Consequences of prenatal geophagy for maternal prenatal health, risk of childhood geophagy and child psychomotor development.

OBJECTIVE: To investigate the relationship between prenatal geophagy, maternal prenatal haematological indices, malaria, helminth infections and cognitive and motor development among offspring. METHODS: At least a year after delivery, 552 of 863 HIV-negative mothers with singleton births who completed a clinical trial comparing the efficacy of sulfadoxine-pyrimethamine and mefloquine during pregnancy in Allada, Benin, responded to a nutrition questionnaire including their geophagous habits during pregnancy. During the clinical trial, helminth infection, malaria, haemoglobin and ferritin concentrations were assessed at 1st and 2nd antenatal care visits (ANV) and at delivery. After the first ANV, women were administered daily iron and folic acid supplements until three what? post-delivery. Singleton children were assessed for cognitive function at age 1 year using the Mullen Scales of Early Learning. RESULTS: The prevalence of geophagy during pregnancy was 31.9%. Pregnant women reporting geophagy were more likely to be anaemic (AOR = 1.9, 95% CI [1.1, 3.4]) at their first ANV if they reported geophagy at the first trimester. Overall, prenatal geophagy was not associated with maternal haematological indices, malaria or helminth infections, but geophagy during the third trimester and throughout pregnancy was associated with poor motor function (AOR = -3.8, 95% CI [-6.9, -0.6]) and increased odds of geophagous behaviour in early childhood, respectively. CONCLUSIONS: Prenatal geophagy is not associated with haematological indices in the presence of micronutrient supplementation. However, it may be associated with poor child motor function and infant geophagy. Geophagy should be screened early in pregnancy.

Administration of olanzapine as an antiemetic agent changes glucose homeostasis in cisplatin-treated rats.

We investigated the effects of olanzapine on cisplatin-induced pica (the consumption of non-nutrient materials such as kaolin) and glucose homeostasis in rats to clarify the effects of olanzapine when used as an anti-emetic drug. Rats were injected intraperitoneally (i.p.) with either 5 mg/kg cisplatin or saline. Additionally, 2 or 10 mg/kg olanzapine were administered i.p. to the rats 10 min before the administration of cisplatin and subsequently administered every 24 h for 3 d. Kaolin and food intake was measured using an automatic monitoring apparatus. Plasma glucose levels were measured by an enzyme electrode method. The plasma levels of insulin and intact proinsulin were measured by enzyme-linked immunosorbent assay (ELISA). The proinsulin-to-insulin (P/I) ratio was calculated. Cisplatin significantly increased kaolin intake, but decreased food intake and body weight up to 72 h. Olanzapine had no effect on these parameters. Neither olanzapine nor cisplatin alone had a significant effect on the plasma levels of glucose, insulin, or proinsulin. However, a combination of olanzapine and cisplatin significantly decreased plasma insulin levels, but increased plasma intact proinsulin levels and the P/I ratio. Our results suggest that an additive deterioration of insulin-secreting beta-cell function and disturbance of glucose homeostasis should be considered during treatment of patients with olanzapine for cisplatin-induced nausea and vomiting.

[Preventive and therapeutic effects of xiaobanxia fuling decoction on cisplatin-induced pica rats].

OBJECTIVE: To investigate the preventive and therapeutic effects of Xiaobanxia Fuling Decoction (XBFD) on cisplatin-induced pica rats and to study its mechanism. METHODS: Forty-two male Sprague-Dawley rats were randomly divided into the following 7 groups, i.e., the blank control group, the model group, the high-, middle-, and low-dose XBFD groups (at the daily dose of 30, 15, and 7. 5 g/kg, respectively), the aprepitant (at the daily dose of 13 mg/kg), and pure Chinese medicine group (at the daily dose of XBFD 15 g/kg), 6 in each group. On the 3rd day of this study, 3 mg/kg cisplatin was intraperitoneally injected to rats except the blank control group and the model group to establish the pica rat model. The consumptions of kaolin, food, and the general situation of rats were observed. The protein and mRNA expressions of neurokinin 1 receptor (NK1R) in both the medulla oblongata and the gastric antrum were measured by immunohistochemical assay and Real-time fluorescent quantitative PCR respectively on the sixth day of this study. RESULTS: On the third, fourth, and fifth day of this study, the consumption of kaolin of rats significantly increased when compared with the blank control group (P<0.01). Compared with the model group, the consumption of kaolin significantly decreased in the high-, middle-, and low-dose XBFD groups on the third, fourth, and fifth day of this study (P<0.05). The food intake of rats in the high-dose XBFD groups significantly increased when compared with the model group on the third day of this study (P<0.05). The protein and mRNA expressions of NK, R in the medulla oblongata and the gastric antrum significantly decreased in the high- and middle-dose XBFD groups when compared with the model group (P<0.05). CONCLUSIONS: XBFD could prevent and treat cisplatin-induced pica in rats. Its effect might be correlated with decreasing expressions of NK, R in the medulla oblongata and the gastric antrum.

Administration of a Probiotic Mixture Ameliorates Cisplatin-Induced Mucositis and Pica by Regulating 5-HT in Rats.

Probiotic-based therapies have been shown to be beneficial for chemotherapy-induced mucositis. Previous research has demonstrated that a probiotic mixture (Bifidobacterium brevis, Lactobacillus acidophilus, Lactobacillus casei, and Streptococcus thermophilus) can ameliorate chemotherapy-induced mucositis and dysbiosis in rats, but the underlying mechanism has not been completely elucidated. We aimed to determine the inhibitory effects of the probiotic mixture on cisplatin-induced mucositis and pica and the underlying mechanism, focusing on the levels of 5-hydroxytryptamine (5-HT, serotonin) regulated by the gut microbiota. A rat model of mucositis and pica was established by daily intraperitoneal injection of cisplatin (6 mg/kg) for 3 days. In the probiotic+cisplatin group, predaily intragastric injection of the probiotic mixture (1 × 109 CFU/kg BW) was administrated for 1 week before cisplatin injection. This was then followed by further daily probiotic injections for 6 days. Histopathology, pro-/anti-inflammatory cytokines, oxidative status, and 5-HT levels were assessed on days 3 and 6. The structure of the gut microbiota was analyzed by 16S rRNA gene sequencing and quantitative PCR. Additionally, 5-HT levels in enterochromaffin (EC) cells (RIN-14B cell line) treated with cisplatin and/or various probiotic bacteria were also determined. The probiotic mixture significantly attenuated kaolin consumption, inflammation, oxidative stress, and the increase in 5-HT concentrations in rats with cisplatin-induced intestinal mucositis and pica. Cisplatin markedly increased the relative abundances of Enterobacteriaceae_other, Blautia, Clostridiaceae_other, and members of Clostridium clusters IV and XIVa. These levels were significantly restored by the probiotic mixture. Importantly, most of the genera increased by cisplatin were significantly positively correlated with colonic 5-HT. Furthermore, in vitro, the probiotic mixture had direct inhibitory effects on the 5-HT secretion by EC cells. The probiotic mixture protects against cisplatin-induced intestine injury, exhibiting both anti-inflammatory and antiemetic properties. These results were closely related to the reestablishment of intestinal microbiota ecology and normalization of the dysbiosis-driven 5-HT overproduction.

Are anemia, gastrointestinal disorders, and pregnancy outcome associated with pica behavior?

OBJECTIVE: This study was conducted to determine the relationship between pica and anemia, gastrointestinal disorders, as well as pregnancy outcomes in pregnant women. METHODOLOGY: This study was a prospective study carried out between January 2016 and June 2017 and was performed on 226 pregnant women who attended four different health care centers to receive routine prenatal care. Sampling was done considering the inclusion criteria, in two steps: cluster sampling and random sampling. Data collection was done using a researcher-made checklist. The significance level was set at p = 0.05. RESULTS: The average age of the participants was 26.10±6.27. The prevalence of pica in pregnant women in the first, second, and third trimesters was 9.3, 8, and 2.1%, respectively. The most common pica craving among pregnant women was for ice and frozen materials (68.2%). There was a statistically significant relationship between gastrointestinal disorders and anemia with pica (p < 0.001). There was also a significant relationship between birth weights of babies born to mothers with pica and those without pica (p = 0.005). CONCLUSION: Pica in pregnant women had a significant relationship with gastrointestinal disorders and anemia during pregnancy and pregnancy outcomes. Thus, in addition to providing healthcare services, health care professionals should consider patients' pica practices and make the necessary interventions.

Impact of Community-Based Nutrition Education on Geophagic Behavior and Dietary Knowledge and Practices among Rural Women in Nakuru Town, Kenya: A Pilot Study.

OBJECTIVE: Geophagia, the deliberate consumption of rocks, soil, or clay, is prevalent in developing countries, particularly sub-Saharan Africa. Health risks associated with this behavior include parasitosis, heavy metal poisoning, nutrient deficiencies, and poor birth outcomes. This pilot study was designed to reduce geophagic practices and improve nutrition among rural Kenyan women. METHODS: The researchers used snowball sampling to recruit participants (n = 135; aged 15-49 years) from low socioeconomic areas who consumed geophagic materials. Interviews were carried out before and after a nutrition intervention implemented by trained community health volunteers. RESULTS: Nutrition education focusing on geophagia significantly (P < .001) decreased the practice in 77% of participants. Postintervention interviews also demonstrated substantial improvement in understanding the concept of making half the plate vegetables using the healthy plate model. CONCLUSIONS AND IMPLICATIONS: Nutrition education can be useful for reducing geophagia (a largely ignored, unsafe dietary behavior) and enhancing nutritional knowledge in African women.

WIN 55,212-2 prevents mechanical allodynia but not alterations in feeding behaviour induced by chronic cisplatin in the rat.

Anorexia, nausea/emesis and peripheral sensorial neuropathy are frequent adverse effects associated with chemotherapy. Cannabinoids have been proposed to alleviate these effects, but their preventive properties in long-term experimental models have not been tested. This study was conducted to determine whether or not a cannabinoid agonist (WIN-55,212-2) can prevent anorexia, pica (an indirect marker of nausea in non-vomiting species, consisting of the ingestion of non-nutritive substances such as kaolin) and mechanical allodynia (a marker of peripheral neuropathy) induced by the antineoplastic drug cisplatin chronically administered. Isolated rats with free access to food and kaolin received either saline, cannabinoid vehicle, WIN-55,212-2 (1-2 mg kg(-1)), cisplatin (1-2 mg kg(-1)), or both drugs once per week for five consecutive weeks. Modifications in temperature, body weight gain, food and kaolin intake, and the threshold for mechanical allodynia were recorded. Additionally, the acute psychoactive effects of the cannabinoid (hypomotility, hypothermia, analgesia and catalepsia) were assayed by means of the cannabinoid tetrad. WIN 55,212-2 prevented the development of mechanical allodynia but not anorexia, pica and reduction in weight gain induced by chronic cisplatin. The effect of WIN 55,212-2 was evident even at a dose lacking activity in the cannabinoid tetrad. The preventive effect on cisplatin-induced mechanical allodynia exerted by the cannabinoid could be due to a neuroprotective role, as has been suggested for other conditions. The present results support the interest in the evaluation of cannabinoids for treatment of patients suffering or likely to suffer neuropathic pain.

Ondansetron, dexamethasone and an NK1 antagonist block radiation sickness in mice.

Radiation sickness is frequently observed in total body irradiation (TBI). We have reported that the kaolin ingestion behavior "pica" may be analogous to nausea and vomiting in mice. We evaluated the effects of anti-emetics on the prevention of radiation-induced pica in mice. After the intraperitoneal injection of ondansetron (OND: 2 mg/kg), dexamethasone (DEX: 2 mg/kg) or CP-99,994 (CP: 15 mg/kg), mice received 9 Gy of TBI, and then kaolin consumption was measured after 24 h. Radiation-induced pica was slightly inhibited by pretreatment with a single administration of OND or DEX, but not by CP (control: 0.69+/-0.19 g, OND: 0.33+/-0.06 g, DEX: 0.39+/-0.07 g, CP: 0.66+/-0.09 g); it was significantly inhibited by the combination treatment of OND and DEX (control: 0.55+/-0.09 g, OND+DEX: 0.30+/-0.06 g, OND+CP: 0.70+/-0.04 g, DEX+CP: 0.58+/-0.02 g). The combination of the three drugs completely abolished the behavior (control: 0.67+/-0.08 g, OND+DEX+CP: 0.10+/-0.05 g). These results suggest that radiation-induced pica in mice may be useful to evaluate drugs for treatment of radiation sickness and that the combination therapy of a serotonin 5-HT3 receptor antagonist and a glucocorticosteroid with a neurokinin NK1 receptor antagonist is effective in reducing the symptom.

An analysis of response-blocking parameters in the prevention of pica.

We manipulated two parameters of response blocking to reduce pica: (a) the criteria for initiating the procedure (either earlier or later in the response chain) and (b) the distance from which the procedure was initiated. Results suggested that response blocking may be effective only when implemented early in the chain and with near-perfect consistency. Further, additional treatment components may be required to eliminate all pica attempts.

[Nutritional and psychological factors associated with the occurrence of pica in pregnant women]. / Fatores nutricionais e psicológicos associados com a ocorrência de picamalácia em gestantes.

PURPOSE: To evaluate the nutritional and psychological factors associated with the occurrence of the practice of pica in pregnant women attending a public hospital in Rio de Janeiro, Brazil. METHODS: The study was based on a descriptive design with exploratory features, and conducted on 13 adult and adolescent pregnant women aged 16 to 40 years with a diagnosis of pica in the current pregnancy. Pica was diagnosed by a nutritionist in a standardized interview situation, when questions about the occurrence and frequency of pica, and types of substance ingestion were investigated. After signing the Informed Consent Form (ICF), all participants were evaluated by a nutritionist and seven of them were submitted to psychological assessment with standardized instruments to evaluate stress and anxiety, and to assess coping strategies. RESULTS: The type of pica most frequently reported was pagophagia (30.8%) and the consumption of fruit with salt (30.8%). The most prevalent coping strategies were "religious practice-focused" and "seeking social support", both presented by 42% of the pregnant women. We observed the occurrence of some degree of stress and anxiety in all pregnant women, as well as comorbidities (69.2%) and gastrointestinal symptoms (84.6%). CONCLUSION: Considering that pica may be associated with increased perinatal risk, it is very important to investigate this disorder during prenatal care, and to dopt obstetric, psychological and nutritional preventive practices to reduce the complications for mother and fetus.

Pica in a Four-Year-Old Girl with Global Developmental Delay.

CASE: Emily is a 4 and half-year-old girl whose foster mother is concerned about her odd eating behaviors. Emily has been with her foster mother for 1 year after exposure to domestic violence. Emily's habit of eating nonfood items led to her foster mother providing "100% supervision." Emily constantly picks up, smells, and tastes nonfood items, particularly rocks and things made of metal. She "explores everything with her tongue." Emily scoops dirt and gravel from sidewalk crevices into her mouth. Although toileting, she catches and licks urine in her hand and searches for stool to put in her mouth. With redirection, Emily stopped putting feces into her mouth, but after spending time with her biological family, this behavior recurred.Emily does not like to eat foods that are hard or require chewing. She does not choke or gag on solid foods or liquids. She likes foods that are sweet. She refuses to eat vegetables and foods with certain textures. Emily pulls food apart with her hands before putting it in her mouth.Emily has global developmental delay, cerebral palsy, contractures in her legs, and strabismus. A medical workup resulted in a diagnosis of trisomy 4p and monosomy 9p. Emily works with a physical therapist and occupational therapist; she attends preschool in a special day class. She is an alert, playful, and socially engaging girl who walks with an abnormal gait, speaks in short sentences, and follows simple directions.

Induction and antagonism of pica induced by teriparatide in rats.

Intermittent subcutaneous injection of teriparatide, an active fragment of human parathyroid hormone, is clinically used for the treatment of osteoporosis. Patients suffer from nausea, which is one of the side effects teriparatide induces; however, the etiology of teriparatide-induced nausea remains unknown. We have reported pica, kaolin ingestion behavior, can be used as an assessment of nausea-related response in rats. In this study, we investigated the characteristics of teriparatide-induced pica and the abilities of anti-emetic drugs to inhibit teriparatide-induced pica. Male and female adolescent (4-week-old), young (8-week-old), and adult (30-week-old) naive rats, and ovariectomized (OVX: 17-week-old) and sham-operated (17-week-old) rats subcutaneously received teriparatide (0.4 mg/kg, n=4), and their kaolin and food intakes were monitored for 24 h after the injection. Among the tested rats, we found that OVX rats, rather than male, female, and sham-operated rats, showed marked teriparatide-induced pica (0 mg/kg: 0.17±0.07 g, 0.4 mg/kg: 6.18±0.91 g). Teriparatide-induced pica in OVX rats was inhibited by intraperitoneal pretreatment with serotonin 5-HT3 (granisetron 0.5 mg/kg), dopamine D2 (prochlorperazine 0.5 mg/kg), neurokinin NK1 (fosaprepitant 1 mg/kg), and histamine H1 (diphenhydramine 10 mg/kg) receptor antagonists to 70%, 11%, 19%, and 59% of that in vehicle-treated control, respectively. These results suggest that teriparatide-induced pica in OVX rats has the potential to reflect teriparatide-induced nausea; 5-HT3, D2, NK1, and H1 receptor activation is involved in the development of this behavior; antagonists of these receptors have the potential to be medical candidates used as treatments for teriparatide-induced nausea in human patients.

Methylnaltrexone prevents morphine-induced kaolin intake in the rat.

Opioids are frequently used analgesics, and emesis is a common opioid-induced adverse effect. Methylnaltrexone, a peripheral opioid antagonist, has the potential to block the undesired effects of opioids that are mediated by peripheral receptors while sparing the analgesic effect. We used a rat model of simulated emesis or pica to study if methylnaltrexone decreases morphine induced-kaolin consumption. We observed that after morphine administration, kaolin intake increased significantly compared to intake in the vehicle group, and the increase could be attenuated by ondansetron administration. Methylnaltrexone dose-dependently reduced kaolin ingestion induced by morphine. Morphine and methylnaltrexone did not significantly affect food intake and body weight in the experimental animals. Our data suggest that methylnaltrexone has therapeutic value in treating opioid-induced nausea and vomiting.

Pica in the geriatric mentally ill: unrelenting and potentially fatal.

Pica has rarely been reported in patients with geriatric mental illness. The authors describe 3 male patients with pica in the geriatric unit of a state mental hospital. Two of these patients had a diagnosis of developmental delay with concomitant diagnoses of schizophrenia and schizoaffective disorder, respectively. The third patient was diagnosed with paranoid schizophrenia. In all 3 cases, pica started late in life and was unrelenting and unresponsive to psychotropic medications, with limited to no response to behavioral interventions. In the 2 patients who died, pica was implicated as the direct cause of death in 1 and the likely cause of death in the other. When pica occurs in elderly patients with mental illness, the risk of mortality should be taken into account in clinical management.

Broadening the perspective of pica: literature review.

Pica is an eating disorder that is manifested by a craving for oral ingestion of a given substance that is unusual in kind and or quantity. It is a long-standing practice that has far reaching implications for prevention and treatment--implications for public health as well as clinical personnel who work in settings where they have the potential for influencing health knowledge, attitudes, and behaviors of their patients. Pica practices also challenge researchers and social scientists whose work encompass development and refinement of models related to nutritional deficiencies. The body of literature on pica is so fragmented that it is difficult to find a precise summary of the knowns and unknowns about the condition. There is little consistency in defining pica, classifying substances ingested, identifying key characteristics of practicers, recommending treatment, or in projecting outcomes. This review presents a framework for understanding pica as a general practice, summarizes divergent reported hypotheses and conclusions, and illustrates that there is a need for more comprehensive studies of prevalence and incidence and use of deductive as well as inductive research processes.

Effects of serum zinc supplementation on pica behavior of persons with mental retardation.

Although pica is one of the most frequently observed eating dysfunctions among people with mental retardation, it is significantly underreported in the literature. Of 806 institutionalized adults with mental retardation in the present study, 15.5% exhibited pica. Prevalence estimates from previous studies have ranged from 25.8% to 3%. Fifty-four percent of the pica group had serum zinc levels below normal range, whereas 7% of the control group had serum zinc levels below the normal range. After supplementation with chelated zinc, residents had significant reductions in pica. Data indicated zinc as a possible adjunct to other treatment approaches.

Neuropharmacological mechanisms of emesis. II. Effects of antiemetic drugs on cisplatin-induced pica in rats.

The effects of diphenhydramine, domperidone, ondansetron, and diphenidol on cisplatin-induced pica (i.e., kaolin ingestion) in rats as the measure analogous to emesis in other species were examined. Ondansetron (2 mg/kg) and diphenidol (30 mg/kg) inhibited kaolin intake induced by cisplatin (10 mg/kg), but diphenhydramine and domperidone did not. Diphenhydramine and diphenidol have been shown to inhibit kaolin intake induced by double rotation, while domperidone and ondansetron did not, and kaolin intake induced by apomorphine was inhibited by domperidone and diphenidol, but not by diphenhydramine or ondansetron. These observations, together with the present findings, suggest that the emetic pathways through the inner ear (double rotation), chemoreceptor trigger zone (apomorphine) and visceral afferent (cisplatin), are pharmacologically independent and are mediated by histamine H1 receptors, dopamine D2 receptors and serotonin 5-HT3 receptors, respectively. It is conceivable that diphenidol may inhibit the emetic center itself, although the receptor on which it acts is not known.

Environmental lead exposure in Christchurch children: soil lead a potential hazard.

A study of childhood blood lead levels and of soil lead levels has been carried out in Christchurch. The results indicate a potent hazard especially to the child with unusual appetite for soil. Screening and preventative programmes are briefly discussed.

Comparing methods for maintaining the safety of a child with pica.

Pica, a potentially life-threatening behavior problem exhibited among persons with mental retardation is sometimes addressed by methods such as application of restraints to reduce or eliminate associated risks (Rojahn, Schroeder, & Mulick, 1980). However, restraints may be associated with decreases in social interaction and negative impact on quality of life. We evaluated two methods (restraint vs. no restraint) for maintaining the safety of a client with pica on three dimensions: (a) level of pica, (b) therapist effort, and (c) impact on quality of life. Both methods prevented pica, however, the no restraint condition required less therapist effort and had less negative impact on quality of life. All three dimensions were included in a clinical decision-making model to determine the least restrictive, safe level of restraint for a 4-year-old girl while assessment and treatment procedures were conducted. The clinical utility of this multifactor decision-making model is discussed.

Pica in pregnancy: does it affect pregnancy outcomes?

PURPOSE: To discover the prevalence of pica, the documentation of pica on medical records, and any relationship of pica to pregnancy outcomes in rural socioeconomically disadvantaged pregnant women. STUDY DESIGN AND METHODS: Prospective, descriptive, correlational investigation with 128 women who sought prenatal care from two rural community health agencies. Demographic and sociocultural variables, pica practices, pica substances ingested, and pregnancy outcomes were collected. RESULTS: Thirty-eight percent of these pregnant women practiced pica. African-American women reported practicing pica more often than other ethnicities. Substances ingested included ice (>1 cup/day), freezer frost, laundry starch, cornstarch, clay dirt, and baked clay dirt. Polypica (ingestion of more than one substance) was practiced by 11 women. Women practicing pica were more likely to have been underweight prior to pregnancy, and smoked fewer cigarettes. Women reporting daily pica practice were significantly more likely to have lower prenatal hematocrits than women who did not practice pica, or who practiced pica less frequently than daily. No specific pregnancy complication was associated with the practice of pica. CLINICAL IMPLICATIONS: Pica exists, and might be more common than healthcare providers assume. Although this study did not show specific pregnancy complications associated with pica, other studies have shown anemia and lead poisoning among women who practice pica. It is not clear that patients volunteer information about pica, so it would be helpful if nurses queried patients at each prenatal visit regarding pica practice. Discussion of pica practices should be based on a nonjudgmental model, for pica may have strong cultural implications, and may be practiced for cultural reasons unknown to the nurse.