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Association between Breastfeeding Duration and Cognitive Development

Association between Breastfeeding Duration and Cognitive Development

A dose-response relationship links longer duration of breastfeeding with better cognitive and motor development in children

Nutrition Remarks Health News Highlights (June 21, 2013)

Written by Deeksha Sharma, Ph.D., Health News Writer for Nutrition Remarks, Solon, OH, USA

Reviewed by Jonathan Y. Bernard, Inserm, Center for research in Epidemiology and Population Health (CESP), U1018, Epidemiology of Diabetes, Obesity and Renal Diseases: Lifelong Approach Team, F-94807, Villejuif, France; Univ Paris-Sud, UMRS 1018, F94807, Villejuif, France.

In a mother-child cohort study, ever-breastfed children scored higher than never-breastfed children on language ability and overall development assessments, after adjustments for many potential confounders. Findings suggest a significant association between longer breastfeeding duration and better cognitive and motor development in 2- and 3-year-old children.

Breastfeeding is found associated with better language and cognitive abilities but these results could be due to the differences between confounding factors like the socio-demographic and occupational characteristics of mothers who breastfed and those who did not. Therefore, new data on the relationship between breastfeeding duration and the child’s cognitive development are required to make national public health policies, especially for countries where breastfeeding rates are low. This study examines the dose–response relationship between breast milk consumption and cognitive development, with an accurate, prospective data collection of breastfeeding from a large cohort.

French EDEN Mother-Child Cohort Study is an ongoing birth-cohort study that aims to investigate the role of pre- and post-natal determinants of child growth, development, and health. From the maternal declarations about child feeding modes in questionnaires at birth, 4, 8, 12 and 24 months, exclusive and any (exclusive and mixed) breastfeeding durations were estimated. The parent-reported questionnaires Communicative Development Inventory (CDI) and Ages and Stages Questionnaire (ASQ) were used respectively to evaluate language ability in 2-year-old and overall development in 3-year-old children.

In multivariable linear models, after adjustment for potential confounders, ever-breastfed scored 3.7 ± 1.8 (mean ± SE, P = .038) higher on the CDI and 6.2 ± 1.9 (P = .001) points higher on the ASQ than never-breastfed children. Among breastfed children, adjusted linear associations between breastfeeding durations and cognitive assessments were significant and positive. For any breastfeeding duration, an additional month was related with an increase of 0.58 ± 0.20 (P = .004) CDI points and 0.60 ± 0.20 (P = .003) ASQ points. An additional month of exclusive-breastfeeding was associated with an increase of 0.75 ± 0.33 (P = .02) CDI points, and 1.00 ± 0.33 (P = .002) ASQ points. Tests of hypotheses of non-linearity of the associations between breastfeeding durations and cognitive assessments were rejected. No interaction was found between breastfeeding durations and sex, gestational age, parental education, or household income.

Exclusive breastfeeding duration was more strongly associated with both cognitive development assessments than any breastfeeding duration, which is a further argument in favor of a dose–response relationship. The main biological hypothesis to explain this association between breastfeeding and child cognitive development is based on the content of breast milk, especially long-chain poly-unsaturated fatty acids (LCPUFA) that may be essential for brain maturation in the newborn.

Study results agree with previous studies showing a relationship between breastfeeding and cognitive and motor development in early childhood. In addition, by suggesting a dose–response relationship, it brings new evidence to the possible benefits of breastfeeding. This builds a stronger argument to public health professionals for promoting longer duration and continuation of breastfeeding as well, while promoting early initiation of it.

This news highlight is based on the following article published by Jonathan Y. Bernard et al. Additional general background information was acquired from PubMed.

Bernard JY et al. Breastfeeding Duration and Cognitive Development at 2 and 3 Years of Age in the EDEN Mother-Child Cohort. J Pediatr. 2013 Jan 10. pii: S0022-3476(12)01425-4.




Food costs may influence your diet and health

Food costs may influence your diet and health

Do we need to pay more to eat healthy food?

Frontier Voice of Nutrition Remarks (December 26, 2012)

Nalin Siriwardhana, Ph.D., interviewed Dr. Anju Aggarwal, Ph.D., a pioneer scientist with training in nutritional epidemiology.

Is it true that healthy foods are always expensive? Can we be wise and pick healthy foods at a reasonable cost? What are the factors that ultimately decide the cost of healthy foods? These are some of the FAQs when it comes to healthy foods and prices. Reasonable and reliable answers can be found only after in depth systematic analyses based on nutritional and economical parameters. A recent scientific publication from Center for Public Health Nutrition, School of Public Health, University of Washington, Seattle, Washington has answered several nutrient and cost related questions. Nutrition Remarks interviewed Dr. Aggarwal, the leading author of the article and expert in nutritional epidemiology, obesity and chronic diseases.

Question from Nutrition Remarks: Why healthy foods are expensive in terms of nutrient content?

Answer from Dr. Aggarwal: In this context, I define healthy foods as those foods which provide you with nutrients without too many empty calories. In other words, healthy foods are nutrient dense and preferably energy poor foods, which help to achieve the daily nutrient requirements within the calorie needs.

Now what makes a given food cheap or expensive? It all depends on what it contains. Added sugars and fats make food energy dense but relatively cheap. Therefore, processed foods rich in added sugars and fats are not healthy but cheap. By contrast, fruits and vegetables are relatively higher in water and nutrient content but lower in added sugars and fats, which make them healthy but expensive.

Question: According to your study, what are the nutrients that cost more and why are they important?

a) The present study has shown that, based on the dietary patterns of our sample, intake all beneficial nutrients (vitamins and minerals) cost more as compared to food components-to-limit (fats and added sugars).

b) Among beneficial nutrients, some nutrients are relatively more expensive than the other depending on the food source. For example: potassium, magnesium, vitamin C, beta carotene obtained from fruits and vegetables are much more expensive than calcium and vitamin D that are obtained from dairy products and fortified foods.

c) All nutrients are important in one’s diet ranging from fats to vitamins and minerals. However, 2010 Dietary Guidelines have identified four nutrients as nutrients of concern – potassium, fiber, vitamin D and calcium.

d) In the present sample – nutrients like potassium and fiber came from expensive sources whereas calcium and vitamin D came from cheaper sources.

It should be noted that the observed relation between diet costs and dietary intakes are based on dietary patterns followed by Americans. Eating healthy need not cost more if consumers are willing to change their dietary habits and are wise enough to choose healthier less expensive options.

Question: What are the nutrients in less expensive food and how they affect health in short and long term basis?

Answer: You can get all the nutrients in less expensive forms. However, the general rule is that foods with higher proportion of added sugars and fats (such as fried foods, grain based desserts, soft drinks, meats) are less expensive. Higher consumption of such foods, over short term, lead to higher calorie intakes without meeting daily nutrient requirements. Over long term, this may increase the risk of metabolic syndrome, obesity, diabetes and put you at a risk of cardiovascular diseases.

Additionally, if you are not able to meet your daily nutrient requirements, it may lead to various nutritional deficiencies as well over time.

Question: Whatchronic diseases are common for those who consume less expensive food?
There are no studies, to my knowledge, that have directly linked diet costs with health outcomes. However, what we already know from existing cross sectional studies is that:

a) Socioeconomic status (SES) is positively associated with diet cost and diet quality,

b) diet cost is positively associated with diet quality, and

c) diet quality is positively associated with health outcomes.

Findings from all these studies combined imply that lower SES tends to consume less expensive diets which tend to be lower in diet quality. Those with poor diet quality are in turn associated with higher risk of various chronic diseases, ranging from metabolic syndrome to cardiovascular diseases to nutritional deficiencies.

Question: How you suggest improving the food quality in low SES groups?

Answer: That is a big question that everyone is trying to find an answer to! We need to take a multi-factorial approaches such as:

a) Promote nutrition education to motivate and help consumers make healthier food choices and shop wisely: Existing studies have shown that, based on current dietary patterns in the US, healthier diets do cost more. However, eating healthy need not be expensive as long as people know what to buy and are willing to make healthier food choices. Although lower SES groups may not be able to accommodate most expensive forms of fruits and vegetables in their diet; however, there are relatively cheaper sources of the same which can very well be adopted in the diet.

b) Dietary Guidelines need to take diet cost into account: Current dietary guidelines (DGAC 2010) promote intake of all the nutrients, particularly the four nutrients of concern – potassium, fiber, calcium and vitamin D. However, based on current dietary patterns of Americans, following dietary guidelines is likely to entail higher diet costs for the consumers. DGAC needs to identify and promote inexpensive forms of variousnutrients, to make these guidelines practical and feasible for the consumers.

c) Ensuring physical access to healthy foods: Recent research has proposed that not all Americans have physical access to supermarkets or healthy foods, which may be one of the reasons for their poor diet quality. Thus, improving access to supermarkets has become the focus of recent public health policy and initiatives. While this may be one of the pre-requisites to improve diets of the population; it may not be the solution until the above strategies are adopted simultaneously.

Question: Are there any regional or cultural differences that further worsen food quality in low SES groups?

Answer: I am sure there is a huge regional and cultural variation. It would be very interesting to see how the observed associations of diet cost, diet quality and health among lower SES groups in developed countries differ from developing countries. My long term goal is to extend out my current research to developing countries.

Question: Whatare the important information that we did not discuss here?

Answer: We have already talked about the potential role of diet costs in influencing diets and health, particularly among lower socioeconomic groups. However, I would like to re-emphasize that one’s decision about what to buy, where to buy and what to eat is influenced by interplay of many other factors such as taste, convenience, physical access to food, culture and food preferences, and food-related attitudes. Further research is needed to fully understand the role of these factors across socioeconomic groups in determining dietary intakes and health.

This news release was a follow-up based on the following original scientific article published by Dr. Aggarwal.

Aggarwal et al Nutrient Intakes Linked to Better Health Outcomes Are Associated with Higher Diet Costs in the US PLOS one -May 25, 2012

Additional general background information was acquired from PubMed and NIH sources.

Dr. Aggarwal would like to acknowledge that the funding was provided by National Institute of Health – NIDDK R01DK076608. She would also like to acknowledge the Principal Investigator of the study, Dr. Adam Drewnowski. He is the Director of Center for Public Health Nutrition at the University of Washington.

Dr. Anju Aggarwal, Ph.D., Dr. Aggarwal’s research interests are in the area of nutritional epidemiology, obesity and chronic diseases. In particular, she is interested in better understanding of the pathways that may explain socioeconomic disparities in diets and health. Her current research is focusing on examining the role of four A’s – access to food environment, availability, affordability and attitudes in determining diet quality and obesity across socioeconomic strata. She is also interested in examining culture-based beliefs and behaviors in relation to diets and health, both in developed and developing countries.

More about Dr. Aggarwal


Written by NalinSiriwardhana, PhD.

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Copyright © 2012 Nutrition Remarks. All rights reserved

Trans Fats are Harmful for Mental Health

Trans Fats are Harmful for Mental Health

Frontier Voice of Nutrition Remarks (December 5, 2011)

Nalin Siriwardhana, PhD, interviewed Cristina Ruano from Prof. Almudena Sánchez-Villega’s research group

Trans fatty acids (trans fats), also called hydrogenated oils, are seriously harmful to human health. Processed foods like fries, doughnuts, cookies, pizza, crackers, and margarines are common sources of trans fats. Trans fats are well-known to promote the risk of heart disease and type 2 diabetes. A recent study has discovered that trans fats are also harmful to mental health. Prof. Sánchez-Villega’s group from Spain systematically studied a large number of individuals (8,430 participants) and showed the harmful effects of trans fats on mental health. According to the study, eating 1 gram of trans fats per day can harmfully affect mental health and could be associated even with mental disorders.

Estimated average trans fats consumption in the Unites States and Canada is 3 to 4 grams per day (Craig-Schmidt, 2006). If numbers are compared, Americans and Canadians eat three to four times more than the harmful levels of trans fats per day.

High-fat milk products and red meat are common sources of saturated fats. Saturated fats can increase bad cholesterol in blood and thus increase heart disease risk. Further, Prof. Sánchez-Villega’s study showed that those who frequently eat a Mediterranean diet have a lower intake of saturated fats and therefore have a healthier lifestyle.

Nutrition Remarks interviewed Cristina Ruano from Prof. Sánchez-Villega’s research group regarding their recent findings. A simplified version of the conversation is as follows:

Question from Nutrition Remarks: What are the main sources of trans fats?

Answer from Cristina Ruano: Processed foods, such as fries, doughnuts, cookies, pizza, crackers, margarines, and high-fat dairy products.

Question: How do trans fats affect health?

Answer: Trans fats increase bad cholesterol (low-density lipoprotein or LDL) and reduce good cholesterol (high-density lipoprotein or HDL). Trans fats can increase inflammation and oxidative stress. Also, trans fats can harmfully affect the nervous system.

Question: How do saturated fats affect health?

Answer: Saturated fats can increase blood cholesterol levels and cause various types of heart disease.

Question: CantheMediterranean diet overcome the effects of saturated fats?

Answer: Those people who frequently eat a Mediterranean diet have a have a lower saturated fats intake and therefore have a healthier lifestyle. Also, there is scientific evidence of the beneficial role of the Mediterranean diet on quality of life, depression risk, and other physical illness like cardiovascular disease, diabetes, or even cancer.

Question: Can the Mediterranean diet beneficially affect quality of life?

Answer: Yes, we have previously published our findings to show that the Mediterranean dietary pattern is directly associated with mental and physical quality of life.

Question: The population you studied ate anaverage of 1 gram of trans fats per day while average Americans and Canadians consume 3 to 4 grams per day. How serious is the risk for Americans and Canadians?

Answer: If we compare the numbers and predict the risk, they are at very high risk. However, a detailed study is required to answer how high that risk is.

Written by Nalin Siriwardhana, PhD

Authors acknowledge the following Spanish public and official agency for funding biomedical research: Instituto de Salud Carlos III.

Original work: Ruano et al. Dietary fat intake and quality of life: the SUN

Project. Nutrition Journal 2011, 10:121.

Cristina Ruano from Dr. Almudena Sanchez-Villegas’s research group is the first author of the original work published in Nutrition Journal. She has been working in the project entitled: “The role of diet and physical activity on quality of life and mental illness in the SUN project” granted by the Spanish agency for funding biomedical research for the last three years. The SUN project (http://www.unav.es/departamento/preventiva/sun ) is a multipurpose, dynamic cohort conducted in Spain with the aim of analyzing the effect of different factors, mainly nutritional factors, on health outcomes such as cardiovascular disease, diabetes, obesity or depression.

Copyright © 2011 Nutrition Remarks. All rights reserved

Health Benefits and Concerns of Fish Oil Use

Health Benefits and Concerns of Fish Oil Use

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Health Benefits and of Fish Oil

Health Benefits and of Fish Oil


What is fish oil?

Fish oil is a well-known healthy fat with numerous health benefits. The most important and abundant components of fish oil are called omega-3 fatty acids (ω-3 fatty acids)/n-3 fatty acids. Docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) are the two major ω-3 fatty acid forms available in fish oil. DHA and EPA in fish oil offer promising health benefits to improve and maintain human health.

What do scientists say about fish oil?


Scientific evidence suggests that consumption of fish oil, along with reduced consumption of saturated fats and ω-6 fatty acids, can significantly improve human health. This improvement is mainly due to the scientific evidence that EPA and DHA can lower harmful triglycerides and bad cholesterol (low-density lipoprotein/LDL) while increasing good cholesterol (high-density lipoprotein/HDL). Moreover, fish oil is known to provide multifunctional health benefits to overcome cardiovascular disease (CVD), inflammation, signs of aging, arthritis, depression and various cancers. There has been a marked increase of fish oil-related scientific studies as well as commercial interest during the past few years. Improved versions of fish oil products backed by proven scientific evidence are now available on the market.

How to get fish oil

Consumption of fish such as anchovies, bluefish, herring, mackerel, mullet, sardines, salmon, sturgeon, tuna, and trout can enrich our bodies with fish oil. In addition, fish oil supplements are commercially available as soft gel capsules. Some of these supplements contain added vitamins, antioxidants, and various attractive flavors.

What are the concerns?

It is always a concern that heat, light, and oxygen can promote the degradation of fish oil supplements and thus cause production of harmful compounds. However, with recent advances in science, incorporation of antioxidants into fish oil and effective storage and packaging methods have been developed to assure quality. However, it is important to follow the storage guidelines provided with the products and simply avoid, as much as possible, exposing the supplement to heat, light, and oxygen. When it comes to cooking fish, extended cooking time and higher temperatures can reduce the beneficial effects of fish oil and even make fish oil unhealthy.

The quality and source of the fish oil is also highly important. Some fish and fish oil supplements may have unhealthy levels of heavy metals such as mercury and selenium. Especially during pregnancy, when eating fish or taking fish oil supplements, it is always good to carefully read the product labels and select the fish oil


Nalin Siriwardhana, PhD

Sean Perera, PhD

Misty R. Bailey, MA, ELS

Health benefits and concerns of Soy Isoflavones

Health benefits and concerns of Soy

Both soy beans and soy products contain soy isoflavones. Soy isoflavones are also available asextracts and capsules. Soy
isoflavones are well studied bioactive compounds dueto promising health benefits. Daidzein and Genistein are the main bioactive soy isoflavones andthey are well known for their bioactivities similar to human estrogen thus,called as phytoestrogens. Also, phytoestrogenic soy isoflavones are known to improve health in postmenopausal women by providing estrogen-like effects. There are scientific evidence that soy isoflavones provide health benefits against cancer,diabetes, cardio vascular diseases (CVD), aging, viral infections and manyother disease conditions. Specifically, they are promising preventive naturalalternatives for prostate and breast cancer. In general they are strong anti-oxidants and anti-inflammatory compounds. Moreover, Equol,an isoflavan produced by intestinal bacteria in response to isoflavone intake,exhibits a wide range of biological properties. Here we provide the most recentscientific evidence regarding the health benefits and concerns of soy isoflavones.

Nalin Siriwardhana Ph.D.

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