•UA may improve dietary diversity in developing and transitional economies.•Evidence suggests that UA may be associated with improved food security.•Poor quality and weak study designs hinder ...interpretation and assessing causation.
This literature review seeks to examine the evidence for the association between urban agriculture (UA) and food security, dietary diversity, and nutritional status and clarify the evidence base for its effectiveness at ameliorating some food security challenges faced by urban residents.
We searched five databases, five grey literature libraries, and hand-searched reference lists to identify all potentially relevant sources. To be included a paper needed to quantify the impact of UA on food security, dietary diversity, or nutrition status. Papers were screened and quality assessed and data were extracted in duplicate.
Developing and transitional economies.
Urban farmers, their households, and communities.
We identified 11,192 potentially relevant studies and included 13 papers from 12 unique studies. Studies identified both positive and no associations with UA and food security, and in one study’s sub-analysis, negative associations were detected. Weak study designs and methods, incomparable measures, compounded with the finding that food insecure households are more likely to engage in UA, all make interpretations difficult. All studies that measured dietary diversity found a positive association. Most studies found a positive association between engagement in UA and food consumption. Findings for nutritional status were mixed, some showing positive associations for stunting.
Poor quality and weak study designs made interpretation difficult and the assignment of causation impossible. The evidence base for UA needs to be strengthened before it can be confidently recommended as a strategy to improve urban food security. We did not however, find any evidence to discourage its use.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
Early-life exposure to toxic compounds may cause long-lasting health effects, but few studies have investigated effects of childhood exposure to nephrotoxic metals on kidney and cardiovascular ...function.
To assess effects of exposure to arsenic and cadmium on kidney function and blood pressure in pre-school-aged children, and potential protection by selenium.
This cross-sectional study was part of the 4.5 years of age (range: 4.4–5.4 years) follow-up of the children from a supplementation trial in pregnancy (MINIMat) in rural Bangladesh, and nested studies on early-life metal exposures. Exposure to arsenic, cadmium and selenium from food and drinking water was assessed by concentrations in children's urine, measured by ICP-MS. Kidney function was assessed by the estimated glomerular filtration rate (eGFR, n=1106), calculated from serum cystatin C, and by kidney volume, measured by ultrasound (n=375). Systolic and diastolic blood pressure was measured (n=1356) after five minutes rest.
Multivariable-adjusted regression analyzes showed that exposure to cadmium, but not arsenic, was inversely associated with eGFR, particularly in girls. A 0.5µg/L increase in urinary cadmium among the girls (above spline knot at 0.12) was associated with a decrease in eGFR of 2.6ml/min/1.73m2, corresponding to 0.2SD (p=0.022). A slightly weaker inverse association with cadmium was also indicated for kidney volume, but no significant associations were found with blood pressure. Stratifying on children's urinary selenium (below or above median of 12.6µg/L) showed a three times stronger inverse association of U-Cd with eGFR (all children) in the lower selenium stratum (B=−2.8; 95% CI: −5.5, −0.20; p=0.035), compared to those with higher selenium (B=−0.79; 95% CI: −3.0, 1.4; p=0.49).
Childhood cadmium exposure seems to adversely affect kidney function, but not blood pressure, in this population of young children in rural Bangladesh. Better selenium status appears to be protective. However, it is important to follow up these children to assess potential long-term consequences of these findings.
•Bangladesh has high levels of arsenic and cadmium in drinking water and food•We assessed toxic exposure, kidney and cardiovascular function in Bangladeshi children•Cadmium appeared to decrease estimated glomerular filtration rate in girls•These effects were somewhat alleviated by selenium
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
Prompt access to primary healthcare before onset of severe illness is vital to improve morbidity and mortality rates. The Gambia has high rates of child mortality and research is needed to ...investigate contributing factors further. This study aimed to identify factors affecting access to primary healthcare for children <5 years (y) in rural Gambia focusing on delayed presentation and severe illness at presentation as indicators in a setting where primary healthcare is delivered free of charge.
Data were extracted from an electronic medical records system at a rural primary healthcare clinic in The Gambia for children (0-5y) between 2009 and 2012. First clinic attendances with malaria, lower respiratory tract infections (LRTI) and diarrhoeal disease, the main contributors to mortality in this setting, were identified and categorized as delayed/non-delayed and severe/non-severe representing our two main outcome measures. Potential explanatory variables, identified through a comprehensive literature review were obtained from an ongoing demographic surveillance system for this population. Variables associated with either delayed/non-delayed and/or with severe/non-severe presentations identified by univariate analysis (p<0.1) were assessed in multivariate models using logistic regression (p<0.05).
Out of 6554 clinic attendances, 571 relevant attendances were identified. Delayed presentation was common (45% of all presentations) and there was a significantly reduced risk associated with being from villages with free regular access to transport (OR 0.502, 95%CI0.310, 0.814, p = 0.005). Children from villages with free regular transport were also less likely to present with severe illness (OR 0.557, 95%CI0.325, 0.954, p = 0.033).
Transport availability rather than distance to health clinic is an important barrier to accessing healthcare for children in The Gambia, and public health interventions should aim to reduce this barrier.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
BackgroundPolicy initiatives such as WHO Age Friendly Cities recognise the importance of the urban environment for improving health of older people, who have both low physical activity (PA) levels ...and greater dependence on local neighbourhoods. Previous research in this age group is limited and rarely uses objective measures of either PA or the environment.MethodsWe investigated the association between objectively measured PA (Actigraph GT3x accelerometers) and multiple dimensions of the built environment, using a cross-sectional multilevel linear regression analysis. Exposures were captured by a novel foot-based audit tool that recorded fine-detail neighbourhood features relevant to PA in older adults, and routine data.Results795 men and 638 women aged 69–92 years from two national cohorts, covering 20 British towns, were included in the analysis. Median time in moderate to vigorous PA (MVPA) was 27.9 (lower quartile: 13.8, upper quartile: 50.4) minutes per day. There was little evidence of associations between any of the physical environmental domains (eg, road and path quality defined by latent class analysis; number of bus stops; area aesthetics; density of shops and services; amount of green space) and MVPA. However, analysis of area-level income deprivation suggests that the social environment may be associated with PA in this age group.ConclusionsAlthough small effect sizes cannot be discounted, this study suggests that older individuals are less affected by their local physical environment and more by social environmental factors, reflecting both the functional heterogeneity of this age group and the varying nature of their activity spaces.
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BFBNIB, CMK, NMLJ, NUK, PNG, SAZU, UL, UM, UPUK
BACKGROUND: Evidence suggests that increased maternal calcium intake during pregnancy may result in lower offspring blood pressure, prompting calls for more robust data in this field, particularly in ...settings of habitually low calcium intake. OBJECTIVE: The objective was to investigate the effect of maternal calcium supplementation on blood pressure in offspring by recruiting children born after a randomized, double-blind, placebo-controlled trial of calcium supplementation during pregnancy. DESIGN: Children (n = 389) from a rural area of The Gambia (mean age: 7.4 ± 1.2 y; range: 5-10 y), whose mothers received a calcium supplement (1500 mg Ca/d from 20 wk of gestation until delivery) or placebo, were followed up in West Africa. Blood pressure was assessed under standardized conditions with use of the Omron 705IT automated oscillometric device (Morton Medical Ltd, London, United Kingdom), and anthropometric and body composition (bioelectrical impedance) measurements were also made. RESULTS: The analysis was restricted to 350 children born at term, which represented 64% of original trial births. There was no difference in systolic (adjusted mean difference: -0.04 mm Hg; 95% CI: -1.78, 1.69 mm Hg) or diastolic (adjusted mean difference: 0.25 mm Hg; 95% CI: -1.27, 1.77 mm Hg) blood pressure between children whose mothers had received calcium and those who received placebo. No interaction between childhood body mass index (in kg/m²; mean: 14.0) and maternal calcium supplementation was observed in this study. CONCLUSION: Calcium supplementation in the second half of pregnancy in Gambian women with very low habitual calcium intakes may not result in lower offspring blood pressure at 5-10 y of age.
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CMK, GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Abstract Background Policy makers are increasingly interested in how changes in local neighbourhood environments can affect health behaviours, especially physical activity, but individual studies ...rarely consider multiple environmental dimensions. Although older people can be particularly at risk of physical challenges in their local environment, few studies have focused on this age group. Methods We developed a local environment audit instrument to capture multiple dimensions of the built environment that could affect the physical activity of older people; we linked the environmental data to physical activity behaviour collected in two nationally representative cohorts: the British Regional Heart Study and British Women's Heart and Health Study. Comprehensive foot-based audits were conducted by trained field staff in 20 towns across England and Scotland covering 590 lower super output areas and data zones; interobserver reliability of the instrument was high. The primary outcome was time spent in moderate-to-vigorous physical activity measured in participants for 1 week during 2010–12 with GT3X accelerometers (Actigraph, Pensacola, FL, USA). Using multilevel regression analysis, we assessed the association between aspects of the built environment and physical activity adjusted for individual-level confounders and area-level population density. Findings 686 men and 638 women aged 69–92 years participated in the accelerometer study and were included in the analysis. Geometric mean time in moderate-to-vigorous physical activity was 26·3 min/day (geometric SD 2·7) in men and 23·8 min/day (SD 2·5) in women. There was no evidence of associations between any of the domains studied (quality of the built environment defined by latent class analysis; number of bus stops; area aesthetics; density of shops and services; amount of green space) and moderate-to-vigorous physical activity. Relative to areas with the worst quality walking environment, people living in areas with the best walking environments spent 2% more time in moderate-to-vigorous physical activity (95% CI −11 to 17, p=0·78 for overall trend). Interpretation Although small effect sizes cannot be discounted, this study suggests that older individuals might be less affected by their local neighbourhood environment than is often presumed in the scientific literature, reflecting both the heterogeneous functionality of this age group and the varying nature of their activity spaces. Funding This study was funded by a grant from the Medical Research Council (MR/J007145/1). The collection and extraction of data on physical activity in these cohorts was supported by grants from the British Heart Foundation (PG/09/024 and PG/13/66/304422) and National Institute for Health Research (PDF 2010-03-23).
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK, ZRSKP
Animal studies have demonstrated that altering the maternal diet during pregnancy affects offspring disease risk. Data from human subjects on the early-life determinants of disease have been derived ...primarily from birth-weight associations; studies of the impact of the maternal diet are scarce and inconsistent. Investigating CVD risk factors in the offspring of women who have participated in maternal supplementation trials provides a useful resource in this research field, by virtue of employing an experimental design (as compared with observational studies). To date, follow-up studies have been published only for a small number of trials; these trials include the impact of maternal protein-energy, multiple-micronutrient and Ca supplementation on offspring disease risk. In Nepal maternal micronutrient supplementation has been shown to be associated with lower offspring systolic blood pressure at 2 years of age. Data from Guatemala on a pre- and postnatal protein-energy community intervention have suggested long-term improvements in fasting glucose and body composition but not in blood pressure. In The Gambia no association has been found between prenatal protein-energy supplementation and markers of CVD risk including body composition, blood pressure and fasting glucose and insulin in childhood and adolescence. Little evidence of an effect of maternal Ca supplementation on offspring blood pressure has been demonstrated in four trials, although the risk of high systolic blood pressure was found to be reduced in one trial. The present paper reviews the current evidence relating maternal nutritional supplementation during pregnancy to offspring CVD risk and explores the potential explanations for the lack of association.
Sex-specific effects of pregnancy calcium carbonate supplementation have been reported in 8–12 year old Gambian children, indicating faster growth in boys but slower growth in girls born to ...calcium-supplemented mothers.
To determine whether the pregnancy supplement resulted in sex-specific effects on offspring IGF1 and other growth-related indices in mid-childhood.
Analysis of archived data obtained in mid-childhood from the children of rural Gambian mothers who had been randomised to 1500 mgCa/d (Ca) or placebo (P) from 20 weeks pregnancy to delivery (ISRCTN96502494).
Of the 526 children born and followed in infancy, 290 had early-morning, fasting plasma assayed for IGF1, IGFBP3, leptin, insulin and calcium-related indices and had anthropometry performed at age 7.5 (SD1.2) years (N/group: Males(M)-Ca = 64, Females(F)-Ca = 77; M-P = 76, F-P = 73). Sex-specific effects of maternal supplementation were considered using regression with sexes separated and together to test for sex ∗ supplement interactions.
Boys had lower IGF1, IGFBP3, leptin and insulin than girls (P ≤ 0.004). IGF1 was higher in M-Ca than M-P (+14.2 (SE7.7)%, P = 0.05) but lower in F-Ca than F-P (−17.8 (SE7.4)%, P = 0.01); sex ∗ supplement interaction P = 0.001. IGF1 concentrations (ng/ml, geometric mean −1SE,+1SE) were M-Ca = 78.14.3,4.5, M-P = 67.83.4,3.6; F-Ca = 99.54.8,5.1, F-P = 118.96.4,6.8. Similar sex ∗ supplement interactions were seen for IGFBP3 and IGF1-adjusted-for-IGFBP3 but group differences were smaller. There were no significant supplement effects on the other biochemical indices.
Calcium carbonate supplementation of pregnant Gambian mothers resulted in higher IGF1 in boys and lower IGF1 in girls during mid-childhood, consistent with the reported maternal supplement effects on growth of the offspring in later childhood.
•Pregnancy calcium supplementation of Gambian mothers resulted in faster childhood growth in boys, slower growth in girls.•At mean age 7.5 years, plasma IGF1 of offspring was altered in a sex-specific manner before growth effects were evident.•Plasma IGF1 was higher in girls than boys.•Plasma IGF1 was higher in boys of calcium-supplemented mothers than those of mothers who consumed placebo.•Plasma IGF1 was lower in girls of calcium-supplemented mothers than those of mothers who consumed placebo.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
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