Pediatric Gastroenterology, Hepatology & Nutrition

The Korean Society of Pediatric Gastroenterology, Hepatology and Nutrition (대한소아소화기영양학회)
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Physicians' Understanding of Nutritional Factors Determining Brain Development and Cognition in the Middle East and Africa

  • Vandenplas, Yvan (KidZ Health Castle, UZ Brussel, Vrije Universiteit Brussel) ;
  • Rakhecha, Aditya (Neonatal Unit, NMC Royal Women's Hospital) ;
  • Edris, Amira (Department of Pediatrics, Kasr Al Ainy Faculty of Medicine, Cairo University) ;
  • Shaaban, Bassel (Departments of Pediatric and NICU, Mediclinic Airport Road Hospital) ;
  • Tawfik, Eslam (Department of Pediatric, Sheikh Khalifa Medical City) ;
  • Bashiri, Fahad A. (Division of Neurology, Department of Pediatrics, College of Medicine & King Khalid University Hospital, King Saud University) ;
  • AlAql, Fahd (King Fahad Medical City) ;
  • Alsabea, Hassan (Medical Park Consultants) ;
  • Haddad, Joseph (Department of Pediatrics, Saint George Hospital, University Medical Center, Balamand University) ;
  • Barbary, Mohammed El (Department of Pediatrics and Neonatology, Faculty of Medicine, Ain Shams University) ;
  • Salah, Mohamed (Nestle Nutrition) ;
  • Abouelyazid, Mohamed (Wyeth Nutrition) ;
  • Kumar, Mudit (Consultant Pediatrician, Mediclinic Parkview Hospital) ;
  • Alsaad, Sulaiman (Department of Pediatrics, Neonatal Intensive Care Unit, Kuwait Oil Company Hospital)
  • Received : 2019.05.31
  • Accepted : 2019.07.20
  • Published : 2019.11.15
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Abstract

Purpose: Proper nutrition is essential for brain development during infancy, contributing to the continued development of cognitive, motor, and socio-emotional skills throughout life. Considering the insufficient published data in the Middle East and North Africa, experts drafted a questionnaire to assess the opinions and knowledge of physicians on the impact of nutrition on brain development and cognition in early life. Methods: The questionnaire consisted of two parts: The first focused on the responders' demographic and professional characteristics and the second questioned the role of nutrition in brain development and cognition. Descriptive statistics were used to summarize respondents' characteristics and their responses to questions. Results: A total of 1,500 questionnaires were distributed; 994 physicians responded. The majority of the surveyed physicians (64.4%) felt that nutrition impacts brain development in early childhood (0-4 years), with almost 90% of physicians agreeing/strongly agreeing that preventing iron, zinc, and iodine deficiency would improve global intelligence quotient. The majority of physicians (83%) agreed that head circumference was the most important measure of brain development. The majority of physicians (68.9%) responded that the period from the last trimester until 18 months postdelivery was crucial for brain growth and neurodevelopment, with 76.8% believing that infants breast-fed by vegan mothers have an increased risk of impaired brain development. Conclusion: The results of this study show that practicing physicians significantly agree that nutrition plays an important role in brain and cognitive development and function in early childhood, particularly during the last trimester until 18 months postdelivery.

Keywords

References

  1. Cusick SE, Georgieff MK. The role of nutrition in brain development: the golden opportunity of the "first 1000 days". J Pediatr 2016;175:16-21. https://doi.org/10.1016/j.jpeds.2016.05.013
  2. Prado EL, Dewey KG. Nutrition and brain development in early life. Nutr Rev 2014;72:267-84. https://doi.org/10.1111/nure.12102
  3. Anderson JW, Johnstone BM, Remley DT. Breast-feeding and cognitive development: a meta-analysis. Am J Clin Nutr 1999;70:525-35. https://doi.org/10.1093/ajcn/70.4.525
  4. Nyaradi A, Li J, Hickling S, Foster J, Oddy WH. The role of nutrition in children's neurocognitive development, from pregnancy through childhood. Front Hum Neurosci 2013;7:97. https://doi.org/10.3389/fnhum.2013.00097
  5. Regional Committee for the Eastern Mediterranean. Regional Strategy on Nutrition 2010-2019. Geneva: World Health Organization; 2010 Sep. Report No.: EM/RC57/5. 11 p.
  6. Hwalla N, Al Dhaheri AS, Radwan H, Alfawaz HA, Fouda MA, Al-Daghri NM, et al. The prevalence of micronutrient deficiencies and inadequacies in the middle east and approaches to interventions. Nutrients 2017;9:E229. https://doi.org/10.3390/nu9030229
  7. Victora CG, Bahl R, Barros AJ, Franca GV, Horton S, Krasevec J, et al.Lancet Breastfeeding Series Group. Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect. Lancet 2016;387:475-90. https://doi.org/10.1016/S0140-6736(15)01024-7
  8. Gernand AD, Schulze KJ, Stewart CP, West KP Jr, Christian P. Micronutrient deficiencies in pregnancy worldwide: health effects and prevention. Nat Rev Endocrinol 2016;12:274-89. https://doi.org/10.1038/nrendo.2016.37
  9. Black MM. Micronutrient deficiencies and cognitive functioning. J Nutr 2003;133 11 Suppl 2:3927S-31S. https://doi.org/10.1093/jn/133.11.3927S
  10. Mattei D, Pietrobelli A. Micronutrients and brain development. Curr Nutr Rep 2019;8:99-107. https://doi.org/10.1007/s13668-019-0268-z
  11. Gahagan S, Delker E, Blanco E, Burrows R, Lozoff B. Randomized controlled trial of iron-fortified versus low-iron infant formula: developmental outcomes at 16 years. J Pediatr 2019;212:124-130.e1. https://doi.org/10.1016/j.jpeds.2019.05.030
  12. Fuglestad AJ, Kroupina MG, Johnson DE, Georgieff MK. Micronutrient status and neurodevelopment in internationally adopted children. Acta Paediatr 2016;105:e67-76. https://doi.org/10.1111/apa.13234
  13. Mocenic I, Kolic I, Nisevic JR, Belancic A, Tratnik JS, Mazej D, et al. Prenatal selenium status, neonatal cerebellum measures and child neurodevelopment at the age of 18 months. Environ Res 2019;176:108529. https://doi.org/10.1016/j.envres.2019.108529
  14. Sharma SK, Bansal MP, Sandhir R. Altered dietary selenium influences brain iron content and behavioural outcomes. Behav Brain Res 2019. doi: 10.1016/j.bbr.2019.112011. [Epub ahead of print].
  15. Cakir M, Senyuva S, Kul S, Sag E, Cansu A, Yucesan FB, et al. Neurocognitive functions in infants with malnutrition; relation with long-chain polyunsaturated fatty acids, micronutrients levels and magnetic resonance spectroscopy. Pediatr Gastroenterol Hepatol Nutr 2019;22:171-80. https://doi.org/10.5223/pghn.2019.22.2.171
  16. Janbek J, Specht IO, Heitmann BL. Associations between vitamin D status in pregnancy and offspring neurodevelopment: a systematic literature review. Nutr Rev 2019;77:330-49. https://doi.org/10.1093/nutrit/nuy071
  17. Markhus MW, Dahl L, Moe V, Abel MH, Brantsaeter AL, Oyen J, et al. Maternal iodine status is associated with offspring language skills in infancy and toddlerhood. Nutrients 2018;10:E1270. https://doi.org/10.3390/nu10091270
  18. Velasco I, Bath SC, Rayman MP. Iodine as essential nutrient during the first 1000 days of life. Nutrients 2018;10:E290. https://doi.org/10.3390/nu10030290
  19. Nissensohn M, Sanchez-Villegas A, Fuentes Lugo D, Henriquez Sanchez P, Doreste Alonso J, Skinner AL, et al. Effect of zinc intake on mental and motor development in infants: a meta-analysis. Int J Vitam Nutr Res 2013;83:203-15. https://doi.org/10.1024/0300-9831/a000161
  20. Srinivasan K, Thomas T, Kapanee AR, Ramthal A, Bellinger DC, Bosch RJ, et al. Effects of maternal vitamin B12 supplementation on early infant neurocognitive outcomes: a randomized controlled clinical trial. Matern Child Nutr 2017. doi: 10.1111/mcn.12325. [Epub ahead of print].
  21. Zheng L, Fleith M, Giuffrida F, O'Neill BV, Schneider N. Dietary polar lipids and cognitive development: a narrative review. Adv Nutr 2019. doi: 10.1093/advances/nmz051. [Epub ahead of print].
  22. Janssen CI, Kiliaan AJ. Long-chain polyunsaturated fatty acids (LCPUFA) from genesis to senescence: the influence of LCPUFA on neural development, aging, and neurodegeneration. Prog Lipid Res 2014;53:1-17. https://doi.org/10.1016/j.plipres.2013.10.002
  23. Melse-Boonstra A, Jaiswal N. Iodine deficiency in pregnancy, infancy and childhood and its consequences for brain development. Best Pract Res Clin Endocrinol Metab 2010;24:29-38. https://doi.org/10.1016/j.beem.2009.09.002
  24. Delange F, Wolff P, Gnat D, Dramaix M, Pilchen M, Vertongen F. Iodine deficiency during infancy and early childhood in Belgium: does it pose a risk to brain development? Eur J Pediatr 2001;160:251-4. https://doi.org/10.1007/s004310000707
  25. Zimmermann MB. The effects of iodine deficiency in pregnancy and infancy. Paediatr Perinat Epidemiol 2012;26 Suppl 1:108-17. https://doi.org/10.1111/j.1365-3016.2012.01275.x
  26. McGarel C, Pentieva K, Strain JJ, McNulty H. Emerging roles for folate and related B-vitamins in brain health across the lifecycle. Proc Nutr Soc 2015;74:46-55. https://doi.org/10.1017/S0029665114001554
  27. Black MM. Effects of vitamin B12 and folate deficiency on brain development in children. Food Nutr Bull 2008;29 2 Suppl:S126-31. https://doi.org/10.1177/15648265080292S117
  28. Ekici F, Tekbas G, Hattapoglu S, Yaramis A, Onder H, Bilici A. Brain MRI and MR spectroscopy findings in children with nutritional vitamin B12 deficiency. Clin Neuroradiol 2016;26:215-20. https://doi.org/10.1007/s00062-014-0351-1
  29. Filippi CG, Ulug AM, Deck MD, Zimmerman RD, Heier LA. Developmental delay in children: assessment with proton MR spectroscopy. AJNR Am J Neuroradiol 2002;23:882-8.
  30. Algarin C, Karunakaran KD, Reyes S, Morales C, Lozoff B, Peirano P, et al. Differences on brain connectivity in adulthood are present in subjects with iron deficiency anemia in infancy. Front Aging Neurosci 2017. doi: 10.3389/fnagi.2017.00054.
  31. Piccoli GB, Clari R, Vigotti FN, Leone F, Attini R, Cabiddu G, et al. Vegan-vegetarian diets in pregnancy: danger or panacea? a systematic narrative review. BJOG 2015;125:623-33. https://doi.org/10.1111/1471-0528.14772