Medical Bulletin 28/ October/ 2024 - Video

77% Indian Children lack WHO’s Dietary Diversity Recommendations: Study finds

A recent study has pointed out that about 77 per cent of children in India aged 6-23 months do not meet the World Health Organization's (WHO) dietary diversity recommendations. This disturbing trend is particularly pronounced in central states like Uttar Pradesh, Rajasthan, Gujarat, Maharashtra, and Madhya Pradesh, where over 80 per cent of kids have been found to show inadequate dietary diversity. In contrast, Sikkim and Meghalaya are the only states reporting under 50 per cent prevalence. The findings were published in the National Medical Journal of India.

Using data from the National Family and Health Survey (NFHS-5) conducted between 2019-21, researchers noted a decline in minimum dietary diversity failure from 87.4 per cent in 2005-06 (NFHS-3) to a concerning level above 75 per cent.

The WHO suggests using the Minimum Dietary Diversity (MDD) score to evaluate the quality of a child's diet -- it is considered to be diverse if it contains five or more food groups, including breastmilk, eggs, legumes and nuts, and fruits and vegetables.

The study revealed some improvements in dietary habits. However, the findings also showed a decline in breast milk and dairy consumption, dropping from 87% to 85% and 54% to 52%, respectively. Factors contributing to dietary deficiencies included maternal education levels, rural residency, lack of access to mass media, and inadequate health counseling for children.

The authors also found that the children of illiterate and rural-residing mothers having no exposure to mass media, those born first and not exposed to counselling and health check-ups at Anganwadi or Integrated Child Development Services (ICDS) centres were more likely to be consuming diets deficient in diversity.

Reference: Gunnal G, Bagaria D, Roy S. Regional patterns in minimum diet diversity failure and associated factors among children aged 6–23 months in India. Natl Med J India 2024;37:181–90. DOI: 10.25259/NMJI_241_2023

Maternal Antibodies May Interfere with Malaria Vaccine Responses: Study Finds

Maternal antibodies passed across the placenta can interfere with the response to the malaria vaccine, which would explain its lower efficacy in infants under five months of age, according to research led by the Barcelona Institute for Global Health (ISGlobal), in collaboration with seven African centers. The findings, published in Lancet Infectious Diseases, suggest that children younger than currently recommended by the WHO may benefit from the RTS,S and R21 malaria vaccines if they live in areas with low malaria transmission, where mothers have less antibodies to the parasite.

“We know that the RTS,S/AS01E malaria vaccine is less effective in infants under five months of age, but the reason for this difference is still debated,” says Carlota Dobaño, who leads the Malaria Immunology group at Barcelona Institute for Global Health, a centre supported by “la Caixa” Foundation.

To investigate this, Dobaño and her team analysed blood samples from more than 600 children (age 5-17 months) and infants (age 6-12 weeks) who participated in the phase 3 clinical trial of RTS,S/AS01E. Using protein microarrays, they measured antibodies against 1,000 P. falciparum antigens before vaccination to determine if and how malaria exposure and age affected IgG antibody responses to the malaria vaccine.

The analysis of antibodies to P. falciparum in children who had received a control vaccine instead of RTS,S/AS01E revealed a typical “exposure” signature, with high levels in the first three months of life due to the passive transfer of maternal antibodies through the placenta, a decline during the first year of life, and then a gradual increase as a result of naturally acquired infections.

In children vaccinated with RTS,S/AS01E, antibodies induced by natural infections did not affect the vaccine response. However, in infants, high levels of antibodies to P. falciparum, presumably passed from their mothers during pregnancy, correlated with reduced vaccine responses. The higher the level of malaria transmission, the more maternal antibodies are transmitted to the baby, resulting in lower vaccine effectiveness.

Reference: The effect of Plasmodium falciparum exposure and maternal anti-circumsporozoite protein antibodies on responses to RTS,S/AS01E vaccination in infants and children: an ancillary observational immunological study to a phase 3, randomised clinical trial. Macià, Dídac et al.The Lancet Infectious Diseases, Volume 0, Issue 0

2 Hormone Receptors May have a Role in Regulating Critical Brain Function

In a comprehensive review published in the issue of Genomic Psychiatry, researchers have unveiled crucial insights into how two types of hormone receptors collaborate to maintain brain health and potentially prevent neurodegenerative diseases.

The study, led by Professor Jan-Åke Gustafsson and colleagues at the University of Houston and Karolinska Institutet, demonstrates that liver X receptors (LXRs) and thyroid hormone receptors (TRs) work together in a previously unrecognized manner to regulate critical brain functions and protect against neurodegeneration.

Key findings include:

• liver X receptors play a crucial role in regulating thyroid hormone function in the brain

• Both receptors are essential for normal brain development and maintenance

• Loss of liver X receptors function leads to age-related neurodegeneration in multiple brain regions

• The receptors work together to maintain cholesterol balance in the brain

The review highlights several promising therapeutic implications:

1. Alzheimer's Disease: liver X receptors activation could help reduce amyloid plaque formation and improve memory

2. Parkinson's Disease: liver X receptors signaling appears to protect dopamine-producing neurons

3. ALS: liver X receptors influence motor neuron survival and function

4. Multiple Sclerosis: The receptors play crucial roles in myelin repair and maintenance

Standing on One Leg May be a Determinant of Biological age

Good balance, muscle strength and an efficient gait contribute to people's independence and well-being as they age. How these factors change, and at what rate, can help clinicians develop programs to ensure healthy aging. Individually, people can train their balance without special equipment and work on maintaining it over time.

In this study, 40 healthy, independent people over 50 underwent walking, balance, grip strength and knee strength tests. Half of the participants were under 65; the other half were 65 and older.

In the balance tests, participants stood on force plates in different situations: on both feet with eyes open, on both feet with eyes closed, on the non-dominant leg with eyes open, and on the dominant leg with eyes open. In the one-legged tests, participants could hold the leg they weren't standing on where they wanted. The tests were 30 seconds each.

Standing on one leg, specifically the nondominant leg, showed the highest rate of decline with age.

Unintentional falls are the leading cause of injuries among adults who are 65 and older. Most falls among older adults result from a loss of balance.

In the other tests:

Researchers used a custom-made device to measure participants' grip. For the knee strength test, participants were in a seated position and instructed to extend their knee as forcefully as possible. Both the grip and knee strength tests were on the dominant side. Grip and knee strength showed significant declines by decade but not as much as balance. Grip strength decreased at a faster rate than knee strength, making it better at predicting aging than other strength measures.

For the gait test, participants walked back and forth on an 8-meter, level walkway at their own pace and speed. Gait parameters didn't change with age.

There were no age-related declines in the strength tests that were specific to sex. This indicates that participants' grip and knee strength declined at a similar rate.