Nutritional advice

Objectives:
Although prior studies showed a correlation between environmental manganese (Mn) exposure and neurodevelopmental disorders in children, the results have been inconclusive. Therefore, this review article has been conducted.

Is a higher manganese exposure adversely associated with childhood neurodevelopment?

Study design:
This review article included 55 studies with 13,388 subjects.
The associations between manganese in biomarkers and neurodevelopmental outcomes were investigated in 15 cohort studies and 37 cross-sectional studies.
The neurological outcomes were assessed more frequently among children between 6 and 18 years of age than children under 6 years old.
A large percentage (44/55) of included studies was of high quality.

Results and conclusions:
The investigators found evidence from cohort studies showed that higher manganese exposure had a negative effect on neurodevelopment, mostly influencing cognitive and motor skills in children under 6 years of age, as indicated by various metrics.

The investigators found results from cross-sectional studies revealed that elevated manganese (Mn) in hair (H-Mn) and drinking water (W-Mn), but not blood (B-Mn) or teeth (T-Mn), were associated with poorer cognitive and behavioral performance in children aged 6-18 years old.
Of these cross-sectional studies, most papers reported that the mean of H-Mn was more than 0.55 μg/g.

The investigators found that a 10-fold increase in hair manganese was associated with a decrease of 2.51 points [95% CI = -4.58 to -0.45) in Full Scale IQ, while B-Mn and W-Mn generated no such significant effects.

The investigators found the pooled correlation analysis revealed that H-Mn showed a more consistent correlation with W-Mn than B-Mn.

The investigators found results regarding sex differences of manganese associations were inconsistent, although the preliminary meta-analysis found that higher W-Mn was associated with better Performance IQ only in boys, at a relatively low water manganese concentrations (most below 50 μg/L).

The investigators concluded higher manganese exposure is negatively associated with childhood neurodevelopment, especially cognitive and motor skills for children under 6 years old and cognitive and behavioural performance for children aged 6-18 years old.
In the older group (6-18 years old), hair is the most reliable indicator of manganese exposure. However, evidence demonstrated sex difference upon manganese exposure while a clear pattern is not elucidated. Population based biomonitoring studies with standard cleaning methodologies of hair are warranted in order to set reference ranges of manganese in hair at different ages. Large prospective cohort studies are certainly warranted in order to support these results and identify the underlying biological mechanisms.

Original title:
Biomarkers of environmental manganese exposure and associations with childhood neurodevelopment: a systematic review and meta-analysis by Liu W, Xin Y, […], Wang F.

Link:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7531154/

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Objectives:
Resistant starch type 2 (RS2) has been documented to regulate gut microbiota and to improve the clinical outcomes of several diseases. However, whether RS2 may benefit patients with end-stage renal disease under maintenance hemodialysis (MHD) remains unknown. Therefore, this review article has been conducted.

Do patients with end-stage renal disease under maintenance hemodialysis benefit from resistant starch type 2 supplementation?

Study design:
This review article included 5 RCTs with 179 patients under maintenance hemodialysis.

Resistant starch type 2 was used for 4 weeks to 2 months.

Results and conclusions:
The investigators found a significant decrease of blood urea nitrogen [WMD = -6.91, 95% CI = -11.87 to -1.95, I2 = 0%, p = 0.006], serum creatinine [WMD = -1.11, 95% CI = -2.18 to -0.05, I2 = 44%, p = 0.04] and interleukin (IL)-6 in blood [SMD = -1.08, 95% CI = -1.64 to -0.53, I2 = 35%, p = 0.0001] was revealed in the resistant starch type 2 group.

The investigators found analyses of blood levels of uric acid, p-cresyl sulfate, indoxyl sulfate, high sensitive C-reaction protein, albumin and phosphorus yielded no significant difference.

The investigators concluded that resistant starch type 2 improves the residual renal function of patients under maintenance hemodialysis and mitigate a proinflammatory response. Nevertheless, results should be cautiously interpreted, because of the limited sample size and different treatment dosages. Large and pragmatic multicenter trials are thus necessary to corroborate the beneficial effects of resistant starch type 2 supplementation on end-stage renal disease.

Original title:
Benefits of resistant starch type 2 for patients with end-stage renal disease under maintenance hemodialysis: a systematic review and meta-analysis by Jia L, Dong X, […], Zhang HL.

Link:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7797550/

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Resistant starch (RS) is starch, including its degradation products, that escapes from digestion in the small intestine of healthy individuals, but rather turned into short-chain fatty acids (such as acetate, butyrate and propionate) by intestinal bacteria in the colon (large intestine). Short chain fatty acids can be absorbed into the body from the colon or stay put and be used by colonic bacteria for energy.

Different types of resistant starch are RS1, RS2 and RS3. 

Resistant starch is present in whole grains, fruits, vegetables and beans/legumes.

Resistant starch type 2 (resistant granules) is intrinsically resistant to digestion and contains high amounts of amylose. Resistant starch type 2 is found in fruits, potatoes, hi-maize RS products, corn and some legumes.

The more “raw” or “uncooked” a food is, the more resistant starch it tends to have, since heat results in gelatinization of starch - making it more accessible to digestion. Type 3 starch is the exception to this rule.

All starches are composed of 2 types of polysaccharides: amylose and amylopectin.

Amylopectin is highly branched, leaving more surface area available for digestion in the small intestine. Amylopectin is broken down quickly, which means it produces a larger rise in blood sugar (glucose) and subsequently, a large rise in insulin.

Amylose is a straight chain, which limits the amount of surface area exposed for digestion. Amylose predominates in resistant starch. Foods high in amylose are digested more slowly. They’re less likely to spike blood glucose or insulin.

Since resistant starch is incompletely digested, we only extract about 2 calories of energy per gram (versus about 4 calories per gram from other starches).
 

Objectives:
As the rise in prevalence of allergic diseases worldwide corresponds in time with increasing infant vaccination, it has been hypothesized that childhood vaccination may increase the risk of allergic disease. Therefore, this review article has been conducted.

Does childhood vaccination increase risk of allergic disease?

Study design:
This review article included 35 publications based on cohort studies and 7 publications based on randomized controlled trials (RCTs).

Results and conclusions:
The investigators found from 2 studies, early vaccination with BCG vaccine was associated with a 17%-reduced risk of eczema [RR = 0.83, 95% CI = 0.73 to 0.93, I2 = 0%] but not food allergy or asthma.

The investigators found no association between pertussis vaccine and any allergic outcome based on a single RCT.

The investigators found in cohort studies that childhood measles vaccination was associated with a reduced risk of 35% for eczema [RR = 0.65, 95% CI= 0.47 to 0.90, I2 = 0.0%], 22% for asthma [RR = 0.78, 95% CI = 0.62 to 0.98, I2 = 93.9%] and, with a similar, statistically non-significant reduction in sensitisation [RR = 0.78, 95% CI = 0.61 to 1.01, I2 = 19.4%].

The investigators concluded there is no evidence that childhood vaccination with commonly administered vaccines is associated with increased risk of later allergic disease. However, pooled analysis of both RCTs and cohort studies show that vaccination with BCG and measles vaccines are associated with a reduced risk of eczema.

Original title:
Childhood Vaccination and Allergy: A Systematic Review and Meta-analyses by Navaratna S, Estcourt MJ, […], Lodge CJ.

Link:
https://pubmed.ncbi.nlm.nih.gov/33569761/

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The BCG (Bacillus Calmette-Guérin) vaccination is used against tuberculosis.
Pertussis vaccine is a vaccine that protects against whooping cough (pertussis).

Objectives:
Visceral adipose tissue (VAT) are deleterious fat deposits in the human body and can be effectively reduced by exercise intervention. Despite well-established exercise prescriptions are available, the effective dosage of exercise for reducing VAT requires verification. Therefore, this review article has been conducted.

What is the most effective exercise dosage (modality, intensity, duration and amount) for decreasing visceral adipose tissue (VAT)?

Study design:
This review article included 32 RCTs with a total of 1,900 participants.

Results and conclusions:
The investigators found that 30-60 min of high-intensity interval training, 3 times per week for 12 to 16 weeks [SMD = -0.39, 95% CI = -0.60 to -0.18] and 30-60 min of aerobic exercise of at least moderate intensity, 3 times per week for 12 to 16 weeks [SMD = -0.26, 95% CI = -0.38 to -0.13] were beneficial for reducing visceral adipose tissue.

The investigators found, by contrast, resistance exercise, aerobic exercise combined with resistance exercise and sprint interval training had no significant effects on reducing visceral adipose tissue.

The investigators found no difference in visceral adipose tissue reduction was observed between exercising more or less than 150 minutes per week.

The investigators found meta-regression revealed that the effect of visceral adipose tissue reduction was not significantly influenced by an increase in the duration of or amount of exercise in an exercise program.

The investigators concluded that 30-60 min of high-intensity interval training, 3 times per week for 12 to 16 weeks and 30-60 min of aerobic exercise of at least moderate intensity, 3 times per week for 12 to 16 weeks causally reduce visceral adipose tissue.

Original title:
Effect of exercise intervention dosage on reducing visceral adipose tissue: a systematic review and network meta-analysis of randomized controlled trials by Chang YH, Yang HY and Shun SC.

Link:
https://pubmed.ncbi.nlm.nih.gov/33558643/

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A causal relationship can be found in RCTs.

High intensity interval trainings are:
-using a stationary bike, pedal as hard and fast as possible for 30 seconds.
-after jogging to warm up, sprint as fast as you can for 15 seconds.
-perform squat jumps as quickly as possible for 30 to 90 seconds.

Objectives:
Does vitamin A supplementation reduce risk of bronchopulmonary dysplasia (BPD) in premature infants?

Study design:
This review article included 9 RCTs with 709 infants received vitamin A treatment (intervention group) and 700 infants did not receive vitamin A treatment (control group).
The dose of vitamin A regimens varied from 1500 to 10,000 IU (450 to 3,003 micrograms) and the treatment durations generally lasted for 4 weeks.

The funnel plots for all synthesized outcomes remained symmetrical, indicating that there was no significant publication bias.

Results and conclusions:
The investigators found when compared to the control group, vitamin A supplementation significantly reduced the incidence of bronchopulmonary dysplasia in premature infants with 33% [OR  =  0.67, 95% CI = 0.52 to 0.88].
The sensitivity analyses were performed by excluding single RCT one by one. The results of sensitivity analysis of all outcomes had indicated no substantial result changes among the overall estimates.

The investigators concluded that vitamin A supplementation is beneficial to reduce bronchopulmonary dysplasia in premature infants.  

Original title:
Vitamin A supplementation prevents the bronchopulmonary dysplasia in premature infants: A systematic review and meta-analysis by Ding Y, Chen Z and Lu Y.

Link:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7837939/

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Bronchopulmonary dysplasia is a form of chronic lung disease that develops in preterm neonates treated with oxygen and positive-pressure ventilation.
 

Objectives:
Recent evidence suggests that diet can modify the risk of future cognitive impairment and dementia. A biologically plausible rationale and initial clinical data indicate that the antioxidant activities of dietary carotenoids may assist the preservation of cognitive function. Therefore, this review article has been conducted.

Does carotenoid supplementation improve cognitive performance among healthy adults?

Study design:
This review article included 9 RCTs, involving 2,228 subjects in the treated group (group with carotenoid supplementation) and 2,174 subjects in control group (group without carotenoid supplementation).
The age of all participants varied from 45 to 78 years.
The majority of clinical trials assessed the effect of xanthophylls such as lutein, zeaxanthin, and astaxanthin, whereas only 1 study determined the effects of β-carotene.
The duration of carotenoid supplementation ranged from 2 weeks to 12 months.
The dosage of carotenoids administered in the studies ranged from 0.5 mg/d to 50 mg/d.
There was no evidence of publication bias.

Results and conclusions:
The investigators found results of the pooled meta-analysis showed a significant effect of carotenoid intervention on cognitive outcomes [Hedge's g = 0.14, 95% CI = 0.08 to 0.20, p 0.0001, I2 = 0.00%].
The sensitivity analysis did not change the overall findings obtained from the primary analysis.

The investigators concluded that these results highlight the potential role of carotenoids (0.5 mg/d to 50 mg/d) in the protection of mental functions even in subjects (healthy participants aged 45-78 years) without cognitive impairment. This is particularly important because the population is aging and preservation of cognitive function is crucial for individual autonomy and quality of life, even in non-demented subjects. Further well-powered and long-term trials are required to determine treatment duration, type of carotenoid and optimal dosage.

Original title:
Carotenoids and Cognitive Outcomes: A Meta-Analysis of Randomized Intervention Trials by Davinelli S, Ali S, […], Corbi G.

Link:
https://www.mdpi.com/2076-3921/10/2/223/htm

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Objectives:
The occurrence of fetal and neonatal disorders in pregnant women with Zika virus infection in the literature is not consistent. Therefore, this review article has been conducted.

What is the prevalence rate of disorders in fetuses/neonates of pregnant women with confirmed or probable Zika virus infection?

Study design:
This review article included 21 cohort studies with a total of 35,568 pregnant women.

Results and conclusions:
The investigators found the meta-analysis showed that central nervous system abnormalities had the highest prevalence ratio of 0.06 [95% CI = 0.03 to 0.09].

The investigators found the meta-analysis showed that intracranial calcifications had a prevalence ratio of 0.01 [95% CI = 0.01 to 0.02] and ventriculomegaly 0.01 [95% CI = 0.01 to 0.02].

The investigators found the meta-analysis showed that the prevalence ratio of microcephaly was 0.03 [95% CI = 0.02 to 0.05], fetal loss (miscarriage and stillbirth) was 0.04 [95% CI = 0.02 to 0.06], small for gestational age was 0.04 [95% CI = 0.00 to 0.09], low birth weight was 0.05 [95% CI = 0.03 to 0.08] and prematurity was 0.07 [95% CI = 0.04 to 0.10].

The investigators found the meta-analysis showed that the positivity in RT-PCR for ZIKV performed in neonates born to infected mothers during pregnancy was 0.25 [95% CI = 0.06 to 0.44].

The investigators found the meta-analysis of meta-analysis for microcephaly with the prevalence ratios from other two previously systematic reviews was 0.03 [95% CI = 0.00 to 0.25].

The investigators concluded that the disorders in foetuses and neonates of pregnant women with probable or confirmed Zika virus infection are microcephaly, CNS congenital abnormalities, intracranial calcifications, ventriculomegaly, fetal loss, small for gestational age, low birth weight and prematurity. The continuous knowledge of this magnitude is essential for the implementation development of health initiatives and programs, in addition to promoting disease prevention, especially in the development of a vaccine for Zika virus.

Original title:
Fetal, neonatal, and infant outcomes associated with maternal Zika virus infection during pregnancy: A systematic review and meta-analysis by Martins MM. Alves da Cunha AJL, […], de Andrade Medronho R.

Link:
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0246643

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CNS congenital anomalies are birth defects of the physical structure of the brain or spinal cord that develop in utero or when a foetus is developing during pregnancy.

Ventriculomegaly is a condition in which the ventricles appear larger than normal on a prenatal ultrasound. The ventricles of the brain are a communicating network of cavities filled with cerebrospinal fluid (CSF) and located within the brain parenchyma.

Microcephaly is a condition where a baby's head is much smaller than expected.

Intracranial calcifications refer to calcifications (small deposits of calcium) within the brain parenchyma or vasculature.

Objectives:
Recent systematic reviews and meta-analyses of randomized, double-blind, placebo-controlled trials (double-blind, placebo-controlled RCTs) have reported controversial findings regarding the associations between calcium supplements on the risk of cardiovascular disease (CVD). Therefore, this review article has been conducted.

Do calcium supplements increase risk of cardiovascular disease (CVD)?

Study design:
This review article included 13 RCTs with 28,935 participants in an intervention group (group with calcium supplements) and 14,243 in a control group (group without calcium supplements).

The mean age of the study participants was 66.3 years (range: 35 to 97 years) and 92.8% of those were women.
Publication bias was not observed.

Results and conclusions:
The investigators found calcium supplements significantly increased the risk of cardiovascular disease with 15% in healthy postmenopausal women [RR = 1.15, 95% CI = 1.06 to 1.25, I2 = 0.0%, n = 14].

The investigators found calcium supplements significantly increased the risk of coronary heart disease with 16% in healthy postmenopausal women [RR = 1.16, 95% CI = 1.05 to 1.28, I2 = 0.0%, n = 9].

The investigators found in the subgroup meta-analysis, dietary calcium intake of 700-1000 mg per day or supplementary calcium intake of 1000 mg per day significantly increased the risk of cardiovascular disease and coronary heart disease.

The investigators concluded that the use of calcium supplements (1000 mg per day) is significantly associated with the increased risk of cardiovascular disease and coronary heart disease by 15%, specifically in postmenopausal women. These findings should be explicitly confirmed by conducting further RCTs with cardiovascular disease outcome measures as well as the incidence of osteoporosis or fractures as the primary endpoints.

Original title:
Calcium Supplements and Risk of Cardiovascular Disease: A Meta-Analysis of Clinical Trials by Myung SK, Kim HB, […], Oh SW.

Link:
https://pubmed.ncbi.nlm.nih.gov/33530332/

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Objectives:
N-acetylcysteine (NAC) is an antioxidant that can regenerate glutathione and is primarily used for acetaminophen overdose. NAC has been tested and used for preventing iatrogenic acute kidney injury or slowing the progression of chronic kidney disease, with mixed results. Therefore, this review article has been conducted.

Has NAC administration a positive effect on the serum creatinine level and the serum cystatin C level?

Study design:
This review article included 6 studies (4 studies were before/after single-arm prospective trials and 2 were parallel randomized controlled trials, comparing NAC against placebo) with a total of 199 participants.

Overall, these studies are small, with a median sample size of 30 (range: 10-60).
The proportion of men ranged from 48% to 83%.
The mean patient age ranged from 33 to 71 years.
The follow-up periods were mostly short.
There was no evidence of publication bias both by visual examination or the Egger test for the analysis of NAC and cystatin C.

Results and conclusions:
The investigators found there was a small but significant decrease in serum creatinine after n-acetylcysteine (NAC) administration overall [WMD = -2.80 μmol/L, 95% CI = -5.6 to 0.0, p = 0.05].

This was greater with non-Jaffe methods [WMD = -3.24 μmol/L, 95% CI = -6.29 to -0.28, p = 0.04] than Jaffe [WMD = -0.51 μmol/L, 95% CI = -7.56 to 6.53, p = 0.89] and in particular with intravenous [WMD = -31.10 μmol/L, 95% CI = -58.37 to -3.83, p = 0.03] compared with oral NAC [WMD = -2.5 μmol/L, 95% CI = -5.32 to 0.32, p = 0.08].

The investigators found there was no change in cystatin C after n-acetylcysteine (NAC) administration [WMD = -0.84 μmol/L, 95% CI = -3.14 to 1.47, p = 0.48, I2 = 0%, p = 0.99].

The investigators concluded there is a small but significant decrease in serum creatinine with n-acetylcysteine (NAC) administration but not in cystatin C. This effect seems to be higher when creatinine is measured with the enzymatic assay (non-Jaffe method) and with intravenous n-acetylcysteine administration.

Original title:
A Systematic Review of the Effect of N-Acetylcysteine on Serum Creatinine and Cystatin C Measurements by Huang JW, Lahey B, […], Hiremath S.

Link:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7879108/

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The Jaffe and enzymatic methods (non-Jaffe methods) are the 2 most common methods for measuring serum creatinine. The Jaffe method is less expensive than the enzymatic method but is also more susceptible to interferences.

Intravenous therapy (abbreviated as IV therapy) is a medical technique that delivers fluids, medications and nutrition directly into a person's vein.
 

Objectives:
Does citrus dietary intake reduce the risk of lung cancer?

Study design:
This review article included 21 observational studies.

Results and conclusions:
The investigators found pooled analyses showed that those with the highest citrus fruit dietary intake compared to the lowest intake had a 9% reduction in lung cancer risk [OR = 0.91, 95% CI = 0.84 to 0.98].

The investigators found a nonlinear association between citrus dietary intake and lung cancer risk in the dose-response analysis [p = 0.0054] and that the risk reached the minimum [OR = 0.91] around 60 g/d.
However, no obvious dose-response association was observed with intakes above 80 g/d.

The investigators concluded that citrus fruit dietary intake is negatively associated with the risk of lung cancer. Besides, there is a nonlinear dose-response relationship between citrus fruit dietary intake and lung cancer risk within a certain range (60-80g per day).

Original title:
Citrus fruit intake and lung cancer risk: A meta-analysis of observational studies by Wang J, Gao J, [...], Qian BY.

Link:
https://pubmed.ncbi.nlm.nih.gov/33529754/

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Citrus fruits include oranges, lemons, limes and grapefruits.

Objectives:
Does a low-carbohydrate diet (LCD) causally increase adiponectin concentration in adults?

Study design:
This review article included 11 RCTs with 534 participants in low-carbohydrate diet group and 513 participants in control group (group without a low-carbohydrate diet).
Proportion of carbohydrate from calorie was from 4 to 34% (4-34 En%).
Time of the follow-up varied between studies and ranged from 6 to 152 weeks.
Meta-regression analysis revealed that age [β = 0.04, p = 0.15], baseline BMI [β= -0.15, p = 0.15], time of follow-up [β = 0.01, p = 0.17], energy percentage of carbohydrates [β = 0.004, p = 0.90], energy percentage of protein [β = -0.12, p = 0.08], energy percentage of fat [β = 0.20, p = 0.61] and baseline adiponectin [β = 0.001, p = 0.97] are not sources of heterogeneity

Results and conclusions:
The investigators found low-carbohydrate diet significantly increased adiponectin concentration [0.02 µg/mL, 95% CI = 0.01 to 0.03, p 0.001].

The investigators found dose-response analysis indicated a nonlinear association between the percentage of carbohydrate and change in adiponectin level from baseline [p = 0.04].

The investigators found in subgroup analysis based on the proportion of carbohydrate from calorie, there was a significant increase in adiponectin concentration in studies that prescribed 30% of calorie from carbohydrates [0.12 µg/mL, 95% CI = 0.07 to 0.18].
In contrast, diets which consisted ≥30% of carbohydrates had no significant effect on adiponectin [0.50 µg/mL, 95% CI = -0.46 to 1.48].

The investigators concluded that a diet with 30% of calorie from carbohydrates (diet with 30 En% carbohydrates) causally increases adiponectin concentration in adults.

Original title:
Effect of low-carbohydrate diet on adiponectin level in adults: a systematic review and dose-response meta-analysis of randomized controlled trials by Shemirani F, Golzarand M, […], Mahmoudi M.

Link:
https://pubmed.ncbi.nlm.nih.gov/33455438/

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The most easy way to follow a diet with maximum 30% of calorie from carbohydrates (diet with 30 En% carbohydrates) is to choose only meals/products with maximum 30 En% carbohydrates. Check here which products contain maximum 30 En% carbohydrates. However, the most practical way to follow a diet with maximum 30 En% carbohydrates is, all meals/products that you eat on a daily basis should on average contain maximum 30 En% carbohydrates.
30 En% carbohydrates means that the total amounts of carbohydrates make up for a 30% of the total kcal of the diet.

Adiponectin is a protein hormone produced and secreted exclusively by adipocytes (fat cells) that regulates the metabolism of lipids and glucose. Adiponectin influences the body's response to insulin. Adiponectin also has antiinflammatory effects on the cells lining the walls of blood vessels.
 

Objectives:
To compare the immunogenicity and safety of the influenza vaccine at reduced or full intradermal doses with full intramuscular doses to inform policy design in the event of vaccine shortages.

Study design:
This review article included a total of 29 RCTs with 13,759 participants and 1 cohort study with 164,021 participants.
Approximately half of the studies (14 studies) involved only participants aged 60 years or older or reported data for participants aged 60 years or older.

Results and conclusions:
The investigators found there was no statistically significant difference in seroconversion rates between the 3-µg, 6-µg, 7.5-µg and 9-µg intradermal vaccine doses and the 15-µg intramuscular vaccine dose for each of the H1N1, H3N2 and B strains.
However, the rates were significantly higher with the 15-µg intradermal dose compared with the 15-µg intramuscular dose for the H1N1 strain [rate ratio (RR) = 1.10, 95% CI = 1.01 to 1.20] and B strain [rate ratio = 1.40, 95% CI = 1.13 to 1.73].

The investigators found the seroprotection rates for the 9-µg and 15-µg intradermal doses did not vary significantly compared with the 15-µg intramuscular dose for all the 3 strains, except for the 15-µg intradermal dose for the H1N1 strain, for which rates were significantly higher [rate ratio = 1.05, 95% CI = 1.01 to 1.09].

The investigators found local adverse events were significantly higher with intradermal doses than with the 15-µg intramuscular dose, particularly erythema [3-µg dose: RR = 9.62, 95% CI = 1.07 to 86.56; 6-µg dose: RR = 23.79, 95% CI = 14.42 to 39.23; 9-µg dose: RR = 4.56, 95% CI = 3.05 to 6.82; 15-µg dose: RR = 3.68, 95% CI = 3.19 to 4.25] and swelling [3-µg dose: RR = 20.16, 95% CI = 4.68 to 86.82; 9-µg dose: RR = 5.23, 95% CI = 3.58 to 7.62; 15-µg dose: RR = 3.47, 95% CI = 2.21 to 5.45].

The investigators found fever and chills were significantly more common with the 9-µg intradermal dose than the 15-µg intramuscular dose [fever: RR = 1.36, 95% CI = 1.03 to 1.80; chills: RR = 1.24, 95% CI = 1.03 to 1.50] while all other systemic adverse events were not statistically significant for all other doses.

The investigators concluded that immunogenicity resulting from 3-µg, 6-µg, 7.5-µg and 9-µg influenza intradermal vaccination doses is not significantly different from full-dose 15-µg intramuscular vaccination for most viral strains, irrespective of patient age.
However, the 15-µg intradermal vaccine shows significantly better immunogenicity for some of the outcomes and strains, suggesting that the immunological response may be dose-related.

Original title:
Immunogenicity and Safety of Reduced-Dose Intradermal vs Intramuscular Influenza Vaccines: A Systematic Review and Meta-analysis by Egunsola O, Clement F, […], Noseworthy T.

Link:
https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2776045

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Intradermal injection is a shallow or superficial injection of a substance into the dermis. The dermis or corium is a layer of skin between the epidermis and subcutaneous tissues,

Objectives:
Vitamin D deficiency during pregnancy or infancy is associated with adverse growth in children. No systematic review has been conducted to summarize available evidence on the effect of vitamin D supplementation in pregnancy and infancy on growth and body composition in children. Therefore, this review article has been conducted.

Does vitamin D supplementation during pregnancy or infancy increase adiposity (severe or morbid overweight) risk in childhood?

Study design:
This review article included 12 RCTs with a total of 4,583 participants.
The doses of vitamin D in the intervention group (group with vitamin D supplements) were 60,000 IU/4 weeks (1,500 mcg/4 weeks) or 60,000 IU/8 weeks and in the control group (group without vitamin D supplements) was 400 IU/day.

Results and conclusions:
The investigators found vitamin D supplementation during pregnancy was associated with higher triceps skinfold thickness (mm) [MD = 0.33, 95% CI = 0.12 to 0.54, I2 = 34%] in neonates.

The investigators found vitamin D supplementation during pregnancy or infancy was associated with significantly increased length for age z-score in infants at 1 year of age [MD = 0.29, 95% CI = 0.03 to 0.54, I2 = 0%].

The investigators found vitamin D supplementation during pregnancy or infancy was associated with lower body mass index (BMI) (kg/m²) [MD = -0.19, 95% CI = -0.34 to -0.04, I2 = 0%] and body mass index z-score (BMIZ) [MD = -0.12, 95% CI = -0.21 to -0.04, I2 = 0%] in offspring at 3-6 years of age.

The investigators found vitamin D supplementation during early life was not observed to be associated with children’s bone, lean or fat mass.

The investigators concluded vitamin D supplementation during pregnancy or infancy is associated with reduced adiposity (severe or morbid overweight) in childhood. Future large well-designed double blinded RCTs are needed to assess the effectiveness of vitamin D supplementation in early life on children’s bone health, lean mass and adiposity.

Original title:
Effect of Vitamin D Supplementation in Early Life on Children's Growth and Body Composition: A Systematic Review and Meta-Analysis of Randomized Controlled Trials by Ma K, Wei SQ, [...], Wen SW.

Link:
https://www.mdpi.com/2072-6643/13/2/524/htm

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Objectives:
Fish oil has been shown to reduce the risk of metabolic disorders. However, the effects of fish oil intervention on glucose metabolism and insulin sensitivity are still controversial, especially in children. Therefore, this review article has been conducted.

Do fish oil supplements (EPA + DHA) improve insulin sensitivity in children?

Study design:
This review article included 13 RCTs with 567 children in placebo group (group without fish oil supplements) and 565 in fish oil group (intervention group).

No heterogeneity was found for the pooled and subgroup analyses.

Results and conclusions:
The investigators found compared with the placebo group, fish oil intervention had beneficial effects on insulin sensitivity in the pooled analysis [WMD = -0.219, 95% CI = -0.392 to -0.046, p = 0.013].

These beneficial effects were also found in subgroup analyses, when the fish oil intervention period was short-term (≤6 months) low dose (eicosapentaenoic acid (EPA) + docosahexaenoic acid (DHA) dose 1.5 g/day) and high ratio (eicosapentaenoic acid to docosahexaenoic acid ≥1).

The investigators concluded fish oil supplements, especially 1.5 g/day EPA + DHA during 6 months, improve insulin sensitivity in children.

Original title:
Effect of Fish Oil on Insulin Sensitivity in Children: A Systematic Review and Meta-Analysis of Randomized, Controlled Trials by Hou M, Zhou W, [...], Lv H.

Link:
https://pubmed.ncbi.nlm.nih.gov/33388274/

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Objectives:
Increasing macular pigment optical density (MPOD) as a result of increased macular concentration of lutein and zeaxanthin may reduce the risk of age-related macular degeneration (AMD). Therefore, this review article has been conducted.

Have daily egg consumption beneficial effects on macular pigment optical density and serum lutein levels?

Study design:
This review article included 5 RCTs with a total of 296 participants.
There was no heterogeneity between studies.

Results and conclusions:
The investigators found that egg consumption significantly increased macular pigment optical density [WMD = +0.037, 95% CI = 0.004 to 0.069, p = 0.027] and serum lutein levels [WMD = +0.150 μmol/L, 95% CI = 0.037 to 0.263, p = 0.009].

The investigators found subgroup analyses showed that egg consumption had a larger effect on macular pigment optical density in studies with a parallel design and increased serum lutein levels to a greater extent in a healthy population.

The investigators concluded daily egg consumption have beneficial effects on macular pigment optical density and serum lutein level is inversely associated with reduced age-related macular degeneration progression. Further clinical trials are required to confirm the results of this review article.

Original title:
A positive effect of egg consumption on macular pigment and healthy vision: a systematic review and meta-analysis of clinical trials by Sikaroudi MK, Saraf-Bank S, […], Soltani S.

Link:
https://pubmed.ncbi.nlm.nih.gov/33491232/

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Objectives:
Data on efficacy of hepatitis-B vaccine (HBV) in patients with inflammatory bowel disease (IBD) is limited. Therefore, this review article has been conducted.

What is the efficacy of hepatitis-B vaccine (HBV) in patients with inflammatory bowel disease (IBD)?

Study design:
This review article included 14 studies with 2,375 patients.
4 data sets were available from 2 studies that compared HBV response in patients with IBD against healthy controls.

Results and conclusions:
The investigators found the pooled odds ratio of HBV response in IBD patients was 0.13 [95% CI = 0.05 to 0.33, p = 0.001].

The investigators found the pooled proportion of adequate immune response (AIR) was 64% [95% CI = 55 to 72.1, p = 0.003] from 13 data sets and effective immune response (EIR) was 39.7% [95% CI = 30.7 to 49.5, p = 0.04] from 10 data sets.

The investigators concluded that patients with inflammatory bowel disease (IBD) on immunosuppression demonstrate significantly reduced HBV response as compared with general population.

Original title:
Hepatitis-B Vaccine Response in Inflammatory Bowel Disease Patients: A Systematic Review and Meta-analysis by Kochhar GS, Mohan BP, […], Farraye F.

Link:
https://pubmed.ncbi.nlm.nih.gov/33393585/

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Objectives:
Does a low selenium level in human tissues increase the risk of breast cancer?

Study design:
This review article included 18 case-control studies with 3,374 women diagnosed with breast cancer (case group) and 3,582 healthy controls (women without breast cancer).

Results and conclusions:
The investigators found selenium level of the case group (group with women diagnosed with breast cancer) was significantly lower than the control group (group with women without breast cancer) [-0.53 μg/L, 95% CI = -0.72 to -0.34, p 0.001].

The investigators found in subgroup analysis that serum selenium level of the case group was significantly lower than the control group [-1.14 μg/L, 95% CI = -1.70 to -0.58, p 0.001].

The investigators found in subgroup analysis that plasma selenium level of the case group was significantly lower than the control group [-0.21 μg/L, 95% CI = -0.37 to -0.04, p 0.014].

The investigators found in subgroup analysis that selenium level of toenail of the case group was significantly lower than the control group [-0.21 μg/L, 95% CI = -0.38 to -0.03, p 0.021].

The investigators concluded that a low selenium level in human tissues increases the risk of breast cancer, which may improve the understanding of the effects of selenium on human health.

Original title:
Relationship Between Selenium in Human Tissues and Breast Cancer: a Meta-analysis Based on Case-Control Studies by Zhu X, Pan D, […], Sun G.

Link:
https://pubmed.ncbi.nlm.nih.gov/33420696/

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Objectives:
Chronic kidney disease (CKD) is a major health problem worldwide. Evidence supporting the use of probiotic, prebiotic and synbiotic supplementation in the management of CKD is mixed, although some studies suggest they may be useful. Therefore, this review article has been conducted.

Do probiotic, prebiotic and synbiotic supplementation improve cardiometabolic and oxidative stress parameters in patients with chronic kidney disease?  

Study design:
This review article included 14 RCTs.

Results and conclusions:
The investigators found in patients with chronic kidney disease, probiotic, prebiotic and synbiotic supplementation significantly reduced:
-total cholesterol [SMD = -0.25, 95% CI = -0.46 to -0.04, I2 = 00.0%];
-fasting blood glucose [SMD = -0.41, 95% CI = -0.65 to -0.17, I2 = 00.0%];
-homeostatic model assessment of insulin resistance [SMD = -0.63, 95% CI = -0.95 to -0.30, I2 = 43.3%];
-insulin levels [SMD = -0.49, 95% CI = -0.90 to -0.08, I2 = 65.2%];
-high-sensitivity C-reactive protein levels [SMD = -0.52, 95% CI = -0.81 to -0.22, I2 = 52.7%] and;
-malondialdehyde levels [SMD = -0.79, 95% CI = -1.22 to -0.37, I2 = 69.8%] compared with control interventions.

The investigators found in patients with chronic kidney disease, probiotic, prebiotic and synbiotic supplementation significantly increased:
-the quantitative insulin sensitivity check index [SMD = 0.78, 95% CI = 0.51 to 1.05, I2 = 00.0%];
-total antioxidant capacity [SMD = 0.42, 95% CI = 0.18 to 0.66, I2 = 00.0%] and;
-glutathione levels [SMD = 0.52, 95% CI = 0.19 to 0.86, I2 = 37.0%].

The investigators concluded probiotic, prebiotic and synbiotic supplementation improve cardiometabolic and oxidative stress parameters in patients with chronic kidney disease.

Original title:
Effect of Probiotic, Prebiotic, and Synbiotic Supplementation on Cardiometabolic and Oxidative Stress Parameters in Patients with Chronic Kidney Disease: a Systematic Review and Meta-analysis by Bakhtiary M, Morvaridzadeh M, […], Heshmati J.

Link:
https://pubmed.ncbi.nlm.nih.gov/33526314/

Additional information of El Mondo:
Find here more information/studies about review article/significant, probitocis, kidney disease, diabetics and chronic diseases.

Levels of malondialdehyde can be also considered (as a marker of lipid peroxidation) to assess the membrane damage in spermatozoa; this is crucial because oxidative stress affects sperm function by altering membrane fluidity, permeability and impairing sperm functional competence.
Lipid peroxidation is a well-established mechanism of cellular injury and is used as an indicator of oxidative stress in cells and tissues.

Glutathione is one of the body's most important and potent antioxidants. As an antioxidant, glutathione helps neutralize free radicals and reduce oxidative stress that can damage the body’s cells.

Homeostasis model assessment (HOMA) and quantitative insulin sensitivity check index (QUICKI) have been used to quantify degrees of insulin resistance and β-cell secretory capacity.
 

Objectives:
Some studies have reported the association between maternal serum zinc (Zn) levels and pre-eclampsia. However, many studies have reported controversial results. Therefore, this review article has been conducted.

Does a low maternal serum zinc level increase risk of pre-eclampsia in African women?

Study design:
This review article included 12 observational studies.

Results and conclusions:
The investigators found the mean values of serum zinc level were significantly lower in pre-eclamptic women as compared with normotensive pregnant women [zinc = 59.40 ± 22.80 μg/dL and 80.24 ± 16.04 μg/dL], respectively.

The investigators found the pooled SMD of zinc was significantly reduced in pre-eclamptic women as compared with normotensive pregnant women with the SMD of -1.45 [95% CI -2.26 to -0.65].

The investigators concluded that the maternal serum zinc level is lower in pre-eclamptic women than normotensive pregnant women. This suggests that zinc could be involved in the etio-pathogenesis of pre-eclampsia. However, the specific functions of zinc in pre-eclampsia pathogenesis should be proved in large-scale clinical trial studies.

Original title:
Maternal Serum Zinc Level and Pre-eclampsia Risk in African Women: a Systematic Review and Meta-analysis by Tesfa E, Nibret E and Munshea A.

Link:
https://pubmed.ncbi.nlm.nih.gov/33527339/

Additional information of El Mondo:
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Pre-eclampsia is a disorder of pregnancy characterized by the onset of high blood pressure and often a significant amount of protein in the urine.

Objectives:
Does a high dietary intake of β-cryptoxanthin reduce the risk of osteoporosis and hip fracture?

Study design:
This review article included 7 cohort studies, 4 case-control studies and 4 cross-sectional studies with a total of 100,496 individuals.
The methodological qualities of all studies were rated as “fair” to “good”.
The number of populations in each study ranged from 59 to 25,566.

Results and conclusions:
The investigators found that a high dietary intake of β-cryptoxanthin significantly reduced risk of osteoporosis with 24% [OR = 0.76, 95% CI = 0.66 to 0.88, p = 0.0002, I2 = 36%, p = 0.11].

The investigators found in subgroup analysis that a high dietary intake of β-cryptoxanthin significantly reduced risk of osteoporosis with 28% [OR = 0.72, 95% CI = 0.58 to 0.91, p = 0.005, I2 = 59%] among women.

The investigators found in subgroup analysis that a high dietary intake of β-cryptoxanthin significantly reduced risk of osteoporosis with 20% [OR = 0.80, 95% CI = 0.65 to 1.00, p = 0.005, I2 = 11%] among men.

The investigators found that a high dietary intake of β-cryptoxanthin significantly reduced risk of hip fracture with 28% [OR = 0.72, 95% CI = 0.60 to 0.87, p = 0.0008, I2 = 55%].

The investigators found in subgroup analysis that a high dietary intake of β-cryptoxanthin significantly reduced risk of hip fracture with 29% [OR = 0.71, 95% CI = 0.54 to 0.94, p = 0.02, I2 = 71%] among women. 

The investigators concluded that a high dietary intake of β-cryptoxanthin reduces the risk of osteoporosis and hip fracture. Further longitudinal studies are needed to validate the causality of current findings.

Original title:
Effects of β-Cryptoxanthin on Improvement in Osteoporosis Risk: A Systematic Review and Meta-Analysis of Observational Studies by Kim SJ, Anh NH, […], Kwon SW.

Link:
https://www.mdpi.com/2304-8158/10/2/296/htm

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Objectives:
Is there a causal relationship between ginger intake and improvements of major oxidative stress (OS) parameters, such as glutathione peroxidase activity, total antioxidant capacity, alondialdehyde (MDA) levels and CAT activity?   

Study design:
This review article included 12 RCTs.

Results and conclusions:
The investigators found ginger intake significantly increased glutathione peroxidase (GPx) activity [SMD = 1.64, 95% CI = 0.43 to 2.85, I2 = 86.8%] compared to control group (group without ginger intake). 

The investigators found ginger intake significantly increased total antioxidant capacity (TAC) [SMD = 0.40, 95% CI = 0.06 to 0.73, I2 = 42.8%] compared to control group. 

The investigators found ginger intake significantly decreased alondialdehyde (MDA) levels [SMD = -0.69, 95% CI = -1.26 to -0.12, I2 = 85.8%] compared to control group.

The investigators found ginger supplementation non-significantly increased CAT activity [SMD = 1.09, 95% CI = -0.07 to 2.25, I2 = 87.6%].

The investigators concluded this meta-analysis (review article) presents convincing evidence supporting the efficacy of ginger supplementation on improving oxidative stress (OS) levels.

Original title:
Effect of ginger (Zingiber officinale) supplementation on oxidative stress parameters: A systematic review and meta-analysis by Morvaridzadeh M, Sadeghi E, […], Heshmati J.

Link:
https://pubmed.ncbi.nlm.nih.gov/33458848/

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Oxidative stress is an imbalance between free radicals and antioxidants in your body.
 

Objectives:
Does a high dietary cholesterol intake increase risk of gestational diabetes mellitus?

Study design:
This review article included 3 cohort studies, 4 cross-sectional studies and 2 case-control studies involving 30,123 participants and 3,237 women with gestational diabetes mellitus (diabetes mellitus in pregnancy).

Results and conclusions:
The investigators found comparing highest versus lowest category of dietary cholesterol intake, that the highest dietary cholesterol intake significantly increased risk of gestational diabetes mellitus with 49% [pooled RR = 1.49, 95% CI = 1.18 to 1.88].

The investigators found in dose-response analysis that the risk of gestational diabetes mellitus significantly increased by 32% [RR = 1.32, 95% CI = 1.20 to 1.45] for every increase of 100 mg per day in dietary cholesterol intake.

The investigators concluded a high dietary cholesterol intake (at least 100 mg per day) increases risk of gestational diabetes mellitus.

Original title:
Dietary Cholesterol Intake and Risk of Gestational Diabetes Mellitus: A Meta-Analysis of Observational Studies by Gao F and Cui CY.

Link:
https://pubmed.ncbi.nlm.nih.gov/33416437/

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Find more information/studies on cholesterol, diabetes mellitus and pregnancy right here.
 

Objectives:
Are serum albumin concentrations lower in patients with stable COPD compared to non-COPD controls?  

Study design:
This review article included 26 studies with a total of 2,554 COPD patients (74% males) and 2,055 non-COPD controls (63% males).
Overall, the mean age of participants across all studies was 61.7 years in COPD patients and 64.6 years in controls (patients without COPD).
Almost all (24 out of 26) were prospective cohort studies.

The Begg’s [p = 0.04] and Egger’s tests [p = 0.01] showed a significant publication bias; however, the trim-and-fill analysis found that no study was missing or should be added.

Results and conclusions:
The investigators found pooled results showed that serum albumin concentrations were significantly lower in COPD patients [SMD = -0.50, 95% CI = -0.67 to -0.32, p 0.001, I2 = 85.7%, p 0.001] .
Sensitivity analysis showed that the effect size was not modified when any single study was in turn removed [effect size ranged between -0.44 and -0.52].

The investigators found no significant differences in SMD of serum albumin concentrations between COPD patients with forced expiratory volume in the 1st second (FEV1) 50% and those with FEV1 > 50%.

The investigators concluded that serum albumin concentrations are lower in patients with stable COPD compared to non-COPD controls. This supports the presence of a deficit in systemic anti-inflammatory and antioxidant defense mechanisms in COPD.

Original title:
Serum Albumin Concentrations in Stable Chronic Obstructive Pulmonary Disease: A Systematic Review and Meta-Analysis by Zinellu E, Fois AG, […], Pirina P.

Link:
https://www.mdpi.com/2077-0383/10/2/269/htm

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Objectives:
Evidence suggests that vitamin C supplementation could be a potential therapy in type 2 diabetes. However, its effectiveness and evidence quality require further evaluation. Therefore, this review article has been conducted.

Does oral vitamin C supplementation improve glycemic control, cardiovascular risk factors and oxidative stress in people with type 2 diabetes?

Study design:
This review article included 28 RCTs with in totaal 1,574 participants.
RCTs were predominantly short term (6 months) with a small number of participants (n 100).

Results and conclusions:
The investigators found that oral vitamin C supplementation significantly reduced systolic blood pressure [mean difference = -6.27, 95% CI = -9.60 to -2.96 mmHg, p = 0.0002, with moderate evidence certainty].

The investigators found that oral vitamin C supplementation significantly reduced HbA1c levels [mean difference = -0.54%, 95% CI = -0.90 to -0.17, p = 0.004, with very low evidence certainty].

The investigators found that oral vitamin C supplementation significantly reduced diastolic blood pressure [mean difference = -3.77, 95% CI = -6.13 to -1.42 mmHg, p = 0.002, with very low evidence certainty].

The investigators concluded evidence from short-term RCTs suggests that oral vitamin C supplementation may improve glycemic control and blood pressure in people with type 2 diabetes. However, vitamin C supplementation cannot currently be recommended as a therapy until larger, long-term and high-quality trials confirm these findings.

Original title:
Effects of Vitamin C Supplementation on Glycemic Control and Cardiovascular Risk Factors in People With Type 2 Diabetes: A GRADE-Assessed Systematic Review and Meta-analysis of Randomized Controlled Trials by Mason SA, Keske MA and Wadley GD.

Link:
https://pubmed.ncbi.nlm.nih.gov/33472962/

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Objectives:
Does type 1 diabetes mellitus (T1DM) decrease bone mineral density (BMD) in children and adolescents?

Study design:
This review article included 9 cross-sectional studies with a total of 1,522 children and adolescents.

Funnel plot and the Egger test did not reveal significant publication bias.

Results and conclusions:
The investigators found a significant decrease in bone mineral density Z-score in the whole body [pooled WMD = -0.47, 95% CI = -0.92 to -0.02, I2 = 80.2%] and lumbar spine [pooled WMD = -0.41, 95% CI = -0.69 to -0.12, I2 = 80.3%] in children and adolescents with type 1 diabetes mellitus, which was consistent in published studies from Asia and South America, but inconsistent in the North America and Europe.
Sensitivity analyses did not modify these findings.

The investigators found, importantly, the differences in bone mineral density Z-scores were independent of age, level of glucose control (HbA1c) and prepubertal stage.

The investigators concluded type 1 diabetes mellitus (T1DM) decreases bone mineral density (BMD) Z-scores in the whole body and lumbar spine in children and adolescents.

Original title:
Association between type 1 diabetes mellitus and reduced bone mineral density in children: a meta-analysis by Zhu Q, J Xu J, […], Shi J.

Link:
https://pubmed.ncbi.nlm.nih.gov/33404757/  

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