Impact of FI, DD, and Micronutrients on Adolescent Brain Functions - Fall 2024 PDF

HOW FOOD INSECURITY, DIETARY DIVERSITY, AND MICRONUTRIENT MIXTURES INTERACT TO INFLUENCE THE CRITICAL NEURODEVELOPMENTAL PERIOD DURING ADOLESCENCE Presented By : Berna Rahi, PhD Sam Houston State University Lebanese American University...

HOW FOOD INSECURITY, DIETARY DIVERSITY, AND MICRONUTRIENT MIXTURES INTERACT TO INFLUENCE THE CRITICAL NEURODEVELOPMENTAL PERIOD DURING ADOLESCENCE Presented By : Berna Rahi, PhD Sam Houston State University Lebanese American University Guest Speaker NUT 699| Fall 2024  2 OVERVIEW Significance of Topic Food Insecurity & Dietary Diversity Food Insecurity, Dietary Diversity, & Micronutrient Deficiencies Food Insecurity, Dietary Diversity, & Neurocognitive Performance Micronutrient Minerals & Cognition in Adolescents Micronutrient Mixtures in Cognition during Adolescence Preliminary Data Public Health Impact  3 FI and DD Globally, 28.9% of the world population was moderately or severely food insecure Dietary diversity (DD) is another indicator of dietary adequacy, and it measures the intake of different food groups over a specific period Both FI and DD are indicators of nutritional status and have been linked to health outcomes. Rabbitt, M.; Reed-Jones, M.; Hales, L.; Burke, M. Household food security in the United States in 2023. U.S. Department of Agriculture, E. R. S., Ed.; 2024. FAO.; 360., F. Minimum Dietary Diversity for Women: A Guide for Measurement; Rome, Italy., 2016. Verger, E. O.; Le Port, A.; Borderon, A.; Bourbon, G.; Moursi, M.; Savy, M.; Mariotti, F.; Martin-Prevel, Y. Dietary Diversity Indicators and Their Associations with Dietary Adequacy and Health Outcomes: A Systematic Scoping Review. Adv Nutr 2021, 1 (5), 1659-1672. DOI: 10.1093/advances/nmab009 From NLM.  What is DD? Originally created by FAO Measures the diet’s micronutrient adequacy Global Diet Quality Project ➔ Diet Quality Questionnaire Score/10 with ≥5 = better DD www.dietquality.org  FI in the USA 13.5% (18.0 million) of U.S. households were food insecure at some time during 2023 Statistically significantly higher than the 12.8% (17.0 million) in 2022  4 Adolescents in the US NHANES ➔Diet of adolescents has the lowest quality among all age groups ➔Lacking DD ➔Risk of achieving micronutrient adequacy, required for their growth and development Jun, S.; Cowan, A. E.; Dodd, K. W.; Tooze, J. A.; Gahche, J. J.; Eicher-Miller, H. A.; Guenther, P. M.; Dwyer, J. T.; Potischman, N.; Bhadra, A.; et al. Association of food insecurity with dietary intakes and nutritional biomarkers among US children, Natio Health and Nutrition Examination Survey (NHANES) 2011-2016. Am J Clin Nutr 2021, 114 (3), 1059-1069. DOI: 10.1093/ajcn/nqab113 From NLM.  5 FI, DD, & Micronutrient Deficiencies Studies have consistently showed that FI leads to reduced consumption of main food groups like meat, dairy, fruits, and vegetables resulting in diets deficient in key nutrients such as folic acid, vitamins B12 and C, calcium (Ca), iron (Fe), magnesium (Mg), selenium (Se), iodine (I), and zinc (Zn). Despite these important associations between FI, DD and dietary intakes, limited and inconsistent data have linked these two measures of diet adequacy and micronutrients biomarkers, the gold standard measure. Jun, S.; Cowan, A. E.; Dodd, K. W.; Tooze, J. A.; Gahche, J. J.; Eicher-Miller, H. A.; Guenther, P. M.; Dwyer, J. T.; Potischman, N.; Bhadra, A.; et al. Association of food insecurity with dietary intakes and nutritional biomarkers among US children, National Health and Nutrition Examination Survey (NHANES) 2011-2016. Am J Clin Nutr 2021, 114 (3), 1059-1069. DOI: 10.1093/ajcn/nqab113 From NLM. Jenkins, M.; Jefferds, M. E. D.; Aburto, N. J.; Ramakrishnan, U.; Martorell, R.; Addo, O. Y. What Do United States Adolescents Eat? Food Group Consumption Patterns and Dietary Diversity from a Decade of Nationally Representative Data. Current Developments in Nutrition 2023, 7 (8). DOI: 10.1016/j.cdnut.2023.101968 (acccessed 2024/09/05). Basiry, M.; Surkan, P. J.; Ghosn, B.; Esmaillzadeh, A.; Azadbakht, L. Associations between nutritional deficiencies and food insecurity among adolescent girls: A cross-sectional study. Food Science & Nutrition 2024, 12 (7), 4623-4636. DOI: https://doi.org/10.1002/fsn3.4065. Lopes, S. O.; Abrantes, L. C. S.; Azevedo, F. M.; Morais, N. S.; Morais, D. C.; Gonçalves, V. S. S.; Fontes, E. A. F.; Franceschini, S.; Priore, S. E. Food Insecurity and Micronutrient Deficiency in Adults: A Systematic Review and Meta-Analysis. Nutrients 2023, 15 (5). DOI: 10.3390/nu15051074 From NLM  6 FI, DD, & Neurocognitive performance Few epidemiological studies observed that FI was associated cognitive performance, learning, academic achievement, and behavior in children. The majority of these studies were performed among school-aged children with scarce data on the effects of FI on neurocognitive function of adolescents. The effects of DD on health have been limited to its association with nutritional status. For instance, several studies have observed that low DD among children is associated with a high prevalence of underweight, stunting, and wasting , with very limited number of research on the effects of DD on cognitive health of children. Shankar, P.; Chung, R.; Frank, D. A. Association of Food Insecurity with Children's Behavioral, Emotional, and Academic Outcomes: A Systematic Review. J Dev Behav Pediatr 2017, 38 (2), 135-150. DOI: 10.1097/dbp.0000000000000383 From NL (Gallegos, D.; Eivers, A.; Sondergeld, P.; Pattinson, C. Food Insecurity and Child Development: A State-of-the-Art Review. Int J Environ Res Public Health 2021, 18 (17). DOI: 10.3390/ijerph18178990 From NLM. de Oliveira, K. H. D.; de Almeida, G. M.; Gubert, M. B.; Moura, A. S.; Spaniol, A. M.; Hernandez, D. C.; Pérez-Escamilla, R.; Buccini, G. Household food insecurity and early childhood development: Systematic review and meta-analysis. Matern Child N 2020, 16 (3), e12967. DOI: 10.1111/mcn.12967 From NLM. Jackson, D. B.; Testa, A.; Semenza, D. C. Household food insecurity and school readiness among preschool-aged children in the USA. Public Health Nutr 2021, 24 (6), 1469-1477. DOI: 10.1017/s1368980021000550 From NLM.  Why focus on adolescents?? 7 Research on nutrition during adolescence specifically has been underinvested, compared with such research in other age groups, which has inhibited the development of adolescent- responsive nutritional policies. Nutritional effects in adolescent development extend beyond musculoskeletal growth, to cardiorespiratory fitness, neurodevelopment, and immunity. Norris, S. A.; Frongillo, E. A.; Black, M. M.; Dong, Y.; Fall, C.; Lampl, M.; Liese, A. D.; Naguib, M.; Prentice, A.; Rochat, T.; et al. Nutrition in adolescent growth and development. Lancet 2022, 399 (10320), 172-184. DOI: 10.1016/s0140-6736(21)01590-7 From NLM.  8 Micronutrient Minerals & Cognition in Adolescents Micronutrients, such as Fe, copper (Cu), Zn, I, Mg, and Se, have crucial roles in the human metabolism spanning from pregnancy to older adulthood and maintaining overall health. An inadequate intake of essential micronutrients ➔ Various disease states ➔ Characterized by a disturbed homeostasis of redox active metals ➔ Neurological disorders, Mental health problems, CVD, cancer and diabetes Jomova, K.; Makova, M.; Alomar, S. Y.; Alwasel, S. H.; Nepovimova, E.; Kuca, K.; Rhodes, C. J.; Valko, M. Essential metals in health and disease. Chem Biol Interact 2022, 367, 110173. DOI: 10.1016/j.cbi.2022.110173 From NLM.  9 Micronutrient Minerals & Cognition in Adolescents Adequate intake of micronutrients is key to preventing deficiencies that can lead to health issues: Weakened immunity Impaired cognitive function Anemia Jomova, K.; Makova, M.; Alomar, S. Y.; Alwasel, S. H.; Nepovimova, E.; Kuca, K.; Rhodes, C. J.; Valko, M. Essential metals in health and disease. Chem Biol Interact 2022, 367, 110173. DOI: 10.1016/j.cbi.2022.110173 From NLM.  Micronutrient Minerals & Cognition in 10 Adolescents Recent analyses from the National Health And Nutrition Examination Survey (NHANES) highlighted that the US population consistently do not meet their nutrient recommendations. approximately 30% of participants did not meet intake recommendations for iron. people living in rural areas had significantly lower intake than those in large or small to medium metro areas suggesting that people living in rural areas may have poorer diets than those living in large urban areas substantial percentage of women – including many who were pregnant or lactating- did not obtain sufficient iodine Wambogo, E. A.; Ansai, N.; Herrick, K. A.; Reedy, J.; Hales, C. M.; Ogden, C. L. Differences in Intakes of Select Nutrients by Urbanization Level in the United States Population 2 Years and Older, NHANES 2013-2018. J Nutr 2024, 154 (2), 617-625. DOI 10.1016/j.tjnut.2023.12.030 From NLM. Freedman, M. R.; Fulgoni, V. L.; Lieberman, H. R. Temporal changes in micronutrient intake among United States Adults, NHANES 2003 through 2018: A cross-sectional study. Am J Clin Nutr 2024, 119 (5), 1309-1320. DOI: 10.1016/j.ajcnut.2024.02.007 From NLM.  12 Micronutrient Minerals & Cognition in Adolescents Micronutrients such as Fe, Mg, Se, I, Zn and copper (Cu) play a pivotal I role in cognitive function during pregnancy and early childhood, and learning, memory and mental health in childhood. Zn Cu Fe, I, Zn, folate, and vitamin A deficiencies, known as the “Generalized Global Micronutrient Deficiencies”, directly impact bodily functions and Se can impair learning abilities. Fe Mg ) Schwarzenberg, S. J.; Georgieff, M. K. Advocacy for Improving Nutrition in the First 1 0 0 0 Days to Support Childhood Development and Adult Health. Pediatrics 2018, 141 (2). DOI: 10.1542/peds.2017-3716 From NLM. Lopes, S. O.; Abrantes, L. C. S.; Azevedo, F. M.; Morais, N. S.; Morais, D. C.; Gonçalves, V. S. S.; Fontes, E. A. F.; Franceschini, S.; Priore, S. E. Food Insecurity and Micronutrient Deficiency in Adults: A Systematic Review and Meta-Analysis. Nutrients 2023, 15 (5). DOI: 10.3390/nu15051074 From NLM.  13 Micronutrient Mixtures in Cognition during Adolescence Key minerals such as Fe, Se, Zn, Mg, Cu, and I are critical for optimal NC function, learning, and mental health in childhood. Fe is essential for myelination and brain cell development; Zn supports attention, learning and memory; Mg and Cu contribute to nervous system function and brain health; Se acts as an antioxidant, protecting against oxidative stress. ----> Majority of the studies in the literature focused on examining the effects of single nutrients. ---->The single nutrient approach fails to account for the complicated interactions. Quezada-Pinedo, H. G.; Cassel, F.; Duijts, L.; Muckenthaler, M. U.; Gassmann, M.; Jaddoe, V. W. V.; Reiss, I. K. M.; Vermeulen, M. J. Maternal Iron Status in Pregnancy and Child Health Outcomes after Birth: A Systematic Review and Meta-Analysis. Nutrients 2021, 13 (7). DOI: 10.3390/nu13072221 From NLM. Vela, G.; Stark, P.; Socha, M.; Sauer, A. K.; Hagmeyer, S.; Grabrucker, A. M. Zinc in gut-brain interaction in autism and neurological disorders. Neural Plast 2015, 2015, 972791. DOI: 10.1155/2015/972791 From NLM. Burk, R. F.; Hill, K. E. Selenoprotein P-expression, functions, and roles in mammals. Biochim Biophys Acta 2009, 1790 (11), 1441-1447. DOI: 10.1016/j.bbagen.2009.03.026 From NLM. Maier, J. A. M.; Locatelli, L.; Fedele, G.; Cazzaniga, A.; Mazur, A. Magnesium and the Brain: A Focus on Neuroinflammation and Neurodegeneration. Int J Mol Sci 2022, 24 (1). DOI: 10.3390/ijms24010223 From NLM. Aims of research Aim 1: Examine the associations between FI, DD and biomarkers of single micronutrients (Fe, Se, Zn, Mg, Cu and I) in Bangladeshi Adolescents Aim 2: Examine the associations of FI and DD with NC functions in adolescents Aim 3: Examine the associations of minerals mixtures with NC functions in our adolescent sample and elucidate if these effects are potentially modified by FI and DD  Longitudinal Study (Aim 1) Cross-sectional Study (Aim 2a) Early exposure and children 9- Children 9-10 years Cohort 10 years cohort Deciduous Food Security and Teeth Dietary Diversity collection Assessment Aim 1 Neurocognitive Mineral Patterns in Early Life Stages: ~13 weeks gest - ~6 yrs Food security performance Aim 2b high Diet Diversity Child Child Pregnancy Birth Age 5-7 yrs Age 9-10 yrs Figure 1: Epidemiological study design (aims 1 & 2)  PRELIMINARY DATA 14 FI, DD and NC performance FI was negatively correlated to measure of executive function of NeuroUX (r=-0.41, p By identifying these critical gaps in nutrition and cognitive function, research can advise targeted interventions to improve diet quality and address micronutrient deficiencies. Formulation of school-based or community-based nutrition programs ---> Improve access to more diverse and nutrient-rich diet ---> Reduce food insecurity ---> Improve brain health outcomes in adolescents  11 Main highlights: The prevalence of stunting among children under five has doubled since 2021, rising from 7% t o 13.9% in 2023, indicating a significant increase in chronic malnutrition. Rates vary from 9.2% among Lebanese t o 18.7% among Syrian refugees, reaching 39.2 % in Informal Tented Settlements. Approximately half of the young children suffer from at least one form of micronutrient deficiency such as zinc, vitamin A, iron and vitamin D. Over two-thirds of adolescent girls and non-pregnant women experience at least one micronutrient deficiency, including vitamin D, iron, zinc, folate, and vitamin B12. Anemia, with a mild t o moderate public health concern, is linked t o poor nutrition and inadequate sanitation facilities, with iron deficiency as the primary risk factor. Developmental delays affect 30% of Lebanese children, 40% of Syrian refugee children, and over 80% of Palestinian children under the age of two. For children aged 2-5 years, the rates are 17% among Lebanese, 30% among Palestinian, and 46% among Syrian refugee children. Lebanon Integrated Micronutrient, Anthropometry, and Child Development Survey 2023 - 2024 (LIMA)- Summary Report. UNICEF  17 REFERENCES Rabbitt, M.; Reed-Jones, M.; Hales, L.; Burke, M. Household food security in the United States in 2023. U.S. Department of Agriculture, E. R. S., Ed.; 2024. FAO.; 360., F. Minimum Dietary Diversity for Women: A Guide for Measurement; Rome, Italy., 2016. Verger, E. O.; Le Port, A.; Borderon, A.; Bourbon, G.; Moursi, M.; Savy, M.; Mariotti, F.; Martin-Prevel, Y. Dietary Diversity Indicators and Their Associations with Dietary Adequacy and Health Outcomes: A Systematic Scoping Review. Adv Nutr 2021, 12 (5), 1659-1672. DOI: 10.1093/advances/nmab009 From NLM. Jun, S.; Cowan, A. E.; Dodd, K. W.; Tooze, J. A.; Gahche, J. J.; Eicher-Miller, H. A.; Guenther, P. M.; Dwyer, J. T.; Potischman, N.; Bhadra, A.; et al. Association of food insecurity with dietary intakes and nutritional biomarkers among US children, National Health and Nutrition Examination Survey (NHANES) 2011-2016. Am J Clin Nutr 2021, 114 (3), 1059-1069. DOI: 10.1093/ajcn/nqab113 From NLM. Jun, S.; Cowan, A. E.; Dodd, K. W.; Tooze, J. A.; Gahche, J. J.; Eicher-Miller, H. A.; Guenther, P. M.; Dwyer, J. T.; Potischman, N.; Bhadra, A.; et al. Association of food insecurity with dietary intakes and nutritional biomarkers among US children, National Health and Nutrition Examination Survey (NHANES) 2011-2016. Am J Clin Nutr 2021, 114 (3), 1059-1069. DOI: 10.1093/ajcn/nqab113 From NLM. Jenkins, M.; Jefferds, M. E. D.; Aburto, N. J.; Ramakrishnan, U.; Martorell, R.; Addo, O. Y. What Do United States Adolescents Eat? Food Group Consumption Patterns and Dietary Diversity from a Decade of Nationally Representative Data. Current Developments in Nutrition 2023, 7 (8). DOI: 10.1016/j.cdnut.2023.101968 (acccessed 2024/09/05). Basiry, M.; Surkan, P. J.; Ghosn, B.; Esmaillzadeh, A.; Azadbakht, L. Associations between nutritional deficiencies and food insecurity among adolescent girls: A cross-sectional study. Food Science & Nutrition 2024, 12 (7), 4623-4636. DOI: https://doi.org/10.1002/fsn3.4065. Lopes, S. O.; Abrantes, L. C. S.; Azevedo, F. M.; Morais, N. S.; Morais, D. C.; Gonçalves, V. S. S.; Fontes, E. A. F.; Franceschini, S.; Priore, S. E. Food Insecurity and Micronutrient Deficiency in Adults: A Systematic Review and Meta-Analysis. Nutrients 2023, 15 (5). DOI: 10.3390/nu15051074 From NLM.  18 REFERENCES Shankar, P.; Chung, R.; Frank, D. A. Association of Food Insecurity with Children's Behavioral, Emotional, and Academic Outcomes: A Systematic Review. J Dev Behav Pediatr 2017, 38 (2), 135- 150. DOI: 10.1097/dbp.0000000000000383 From NLM. (Gallegos, D.; Eivers, A.; Sondergeld, P.; Pattinson, C. Food Insecurity and Child Development: A State-of-the-Art Review. Int J Environ Res Public Health 2021, 18 (17). DOI: 10.3390/ijerph18178990 From NLM. Lebanon Integrated Micronutrient, Anthropometry, and Child Development Survey 2023 - 2024 (LIMA)- Summary Report. UNICEF. de Oliveira, K. H. D.; de Almeida, G. M.; Gubert, M. B.; Moura, A. S.; Spaniol, A. M.; Hernandez, D. C.; Pérez-Escamilla, R.; Buccini, G. Household food insecurity and early childhood development: Systematic review and meta-analysis. Matern Child Nutr 2020, 16 (3), e12967. DOI: 10.1111/mcn.12967 From NLM. Jackson, D. B.; Testa, A.; Semenza, D. C. Household food insecurity and school readiness among preschool-aged children in the USA. Public Health Nutr 2021, 24 (6), 1469-1477. DOI: 10.1017/s1368980021000550 From NLM. Norris, S. A.; Frongillo, E. A.; Black, M. M.; Dong, Y.; Fall, C.; Lampl, M.; Liese, A. D.; Naguib, M.; Prentice, A.; Rochat, T.; et al. Nutrition in adolescent growth and development. Lancet 2022, 399 (10320), 172-184. DOI: 10.1016/s0140-6736(21)01590-7 From NLM. Jomova, K.; Makova, M.; Alomar, S. Y.; Alwasel, S. H.; Nepovimova, E.; Kuca, K.; Rhodes, C. J.; Valko, M. Essential metals in health and disease. Chem Biol Interact 2022, 367, 110173. DOI: 10.1016/j.cbi.2022.110173 From NLM. Wambogo, E. A.; Ansai, N.; Herrick, K. A.; Reedy, J.; Hales, C. M.; Ogden, C. L. Differences in Intakes of Select Nutrients by Urbanization Level in the United States Population 2 Years and Older, NHANES 2013-2018. J Nutr 2024, 154 (2), 617-625. DOI: 10.1016/j.tjnut.2023.12.030 From NLM. Freedman, M. R.; Fulgoni, V. L.; Lieberman, H. R. Temporal changes in micronutrient intake among United States Adults, NHANES 2003 through 2018: A cross-sectional study. Am J Clin Nutr 2024, 119 (5), 1309-1320. DOI: 10.1016/j.ajcnut.2024.02.007 From NLM. Vela, G.; Stark, P.; Socha, M.; Sauer, A. K.; Hagmeyer, S.; Grabrucker, A. M. Zinc in gut-brain interaction in autism and neurological disorders. Neural Plast 2015, 2015, 972791. DOI: 10.1155/2015/972791 From NLM.  19 REFERENCES ) Schwarzenberg, S. J.; Georgieff, M. K. Advocacy for Improving Nutrition in the First 1 0 0 0 Days to Support Childhood Development and Adult Health. Pediatrics 2018, 141 (2). DOI: 10.1542/peds.2017-3716 From NLM. Lopes, S. O.; Abrantes, L. C. S.; Azevedo, F. M.; Morais, N. S.; Morais, D. C.; Gonçalves, V. S. S.; Fontes, E. A. F.; Franceschini, S.; Priore, S. E. Food Insecurity and Micronutrient Deficiency in Adults: A Systematic Review and Meta-Analysis. Nutrients 2023, 15 (5). DOI: 10.3390/nu15051074 From NLM. Quezada-Pinedo, H. G.; Cassel, F.; Duijts, L.; Muckenthaler, M. U.; Gassmann, M.; Jaddoe, V. W. V.; Reiss, I. K. M.; Vermeulen, M. J. Maternal Iron Status in Pregnancy and Child Health Outcomes after Birth: A Systematic Review and Meta-Analysis. Nutrients 2021, 13 (7). DOI: 10.3390/nu13072221 From NLM. Burk, R. F.; Hill, K. E. Selenoprotein P-expression, functions, and roles in mammals. Biochim Biophys Acta 2009, 1790 (11), 1441-1447. DOI: 10.1016/j.bbagen.2009.03.026 From NLM. Maier, J. A. M.; Locatelli, L.; Fedele, G.; Cazzaniga, A.; Mazur, A. Magnesium and the Brain: A Focus on Neuroinflammation and Neurodegeneration. Int J Mol Sci 2022, 24 (1). DOI: 10.3390/ijms24010223 From NLM.