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      The IMpact of Vertical HIV infection on child and Adolescent SKeletal development in Harare, Zimbabwe (IMVASK Study): a protocol for a prospective cohort study

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          Abstract

          Introduction

          The scale-up of antiretroviral therapy (ART) across sub-Saharan Africa (SSA) has reduced mortality so that increasing numbers of children with HIV (CWH) are surviving to adolescence. However, they experience a range of morbidities due to chronic HIV infection and its treatment. Impaired linear growth (stunting) is a common manifestation, affecting up to 50% of children. However, the effect of HIV on bone and muscle development during adolescent growth is not well characterised. Given the close link between pubertal timing and musculoskeletal development, any impairments in adolescence are likely to impact on future adult musculoskeletal health. We hypothesise that bone and muscle mass accrual in CWH is reduced, putting them at risk of reduced bone mineral density (BMD) and muscle function and increasing fracture risk. This study aims to determine the impact of HIV on BMD and muscle function in peripubertal children on ART in Zimbabwe.

          Methods and analysis

          Children with (n=300) and without HIV (n=300), aged 8–16 years, established on ART, will be recruited into a frequency-matched prospective cohort study and compared. Musculoskeletal assessments including dual-energy X-ray absorptiometry, peripheral quantitative computed tomography, grip strength and standing long jump will be conducted at baseline and after 1 year. Linear regression will be used to estimate mean size-adjusted bone density and Z-scores by HIV status (ie, total-body less-head bone mineral content for lean mass adjusted for height and lumbar spine bone mineral apparent density. The prevalence of low size-adjusted BMD (ie, Z-scores <−2) will also be determined.

          Ethics and dissemination

          Ethical approval for this study has been granted by the Medical Research Council of Zimbabwe and the London School of Hygiene and Tropical Medicine Ethics Committee. Baseline and longitudinal analyses will be published in peer-reviewed journals and disseminated to research communities.

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          Advocacy for Improving Nutrition in the First 1000 Days to Support Childhood Development and Adult Health

          Sarah Schwarzenberg, Michael K. Georgieff (2018)
          Maternal prenatal nutrition and the child's nutrition in the first 2 years of life (1000 days) are crucial factors in a child's neurodevelopment and lifelong mental health. Child and adult health risks, including obesity, hypertension, and diabetes, may be programmed by nutritional status during this period. Calories are essential for growth of both fetus and child but are not sufficient for normal brain development. Although all nutrients are necessary for brain growth, key nutrients that support neurodevelopment include protein; zinc; iron; choline; folate; iodine; vitamins A, D, B6, and B12; and long-chain polyunsaturated fatty acids. Failure to provide key nutrients during this critical period of brain development may result in lifelong deficits in brain function despite subsequent nutrient repletion. Understanding the complex interplay of micro- and macronutrients and neurodevelopment is key to moving beyond simply recommending a "good diet" to optimizing nutrient delivery for the developing child. Leaders in pediatric health and policy makers must be aware of this research given its implications for public policy at the federal and state level. Pediatricians should refer to existing services for nutrition support for pregnant and breastfeeding women, infants, and toddlers. Finally, all providers caring for children can advocate for healthy diets for mothers, infants, and young children in the first 1000 days. Prioritizing public policies that ensure the provision of adequate nutrients and healthy eating during this crucial time would ensure that all children have an early foundation for optimal neurodevelopment, a key factor in long-term health.
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            Global variation in grip strength: a systematic review and meta-analysis of normative data

            Richard M. Dodds, Holly E Syddall, Rachel Cooper … (2016)
            Background: weak grip strength is a key component of sarcopenia and is associated with subsequent disability and mortality. We have recently established life course normative data for grip strength in Great Britain, but it is unclear whether the cut points we derived for weak grip strength are suitable for use in other settings. Our objective was to investigate differences in grip strength by world region using our data as a reference standard. Methods: we searched MEDLINE and EMBASE for reporting age- and gender-stratified normative data for grip strength. We extracted each item of normative data and converted it on to a Z-score scale relative to our British centiles. We performed meta-regression to pool the Z-scores and compare them by world region. Findings: our search returned 806 abstracts. Sixty papers met inclusion criteria and reported on 63 different samples. Seven UN regions were represented, although most samples (n = 44) were based in developed regions. We extracted 726 normative data items relating to 96,537 grip strength observations. Normative data from developed regions were broadly similar to our British centiles, with a pooled Z-score 0.12 SDs (95% CI: 0.07, 0.17) above the corresponding British centiles. By comparison, normative data from developing regions were clearly lower, with a pooled Z-score of −0.85 SDs (95% CI: −0.94, −0.76). Interpretation: our findings support the use of our British grip strength centiles and their associated cut points in consensus definitions for sarcopenia and frailty across developed regions, but highlight the need for different cut points in developing regions.
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              Exercise and bone health across the lifespan

              Lívia Santos, Kirsty Elliott-Sale, Craig Sale (2017)
              With ageing, bone tissue undergoes significant compositional, architectural and metabolic alterations potentially leading to osteoporosis. Osteoporosis is the most prevalent bone disorder, which is characterised by progressive bone weakening and an increased risk of fragility fractures. Although this metabolic disease is conventionally associated with ageing and menopause, the predisposing factors are thought to be established during childhood and adolescence. In light of this, exercise interventions implemented during maturation are likely to be highly beneficial as part of a long-term strategy to maximise peak bone mass and hence delay the onset of age- or menopause-related osteoporosis. This notion is supported by data on exercise interventions implemented during childhood and adolescence, which confirmed that weight-bearing activity, particularly if undertaken during peripubertal development, is capable of generating a significant osteogenic response leading to bone anabolism. Recent work on human ageing and epigenetics suggests that undertaking exercise after the fourth decade of life is still important, given the anti-ageing effect and health benefits provided, potentially occurring via a delay in telomere shortening and modification of DNA methylation patterns associated with ageing. Exercise is among the primary modifiable factors capable of influencing bone health by preserving bone mass and strength, preventing the death of bone cells and anti-ageing action provided.
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                Author and article information

                Journal
                Journal ID (nlm-ta): BMJ Open
                Journal ID (iso-abbrev): BMJ Open
                Journal ID (hwp): bmjopen
                Journal ID (publisher-id): bmjopen
                Title: BMJ Open
                Publisher: BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                ISSN (Electronic): 2044-6055
                Publication date Collection: 2020
                Publication date (Electronic): 9 February 2020
                Volume: 10
                Issue: 2
                Electronic Location Identifier: e031792
                Affiliations
                [1 ] departmentClinical Research Department , London School of Hygiene and Tropical Medicine , London, UK
                [2 ] Biomedical Research and Training Institute , Harare, Zimbabwe
                [3 ] departmentMusculoskeletal Research Unit , University of Bristol , Bristol, UK
                [4 ] departmentOlder Person's Unit , Royal United Hospital NHS Trust , Bath, UK
                [5 ] departmentDepartment of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health , London School of Hygiene and Tropical Medicine , London, UK
                [6 ] departmentDepartment of Radiology , University of Zimbabwe , Harare, Zimbabwe
                [7 ] departmentDepartment of Paediatrics and Child Health, College of Health Sciences , University of Zimbabwe , Harare, Zimbabwe
                [8 ] departmentLifecourse Epidemiology Unit , MRC , Southampton, UK
                [9 ] departmentPopulation Health , London School of Hygiene & Tropical Medicine , London, UK
                [10 ] departmentInfectious Disease Epidemiology , London School of Hygiene and Tropical Medicine , London, UK
                [11 ] departmentClinical Research Department , London School of Hygiene and Tropical Medicine , London, UK
                Author notes
                [Correspondence to ] Dr Ruramayi Rukuni; ruramayi.rukuni@ 123456lshtm.ac.uk
                Author information
                http://orcid.org/0000-0002-2111-1311
                http://orcid.org/0000-0001-9967-5822
                Article
                Publisher ID: bmjopen-2019-031792
                DOI: 10.1136/bmjopen-2019-031792
                PMC ID: 7045196
                PubMed ID: 32041852
                SO-VID: 14cb415c-fd91-45c9-a396-f8796df1c8af
                Copyright © © Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY. Published by BMJ.
                License:

                This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.

                History
                Date received : 18 May 2019
                Date revision received : 08 December 2019
                Date accepted : 02 January 2020
                Categories
                Subject: Public Health
                Subject: Protocol
                Subject: 1506
                Subject: 1724
                Custom metadata
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                ScienceOpen disciplines: Medicine
                Keywords: hiv & aids,tropical medicine,paediatric radiology,epidemiology
                Data availability:
                ScienceOpen disciplines: Medicine
                Keywords: hiv & aids, tropical medicine, paediatric radiology, epidemiology

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