Maternal-focused interventions to improve infant growth and nutritional status in low-middle income countries: A systematic review of reviews.

BACKGROUND: Small and nutritionally at-risk infants under 6 months (<6m) are a vulnerable group at increased risk of mortality, morbidity, poor growth and sub-optimal development. Current national and international (World Health Organization) management guidelines focus mainly on infants' needs, yet growing evidence suggests that maternal factors also influence infant outcomes. We aimed to inform future guidelines by exploring the impacts of maternal-focused interventions on infant feeding and growth. METHODS: We conducted a systematic review of reviews published since 2008 (PROSPERO, register number CRD 42019141724). We explored five databases and a wide variety of maternal-focused interventions based in low- and middle-income countries. Infant outcomes of interest included anthropometric status, birthweight, infant mortality, breastfeeding and complementary feeding practices. Given heterogenous interventions, we present a narrative synthesis of the extracted data. RESULTS: We included a total of 55 systematic reviews. Numerous maternal interventions were effective in improving infant growth or feeding outcomes. These included breastfeeding promotion, education, support and counselling interventions. Maternal mental health, while under-researched, showed potential to positively impact infant growth. There was also some evidence for a positive impact of: women's empowerment, m-health technologies, conditional cash transfers, water, sanitation and hygiene and agricultural interventions. Effectiveness was increased when implemented as part of a multi-sectoral program. Antenatal supplementation with macronutrient, multiple micronutrients, Vitamin D, zinc, iron folic acid and possibly calcium, iodine and B12 in deficient women, improved birth outcomes. In contrast, evidence for postnatal supplementation was limited as was evidence directly focusing on small and nutritionally at-risk infants; most reviews focused on the prevention of growth faltering. CONCLUSION: Our findings suggest sufficient evidence to justify greater inclusion of mothers in more holistic packages of care for small and nutritionally at-risk infants aged <6m. Context specific approaches are likely needed to support mother-infant dyads and ensure infants survive and thrive.

Nujiangexanthone A Inhibits Cervical Cancer Cell Proliferation by Promoting Mitophagy.

Nujiangexanthone A (NJXA), a bioactive component isolated from the leaves of Garcinia nujiangensis, has been reported to exhibit anti-inflammatory, antioxidant, and antitumor effects. Our previous work has shown that NJXA induced G0/1 arrest and apoptosis, thus suppressing cervical cancer cell growth. The present study provides new evidence that NJXA can induce cell death in HeLa cells by promoting mitophagy. We first identified that NJXA triggered GFP-LC3 and YFP-Parkin puncta accumulation, which are biomarkers of mitophagy. Moreover, NJXA degraded the mitochondrial membrane proteins Tom20 and Tim23 and mitochondrial fusion proteins MFN1 and MFN2, downregulated Parkin, and stabilized PINK1. Additionally, we revealed that NJXA induced lysosome degradation and colocalization of mitochondria and autophagosomes, which was attenuated by knocking down ATG7, the key regulator of mitophagy. Furthermore, since mitophagy is induced under starvation conditions, we detected the cytotoxic effect of NJXA in nutrient-deprived HeLa cells and observed better cytotoxicity. Taken together, our work contributes to the further clarification of the mechanism by which NJXA inhibits cervical cancer cell proliferation and provides evidence that NJXA has the potential to develop anticancer drugs.

Nutrient status and growth in vegan children.

Vegan diets have risen in popularity over the past 9 years. However, few studies have examined nutrient status and the effect of a vegan diet on the growth of children. This study analysed the existing literature on the health impact and growth impact of selected nutrients in vegan children. We assessed the intake of calories and protein, as well as the nutrients iron, calcium, vitamin D, cobalamin and folate. With a small percentage of outliers, vegan children showed normal growth and were less often obese. We found limited evidence that children on a vegan diet can obtain all the examined nutrients. Furthermore, as proper planning and supplementation by caregivers is needed, it is currently unknown how often vegan children follow well-planned diets. Deficiencies in cobalamin, calcium, and vitamin D seem to be the biggest risks associated with a poorly planned vegan diet. For a more definitive assessment, data on the intake and nutrient status of omega-3 fatty acids, zinc, iodine, and selenium in vegan children are needed. Future research should account for demographic shifts in those following a vegan diet, and should discriminate between vegan sub-populations that are open or closed towards scientific approaches, towards health in general, and toward supplementation. Studies should assess the modes and dosages of supplementation and the use of fortified foods or drinks, as well as adherence to the diet itself. Plant ferritin as a source of iron and endogenous cobalamin synthesis warrants further scientific inquiry. In summary, the current literature suggests that a well-planned vegan diet using supplementation is likely to provide the recommended amounts of critical nutrients to provide for normal progression of height and weight in children, and can be beneficial in some aspects. However, data on 5 critical nutrients are still missing, hampering a more definitive conclusion.

Malnutrition in Orthopaedic Sports Medicine: A Review of the Current Literature.

CONTEXT: Malnutrition is well-studied in various aspects of the orthopaedic literature, most commonly in relation to arthroplasty, spine surgery, and trauma. However, the management of nutritional deficiencies is commonly overlooked among orthopaedic sports medicine providers. The purpose of this article is to analyze the available sports medicine literature to review the associations between malnutrition and the management of orthopaedic sports medicine patients from a treatment and performance standpoint. EVIDENCE ACQUISITION: PubMed was searched for relevant articles published from 1979 to 2019. STUDY DESIGN: Clinical review. LEVEL OF EVIDENCE: Level 4. RESULTS: Few studies exist on the implications of macronutrient deficiencies specific to orthopaedic sports medicine procedures. Interestingly, micronutrient disorders-namely, hypovitaminosis D and iron deficiency-have been well studied and may lead to worse postoperative outcomes, injury rates, and athletic performance. Nutritional supplementation to correct such deficiencies has been shown to mitigate these effects, though further study is required. CONCLUSION: Nutritional deficiencies are highly prevalent in orthopaedic sports medicine patients, and practitioners should be aware of their potential effects on treatment and performance outcomes. Management of such deficiencies and their effect on surgical patients remain an area of potential future research. Future studies are warranted in order to explore the potential therapeutic role of nutritional supplementation to prevent complications after common orthopaedic sports medicine procedures, improve athletic performance, and reduce injury rates.

Trait-based approaches reveal fungal adaptations to nutrient-limiting conditions.

The dependency of microbial activity on nutrient availability in soil is only partly understood, but highly relevant for nutrient cycling dynamics. In order to achieve more insight on microbial adaptations to nutrient limiting conditions, precise physiological knowledge is needed. Therefore, we developed an experimental system assessing traits of 16 saprobic fungal isolates in nitrogen (N) limited conditions. We tested the hypotheses that (1) fungal traits are negatively affected by N deficiency to a similar extent and (2) fungal isolates respond in a phylogenetically conserved fashion. Indeed, mycelial density, spore production and fungal activity (respiration and enzymatic activity) responded similarly to limiting conditions by an overall linear decrease. By contrast, mycelial extension and hyphal elongation peaked at lowest N supply (C:N 200), causing maximal biomass production at intermediate N contents. Optimal N supply rates differed among isolates, but only the extent of growth reduction was phylogenetically conserved. In conclusion, growth responses appeared as a switch from explorative growth in low nutrient conditions to exploitative growth in nutrient-rich patches, as also supported by responses to phosphorus and carbon limitations. This detailed trait-based pattern will not only improve fungal growth models, but also may facilitate interpretations of microbial responses observed in field studies.

Hysteretic response of Microbial Eukaryotic Communities to Gradually Decreased Nutrient Concentrations in Eutrophic Water.

External environments to microbial eukaryotic communities often change gradually with time. However, whether the responses of microbial eukaryotic communities to these gradually changed environments are continuous or hysteretic and the mechanisms underlying these responses are largely unknown. Here, we used a microcosm to investigate the temporal variation of microbial eukaryotic communities with the gradually decreased nutrient concentrations (nitrogen and phosphorus). We found the differences of microbial eukaryotic community composition and species richness between the control and treatment groups were low during the days 0 to 12, although the nutrient concentrations decreased rapidly during this period in treatment group. However, these differences were clear during the days 14 to 18, although the nutrient concentrations decreased slowly during this period in treatment group. The mechanisms for these results are that the strong homogenous selection (perhaps due to the biotic factors) during the days 8 to 10 in treatment group might enhance the stability of microbial eukaryotic communities. However, the continuously decreased nutrient concentrations weakened the homogenous selection and promoted the strength of environmental filtering, and therefore resulted in the distinct change of microbial eukaryotic communities during the days 14 to 18 in treatment group. Fungi, Chlorophyta and Chrysophyta which associated with the nutrient removal played important roles in this hysteretic change of microbial eukaryotic communities. Overall, our findings suggest that disentangling the non-linear response of communities to gradual environmental changes is essential for understanding ecosystem restoration and degradation in future.

Influence of short-term macronutrient deprivation in maize on photosynthetic characteristics, transpiration and pigment content.

The aim of the research was to compare the impact of short-term deprivation of selected macronutrients (Ca, K, Mg and P) on the photosynthetic characteristics, transpiration and pigment content in maize. The strongest inhibition of photosynthesis was caused by a deprivation of Mg, which was visible as a decrease in the photosynthetic and transpiration rates, stomatal conductance, photosystem II (PSII) performance, chlorophyll and flavonol content with a simultaneously increased content of anthocyanins. In the K-deprived plants, a decrease in the photosynthetic rate was observed. However, the transpiration rate and stomatal conductance did not differ significantly compared with the control. In the K-deprived plants, a decrease in chlorophyll and an increase in the anthocyanin content were also observed. We showed that Ca starvation resulted in a decrease in the photosynthetic and transpiration rates, stomatal conductance and PSII performance, while the pigment content was not significantly different compared with the control. In the case of P-deprived plants, we observed a decrease in the photosynthetic and transpiration rates. Interestingly, the inhibition of stomatal conductance was the strongest in the P-deprived plants compared with all of the investigated elements. However, the performance of PSII was not significantly affected by P starvation compared with the control. Our results present for the first time a comprehensive analysis of the effect of short-term macronutrient deprivation on photosynthesis and transpiration in maize plants.

Metabolomics for improved treatment monitoring of phenylketonuria: urinary biomarkers for non-invasive assessment of dietary adherence and nutritional deficiencies.

Management of phenylketonuria (PKU) requires lifelong restriction of phenylalanine (Phe) intake using specialized medical foods to prevent neurocognitive impairment in affected patients. However, dietary adherence is challenging to maintain while ensuring adequate nutrition, which can lead to sub-optimal clinical outcomes. Metabolomics offers a systematic approach to identify new biomarkers of disease progression in PKU when using urine as a surrogate for blood specimens that is more accurate than self-reported diet records. Herein, the plasma and urine metabolome of a cohort of classic PKU patients (median age = 11 years; n = 22) mainly prescribed (78%) a Phe-restricted diet were characterized using multisegment injection-capillary electrophoresis-mass spectrometry (MSI-CE-MS). Overall, there was good mutual agreement between plasma Phe and tyrosine (Tyr) concentrations measured from PKU patients when using an amino acid analyzer based on UPLC-UV as compared to MSI-CE-MS with a mean bias of 12% (n = 82). Longitudinal measurements of recently diagnosed PKU infants (n = 3) revealed good long-term regulation of blood Phe with dietary management, and only occasional episodes exceeding the recommended therapeutic range (>360 µM) unlike older PKU patients. Plasma metabolomic studies demonstrated that non-adherent PKU patients had lower circulating concentrations of Tyr, arginine, 2-aminobutyric acid, and propionylcarnitine (q < 0.05, FDR) that were inversely correlated to Phe (r ≈ -0.600 to -0.830). Nontargeted metabolite profiling also revealed urinary biomarkers associated with poor dietary adherence among PKU patients, including elevated concentrations of catabolites indicative of Phe intoxication (e.g., phenylpyruvic acid, phenylacetylglutamine, hydroxyphenylacetic acid). Additionally, PKU patients with poor blood Phe control had lower excretion of urinary compounds derived from co-metabolism of Tyr due to microbiota activity (e.g., cresol sulfate, phenylsulfate), as well as several metabolites associated with inadequate nutrient intake, including low carnitine and B vitamin status (e.g., folic acid, vitamin B12). Interestingly, an unknown urinary metabolite was strongly correlated with Phe excretion in PKU patients (r = 0.861), which was subsequently identified as imidazole lactic acid when using high resolution MS/MS. Overall, urine profiling offers a non-invasive approach for better treatment monitoring of individual PKU patients, which can also guide the design of novel therapies that improve adherence to Phe-restricted diets without acquired nutritional deficiencies.

Different DHA or EPA production responses to nutrient stress in the marine microalga Tisochrysis lutea and the freshwater microalga Monodus subterraneus.

This study investigated the effect of nitrogen (N) and phosphorous (P) stress on the production of DHA or EPA and total fatty acids (TFAs) in the marine microalga Tisochrysis lutea and the freshwater microalga Monodus subterraneus. Five N or P starvation/limitation conditions (N sufficient and P limited, N sufficient and P starved, N starved and P sufficient, N starved and P limited, and N and P starved) and one N and P sufficient condition (control) were studied. The results demonstrated that the proportion of DHA or EPA among TFAs and production in the microalgae suspensions decreased (57%, 73% for N stress and 18%, 51% for P stress, respectively) under N or P stress in both microalgae compared with the N and P sufficient group. Differently, DHA dry weight content of T. lutea decreased significantly, and EPA dry weight content of M. subterraneus decreased slightly under N starved conditions. Clear differences in TFA content/production and the relationship between TFA and DHA or EPA production/content and CO2 fixation were observed between the two microalgae. These results give a new sight on the difference between marine microalgae and freshwater microalgae. Meanwhile, it gave a potential application to produce DHA or EPA and TFA combining with CO2 fixation by these microalgae.

Ovine liver proteome: Assessing mechanisms of seasonal weight loss tolerance between Merino and Damara sheep.

The effect of feed restriction on the liver protein profiles of two different breeds of sheep was studied. We compared Merino with the Damara, breeds with respectively low and high tolerance to nutritional stress. Each breed was grouped into two nutritional treatments: restricted (12-14% loss of live weight) and control (maintenance). The trial lasted 42 days. Animals were sacrificed and liver samples subjected to label free shotgun proteomics. The resultant proteins had both their fold change and statistical significance in an unpaired t-test calculated to identify differential protein abundance. The tool WebGestalt was utilized to perform an Overrepresentation Enrichment Analysis (ORA) for gene ontology terms associated with the significant proteins. We further validated shotgun proteomics findings using a selected reaction monitoring (SRM)-based targeted proteomics approach, where similar trends in regulation were obtained for a subset of relevant proteins across an independent cohort of animals. Results confirm that Damara has adapted to nutritional stress by mobilizing stored fatty acids within adipose tissue and converting them to energy more efficiently than Merino. Finally, Merino had an overabundance pattern primarily directed to protein synthesis pathways. Regulated proteins identified may be used as a basis for marker selection towards tolerance to nutritional stress. BIOLOGICAL SIGNIFICANCE: Sheep are one of the most important livestock animals. They remain however poorly understudied and described. Seasonal weight loss (SWL) due to pasture scarcity during the dry season is one of the most limiting conditions to ruminant production in the tropics. To counter SWL, farmers may use supplementation, expensive or difficult to implement. A more suitable long-term solution would be to use breeds that are naturally adapted to nutritional stress. This work contrasts two breeds with different levels of tolerance to SWL, the Damara and the Merino, respectively well and poorly adapted. Comparison is conducted at the level of the hepatic tissue and using label free proteomics. This work identifies a series of pathways in the liver of the Damara via label free proteomics that suggest a unique fatty acid metabolic process within this breed. Proteins that have increased abundance in the Damara in association with fatty acid metabolism may be used as potential markers of tolerance to nutritional stress. This research will pave the way for more viable, long-term solutions for farmers facing annual production problems due to drought in the tropics and the Mediterranean region.

Disease Progression and Pharmacological Intervention in a Nutrient-Deficient Rat Model of Nonalcoholic Steatohepatitis.

BACKGROUND: There is a marked need for improved animal models of nonalcoholic steatohepatitis (NASH) to facilitate the development of more efficacious drug therapies for the disease. METHODS: Here, we investigated the development of fibrotic NASH in male Wistar rats fed a choline-deficient L-amino acid-defined (CDAA) diet with or without cholesterol supplementation for subsequent assessment of drug treatment efficacy in NASH biopsy-confirmed rats. The metabolic profile and liver histopathology were evaluated after 4, 8, and 12 weeks of dieting. Subsequently, rats with biopsy-confirmed NASH were selected for pharmacological intervention with vehicle, elafibranor (30 mg/kg/day) or obeticholic acid (OCA, 30 mg/kg/day) for 5 weeks. RESULTS: The CDAA diet led to marked hepatomegaly and fibrosis already after 4 weeks of feeding, with further progression of collagen deposition and fibrogenesis-associated gene expression during the 12-week feeding period. Cholesterol supplementation enhanced the stimulatory effect of CDAA on gene transcripts associated with fibrogenesis without significantly increasing collagen deposition. Pharmacological intervention with elafibranor, but not OCA, significantly reduced steatohepatitis scores, and fibrosis-associated gene expression, however, was unable to prevent progression in fibrosis scores. CONCLUSION: CDAA-fed rats develop early-onset progressive NASH, which offers the opportunity to probe anti-NASH compounds with potential disease-modifying properties.

Adequacy of macro and micronutrients in infants and young children's diets in Zanzibar, Tanzania.

BACKGROUND: A study was conducted in Zanzibar using ProPAN software to assess nutrient adequacy of foods given to infants and children aged 6-23 months old in Zanzibar. METHODOLOGY: The 24-hr dietary recall method embedded in ProPAN software was used to determine the adequacy of energy, protein, iron, calcium, zinc and vitamin A in foods consumed by children. Sample of 200 mothers/caretakers with children aged 6-23 months were interviewed. RESULTS: Most frequent foods given to infants and children were tea, bread, white rice and fish. Key nutrients such as iron, zinc and vitamin A were below the recommended levels except for vitamin C from the diets consumed by children aged 11-23 months. Energy and protein were considered to be adequate as more than 90% of the children received enough of these nutrients. Mean age of introduction of complementary foods was four months. CONCLUSION: Children diets were limited in fruits and vegetables that caused micronutrients of nutritional importance such as iron, zinc and vitamin A to be supplied below recommended level. Equally, fat intake was below recommended level. Nutrition education on appropriate complementary foods should be given to caregivers. Promotion of consumption of diversified diets and locally available nutrient dense foods should be emphasized so as to achieve adequate intake of nutrients to infants and young children.

Several problem nutrients are identified in the complementary diet of 6 to 11 month old breastfed children in Western Guatemala.

BACKGROUND AND OBJECTIVES: The failure of infants in developing countries to meet nutrient intake recommendations is well documented. The objective of this study was to assess the nutritional adequacy and identify problem nutrients of the diets of Guatemalan infants with continued breastfeeding. METHODS AND STUDY DESIGN: A single previous-day dietary recall was collected from a convenience sample of 94 mothers of infants aged 6-11 mo attending a public health clinic in the urban area of Quetzaltenango, Guatemala. Energy and nutrient content of complementary feeding (CF) and breastmilk, modelled by subtracting estimated energy intakes from CF from energy requirements, were calculated and nutrient adequacy of the diet was assessed. Nutrient densities and critical nutrient densities of CF were computed to identify "problem nutrients" and main food sources of these nutrients. RESULTS: Complementary diets were adequate for protein, but likely to be inadequate for pantothenic acid and vitamins C, A, D, E, and K, as well as calcium, iron and zinc. In the worst-case scenario, i.e. for small girls with limited energy allowances, riboflavin, niacin, vitamin B-6 and magnesium were identified as "problem nutrients" as well. Formula milk, cow milk and Incaparina® were main food sources of "problem nutrients". CONCLUSIONS: The intake of micronutrients during the first six months of the recommend CF period in Guatemala has a number of notable inadequacies, but the gaps are narrower than traditionally reported for this age group in low-income settings.

Differences in resistance to nitrogen and phosphorus deficiencies explain male-biased populations of poplar in nutrient-deficient habitats.

In most forest soils, the availability of nitrogen (N) and phosphorus (P) nutrients is low and unable to meet the requirement of tree growth. In the past decades, sex-based differences in poplar have been investigated in morphology and physiology. Proteomic techniques provide new insights into sex-specific differences at the molecular level. This review gives a comparative overview of the effects of N and P deficiencies on poplar physiological and proteomic characteristics. Male poplars are more efficient at photosynthesis and nutrient usage than females. Proteins related to carbohydrate metabolism, defence responses and transcription and translation processes are changed to adapt diversely in males and females. These results provide evidence that male poplar have better resistance to nutrient-limiting conditions than females, which may be reasonable for the male-biased sex ratio in nutrient-deficient habitats. Furthermore, this review also discusses the potential growth-defence trade-offs in male and female poplar coping with nutrient limitations. BIOLOGICAL SIGNIFICANCE: In the past decades, the physiological and molecular responses of individual trees exposed to nutrient deficiency have been well studied. An important model woody plant, Populus, is dioecious and shows a male-biased sex ratio in nutrient-deficient habitats. Individually, different responses to nutrient limitation between the sexes determine the bias of population sex ratios. Proteomic techniques provide new insights into sex-based differences in the molecular mechanisms underlying nutrient deficiency. This review gives a comparative overview of the identification of nitrogen and phosphorus deficiency effects on physiological and proteomic characteristics. Male poplars are more resistant and have a smaller range of protein changes than females in response to N and P deficiency, which explains the observed male-biased sex ratios to a certain extent. Furthermore, this review also discusses the possible growth-defense trade-offs in male and female poplars coping with nutrient deficiency.