Informant-based tools for assessment and monitoring of cognition, behavior, and function in neurocognitive disorders: Systematic review and report from a CCCDTD5 Working Group.

OBJECTIVE: As part of the fifth Canadian Consensus Conference on the Diagnosis and Treatment of Dementia, we assessed the literature on informant-based tools for assessment and monitoring of cognition, behavior, and function in neurocognitive disorders (NCDs) to provide evidence-based recommendations for clinicians and researchers. METHODS: A systematic review was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses standards guidelines. Publications that validated the informant-based tools or described their key properties were reviewed. Quality of the studies was assessed using the modified Quality Assessment tool for Diagnostic Accuracy Studies. RESULTS: Out of 386 publications identified through systematic search, 34 that described 19 informant-based tools were included in the final review. Most of these tools are backed by good-quality studies and are appropriate to use in clinical care or research. The tools vary in their psychometric properties, domains covered, comprehensiveness, completion time, and ability to detect longitudinal change. Based on these properties, we identify different tools that may be appropriate for primary care, specialized memory clinic, or research settings. We also identify barriers to use of these tools in routine clinical practice. CONCLUSION: There are several good-quality tools available to collect informant-report for assessment and monitoring of cognition, behavior, or function in patients with NCDs. Clinicians and researchers may choose a particular tool based on their specific needs such as domains of interest, desired psychometric properties, and feasibility. Further work is needed to make the tools more user-friendly and to adopt them into routine clinical care.

First foods: Diet quality among infants aged 6-23 months in 42 countries.

Diet quality is closely linked to child growth and development, especially among infants aged 6-23 months who need to complement breastmilk with the gradual introduction of nutrient-rich solid foods. This paper links Demographic and Health Survey data on infant feeding to household and environmental factors for 76,641 children in 42 low- and middle-income countries surveyed in 2006-2013, providing novel stylized facts about diets in early childhood. Multivariate regressions examine the associations of household socioeconomic characteristics and community level indicators of climate and infrastructure with dietary diversity scores (DDS). Results show strong support for an infant-feeding version of Bennett's Law, as wealthier households introduce more diverse foods at earlier ages, with additional positive effects of parental education, local infrastructure and more temperate agro-climatic conditions. Associations with consumption of specific nutrient-dense foods are less consistent. Our findings imply that while income growth is indeed an important driver of diversification, there are strong grounds to also invest heavily in women's education and food environments to improve diet quality, while addressing the impacts of climate change on livelihoods and food systems. These results reveal systematic patterns in how first foods vary across developing countries, pointing to new opportunities for research towards nutrition-smart policies to improve children's diets.

Seafood safety: A need for greater awareness.

Although seafood consumption is recommended as part of a healthy diet, several marine biotoxins are present in seafood, which are associated with adverse health effects such as gastrointestinal and neurological symptoms and, therefore, pose unique food safety concerns. Given that global seafood consumption has increased and is expected to increase further along with increasing interest in reducing meat consumption also as part of commitments to climate change, oversight of seafood quality should be a priority to prevent future contamination. In this editorial, several measures are recommended that should be taken to ensure consumer seafood safety.

Caste-Based Inequality in Fruit and Vegetable Consumption in India.

OBJECTIVE: Fruit and vegetable (F&V) consumption is of central importance to many diet-related health outcomes. In India, caste is a major basis of socioeconomic inequality. Recent analysis shows that more disadvantaged "lower" castes consume less F&V than the rest. This article explores whether this consumption gap arises due to differential distribution of drivers of consumption such as income and education across castes, or whether behavioral differences or discrimination may be at play. DESIGN: The Oaxaca-Blinder regression decomposition is applied to explain the gap in F&V consumption between "upper" castes and "lower" castes, using data from the 68th (2011-2012) round of the National Sample Survey Organization household survey. RESULTS: Differences in the distribution of F&V drivers account for all of the 50 grams/person/day consumption gap between upper and lower castes. In particular, much of the gap is explained by income differential across castes. CONCLUSIONS: In the long run, India's positive discrimination policies in education and employment that seek to equalize income across castes are also likely to help close the F&V consumption gap, leading to health benefits. In the medium run, interventions acting to boost lower caste income, such as cash transfers targeting lower castes, may be effective.

What underlies inadequate and unequal fruit and vegetable consumption in India? An exploratory analysis.

Adequate consumption of fruit and vegetables is key to improved diet-related health in India. We analyse fruit and vegetable consumption in the Indian population using National Sample Survey data. A series of regressions is estimated to characterise the distribution of household fruit and vegetable consumption and explore key socio-economic and food system drivers of consumption. Household income and price are important correlates, but consumption is also higher where households are headed by females, are rural, or involve agricultural livelihoods. Caste is an important source of inequality, particularly amongst those with low consumption, with Scheduled Tribes consuming less F&V than others. We also find preliminary evidence that formal agricultural market infrastructure is positively associated with fruit and vegetable consumption in India.

CCCDTD5 recommendations on early and timely assessment of neurocognitive disorders using cognitive, behavioral, and functional scales.

INTRODUCTION: Earlier diagnosis of neurocognitive disorders and neurodegenerative disease is needed to implement preventative interventions, minimize harm, and reduce risk of exploitation in the context of undetected disease. Along the spectrum from subjective cognitive decline (SCD) to dementia, evidence continues to emerge with respect to detection, staging, and monitoring. Updates to previous guidelines are required for clinical practice. METHODS: A subcommittee of the 5th Canadian Consensus Conference on Diagnosis and Treatment of Dementia (CCCDTD) reviewed emerging evidence to address the following: (1) Is there a role for screening at-risk patients without clinical concerns? In what context is assessment for dementia appropriate? (2) What tools can be used to evaluate patients in whom cognitive decline is suspected? (3) What important information can be gained from an informant, using which measures? (4) What instruments can be used to get more in-depth information to diagnose mild cognitive impairment (MCI) or dementia? (5) What is the approach to those with cognitive concerns but without objective changes (ie, SCD)? (6) How do we track response to treatment and change over time? The Grading of Recommendations Assessment, Development, and Evaluation system was used to rate quality of the evidence and strength of the recommendations. RESULTS: We recommend instruments to assess and monitor cognition, behavior, and function across the cognitive spectrum, including reports from patient and informant. We recommend against screening asymptomatic older adults but recommend investigation for self- or informant reports of changes in cognition, emergence of behavioral or psychiatric symptoms, or decline in function or self-care. Standardized assessments should be used for cognitive and behavioral change that have sufficient validity for use in clinical practice. DISCUSSION: The CCCDTD5 provides evidence-based recommendations for detection, assessment, and monitoring of neurocognitive disorders. Although these guidelines were developed for use in Canada, they may also be useful in other jurisdictions.

Future diets in India: A systematic review of food consumption projection studies.

Against a backdrop of a rapidly changing food system and a growing population, characterisation of likely future diets in India can help to inform agriculture and health policies. We systematically searched six published literature databases and grey literature repositories up to January 2018 for studies projecting the consumption of foods in India to time points beyond 2018. The 11 identified studies reported on nine foods up to 2050: the available evidence suggests projected increases in per capita consumption of vegetables, fruit and dairy products, and little projected change in cereal (rice and wheat) and pulse consumption. Meat consumption is projected to remain low. Understanding and mitigating the impacts of projected dietary changes in India is important to protect public health and the environment.

Household dairy production and child growth: Evidence from Bangladesh.

Research from richer countries finds that dairy consumption has strong positive associations with linear growth in children, but surprisingly little evidence exists for developing countries where diets are far less diversified. One exception is a recent economics literature using the notion of incomplete markets to estimate the impacts of cattle ownership on children's milk consumption and growth outcomes in Eastern Africa. In addition to external validity concerns, an obvious internal validity concern is that dairy producers may systematically differ from non-dairy households, particularly in terms of latent wealth or nutritional knowledge. We re-examine these concerns by applying a novel double difference model to data from rural Bangladesh, a country with relatively low levels of milk consumption and high rates of stunting. We exploit the fact that a cow's lactation cycles provide an exogenous source of variation in household milk supply, which allows us to distinguish between a control group of households that do not own cows, a treatment group that own cows that have produced milk, and a placebo group of cow-owning households that have not produced milk in the past 12 months. We find that household dairy production increases height-for-age Z scores by 0.52 standard deviations in the critical 6-23 month growth window, though in the first year of life we find that household dairy supply is associated with a 21.7 point decline in the rate of breastfeeding. The results therefore suggest that increasing access to dairy products can be extremely beneficial to children's nutrition, but may need to be accompanied by efforts to improve nutritional knowledge and appropriate breastfeeding practices.

What drives diversification of national food supplies? A cross-country analysis.

Little previous research has explored what drives the diversification of national food supplies (DFS) across countries and regions. We construct and analyse a cross-country dataset linking a simple DFS indicator - the share of calories supplied by nonstaple foods - with structural transformation and agroecological indicators. Panel econometric models show that several indicators of structural transformation (economic growth, urbanization and demographic change) are strong predictors of diversification within countries, yet time-invariant agroecological factors are also significantly associated with diversification, which appears to explain why some countries have exceptionally low or high DFS relative to their level of economic development. We discuss the implications of these findings for food and nutrition strategies.