Mens sana in corpore sano – healthy mind and healthy body

Food insecurity – defined as an individual or household lacking access to sufficient, safe, and nutritious food that meets individuals’ dietary needs – has been linked to children’s behavioral, academic, and emotional problems and an increased risk of the development of mental health disorders [1, 2].

In a Canadian study on food insecurity in young children, researchers found that children from food-insecure families were disproportionately likely to experience persistent symptoms of hyperactivity and inattention. These results were still true after controlling for immigrant status, family structure, maternal age at child’s birth, family income, maternal and paternal education, prenatal tobacco exposure, maternal and paternal depression and negative parenting [3].

Accordingly, a systematic review on food insecurity and attention-deficit hyperactivity disorder (ADHD) symptoms in children reported a predictive and inverse relationship between the two, with possible lasting impacts into adulthood. Authors concluded that evidence exists to hypothesize that childhood food insecurity is associated with predisposing or exacerbating ADHD symptoms in children [4].

In 2017 Dr. Raju, President of the Indian Psychiatric Society concluded in a speech on medical nutrition in mental health and disorders that there is growing evidence for a relationship between quality of diet and mental health. According to Raju, the importance of nutrients as important agents for prevention, treatment, or augmentation of treatment for mental disorders has been established. “Empathic interactions and rational nutrition along with specific pharmacological and physical interventions could form an ideal and humane patient-friendly package in psychiatric practice” [5].

Therefore, identifying families in risk of food insecurity and getting children and adolescents the best possible food supply could result in fewer children with ADHD symptoms.

REFERENCES:

  1. Althoff, R.R., M. Ametti, and F. Bertmann, The role of food insecurity in developmental psychopathology. Prev Med, 2016. 92: p. 106-109.
  2. Shankar, P., R. Chung, and D.A. Frank, Association of Food Insecurity with Children’s Behavioral, Emotional, and Academic Outcomes: A Systematic Review. J Dev Behav Pediatr, 2017. 38(2): p. 135-150.
  3. Melchior, M., et al., Food insecurity and children’s mental health: a prospective birth cohort study. PLoS One, 2012. 7(12): p. e52615.
  4. Lu, S., et al., The Relationship between Food Insecurity and Symptoms of Attention-Deficit Hyperactivity Disorder in Children: A Summary of the Literature. Nutrients, 2019. 11(3).
  5. Raju, M., Medical nutrition in mental health and disorders. Indian J Psychiatry, 2017. 59(2): p. 143-148.
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Neurodevelopmental disorders such as attention deficit disorder (ADHD), autism spectrum disorder (ASS) and different types of anxiety disorders are associated with a higher risk of poor dietary, physical activity and sleep habits. Shaping behavior in children with neurodevelopmental symptoms can be challenging. How do parents experience shaping healthy habits in these children? What are tips and tricks to encourage your child to live healthy? We took together the results of a recent study conducted in Boston and our own results from a qualitative interview with parents of children that followed the TRACE-diet to help you encourage your child to be healthy.

What is hard?
For parents of children with a neurodevelopmental disorder (ND) it can be challenging to convince their children to make healthy choices. Some parents explain that taking an unhealthy option from a neurotypical child might also lead to an anger meltdown, but this meltdown is not comparable with a ND meltdown, which can last the whole day. Furthermore, children with ND can be more impulsive, which makes it harder for them to think before they choose. Other children with ND are resistant to change, and/or lack intrinsic motivation to change. The parents that tried taking their child to a health professional, reported a lack of clinical expertise among lifestyle experts to level with children with a neurodevelopmental disorder.

What is helpful?
Agency
Both studies found that allowing your kid agency in making choices is critical to create a healthy habit. It is important to limit the choices, otherwise your child will drown in options. Offer, for instance, a healthy snack and an unhealthy snack and let your child decide whether he/she wants the healthy snack now, or later.

Family engagement
Work as a team! This was a helpful strategy that was reported by most parents in the TRACE study. If you follow the diet with the whole family, the child does not feel left out or punished. Also, just not having snacks at home prevents your child from sneaking into the cabinet and taking one.

Positive reinforcement
It is important to define a goal together with your child. What are we working for? And for how long? You can help your child visualize this goal by making a calendar. Will your child only be rewarded at the end of the goal? Or are there also smaller sub-goals? For some children, a long-term goal such as “sleeping better” or “less belly pains” will be rewarding enough, but other children might need short-term goals.

The role of pets
In the Boston study, almost one-third of the parents reported that they used the role of pets to promote healthy habits. Animals can be used as a positive reinforcement for good choices, but they can also help to maintain healthy routines such as physical activity (walking the dog) and family engagement (walking the dog with the whole family).

 

REFERENCES

  1. Bowling, A. Blaine, R.E., Kaur, R., Davison, K.R. (2019). Shaping healthy habits in children with neurodevelopmental and mental health disorders: parent perceptions of barriers, facilitators and promising strategies. International Journal of Behavioral Nutrition and Physical Activity. 16:52.
  2. TRACE-study. For more information visit project-trace.nl
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MoBa is short for The Norwegian Mother and Child Cohort Study which is a large pregnancy observational study. During the years 1999-2008 pregnant women in Norway were recruited to the study. The study is conducted by the Norwegian Institute of Public Health. Questionnaires regarding health, diet and environment were sent out to the women during and after pregnancy. Women are sent regular follow-up questionnaires. As the child grows up, the child also completes questionnaires. In addition, the fathers were invited to participate with a questionnaire when their partner was pregnant. Biological samples were also collected from the mother, father and child. Today there are 114 500 children, 95 000 mothers and 75 000 fathers participating in the study.

https://www.fhi.no/en/studies/moba/

The study was set up to gain knowledge about the causes behind serious disease. The study is unique because it gathers information from fetal (in vitro) life and follows the offspring into adulthood. In this manner it is possible to look at early influences and later disease. The study is prospective, which means that information about mothers, fathers and their offspring is registered before a disease has manifested itself. With this design, women are asked questions several times during her pregnancy and do not have to try to remember what she did when looking back at her pregnancy.

MoBa is population-based and became nationwide with 50 participating hospitals in Norway. For more information on the many publications based on MoBa data, visit this link:

https://www.fhi.no/en/studies/moba/for-forskere-artikler/publications/

The participating women in MoBa also filled in a questionnaire about eating habits before and during pregnancy.

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The food choices we make, how much we exercise and the amount of body fat we have affects our health already at a young age. Although seemingly healthy, our metabolism might tell a different story. This can already be seen at a young age.

The Estonian Children Personality Behaviour and Health Study (ECPBHS) started 20 years ago in 1998 and has since measured the participants’ body composition and assessed their metabolic abnormalities, such as insulin resistance and metabolic syndrome, at ages 15, 18, 25 and 33 years.

Insulin resistance is a state in which the body does not respond to normal levels of insulin efficiently, eventually causing a rise in blood sugar levels. It has been proposed that insulin resistance has a role in the development of several metabolic abnormalities what we know as metabolic syndrome1. These metabolic abnormalities include a large waistline (abdominal obesity), high levels of certain types of fat in the blood called triglycerides, a low level of HDL cholesterol, high blood pressure or usage of blood pressure medication and elevated fasting blood sugar levels or type 2 diabetes diagnosis2.

We have found that already at age 25, individuals who consumed more than 300 milligrams of cholesterol per day and had more than 4 hours of screen time were at higher risk of components of metabolic syndrome3. Insulin resistance was associated with male gender3,4, overweight and obesity, low physical activity levels and the consumption of lipids above the recommended daily energy intake*4. Individuals who consumed carbohydrates below the recommended daily energy intake*, were less likely to be insulin resistant. Already at age 25, insulin resistant individuals had higher serum cholesterol, lower HDL cholesterol, and higher triglyceride levels, fasting blood sugar and insulin levels. People who were overweight also had 4 times higher odds of insulin resistance and being obese increased the odds 12 times if compared to normal weight individuals4. From 15 to 25 years the occurrence of components of metabolic syndrome increased rapidly. At age 15 years 18% of participants had one or more metabolic abnormality and by age 25 years the number had doubled, whereas 5% already had metabolic syndrome.3 Individuals who were insulin resistant were more likely to have metabolic syndrome.4

Insulin resistance and the metabolic syndrome are risk factors for type 2 diabetes and cardiovascular disease later in life1. As we observed, one fifth of the adolescents already have at least one metabolic abnormality and the number of components of metabolic syndrome increases from adolescence to young adulthood. That is why it is important that healthy lifestyle habits should be introduced and encouraged already in early childhood. Although young people may seem to be healthy, the first signs of developing metabolic abnormalities may already be there.

*According to the Estonian nutrition and physical activity recommendations (2015), the recommended consumption of macronutrients from daily energy intake (E%) is as following: proteins 10–20%, lipids 25–35%, carbohydrates 50–60%5.

Written by:
Urmeli Joost, MSc is a PhD student at the Institute of Family Medicine and Public Health, University of Tartu, Estonia. Her main focus of research is the genetic, environmental and behavioural factors in obesity, dyslipidemia and glucose metabolism.

Inga Villa, MD, PhD is a Lecturer in Health Promotion at the Institute of Family Medicine and Public Health, University of Tartu, Estonia. Her main focus of research is nutrition, physical activity and sociocultural factors on health status and body composition.

REFERENCES
1. Xu, H., Li, X., Adams, H., Kubena, K. & Guo, S. Etiology of Metabolic Syndrome and Dietary Intervention. Int J Mol Sci 20, (2018).

2. Alberti, K. G. M. M. et al. Harmonizing the metabolic syndrome: a joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity. Circulation 120, 1640–1645 (2009).

3. Taimur, T. Metaboolse sündroomi komponentide levimus ja seosed toitumisega noorukieast täiskasvanueani. Tartu: Tartu Ülikooli peremeditsiini ja rahvatervishoiu instituut; 2018.

4. Joost U. Insuliinresistentsuse seosed elustiiliharjumustega noortel täiskasvanutel Eestis [masters thesis]. Tartu: Tartu Ülikooli tervishoiu instituut; 2015.

5. Pitsi, et al. Eesti toitumis- ja liikumissoovitused 2015. Tervise Arengu Instituut. Tallinn, 2017.

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In my previous blogs, I explained the research questions of my study. This study will be performed in two cohorts which I will elaborate on in this current blog about early life nutrition and studying gut microbiota. The cohorts are called BIBO and BINGO.  

BIBO stands for ‘Basale Invloeden op de Baby’s Ontwikkeling’ (in English: basal influences on  infant’s development). Recruitment of this cohort started in 2006, and a total of 193 mothers and their infants were included. At age 10, 168 mothers and their children still joined the BIBO study; the attrition rate is thus low. The majority of the mothers are highly educated (76%). The number of boys (52%) and girls (48%) in this cohort are roughly equally divided. A unique aspect of the BIBO study is the number of stool samples collected in early life. Also, detailed information about early life nutrition has been recorded during the first six months of life (e.g. information on daily frequency of breastfeeding, formula feeding, and mixed feeding). Together, these stool samples and nutrition diaries provide important insights in the relations between early life nutrition and gut microbiota development. Data about children within the BIBO cohort will be collected at age 12,5 years and 14 years. At 12,5 years, the participants will be invited to the university for an fMRI scan (more information about the fMRI scan will be given in a future blog). At age 14, children’s impulsive behavior will be assessed by means of behavioral tests and (self- and mother-report) questionnaires.

BINGO stands for ‘Biologische INvloeden op baby’s Gezondheid en Ontwikkeling’ (in English: biological influences on infant’s health and development). When investigating biological influences on infant’s health and development, it is important to start before birth. Therefore, 86 healthy women were recruited during pregnancy. Recruitment took place in 2014 and 2015. One unique property of the BINGO cohort is the fact that not only mothers were recruited, but also their partners. The role of fathers is often neglected in research, and thus an important strength of this BINGO cohort. Another unique property is that samples of mothers’ milk were collected three times during the first three months of life, to investigate breast milk composition. As for many infants their diet early in life primarily consists of breast milk, it is interesting to relate breast milk composition to later gut microbiota composition and development. Currently, 79 mothers and children, and 54 fathers are still joining the BINGO study. The average age of the participants at the time of recruitment was 32 years for mothers and 33 years for the father. Majority of the parents within this cohort are highly educated (77%) and from Dutch origin (89%). The number of boys (52%) and girls (48%) in this cohort are roughly equally divided. At age 3, children’s impulsive behavior will be assessed by means of behavioral tests and mother-report questionnaires.

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This project has received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement No 728018

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