Pediatric Gastroenterology, Hepatology & Nutrition

The Korean Society of Pediatric Gastroenterology, Hepatology and Nutrition (대한소아소화기영양학회)
권호 표지
DOI QR코드

DOI QR Code

Neurocognitive Functions in Infants with Malnutrition; Relation with Long-chain Polyunsaturated Fatty Acids, Micronutrients Levels and Magnetic Resonance Spectroscopy

  • Cakir, Murat (Department of Pediatric Gastroenterology Hepatology and Nutrition, Faculty of Medicine, Karadeniz Technical University) ;
  • Senyuva, Sukran (Department of Pediatrics, Faculty of Medicine, Karadeniz Technical University) ;
  • Kul, Sibel (Department of Radiology, Faculty of Medicine, Karadeniz Technical University) ;
  • Sag, Elif (Department of Pediatric Gastroenterology Hepatology and Nutrition, Faculty of Medicine, Karadeniz Technical University) ;
  • Cansu, Ali (Department of Pediatric Neurology, Faculty of Medicine, Karadeniz Technical University) ;
  • Yucesan, Fulya Balaban (Department of Biochemistry, Faculty of Medicine, Karadeniz Technical University) ;
  • Yaman, Serap Ozer (Department of Biochemistry, Faculty of Medicine, Karadeniz Technical University) ;
  • Orem, Asim (Department of Biochemistry, Faculty of Medicine, Karadeniz Technical University)
  • Received : 2018.04.26
  • Accepted : 2018.09.01
  • Published : 2019.03.15
Download PDF
⟨ Previous Next ⟩

Abstract

Purpose: Malnutrition may influence neurocognitive development in children by directly affecting the brain structural development, or indirectly by affecting the children's cognition experience. Malnutrition alters the cell numbers, cell migration, synaptogenesis, and neurotransmission due to inadequate availability of necessary micronutrients to support cell growth. We aimed to analyze neurocognitive development in infants with malnutrition and its association with long chain polyunsaturated fatty acids (LC-PUFA), micronutrients levels and magnetic resonance spectroscopy (MRS) findings. Methods: The study included two groups; group 1, infants with malnutrition (n=24), group 2; healthy infants (n=21). Peripheral blood was obtained from the participants for studying micronutrients and LC-PUFA levels. The neurocognitive development was analyzed by the use of an Ankara Developmental Screening Inventory test. MRS were performed on all infants. Results: All parameters of neurocognitive development and serum calcium ($9.6{\pm}0.9mg/dL$ vs. $10.4{\pm}0.3mg/dL$, p<0.05) and magnesium ($2.02{\pm}0.27mg/dL$ vs. $2.2{\pm}0.14mg/dL$, p<0.05) levels were noted as being low in infants with marked malnutrition. No difference was found in LC-PUFA levels between healthy and malnourished infants. Thalamic choline/creatine levels were significantly high in infants with malnutrition ($1.33{\pm}0.22$ vs. $1.18{\pm}0.22$, p<0.05). Total neurocognitive development in infants was positively correlated with serum calcium levels (p<0.05, r=0.381). Conclusion: Calcium supplementation may improve neurocognitive development in malnourished infants.

Keywords

References

  1. Agostoni C, Manzoni P. Nutrition and neurocognitive development. Early Hum Dev 2013;89 Suppl 1:S1-3. https://doi.org/10.1016/S0378-3782(13)00138-2
  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. Grantham-McGregor S, Cheung YB, Cueto S, Glewwe P, Richter L, Strupp B; International Child Development Steering Group. Developmental potential in the first 5 years for children in developing countries. Lancet 2007;369:60-70. https://doi.org/10.1016/S0140-6736(07)60032-4
  4. Black MM. Micronutrient deficiencies and cognitive functioning. J Nutr 2003;133:3927S-31S. https://doi.org/10.1093/jn/133.11.3927S
  5. Uauy R, Dangour AD. Nutrition in brain development and aging: role of essential fatty acids. Nutr Rev 2006;64:S24-33. https://doi.org/10.1301/nr.2006.may.S24-S33
  6. Ulmer S, Backens M, Ahlhelm FJ. Basic principles and clinical applications of magnetic resonance spectroscopy in neuroradiology. J Comput Assist Tomogr 2016;40:1-13. https://doi.org/10.1097/RCT.0000000000000322
  7. World Health Organization. Severe acute malnutrition [Internet]. Geneva: World Health Organization; 2009 [cited 2017 Dec 10]. Available from: http://www.who.int/nutrition/topics/malnutrition/en/.
  8. Erol N, Sezgin N, Savasir I. Validity studies for development-screening inventory. Turk J Psychol 1993;8:16-22.
  9. Savasir I, Sezgin N, Erol N. Handbook of Ankara development-screening inventory. 2nd ed. Ankara: Rekmay; 1998.
  10. Hamaguchi H, Cleve H. Solubilization of human erythrocyte membrane glycoproteins and separation of the MN glycoprotein from a glycoprotein with I, S, and A activity. Biochim Biophys Acta 1972;278:271-80. https://doi.org/10.1016/0005-2795(72)90232-2
  11. Sattler W, Puhl H, Hayn M, Kostner GM, Esterbauer H. Determination of fatty acids in the main lipoprotein classes by capillary gas chromatography: BF3/methanol transesterification of lyophilized samples instead of Folch extraction gives higher yields. Anal Biochem 1991;198:184-90. https://doi.org/10.1016/0003-2697(91)90526-Y
  12. Granados-Rojas L, Serrano N, Gutierrez-Ospina G, Diaz-Cintra S. Prenatal protein malnutrition differentially affects the volume of the granule layer and mossy fibers in young male and female rats. Proc West Pharmacol Soc 2002;45:53-4.
  13. Mathangi DC, Namasivayam A. Effect of chronic protein restriction on motor co-ordination and brain neurotransmitters in albino rats. Food Chem Toxicol 2001;39:1039-43. https://doi.org/10.1016/S0278-6915(01)00051-5
  14. Alamy M, Bengelloun WA. Malnutrition and brain development: an analysis of the effects of inadequate diet during different stages of life in rat. Neurosci Biobehav Rev 2012;36:1463-80. https://doi.org/10.1016/j.neubiorev.2012.03.009
  15. Benitez-Bribiesca L, De la Rosa-Alvarez I, Mansilla-Olivares A. Dendritic spine pathology in infants with severe protein-calorie malnutrition. Pediatrics 1999;104:e21. https://doi.org/10.1542/peds.104.2.e21
  16. 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
  17. Engle PL, Fernandez PD. INCAP studies of malnutrition and cognitive behavior. Food Nutr Bull 2010;31:83-94. https://doi.org/10.1177/156482651003100109
  18. Isik Y, Kalyoncu M, Okten A. Serum leptin levels in marasmic children and the relationship between leptin and lipid profile. Ann Nutr Metab 2004;48:259-62. https://doi.org/10.1159/000080460
  19. Akuyam A, Isah HS, Ogala WN. Serum lipid profile in malnourished Nigerian children in Zaria. Niger Postgrad Med J 2008;15:192-6.
  20. Fageer SA, Karar TA, Hag SM. Assessment of plasma levels of proteins, total cholesterol and high density. J Sci Technol 2013;14:35-43.
  21. Veiga GR, Ferreira HS, Sawaya AL, Calado J, Florencio TM. Dyslipidaemia and undernutrition in children from impoverished areas of Maceio, state of Alagoas, Brazil. Int J Environ Res Public Health 2010;7:4139-51. https://doi.org/10.3390/ijerph7124139
  22. Chisti MJ, Salam MA, Ashraf H, Faruque AS, Bardhan PK, Shahid AS, et al. Prevalence, clinical predictors, and outcome of hypocalcaemia in severely-malnourished under-five children admitted to an urban hospital in Bangladesh: a case-control study. J Health Popul Nutr 2014;32:270-5.
  23. Singla PN, Chand P, Kumar A, Kachhawaha JS. Serum magnesium levels in protein-energy malnutrition. J Trop Pediatr 1998;44:117-9. https://doi.org/10.1093/tropej/44.2.117
  24. El-khayat H, Shaaban S, Emam EK, Elwakkad A. Cognitive functions in protein-energy malnutrition: in relation to long chain-polyunsaturated fatty acids. Pak J Biol Sci 2007;10:1773-81. https://doi.org/10.3923/pjbs.2007.1773.1781
  25. Gil A, Ramirez M, Gil M. Role of long-chain polyunsaturated fatty acids in infant nutrition. Eur J Clin Nutr 2003;57 Suppl 1:S31-4. https://doi.org/10.1038/sj.ejcn.1601810
  26. Schulzke SM, Patole SK, Simmer K. Long-chain polyunsaturated fatty acid supplementation in preterm infants. Cochrane Database Syst Rev 2011:CD000375.
  27. Smithers LG, Gibson RA, Makrides M. Maternal supplementation with docosahexaenoic acid during pregnancy does not affect early visual development in the infant: a randomized controlled trial. Am J Clin Nutr 2011;93:1293-9. https://doi.org/10.3945/ajcn.110.009647
  28. McCann JC, Ames BN. Is docosahexaenoic acid, an n-3 long-chain polyunsaturated fatty acid, required for development of normal brain function? An overview of evidence from cognitive and behavioral tests in humans and animals. Am J Clin Nutr 2005;82:281-95. https://doi.org/10.1093/ajcn/82.2.281
  29. Simmer K, Patole SK, Rao SC. Long-chain polyunsaturated fatty acid supplementation in infants born at term. Cochrane Database Syst Rev 2008:CD000376.
  30. Kendall GS, Melbourne A, Johnson S, Price D, Bainbridge A, Gunny R, et al. White matter NAA/Cho and Cho/Cr ratios at MR spectroscopy are predictive of motor outcome in preterm infants. Radiology 2014;271:230-8. https://doi.org/10.1148/radiol.13122679
  31. Guo L, Wang D, Bo G, Zhang H, Tao W, Shi Y. Early identification of hypoxic-ischemic encephalopathy by combination of magnetic resonance (MR) imaging and proton MR spectroscopy. Exp Ther Med 2016;12:2835-42. https://doi.org/10.3892/etm.2016.3740
  32. Nassar M, Shaaban S, Abbas Y, Galal A, Naguib A, Kamal El-Deen A. Proton Magnetic Resonance Spectroscopy in protein energy malnutrition patients. J Pediatr Gastroenterol Nutr 2011;52 Suppl 1:e63.
  33. 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.
  34. Hart PH, Lucas RM, Walsh JP, Zosky GR, Whitehouse AJ, Zhu K, et al. Vitamin D in fetal development: findings from a birth cohort study. Pediatrics 2015;135:e167-73. https://doi.org/10.1542/peds.2014-1860
  35. Schlogl M, Holick MF. Vitamin D and neurocognitive function. Clin Interv Aging 2014;9:559-68.

Cited by

  1. Physicians' Understanding of Nutritional Factors Determining Brain Development and Cognition in the Middle East and Africa vol.22, pp.6, 2019, https://doi.org/10.5223/pghn.2019.22.6.536
  2. Neurodevelopmental effects of childhood malnutrition: A neuroimaging perspective vol.231, 2019, https://doi.org/10.1016/j.neuroimage.2021.117828