mujeres y la forma clínica de la ENI más frecuente fue la bacteriemia en 18 (62,1%) pacientes. El 65,5% tenía el esquema de vacunación completo, según el Ministerio de Salud de Perú. El 82,8% del aislamiento del germen fue de sangre. La resistencia antibiótica fue más frecuente a la eritromicina (55,2%), trimetoprim-sulfametoxazol (48,3%) y penicilina (24,1%). Los serotipos registrados fueron 6C, 19A, 23A y 24F. Un paciente falleció por meningitis. En conclusión, la ENI fue más frecuente en niños de uno a cinco años y en la forma clínica de bacteriemia. Se encontraron cinco serotipos reportados en estudios previos con resistencia a penicilina y eritromicina.

Role of Government Financial Support and Vulnerability Characteristics Associated with Food Insecurity during the COVID-19 Pandemic among Young Peruvians.

Peruvian households have experienced one of the most prevalent economic shocks due to COVID-19, significantly increasing their vulnerability to food insecurity (FI). To understand the vulnerability characteristics of these households among the Peruvian young population, including the role of the government's response through emergency cash transfer, we analysed longitudinal data from the Young Lives study (n = 2026), a study that follows the livelihoods of two birth cohorts currently aged 18 to 27 years old. FI was assessed using the Food Insecurity Experience Scale. Household characteristics were collected before and during the COVID-19 outbreak in Peru to characterise participants' vulnerability to FI. Multivariate logistic regression was used to evaluate the association between government support and participants' vulnerability characteristics to FI. During the period under study (March to December 2020), 24% (95% CI: 22.1-25.9%) of the participants experienced FI. Families in the top wealth tercile were 49% less likely to experience FI. Larger families (>5 members) and those with increased household expenses and decreased income due to COVID-19 were more likely to experience FI (by 35%, 39% and 42%, respectively). There was no significant association between government support and FI (p = 0.768). We conclude that pre-pandemic socioeconomic status, family size, and the economic disruption during COVID-19 contribute to the risk of FI among the Peruvian young population, while government support insufficiently curtailed the risk to these households.

The impact of COVID-19 lockdowns on physical domestic violence: Evidence from a list randomization experiment.

We quantify the increase in physical domestic violence (family or intimate partner violence) experienced by young people aged 18-26 during the 2020 COVID-19 lockdowns in Peru. To do this we use an indirect methodology, the double list randomization experiment. The list experiment was embedded in a telephone survey to participants of the Young Lives study, a long-standing cohort survey. We find that 8.3% of the sample experienced an increase in physical violence within their households during the lockdown period. Those who had already reported experiencing domestic violence in the last round of (in-person) data collection in 2016 are more likely to have experienced increased physical violence during the COVID-19 lockdown, with 23.6% reporting an increase during this time. The reported increase in violence does not differ significantly by gender. List experiments, if carefully conducted, may be a relatively cheap and feasible way to elicit information about sensitive issues during a phone survey.

Surface Disinfection using Ultraviolet Lightwith a Mobile Manipulation Robot.

Robots are being increasingly used in the fight against highly-infectious diseases such as Ebola, MERS, and SARS-COV-2. Many of the robots that are being used employ ultraviolet lights mounted on a mobile base to inactivate the pathogens. However, these lights are often mounted in a fixed configuration and do not provide adequate decontamination of horizontal surfaces, which can be a major source of cross-contamination. In the paper, we describe the design, implementation, and testing of an Ultraviolet Germicidal Irradiation (UVGI) system implemented on a mobile manipulation robot. A human supervisor designates a surface for disinfection, the robot autonomously plans and executes an end-effector trajectory to disinfect the surface to the required certainty, and then displays the results for the human supervisor to verify. We also provide some background information on UVGI and describe how we constructed and validated mathematical models of Ultraviolet (UV) radiation propagation and accumulation. Finally, we describe our implementation on a Fetch mobile manipulation platform, and discuss how the practicalities of implementation on a real robot affect our models.

Application of a dry heat treatment to enhance the functionality of low-heat nonfat dry milk.

Nonfat dry milk is a valuable food and ingredient because it contains proteins, fat, carbohydrates, minerals, and vitamins. When manufactured, this product is classified into high heat (HH) or low heat (LH) depending on the pre-heat treatment used in pasteurization. Radio frequency dielectric heating, if used alone or as part of a dry heat technology, may induce component interactions in milk powders, which could alter or improve functionality. To pursue this objective, LH was subjected to radio frequency dielectric heating to 80, 85, and 90°C with a subsequent hold period of 60 or 90 min in an oven, set at the designated temperature, 80, 85, or 90°C, assessed for functionality in liquid and gel systems, cooled, and subsequently compared with LH and HH. The functionality assessment included heat stability and foaming, emulsion, and gelling properties. For foaming, LH presented a statistically lower overrun and foam stability compared with all dry-heated LH. The LH dry-heated at ≥85°C exhibited significantly greater foaming capacity than did the LH. Emulsification properties were not significantly different as a function of dry heating compared with LH. As gels, water-holding capacity was greater and syneresis was significantly less for all gels made with the dry-heated LH at <85°C. Gel firmness and cohesiveness were not affected by dry heating. The heat coagulation time at native pH was significantly greater for LH that were dry-heated for 90 min compared with LH. At adjusted pH (6.4 to 7.2), the heat stability was improved if the LH was dry-heated. The dry-heated LH had significantly less foaming properties, but greater emulsion activity compared with the HH. Overall, the dry heat treatment conditions of this study did not result in acid-induced gels with equivalent properties as gels made with HH. Syneresis was similar for all gels except for those made from the dry-heated LH to 90°C and held for 60 min, as this gel had significantly more syneresis than did the gels made from HH. However, the heat stability of dry-heated LH at native, 6.8, 7.0, and 7.2 pH was greater compared with the heat stability of HH. The application of a dry heat treatment enhanced the functional properties of LH, opening the opportunity to develop food products that can use this modified nonfat dry milk such as ice cream, bakery, and meat products.

The structural relationship between early nutrition, cognitive skills and non-cognitive skills in four developing countries.

This study provides evidence about how cognitive and non-cognitive skills are acquired during childhood in four developing countries (Ethiopia, India, Peru and Vietnam), highlighting the role of early nutrition as a determinant in this process. An increase of one standard deviation in height-for-age at the age of 1 is found to have a total effect on cognitive skills at age 8 by 5.4 percent in Ethiopia, 9.0 percent in India, 7.6 percent in Peru and 8.4 percent in Vietnam. The corresponding total effect on non-cognitive skills is 1.1 percent in Ethiopia, 3.4 percent in India, 2.6 percent in Peru and 1.7 percent in Vietnam. The evidence suggests the effect of early nutrition on non-cognitive skills is indirect, mediated by cognitive skills. The effect is also relatively small in magnitude.

Participation in the Juntos Conditional Cash Transfer Program in Peru Is Associated with Changes in Child Anthropometric Status but Not Language Development or School Achievement.

BACKGROUND: It is unclear what effects a conditional cash transfer (CCT) program would have on child anthropometry, language development, or school achievement in the context of the nutrition transition experienced by many low- and middle-income countries. OBJECTIVE: We estimated the association of participation in Peru's Juntos CCT with anthropometry, language development, and school achievement among children aged 7-8 y. METHODS: We used data from the Young Lives Study of a cohort born between 2001 and 2002. We estimated associations of the Juntos program with height-for-age z score (HAZ), body mass index-for-age z score (BAZ), stunting, and overweight at age 7-8 y separately for children participating in the program for ≥2 y (n = 169) and children participating for <2 y (n = 188). We then estimated associations with receptive vocabulary and grade achievement among children who had been assessed at age 4-6 y before enrollment in Juntos (n = 243). We identified control subjects using propensity score matching and conducted difference-in-differences comparisons. RESULTS: Juntos participation was associated with increases in HAZ among boys participating for ≥2 y [average effect of treatment among the treated (ATT): 0.43; 95% CI: 0.09, 0.77; P = 0.01] and for boys participating for <2 y (ATT: 0.52; 95% CI: 0.23, 0.80; P < 0.01). Among girls participating in the program for ≥2 y, BAZ declined (ATT: -0.60; 95% CI: -1.00, -0.21; P < 0.01) as did the prevalence of overweight (ATT: -22.0 percentage points; 95% CI: -42.5, -2.7 percentage points; P = 0.03). We observed no significant associations of Juntos participation with receptive vocabulary or grade attainment. CONCLUSIONS: CCT program participation in Peru was associated with better linear growth among boys and decreased BAZ among girls, highlighting that a large-scale poverty-alleviation intervention may influence anthropometric outcomes in the context of the nutrition transition.

Height in mid childhood and psychosocial competencies in late childhood: evidence from four developing countries.

We use longitudinal data from children growing up in four developing countries (Peru, India, Vietnam, Ethiopia) to study the relationship between height at the age of 7-8 and a set of psychosocial competencies measured at the age of 11-12 that are known to be correlated with earnings during adulthood: self-efficacy, self-esteem and aspirations. Results show that a one standard deviation increase in height-for-age tends to increase self-efficacy, self-esteem and aspirations by 10.4%, 6.4% and 5.1%, respectively. We argue that these findings are likely to be informing of an underlying relationship between undernutrition and the formation of non-cognitive skills.