Nutrition, growth, and other factors associated with early cognitive and motor development in Sub-Saharan Africa: a scoping review.

BACKGROUND: Food insecurity, poverty and exposure to infectious disease are well-established drivers of malnutrition in children in Sub-Saharan Africa. Early development of cognitive and motor skills - the foundations for learning - may also be compromised by the same or additional factors that restrict physical growth. However, little is known about factors associated with early child development in this region, which limits the scope to intervene effectively. To address this knowledge gap, we compared studies that have examined factors associated with early cognitive and/or motor development within this population. METHODS: Predetermined criteria were used to examine four publication databases (PsycInfo, Embase, Web of Science and Medline) and identify studies considering the determinants of cognitive and motor development in children aged 0-8 years in Sub-Saharan Africa. RESULTS: In total, 51 quantitative studies met the inclusion criteria, reporting on 30% of countries across the region. Within these papers, factors associated with early child development were grouped into five themes: Nutrition, Growth and Anthropometry, Maternal Health, Malaria and HIV, and Household. Food security and dietary diversity were associated with positive developmental outcomes, whereas exposure to HIV, malaria, poor maternal mental health, poor sanitation, maternal alcohol abuse and stunting were indicators of poor cognitive and motor development. DISCUSSION: In this synthesis of research findings obtained across Sub-Saharan Africa, factors that restrict physical growth are also shown to hinder the development of early cognitive and motor skills, although additional factors also influence early developmental outcomes. The study also reviews the methodological limitations of conducting research using Western methods in sub-Saharan Africa.

A holistic approach to healthy ageing: how can people live longer, healthier lives?

BACKGROUND: Although lifespan is increasing, there is no evidence to suggest that older people are experiencing better health in their later years than previous generations. Nutrition, at all stages of life, plays an important role in determining health and wellbeing. METHODS: A roundtable meeting of UK experts on nutrition and ageing considered key aspects of the diet-ageing relationship and developed a consensus position on the main priorities for research and public health actions that are required to help people live healthier lives as they age. RESULTS: The group consensus highlighted the requirement for a life course approach, recognising the multifactorial nature of the impact of ageing. Environmental and lifestyle influences at any life stage are modified by genetic factors and early development. The response to the environment at each stage of life can determine the impact of lifestyle later on. There are no key factors that act in isolation to determine patterns of ageing and it is a combination of environmental and social factors that drives healthy or unhealthy ageing. Too little is known about how contemporary dietary patterns and sedentary lifestyles will impact upon healthy ageing in future generations and this is a priority for future research. CONCLUSIONS: There is good evidence to support change to lifestyle (i.e. diet, nutrition and physical) activity in relation to maintaining or improving body composition, cognitive health and emotional intelligence, immune function and vascular health. Lifestyle change at any stage of life may extend healthy lifespan, although the impact of early changes appears to be greatest.

A novel technique to optimise the length of a linear accelerator treatment room maze without compromising radiation protection.

Simulations with the FLUktuierende KAskade (FLUKA) Monte Carlo code were used to establish the possibility of introducing lead to cover the existing concrete walls of a linear accelerator treatment room maze, in order to reduce the dose of the scattered photons at the maze entrance. In the present work, a pilot study performed at Singleton Hospital in Swansea was used to pioneer the use of lead sheets of various thicknesses to absorb scattered low energy photons in the maze. The dose reduction was considered to be due to the strong effect of the photoelectric interaction in lead resulting in attenuation of the back-scattered photons. Calculations using FLUKA with mono-energetic photons were used to represent the main components of the x-ray spectrum up to 10 MV. Mono-energetic photons were used to enable the study of the behaviour of each energy component from the associated interaction processes. The results showed that adding lead of 1 to 4 mm thickness to the walls and floor of the maze reduced the dose at the maze entrance by up to 80%. Subsequent scatter dose measurements performed at the maze entrance of an existing treatment room with lead sheet of 1.3 mm thickness added to the maze walls and floor supported the results from the simulations. The dose reduction at the maze entrance with the lead in place was up to 50%. The variation between simulation and measurement was attributed to the fact that insufficient lead was available to completely cover the maze walls and floor. This novel proposal of partly, or entirely, covering the maze walls with lead a few millimetres in thickness has implications for the design of linear accelerator treatment rooms since it has the potential to provide savings, in terms of space and costs, when an existing maze requires upgrading in an environment where space is limited and the maze length cannot be extended sufficiently to reduce the dose.

Not re-inventing the wheel: the adaptive implementation of the meeting centres support programme in four European countries.

OBJECTIVES: The implementation of new health services is a complex process. This study investigated the first phase of the adaptive implementation of the Dutch Meeting Centres Support Programme (MCSP) for people with dementia and their carers in three European countries (Italy, Poland, the UK) within the JPND-MEETINGDEM project. Anticipated and experienced factors influencing the implementation, and the efficacy of the implementation process, were investigated. Findings were compared with previous research in the Netherlands. METHOD: A qualitative multiple case study design was applied. Checklist on anticipated facilitators and barriers to the implementation and semi-structured interview were completed by stakeholders, respectively at the end and at the beginning of the preparation phase. RESULTS: Overall, few differences between countries were founded. Facilitators for all countries were: added value of MCSP matching needs of the target group, evidence of effectiveness of MCSP, enthusiasm of stakeholders. General barriers were: competition with existing care and welfare organizations and scarce funding. Some countries experienced improved collaborations, others had difficulties finding a socially integrated location for MCSP. The step-by-step implementation method proved efficacious. CONCLUSION: These insights into factors influencing the implementation of MCSP in three European countries and the efficacy of the step-by-step preparation may aid further implementation of MCSP in Europe.

Setting targets leads to greater long-term weight losses and 'unrealistic' targets increase the effect in a large community-based commercial weight management group.

BACKGROUND: Setting personal targets is an important behavioural component in weight management programmes. Normal practice is to encourage 'realistic' weight loss, although the underlying evidence base for this is limited and controversial. The present study investigates the effect of number and size of weight-loss targets on long-term weight loss in a large community sample of adults. METHODS: Weight change, attendance and target weight data for all new UK members, joining from January to March 2012, were extracted from a commercial slimming organisation's electronic database. RESULTS: Of the 35 380 members who had weight data available at 12 months after joining, 69.1% (n = 24 447) had a starting body mass index (BMI) ≥30 kg m-2 . Their mean (SD) weight loss was 12.9% (7.8%) and, for both sexes, weight loss at 12 months was greater for those who set targets (P < 0.001). Those that set ≥4 targets achieved the greatest loss (P < 0.001). The odds ratio for weight loss ≥10% at 12 months was 10.3 (95% confidence interval = 9.7-11.1, P < 0.001) where targets had been set compared to none. At the highest quintile of target size, the size of the first target explained 47.2% (P < 0.001) of the variance in weight loss achieved at 12 months. The mean (SD) BMI reduction in those with a target >25% was 7.6 (4.0) kg m-2 . A higher percentage of obese members did not set targets (P < 0.001) compared to those with a BMI <30 kg m-2 . CONCLUSIONS: Much of the variance in weight loss achieved in this population was explained by the number of targets set and the size of the first target. Although obese people were less likely to set targets, doing so increased the likelihood of achieving clinically significant weight loss and, for some 'unrealistic' targets, improved the results.

Nutrition in early life and the programming of adult disease: a review.

Foetal development and infancy are life stages that are characterised by rapid growth, development and maturation of organs and systems. Variation in the quality or quantity of nutrients consumed by mothers during pregnancy, or infants during the first year of life, can exert permanent and powerful effects upon developing tissues. These effects are termed 'programming' and represent an important risk factor for noncommunicable diseases of adulthood, including the metabolic syndrome and coronary heart disease. This narrative review provides an overview of the evidence-base showing that indicators of nutritional deficit in pregnancy are associated with a greater risk of type-2 diabetes and cardiovascular mortality. There is also a limited evidence-base that suggests some relationship between breastfeeding and the timing and type of foods used in weaning, and disease in later life. Many of the associations reported between indicators of early growth and adult disease appear to interact with specific genotypes. This supports the idea that programming is one of several cumulative influences upon health and disease acting across the lifespan. Experimental studies have provided important clues to the mechanisms that link nutritional challenges in early life to disease in adulthood. It is suggested that nutritional programming is a product of the altered expression of genes that regulate the cell cycle, resulting in effective remodelling of tissue structure and functionality. The observation that traits programmed by nutritional exposures in foetal life can be transmitted to further generations adds weight the argument that heritable epigenetic modifications play a critical role in nutritional programming.

Limiting antenatal weight gain improves maternal health outcomes in severely obese pregnant women: findings of a pragmatic evaluation of a midwife-led intervention.

BACKGROUND: Antenatal obesity in pregnancy is associated with complications of pregnancy and poor obstetric outcomes. Although most guidance on pregnancy weight is focused on the prepregnancy period, pregnancy is widely viewed as a period where women are open to lifestyle change to optimise their health. METHODS: The hospital-based Bumps and Beyond intervention invited all pregnant women with a body mass index (BMI) >35 kg m(-2) to take part in a programme of health education around diet and exercise, accompanied by one-to-one guidance and monitoring of dietary change. This service evaluation compares 89 women who completed at a programme of seven sessions with healthy lifestyle midwives and advisors (intervention) versus a group of 89 women who chose not to attend (non-intervention). RESULTS: Mean (SD) weight gain in the intervention group [4.5 (4.6) kg] was less than in the non-intervention group [10.3 (4.4) kg] between antenatal booking and 36 weeks of gestation (< 0.001). This was associated with a 95% reduction in the risk of gestational hypertension during pregnancy and a general reduction in pregnancy complications. There was no effect of the intervention upon gestational diabetes or complications in labour other than post-partum haemorrhage (reduced by 55%). The impact of the intervention on gestational weight gain was greater in women with BMI >40 kg m(-2) at booking. There were no adverse effects of the intervention, even though 21% of the intervention group lost weight during their pregnancy. CONCLUSIONS: Intensive, personalised weight management intervention may be an effective strategy for the prevention of hypertensive disorders during pregnancy.

Assessing communication skills in dietetic consultations: the development of the reliable and valid DIET-COMMS tool.

BACKGROUND: There is an increasing emphasis on the development of communication skills for dietitians but few evidence-based assessment tools available. The present study aimed to develop a dietetic-specific, short, reliable and valid assessment tool for measuring communication skills in patient consultations: DIET-COMMS. METHODS: A literature review and feedback from 15 qualified dietitians were used to establish face and content validity during the development of DIET-COMMS. In total, 113 dietetic students and qualified dietitians were video-recorded undertaking mock consultations, assessed using DIET-COMMS by the lead author, and used to establish intra-rater reliability, as well as construct and predictive validity. Twenty recorded consultations were reassessed by nine qualified dietitians to assess inter-rater reliability: eight of these assessors were interviewed to determine user evaluation. RESULTS: Significant improvements in DIET-COMMS scores were achieved as students and qualified staff progressed through their training and gained experience, demonstrating construct validity, and also by qualified staff attending a training course, indicating predictive validity (P < 0.05). An acceptable level of intra-rater reliability (rs  = 0.90) and a moderate level of inter-rater reliability (r = 0.49) were demonstrated. Interviews identified many positive features and possible uses for DIET-COMMS in both pre- and post-registration settings. The need for assessor training was emphasised and how readily qualified dietitians would accept assessment of skills in practice was questioned. DISCUSSION: DIET-COMMS is a short, user-friendly, reliable and valid tool for measuring communication skills in patient consultations with both pre- and post-registration dietitians. Additional work is required to develop a training package for assessors and to identify how DIET-COMMS assessment can acceptably be incorporated into practice.

The types of food introduced during complementary feeding and risk of childhood obesity: a systematic review.

The determinants of childhood overweight and obesity are complex, but infant feeding and the early diet are important contributing factors. The complementary feeding period in particular, is a time during which children are nutritionally vulnerable, and a time where life-long eating habits may be established. We conducted a systematic review of the literature that investigated the relationship between the types of food consumed by infants during the complementary feeding period and overweight or obesity during childhood. Electronic databases were searched from inception until June 2012 using specified keywords. Following the application of strict inclusion/exclusion criteria, 10 studies were identified and reviewed by two independent reviewers. Data were extracted and aspects of quality were assessed using an adapted Newcastle-Ottawa scale. Studies were categorised into three groups: macronutrient intake, food type/group and adherence to dietary guidelines. Some association was found between high protein intakes at 2-12 months of age and higher body mass index (BMI) or body fatness in childhood, but was not the case in all studies. Higher energy intake during complementary feeding was associated with higher BMI in childhood. Adherence to dietary guidelines during weaning was associated with a higher lean mass, but consuming specific foods or food groups made no difference to children's BMI. We concluded that high intakes of energy and protein, particularly dairy protein, in infancy could be associated with an increase in BMI and body fatness, but further research is needed to establish the nature of the relationship. Adherence to dietary guidelines during weaning is recommended.

Timing of the introduction of complementary feeding and risk of childhood obesity: a systematic review.

The World Health Organisation recommends exclusive breastfeeding until 6 months of age and continued breastfeeding until 2 years of age or beyond. Appropriate complementary foods should be introduced in a timely fashion, beginning when the infant is 6 months old. In developing countries, early or inappropriate complementary feeding may lead to malnutrition and poor growth, but in countries such as the United Kingdom and United States of America, where obesity is a greater public health concern than malnutrition, the relationship to growth is unclear. We conducted a systematic review of the literature that investigated the relationship between the timing of the introduction of complementary feeding and overweight or obesity during childhood. Electronic databases were searched from inception until 30 September 2012 using specified keywords. Following the application of strict inclusion/exclusion criteria, 23 studies were identified and reviewed by two independent reviewers. Data were extracted and aspects of quality were assessed using an adapted Newcastle-Ottawa scale. Twenty-one of the studies considered the relationship between the time at which complementary foods were introduced and childhood body mass index (BMI), of which five found that introducing complementary foods at <3 months (two studies), 4 months (2 studies) or 20 weeks (one study) was associated with a higher BMI in childhood. Seven of the studies considered the association between complementary feeding and body composition but only one study reported an increase in the percentage of body fat among children given complementary foods before 15 weeks of age. We conclude that there is no clear association between the timing of the introduction of complementary foods and childhood overweight or obesity, but some evidence suggests that very early introduction (at or before 4 months), rather than at 4-6 months or >6 months, may increase the risk of childhood overweight.

Childhood obesity and risk of the adult metabolic syndrome: a systematic review.

BACKGROUND: While many studies have demonstrated positive associations between childhood obesity and adult metabolic risk, important questions remain as to the nature of the relationship. In particular, it is unclear whether the associations reflect the tracking of body mass index (BMI) from childhood to adulthood or an independent level of risk. This systematic review aimed to investigate the relationship between childhood obesity and a range of metabolic risk factors during adult life. OBJECTIVE: To perform an unbiased systematic review to investigate the association between childhood BMI and risk of developing components of metabolic disease in adulthood, and whether the associations observed are independent of adult BMI. DESIGN: Electronic databases were searched from inception until July 2010 for studies investigating the association between childhood BMI and adult metabolic risk. Two investigators independently reviewed studies for eligibility according to the inclusion/exclusion criteria, extracted the data and assessed study quality using the Newcastle-Ottawa Scale. RESULTS: The search process identified 11 articles that fulfilled the inclusion and exclusion criteria. Although several identified weak positive associations between childhood BMI and adult total cholesterol, low-density lipo protein-cholesterol, triglyceride and insulin concentrations, these associations were ameliorated or inversed when adjusted for adult BMI or body fatness. Of the four papers that considered metabolic syndrome as an end point, none showed evidence of an independent association with childhood obesity. CONCLUSIONS: Little evidence was found to support the view that childhood obesity is an independent risk factor for adult blood lipid status, insulin levels, metabolic syndrome or type 2 diabetes. The majority of studies failed to adjust for adult BMI and therefore the associations observed may reflect the tracking of BMI across the lifespan. Interestingly, where adult BMI was adjusted for, the data showed a weak negative association between childhood BMI and metabolic variables, with those at the lower end of the BMI range in childhood, but obese during adulthood at particular risk.

Multiple-instance-learning-based detection of coeliac disease in histological whole-slide images.

We present a multiple-instance-learning-based scheme for detecting coeliac disease, an autoimmune disorder affecting the intestine, in histological whole-slide images (WSIs) of duodenal biopsies. We train our model to detect 2 distinct classes, normal tissue and coeliac disease, on the patch-level, and in turn leverage slide-level classifications. Using 5-fold cross-validation in a training set of 1841 (1163 normal; 680 coeliac disease) WSIs, our model classifies slides as normal with accuracy (96.7±0.6)%, precision (98.0±1.7)%, and recall (96.8±2.5)%, and as coeliac disease with accuracy (96.7±0.5)%, precision (94.9±3.7)%, and recall (96.5±2.9)% where the error bars are the cross-validation standard deviation. We apply our model to 2 test sets: one containing 191 WSIs (126 normal; 65 coeliac) from the same sources as the training data, and another from a completely independent source, containing 34 WSIs (17 normal; 17 coeliac), obtained with a scanner model not represented in the training data. Using the same-source test data, our model classifies slides as normal with accuracy 96.5%, precision 98.4% and recall 96.1%, and positive for coeliac disease with accuracy 96.5%, precision 93.5%, and recall 97.3%. Using the different-source test data the model classifies slides as normal with accuracy 94.1% (32/34), precision 89.5%, and recall 100%, and as positive for coeliac disease with accuracy 94.1%, precision 100%, and recall 88.2%. We discuss generalising our approach to screen for a range of pathologies.

Childhood obesity and adult cardiovascular disease risk: a systematic review.

BACKGROUND: Although the relationship between adult obesity and cardiovascular disease (CVD) has been shown, the relationship with childhood obesity remains unclear. Given the evidence of tracking of body mass index (BMI) from childhood to adulthood, this systematic review investigated the independent relationship between childhood BMI and adult CVD risk. OBJECTIVE: To investigate the association between childhood BMI and adult CVD risk, and whether the associations observed are independent of adult BMI. DESIGN: Electronic databases were searched from inception until July 2008 for studies investigating the association between childhood BMI and adult CVD risk. Two investigators independently reviewed studies for eligibility according to inclusion/exclusion criteria, extracted the data and assessed study quality using the Newcastle-Ottawa Scale. RESULTS: Positive associations between childhood BMI and adult blood pressure or carotid intima-media thickness were generally attenuated once adjusted for adult BMI. Associations between childhood BMI and CVD morbidity/mortality had not been adjusted and do not provide evidence of an independent relationship. Negative associations between childhood BMI and blood pressure were observed in several adjusted data sets. CONCLUSIONS: Little evidence was found to suggest that childhood obesity is an independent risk factor for CVD risk. Instead, the data suggest that relationships observed are dependent on the tracking of BMI from childhood to adulthood. Importantly, evidence suggests that risk of raised blood pressure is highest in those who are at the lower end of the BMI scale in childhood and overweight in adulthood. The findings challenge the widely accepted view that the presence of childhood obesity is an independent risk factor for CVD and that this period should be a priority for public health intervention. Although interventions during childhood may be important in prevention of adult obesity, it is important to avoid the potential for negative consequences when the timing coincides with critical stages of neurological, behavioural and physical development.

Dominant negative mutation in cell surface beta 1,4-galactosyltransferase inhibits cell-cell and cell-matrix interactions.

In addition to its traditional location within the Golgi complex, beta 1,4-galactosyltransferase (GalTase) is also present on the cell surface, where it is thought to function as a cell adhesion molecule by binding to extracellular oligosaccharide ligands. Recent studies suggest that cells contain two forms of GalTase with distinct cytoplasmic domains. The longer form of GalTase contains a 13-amino acid cytoplasmic extension and is preferentially targeted to the plasma membrane, relative to the shorter GalTase protein that is confined primarily to the Golgi compartment. In this study, we created a dominant negative mutation that interferes with the function of cell surface GalTase by transfecting into cells cDNAs encoding truncated versions of the long form of GalTase containing the complete cytoplasmic and transmembrane domains, but devoid of the catalytic domain. In both F9 embryonal carcinoma cells and Swiss 3T3 fibroblasts, overexpressing the truncated long GalTase (TLGT) protein displaced the endogenous cell surface GalTase from its association with the cytoskeleton, resulting in a loss of intercellular adhesion and cell spreading specifically on matrices that use GalTase as a cell surface receptor. In contrast, overexpressing the analogous truncated short GalTase (TSGT) protein did not affect cell morphology or GalTase activity. In control assays, inducing the TLGT protein had no effect on cell interactions with fibronectin (which is independent of GalTase), or on the cytoskeleton attachment of another matrix receptor (beta 1 integrin), or on overall glycoprotein synthesis, thus eliminating nonspecific effects of the TLGT protein on cellular adhesion and metabolism. These results represent the first molecular manipulation of cell surface GalTase expression and confirm its function as a cell adhesion molecule. These studies further suggest that the cytoskeleton contains a defined, saturable number of binding sites for GalTase, which enables it to function as an adhesion molecule.

Communication skills for behaviour change in dietetic consultations.

BACKGROUND: Both the UK's National Health Service (NHS) and the National Institute of health and Clinical Excellence (NICE) have recommended increased training for health professionals in communication skills. There is evidence to suggest that communication skills are important in helping people to change health-related behaviour, which is a key role for dietitians. This study investigated the views of UK dietitians about their training needs and experience in relation to communication skills in dietetic practice. METHODS: In October 2007, a cross-sectional survey was mailed to all British Dietetic Association members (n = 6013). The survey gathered quantitative data and free-text comments to ascertain the level, type and effect of communication skills training received by dietitians at both the pre- and post-registration level. RESULTS: There were 1158 respondents; a response rate of 19.3%. Ninety-eight percent (n = 1117) rated communication skills as either very or extremely important in client consultations. Post-registration training had been undertaken by 73% (n = 904). Of these, over 90% of respondents perceived that post-registration training had led to improvements in their relationships with patients, their confidence in client interviews and their ability to cope with challenging clients. However, 248 (21.4%) felt time keeping in interviews had worsened. Lack of time for client interviews was also the most commonly identified barrier (19%, n = 216) to implementing the skills. CONCLUSIONS: This study has explored an important and under-researched area. Respondents strongly endorsed the importance of good communication skills and the benefits of post-registration training in this area. Some felt that good communication was time consuming but others felt that time management had improved. Further research and training is required to support the implementation of these skills into dietetic practice.