Per Ole Iversen

• Gervin, Kristina; Kverneland, Magnhild; Nakken, Karl Otto; Rudi, Knut; Iversen, Per Ole & Selmer, Kaja Kristine (2026). Epigenetic ageing is accelerated in drug-resistant epilepsy and dynamically modulated during ketogenic diet therapy. EBioMedicine. 131. doi: 10.1016/j.ebiom.2026.106449.
• Daele, Wim Van; Tadeo, Raul Yhossef Tito; Perera, Jennifer; Tshokey, Tshokey; Iversen, Per Ole & Jayasinghe, Saroj [Show all 12 contributors for this article] (2026). Toward ethical human microbiome research: improving health through radical interdisciplinary and intercultural co-laboration. Microbiome. 14. doi: 10.1186/s40168-026-02340-w. Full text in Research Archive Show summary

  Abstract As human microbiome research is globalizing, it raises ethical concerns regarding the European and North American dominance in the field, which may reproduce a colonial bias and perpetuate inequities in global health research and outcomes. We suggest disentangling this ethical quandary into three main concerns: 1) scientific bias toward European and North American populations; 2) limited meaningful community inclusion, participation, and ownership, and 3) scant significant inclusion of diverse global researchers. We then formulate three recommendations for their resolution, deploying co-laboration —joint labor of diverse partners in generating synergies between diverse disciplines, cultures, and knowledges around shared concerns—and co-laborative science —a form of citizen science based on such synergies between diverse partners—to guide meaningful inclusive, participatory, and ethical human microbiome research. To conclude, we promote a programmatic list for putting co-laborative ethical science into practice, benefiting global communities, individuals, and researchers alike and decolonizing and improving health worldwide.

• Kjendbakke, Ida; Selmer, Kaja Kristine; Nakken, Karl Otto; Hofoss, Dag; Iversen, Per Ole & Kverneland, Magnhild (2026). Micronutrient intake in adults with drug-resistant epilepsy treated with the modified Atkins diet needs monitoring. Frontiers in Nutrition. 13. doi: 10.3389/fnut.2026.1797011. Full text in Research Archive
• Gervin, Kristina; Kverneland, Magnhild; Nakken, Karl Otto; Rudi, Knut; Iversen, Per Ole & Landmark, Cecilie Johannessen [Show all 7 contributors for this article] (2026). DNA methylation of antiseizure medication metabolism genes and pharmacokinetic changes in adult epilepsy patients treated with the modified Atkins diet. Genes & Nutrition. ISSN 1555-8932. 21. doi: 10.1186/s12263-026-00796-x. Full text in Research Archive Show summary

  Background The modified Atkins diet is increasingly used as an adjunctive therapy for drug-resistant epilepsy. Recent evidence suggests that such dietary interventions may affect the pharmacokinetics of antiseizure medications and induce DNA methylation changes. However, it remains unclear whether epigenetic regulation of drug-metabolizing enzymes contributes to variability in medication serum levels. Results We analyzed 58 adults with drug-resistant epilepsy treated with a modified Atkins diet for 12 weeks. DNA methylation was profiled in peripheral blood before diet initiation (baseline) and after 4 weeks and 12 weeks using a genome-wide array. A total of 131 cytosine-phosphate-guanine (CpG) sites mapped to 13 candidate genes involved in antiseizure medication metabolism were assessed. One CpG in the CES1 gene showed significant methylation changes from baseline to 4 weeks, 12 weeks, and across all timepoints (FDR = 0.0018), indicating consistent longitudinal effects. Repeated measures correlation analyses were used to evaluate within-individual associations between DNA methylation and antiseizure medication serum concentrations. Two CpG–drug associations showed strong positive intra-individual correlations: CYP3A5 methylation was significantly associated with carbamazepine serum levels (repeated measures correlation coefficient = 0.81, FDR = 0.023), whereas CYP3A4 methylation showed a similarly strong but borderline association with topiramate (correlation coefficient = 0.76, FDR = 0.051). Conclusions This study finds that a modified Atkins diet may be associated with DNA methylation variation at genes involved in drug metabolism. Furthermore, DNA methylation levels were strongly associated with individual serum concentrations of certain antiseizure medications. These findings are consistent with the concept of a diet–epigenome–drug metabolism axis and warrant further investigation in larger studies to assess clinical implications for personalized dietary and pharmacological management in epilepsy.

• Klevmoen, Marianne; Lennep, Jeanine Roeters van; Bogsrud, Martin Prøven; Vesterbekkmo, Elisabeth Kleivhaug; Pedersen, Eva Ringdal & Hovland, Anders Wilhelm [Show all 14 contributors for this article] (2026). Extensive pregnancy-related off-treatment time in women with familial hypercholesterolaemia. Atherosclerosis. ISSN 0021-9150. 415. doi: 10.1016/j.atherosclerosis.2026.120668. Full text in Research Archive Show summary

  Background and aims: Women with familial hypercholesterolaemia (FH) lose substantial treatment time during their reproductive years as most lipid-lowering therapies are contraindicated from the preconception through the end of breastfeeding. We examined the duration of real-life pregnancy-related off-treatment time in 27 women with FH in Norway. Methods: Women with FH in Norway who had completed the ongoing FH-FEMINA study (ClinicalTrials.gov ID NCT05367310) were included. Women were followed from 36th week of gestation and until one year after delivery or until end of breastfeeding. Information on use of medication before, during and after the current and previous pregnancies was collected. Pregnancy-related off-treatment time was calculated from discontinuation of lipid-lowering therapy when planning pregnancy, throughout pregnancy, and after delivery. Results: The total duration of pregnancy-related off-treatment time after all childbirths (median 1, range 1-3) per woman was a median of 2.9 years (25th-75th percentile; 1.6-4.0), ranging from 0.8 to 12 years. The pregnancy itself accounted for median of 42.1% of the pregnancy-related off-treatment time, whereas the time before and after pregnancy accounted for a median of 57.9% (range 11.4% to 91.2%). When including untreated years in childhood and/or prior to diagnosis, the lifelong off-treatment time represented a median of 66.3% (range 41.9 to 100%) of lifetime without treatment. Conclusion: Early diagnosis and initiation of treatment is essential in girls with FH to compensate for pregnancy-related off-treatment time later in life. To minimize these pregnancy-related off-treatment periods, healthcare professionals should support women with FH to resume lipid-lowering therapy immediately after breastfeeding and between pregnancies. In addition, more knowledge on the potential effects of statin use during pregnancy and breastfeeding on maternal and offspring health is urgently needed.

• Iversen, Per Ole; Gedde-Dahl, Tobias; Tjønnfjord, Geir Erland & Ali, Maryan Mohamed (2025). Quality of life the first year after allogeneic haematopoietic stem cell transplantation—A randomized controlled trial examining extracorporeal photophoresis to prevent graft‐versus‐host disease. British Journal of Haematology. ISSN 0007-1048. 207(5), p. 2183–2186. doi: 10.1111/bjh.70119. Full text in Research Archive
• Gudmundstuen, Anne Marte; Iversen, Per Ole; Pesonen, Maiju; Hjermstad, Marianne Jensen; Bye, Asta & Tjønnfjord, Geir Erland [Show all 7 contributors for this article] (2025). Comparing indirect calorimetry and predictive equations for energy expenditure - 1 year follow-up of adult hematopoietic stem cell transplanted recipients. Clinical Nutrition ESPEN. ISSN 2405-4577. 70, p. 218–226. doi: 10.1016/j.clnesp.2025.09.027. Full text in Research Archive Show summary

  Background and aims Recipients of allogeneic hematopoietic stem cell transplantation (allo-HSCT) often undergo body composition changes that may impact their energy expenditure (EE), however, the accurate energy requirements may be difficult to estimate. Indirect calorimetry (IC) is recommended as the gold standard to assess measured energy expenditure (mEE), but its use is resource-demanding and thus rarely applied compared to predictive energy equations. Here we evaluated the agreement between mEE by IC and EE estimated by several predictive energy equations, or the ESPEN recommendation, during 1-year follow-up of adult allo-HSCT recipients. Methods We examined 117 adult patients with hematological malignancies who received allo-HSCT. mEE was assessed by IC in non-fasting patients before transplantation, and at 3, 6, 9 and 12 months post-allo-HSCT. Agreement between mEE and predictive values using the Harris-Benedict-HB, Mifflin St. Jeor-MSJ, Ireton Jones-IJ equations and the fixed ESPEN recommendation of 25 kcal/kg/day was evaluated using Bland–Altman analysis and accuracy within ± 10 %. Changes in mEE over time were analyzed using linear mixed model with age as a covariate. Results A total of 509 mEE measurements by IC were obtained. HB and MSJ overestimated mEE on average (mean bias: + 2.9 and + 3.8 kcal/kg/day), while IJ, and the fixed ESPEN recommendation underestimated mEE (biases: – 0.7 and – 4.7 kcal/kg/day, respectively). None of the equations or the fixed ESPEN recommendation achieved > 50 % accuracy within ± 10 % of mEE by IC. IJ had the highest variability and widest limits of agreement. mEE changed significantly over time (p < 0.001), with no significant differences between the initially randomized intervention and control group (p = 0.982). Mean mREE was 24.74 ± 3.80 kcal/kg/day and 31.14 ± 4.91 kcal/kg/day when adjusted for FFM. Age was not significantly associated with mREE (p = 0.198). Conclusion Our findings indicate that commonly used predictive equations and the fixed ESPEN recommendation showed limited accuracy compared with mEE in allo-HSCT recipients. Only mEE obtained by IC captured longitudinal changes in EE during the first year post-transplantation. mEE by IC varied significantly the first year post-transplant. ClinicalTrials.gov, ID NCT01181076.

• Singh, Preet Bano; Singh, Simon Vivan; Iversen, Per Ole & Jensen, Janicke Liaaen (2025). Evaluation and management of chemosensory, trigeminal and salivary dysfunctions in patients with post coronavirus disease. Clinical Nutrition ESPEN. ISSN 2405-4577. 70(December 2025), p. 452–462. doi: 10.1016/j.clnesp.2025.10.018. Full text in Research Archive Show summary

  Background & aims While the management of olfactory disorders among patients with post Coronavirus Disease (COVID-19) is well elucidated, treatment of taste dysfunction, oral burning, and oral dryness is less extensively studied among post-COVID-19 patients. This prospective study aimed (i) to assess the prevalence of chemosensory, trigeminal, and salivary dysfunctions in patients at two different time points following COVID-19 infection, and (ii) to evaluate the recovery process over time. Methods In this cross-sectional study, 54 Early-post-COVID-19 (3–11 months since COVID-19), 46 Late-post-COVID-19 (≥12 months since COVID-19) and 76 Non-COVID-19 controls were recruited. Participants’ olfactory, gustatory, trigeminal, and salivary status were investigated. Depending on the test outcomes, tailored treatments were administered, and patients were monitored every 3–6 months. Results The findings indicated that none of these dysfunctions improved on their own over time. Patients in both post-COVID-19 groups demonstrated significantly reduced smell, trigeminal and salivary functions compared to the control group. Taste impairment was significantly more severe in Late-post-COVID-19 patients compared to Early-post-COVID-19 patients. Follow-up evaluations revealed significant improvement in both smell and taste functions at each follow-up visit across both patient groups. Conclusion Chemosensory, trigeminal, and salivary disorders in post-COVID-19 patients may not resolve with time alone, underscoring the need for tailored treatments to achieve significant improvements.

• Skaarud, Kristin Aneta Joan; Gudmundstuen, Anne Marte; Pesonen, Maiju; Hjermstad, Marianne Jensen; Iversen, Per Ole & Tjønnfjord, Geir Erland (2025). The role of fat-soluble vitamins for graft-versus host disease after myeloablative conditioning in allogeneic stem cell transplanted patients. Scientific Reports. 15. doi: 10.1038/s41598-024-84805-2. Full text in Research Archive Show summary

  Whether the fat-soluble vitamins A, D, E, and K are associated with development of graft-versus-host disease (GvHD) after allogeneic stem cell transplantation, is unclear. We assessed if the levels of these vitamins were associated with development of GvHD during the first year after transplantation using data from a two-armed randomized nutritional intervention trial. Changes in plasma levels during 1-year follow-up were analyzed using a linear mixed model for repeated measurements. Vitamin A, D, E, and K levels changed significantly the first year in both study arms (p < 0.001). Higher levels of vitamin E over time were associated with less acute GvHD grades 3–4 (OR = 0.997, 95% CI: (0.994, 0.999), p = 0.017). No associations were found with vitamin A, D, E and K levels and chronic GvHD. Multivariable analysis adjusted for treatment group, age, pre-transplant vitamin level and risk factors for GvHD did not change the results. Six weeks post-transplantation, higher levels of vitamin E were associated with less acute GvHD grades 3–4, (p = 0.012). In conclusion, we found an association between higher levels of vitamin E over time and less severe acute GvHD. Whether this reflects a causal relationship warrants further study. ClinicalTrials.gov (NCT01181076).

• Tushabe, Gerald; Rukundo, Peter Milton; Kaaya, Archileo Natigo; Nahalomo, Aziiza; Nateme, NC & Iversen, Per Ole [Show all 8 contributors for this article] (2025). Retrogressive or misplaced priorities? An assessment of public expenditure for food security and disaster risk reduction in Uganda. International Journal of Disaster Risk Management (IJDRM). ISSN 2620-2662. 7, p. 15–38. doi: 10.18485/ijdrm.2025.7.1.2. Full text in Research Archive Show summary

  The article argues that a rights-based approach to public investment and expenditure in agriculture and disaster risk management is a viable pathway for Uganda to realise the right to adequate food and sustainable development in line with the government’s national and international human rights commitments. This study employed a qualitative research paradigm to examine both primary and secondary data on public investment and expenditure in food security and disaster risk reduction in Uganda. Fifty-six key informant interviews were conducted with purposively selected officials at national and Local Government levels. Data and insights obtained were analysed using thematic and rights-based budget analyses. There is minimal application of rights-based approach principles in the budgeting for food security or disaster risk reduction in Uganda. Public expenditure in the agriculture sector and disaster risk management is inadequate to meet the increasing disasters in the country or to effectively protect the right to adequate food of vulnerable communities in disaster-prone regions. As a State Party to the International Covenant on Economic, Social and Cultural Rights and a signatory to the Sendai Framework for Disaster Risk Reduction, Uganda is obligated to protect and fulfil the right to adequate food for vulnerable communities in the event of disasters. This will require increased public and private investment in the agriculture sector and strengthening the disaster risk financing mechanisms at both national and Local Government levels.

• Hjertholm, Katrine; Iversen, Per Ole; Holmboe-Ottesen, Gerd & Jepsen, Randi (2025). Risk factors for undernutrition and poor growth during the first 6 months of life in sub-Saharan Africa: A scoping review. Clinical Nutrition ESPEN. ISSN 2405-4577. 68, p. 309–318. doi: 10.1016/j.clnesp.2025.05.019. Full text in Research Archive Show summary

  Background & aims Early infant undernutrition and suboptimal growth represent significant public health challenges in many low- and middle-income countries, yet information regarding the risk factors for poor growth remains limited. A scoping review was conducted to map the existing evidence on indicators of undernutrition and poor growth and related risk factors among infants aged 0–6 months in sub-Saharan Africa. Methods This scoping review was conducted in accordance with the Joanna Briggs Institute framework and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews. MEDLINE, Embase, and Scopus were systematically searched for eligible studies, with no restrictions on time or language. Results A total of 50 studies met the inclusion criteria for this review. The most frequently reported indicator of undernutrition was stunting, followed by underweight and wasting. Sex, feeding, illness, and birth size were the most studied infant risk factors for poor growth. The maternal risk factors most frequently investigated included age, education, human immunodeficiency virus infection, and occupation. Socioeconomic status and factors related to water, sanitation, and hygiene were the most studied household risk factors. Conclusions Several indicators of undernutrition and poor growth were identified, with stunting being the most frequently reported. Associated risk factors included multiple infant-, maternal-, and household factors, highlighting the need for complex multilayered interventions to address undernutrition and poor growth among these vulnerable infants.

• Song, Peige; Adeloye, Davies; Acharya, Yubraj; Bojude, Danladi Adamu; Ali, Sajjad & Alibudbud, Rowalt [Show all 59 contributors for this article] (2024). Setting research priorities for global pandemic preparedness: An international consensus and comparison with ChatGPT's output. Journal of Global Health. ISSN 2047-2978. 14. doi: 10.7189/jogh.14.04054. Full text in Research Archive
• Kakwangire, Paul; Ngari, Moses; Muhoozi, Grace Kyamazima Mehangye; Westerberg, Ane Cecilie; Friberg, Prudence Atukunda & Iversen, Per Ole (2024). Associations between sociodemographic exposures, growth and development during infancy with development at the age of eight years among children: Analysis of a maternal education trial in rural Uganda. Journal of Global Health. ISSN 2047-2978. 14. doi: 10.7189/jogh.14.04228. Full text in Research Archive Show summary

  Background Links between early life exposures and child development later in life are not sufficiently explored in low- and middle-income countries. We studied associations between sociodemographic variables, growth and development at six to eight months with developmental outcomes at eight years. Methods We used data from a maternal education trial which included 511 mother-infant pairs at children’s age of six to eight months (baseline). In this follow-up study, data from 361 mother-child pairs were available. Questionnaires were used to collect sociodemographic variables. Growth (anthropometry) was measured by study personnel and converted to z-scores according to the World Health Organization (WHO) growth reference. Child development (cognitive, motor and language) at baseline was assessed using Bayley Scales of Infant and Todler Development, third edition (BSID-III). Development at eight years was measured using two neuropsychological tools: Kaufman Assessment Battery for Children Second Edition (KABC-II) and Test of Variables of Attention (TOVA). Results Higher weight-for-age z-scores (adjusted odds ratio (aOR) = 0.74; 95% confidence interval (CI) = 0.53, 0.98; P = 0.04), better maternal education (aOR = 0.86; 95% CI = 0.78, 0.96; P = 0.03). and better household head education (aOR = 0.86; 95% CI = 0.78, 0.96; P = 0.03) at six to eight months of age were associated with lower odds of scoring below average on KABC-II categorical scores at eight years of age. Motor composite scores and maternal parity at six to eight months of age were positively associated with auditory and visual TOVA scores (all P-values <0.05) at eight years. Cognitive composite scores at six to eight months of age were positively associated with visual TOVA scores (P < 0.05). In contrast, weight-for-length z-scores and household head age were negatively associated with both auditory and visual TOVA scores (P < 0.05). Being a female child was associated with lower auditory and visual TOVA scores (P < 0.05). Conclusions At six to eight months of age, growth and development, gender, maternal education and parity, and household head age and education were associated with child development at eight years. Interventions emphasising improved growth and development in infancy, as well as parental educational attainment, may improve long-term developmental outcomes.

• Brevik, Oda Kallevig; Kaaya, A.N. & Iversen, Per Ole (2024). AFLATOXIN EXPOSURE IN CHILDREN AGED 4 MONTHS TO 5 YEARS FROM SUB-SAHARAN AFRICA AND ITS EFFECT ON STUNTED CHILD GROWTH – A TOPICAL REVIEW. African Journal of Food, Agriculture, Nutrition and Development. ISSN 1684-5358. 24(11), p. 25121–25142. doi: 10.18697/AJFAND.136.25060. Full text in Research Archive Show summary

  The mould species fungi encompass among others the family of Aspergillus which produce and secrete a number of compounds toxic to human health, namely the aflatoxins. These mycotoxins are converted to secondary metabolites that exert the often detrimental biological effect, and they are commonly found in various foods such as fruits, nuts, seeds, and grains. Members of the Aspergillus family thrive in wet and humid conditions, so they are particularly prevalent in regions with a tropical climate, for example in countries in sub-Saharan Africa. Aflatoxins are a type of mycotoxins considered to be among the most known potent mutagenic and carcinogenic substances. For example, it can cause liver cancer. Importantly, aflatoxins often contaminate weaning foods consumed by small children. This topical review outlines the evidence on the associations between aflatoxin exposure and impaired linear growth (stunting, that is low height/length for age) in small children (aged 4 months to 5 years) from sub-Saharan Africa. Ten studies were retrieved from the database PubMed after considering predefined inclusion and exclusion criteria. Six out of the ten studies found a significant inverse association between increased aflatoxin exposure and stunted child growth. Although aflatoxin exposure and stunting prevalence were high and widespread in most of the included studies, in general, studies conducted in Western Africa had the highest aflatoxin exposure and stunting prevalence. The only included randomized controlled trial found that a diet aimed at reducing aflatoxin exposure significantly improved linear growth in children at 13, but not at 22, months of age. The evidence suggests that aflatoxins have an impact on linear growth among children aged 4 months to five years. Possibly there is a threshold value for aflatoxin exposure before a significant impact on growth can be identified. Raised awareness and management strategies for the high aflatoxin exposure rates in sub-Saharan Africa and its negative health effects, in particular stunted child growth, are warranted.

• Kakwangire, Paul; Muhoozi, Grace Kyamazima Mehangye; Ngari, Moses; Matovu, Nicholas; Westerberg, Ane Cecilie & Iversen, Per Ole [Show all 7 contributors for this article] (2024). 8-Year Follow-up of a Maternal Education Trial in a Low-Resource Setting. Pediatrics. ISSN 0031-4005. 153(4). doi: 10.1542/peds.2023-063352. Full text in Research Archive
• Kakwangire, Paul; Atukunda, Prudence; Ngari, Moses; Westerberg, Ane Cecilie; Iversen, Per Ole & Muhoozi, Grace Kyamazima Mehangye (2024). Long-term effects on depressive symptoms among Ugandan mothers – Findings from a follow-up of a cluster-randomized education trial in a rural low-resource setting. Journal of Affective Disorders. ISSN 0165-0327. 351, p. 598–606. doi: 10.1016/j.jad.2024.01.263. Full text in Research Archive Show summary

  Introduction Depression is increasingly affecting mothers in poor countries such as Uganda. Various interventions have been implemented to tackle this problem, but their sustainability is under-researched. Here we present follow-up data on maternal depression six years after a cluster-randomized controlled maternal education trial in rural Uganda. Methods The intervention lasted six months and consisted of nutrition, hygiene, sanitation and child stimulation education, delivered to 511 mothers of 6 to 8 months' old children. Six years later we assessed maternal depressive symptoms using two psychometric tools; the Beck Depression Inventory II (BDI-II) and Center for Epidemiologic Studies Depression scale (CESsingle bondD). Results For this follow-up study, data was available from 307/511 (60 %) mothers. Intention-to-treat analyses adjusting for clustering showed that the intervention mothers had non-significantly less depression symptoms (absolute score difference − 2; 95 % CI -5 to 0; p = 0.07) on BDI-II, and borderline significantly less depression symptoms (absolute score difference − 3; 95 % CI -5 to 0; p = 0.05) on CES-D compared to the controls. For categorized depression scores, the control mothers had significantly higher proportion of women classified in the worse depression categories for both BDI-II and CESsingle bondD. We did not find any baseline characteristics associated with maternal depression. Limitations The BDI-II and CES-D tools are both self-reported and we cannot rule out the possibility of social desirability bias in reporting of depression symptoms. Conclusion Six years after the maternal education trial, some benefits on maternal mental health were sustained. More studies are warranted on sustainability and scale-up of such interventions.

• Koroma, Aminata; Stephenson, Kevin; Iversen, Per Ole; Manary, Mark & Hendrixson, David Taylor (2024). The Effect of Breastfeeding Practices of Undernourished Mothers in Rural Sierra Leone on Infant Growth and Mortality. Children. 11(2). doi: 10.3390/children11020233. Full text in Research Archive Show summary

  Breastfeeding provides optimal infant nutrition; however, &lt;50% of infants are exclusively breastfed (EBF) for 6 months. We aimed to describe breastfeeding practices and their effects on growth and mortality among a high-risk mother-infant cohort in rural Sierra Leone. This was a secondary analysis of data from a randomized nutrition intervention trial among undernourished pregnant women. The study’s primary outcomes were infant weight and length gains at 6 weeks of age. We included 1270 singleton infants in the analysis, with 1092 (85.6%) having 24-week outcome data. At 6 weeks, 88% were EBF, but the rate of EBF decreased to 17% at 24 weeks. The EBF infants at 6 weeks had improved length (difference of 0.9 mm/week; 95% CI 0.4 to 1.3; p &lt; 0.001) and weight (difference of 40 g/week; 95% CI 24 to 53; p &lt; 0.001) gains compared to the non-EBF infants. At 12 weeks, the EBF infants had improved weight (difference of 12 g/week; 95% CI 2 to 22; p = 0.024) gain. The EBF infants had lower mortality than the infants who were not EBF (hazard ratio of 0.39; 95% CI 0.18 to 0.84; p = 0.017). In summary, the infants who were EBF had greater weight and length gain and reduced mortality than those who were not EBF. Efforts to improve breastfeeding should thus be prioritized to improve infant health.

• Iversen, Per Ole; Guéant, Jean-Louis; Oussalah, A; Refsum, Helga; Nexo, Ebba & Tjønnfjord, Geir Erland [Show all 7 contributors for this article] (2024). Heterozygous Mutations in Both the AMN and CBS Genes: Double Haploinsufficiency as an Unusual Cause of Vitamin B12 Deficiency-A Case Report. Clinical Case Reports. 12(11). doi: 10.1002/ccr3.9600. Full text in Research Archive Show summary

  Vitamin B12 deficiency is usually simple to diagnose. However, our patient demonstrates that in difficult cases, the ordinary clinician may need a transdisciplinary approach. The finding of a double haploinsufficiency as a possible cause of vitamin B12 deficiency in our patient, illustrates the usefulness of performing large panel clinical exome sequencing.

• Ngari, Moses; Mwangome, Martha; Ouma, N; Nyaguara, A; Mturi, Neema & Obiero, Christina [Show all 12 contributors for this article] (2024). Inpatient and postdischarge mortality among children with anaemia and malaria parasitaemia in Kenya: A cohort study. BMJ Global Health. 9(10). doi: 10.1136/bmjgh-2024-016600. Full text in Research Archive Show summary

  Background Anaemia and malaria are leading causes of paediatric hospitalisation and inpatient mortality in sub-Saharan Africa. However, there is limited empirical data on survival following hospital discharge. We aimed to estimate independent effects of anaemia and malaria parasitaemia on inpatient and 1 year postdischarge mortality among Kenyan children. Methods A retrospective cohort study among children admitted to Kilifi County Hospital (KCH) from 2010 to 2019 and followed-up for 1 year postdischarge in Kilifi Health and Demographic Surveillance System (KHDSS). The main exposures were anaemia and malaria parasitaemia at the time of hospital admission while inpatient and 1 year postdischarge mortality were the outcomes. Results We included 9431 admissions among 7578 children (43% girls), median (IQR) age 19 (9.9‒23) months. 2069 (22%), 3893 (41%) and 1140 (12%) admissions had mild, moderate and severe anaemia, whereas 366 (3.9%), 779 (8.3%) and 224 (2.4%) had low, medium and high malaria parasitaemia, respectively. Overall, there were 381 (4.0%) inpatient deaths: 317/381 (83%) and 47/381 (12%) among children with any level of anaemia and malaria parasitaemia, respectively. Moderate and severe, but not mild anaemia, were positively associated with inpatient death. Low and high level parasitaemia were positively associated with inpatient mortality, while medium level parasitaemia was negatively associated. There were 228 (3.1%) postdischarge deaths: 32.8 (95% CI 28.8‒37.3) deaths/1000 child-years. 180/228 (79%) deaths occurred within 6 months after index discharge and 99/228 (43%) occurred in the community. Overall, 180/228 (79%) and 10/228 (4.4%) postdischarge deaths occurred among children with any level of anaemia and malaria parasitaemia, respectively. Severe anaemia was positively associated with postdischarge mortality (adjusted HR 1.94 (95% CI 1.11‒3.40)), while medium level parasitaemia was negatively associated. Conclusion Interventions to create awareness of postdischarge risks, improve uptake of existing interventions and improved discharge processes targeting high-risk groups such as children admitted with severe anaemia, need to be prioritised.

• Hasanaliyeva, Gulatikin; Giannakopoulou, O; Wang, Juan; Baranski, Marcin; Sulfar, E & Knutt, Daryl [Show all 18 contributors for this article] (2024). Effects of Climatic Conditions and Agronomic Practices on Health, Tuber Yield and Mineral Composition of two contrasting Potato Varieties developed for High and Low Input Production Systems. Agronomy. 15(1). doi: 10.3390/agronomy15010089. Full text in Research Archive Show summary

  Modern potato varieties from high-input, conventional farming-focused breeding programs produce substantially (up to 45%) lower yields when grown in organic production systems, and this was shown to be primarily due to less efficient fertilization and late blight (Phytophthora infestans) control methods being used in organic farming. It has been hypothesized that the breeding of potato varieties suitable for the organic/low-input sector should (i) focus on increasing nutrient (especially N) use efficiency, (ii) introduce durable late blight resistance, and (iii) be based on selection under low-input conditions. To test this hypothesis, we used an existing long-term factorial field experiment (the NEFG trials) to assess the effect of crop management practices (rotation design, fertilization regime, and crop protection methods) used in conventional and organic farming systems on crop health, tuber yield, and mineral composition parameters in two potato varieties, Santé and Sarpo mira, that were developed in breeding programs for high and low-input farming systems, respectively. Results showed that, compared to Santé, the variety Sarpo mira was more resistant to foliar and tuber blight but more susceptible to potato scab (Streptomyces scabies) and produced higher yields and tubers with higher concentrations of nutritionally desirable mineral nutrients but lower concentrations of Cd. The study also found that, compared to the Cu-fungicides permitted for late blight control in organic production, application of synthetic chemical fungicides permitted and widely used in conventional production resulted in significantly lower late blight severity in Sante but not in Sarpo mira. Results from both ANOVA and redundancy analysis (RDA) indicate that the effects of climatic (precipitation, radiation, and temperature) and agronomic (fertilization and crop protection) explanatory variables on crop health and yield differed considerably between the two varieties. Specifically, the RDA identified crop protection as a significant driver for Santé but not Sarpo mira, while precipitation was the strongest driver for crop health and yield for Sarpo mira but not Santé. In contrast, the effect of climatic and agronomic drivers on tuber mineral and toxic metal concentrations in the two varieties was found to be similar. Our results support the hypothesis that selection of potato varieties under low agrochemical input conditions can deliver varieties that combine (i) late blight resistance/tolerance, (ii) nutrient use efficiency, and (iii) yield potential in organic farming systems.

• Kamudoni, Penjani Rhoda; Katenga-Kaunda, Lilián Ziyenda; Tharrey, Marion; Tharrey, M; Mphande, Maggie & Chithambo, Shyreen [Show all 13 contributors for this article] (2024). Context-Tailored Food-Based Nutrition Education and Counseling for Pregnant Women to Improve Birth Outcomes: A Cluster-Randomized Controlled Trial in Rural Malawi. Current Developments in Nutrition (CDN). 8(12). doi: 10.1016/j.cdnut.2024.104506. Full text in Research Archive Show summary

  Background Inadequate maternal dietary intakes remain a public health challenge in low-income countries like Malawi and can cause adverse birth outcomes. Objectives To improve maternal dietary intakes and thus reduce the prevalence of adverse birth outcomes in rural Malawi. Methods We performed a 2-armed (1:1) cluster-randomized controlled trial in Southern Malawi, enrolling pregnant women at gestational age 12–18 wk. Twenty villages (clusters) were randomly assigned to an intervention or a control group. A nutrition education and counseling (NEC) intervention consisted of education sessions followed by cooking demonstrations and counseling sessions. The women were encouraged to use locally available nutrient-dense foods to enhance dietary adequacy and -diversity. We applied linear programming to identify food combinations that could increase micronutrient intakes. The control group received standard antenatal health education. Results Among the 311 women recruited, 187 (60%) completed the trial. We found no significant difference in mean birth weights recorded within 1 or 24 h of birth between the intervention and control groups. Intervention infants had greater birth length (P = 0.043) and abdominal circumference (P = 0.007) compared to controls, whereas other birth outcomes did not differ significantly. Notably, a quantile analysis revealed that the NEC intervention favored birth weight among mothers with a height below the mean height of the participant sample (156 cm) (P-interaction = 0.043). Conclusions Tailoring NEC in food-insecure communities did not result in a significant difference in birth weight among infants of the participating mothers, but mean birth length and abdominal circumference were greater in the intervention group compared to controls. We noted that the NEC intervention favored birth weight among mothers with a lower height than the mean sample height. Our results warrant further investigation into offering tailored NEC early in pregnancy and on a larger scale.

• Wang, Juan; Sufar, Enas Khalid; Bernhoft, Aksel; Seal, Chris; Rempelos, Leonidas & Hasanaliyeva, Gultekin [Show all 11 contributors for this article] (2024). Mycotoxin contamination in organic and conventional cereal grain and products: A systematic literature review and meta-analysis. Comprehensive Reviews in Food Science and Food Safety. 23(3). doi: 10.1111/1541-4337.13363. Full text in Research Archive Show summary

  There is still considerable controversy about the relative risk of mycotoxin exposure associated with the consumption of organic and conventional cereals. Using validated protocols, we carried out a systematic literature review and meta-analyses of data on the incidence and concentrations of mycotoxins produced by Fusarium, Claviceps, Penicillium, and Aspergillus species in organic and conventional cereal grains/products. The standard weighted meta-analysis of concentration data detected a significant effect of production system (organic vs. conventional) only for the Fusarium mycotoxins deoxynivalenol, with concentrations ∼50% higher in conventional than organic cereal grains/products (p < 0.0001). Weighted meta-analyses of incidence data and unweighted meta-analyses of concentration data also detected small, but significant effects of production system on the incidence and/or concentrations of T-2/HT-2 toxins, zearalenone, enniatin, beauvericin, ochratoxin A (OTA), and aflatoxins. Multilevel meta-analyses identified climatic conditions, cereal species, study type, and analytical methods used as important confounding factors for the effects of production system. Overall, results from this study suggest that (i) Fusarium mycotoxin contamination decreased between the 1990s and 2020, (ii) contamination levels are similar in organic and conventional cereals used for human consumption, and (iii) maintaining OTA concentrations below the maximum contamination levels (3.0 μg/kg) set by the EU remains a major challenge.

• Stevanovic, Stanislava; Dalmao-Fernandez, Andrea; Mohamed, Derya; Nyman, Tuula Anneli; Kostovski, Emil & Iversen, Per Ole [Show all 11 contributors for this article] (2024). Time-dependent reduction in oxidative capacity among cultured myotubes from spinal cord injured individuals. Acta Physiologica. ISSN 1748-1708. 240:e14156(7), p. 1–15. doi: 10.1111/apha.14156. Full text in Research Archive Show summary

  Background Skeletal muscle adapts in reaction to contractile activity to efficiently utilize energy substrates, primarily glucose and free fatty acids (FA). Inactivity leads to atrophy and a change in energy utilization in individuals with spinal cord injury (SCI). The present study aimed to characterize possible inactivity-related differences in the energy metabolism between skeletal muscle cells cultured from satellite cells isolated 1- and 12-months post-SCI. Methods To characterize inactivity-related disturbances in spinal cord injury, we studied skeletal muscle cells isolated from SCI subjects. Cell cultures were established from biopsy samples from musculus vastus lateralis from subjects with SCI 1 and 12 months after the injury. The myoblasts were proliferated and differentiated into myotubes before fatty acid and glucose metabolism were assessed and gene and protein expressions were measured. Results The results showed that glucose uptake was increased, while oleic acid oxidation was reduced at 12 months compared to 1 month. mRNA expressions of PPARGC1α, the master regulator of mitochondrial biogenesis, and MYH2, a determinant of muscle fiber type, were significantly reduced at 12 months. Proteomic analysis showed reduced expression of several mitochondrial proteins. Conclusion In conclusion, skeletal muscle cells isolated from immobilized subjects 12 months compared to 1 month after SCI showed reduced fatty acid metabolism and reduced expression of mitochondrial proteins, indicating an increased loss of oxidative capacity with time after injury.

• Rogn, Åsmund; Jensen, Janicke Liaaen; Iversen, Per Ole & Singh, Preet Bano (2024). Post-COVID-19 patients suffer from chemosensory, trigeminal, and salivary dysfunctions. Scientific Reports. 14. doi: 10.1038/s41598-024-53919-y. Full text in Research Archive Show summary

  Recent literature indicates that post-COVID-19 patients suffer from a plethora of complications, including chemosensory dysfunction. However, little attention has been given to understand the interactions between chemosensory, trigeminal, and salivary dysfunctions in these patients. The aims of this study were (1) to investigate the prevalence and combinations of chemosensory, trigeminal, and salivary dysfunctions, (2) to identify the odorants/tastants that are compromised, and (3) to explore possible associations between the four dysfunctions in post-COVID-19 patients. One hundred post-COVID-19 patients and 76 healthy controls (pre-COVID-19) were included in this cross-sectional, case-controlled study. Participants' smell, taste, trigeminal, and salivary functions were assessed. The patients had a significantly higher prevalence of parosmia (80.0%), hyposmia (42.0%), anosmia (53.0%), dysgeusia (34.0%), complete ageusia (3.0%), specific ageusia (27.0%), dysesthesia (11.0%) and dry mouth (18.0%) compared to controls (0.0% for all parameters, except 27.6% for hyposmia). Complete loss of bitter taste was the most prevalent specific ageusia (66.7%) and coffee was the most common distorted smell (56.4%). Seven different combinations of dysfunction were observed in the patients, the most common being a combination of olfactory and gustatory dysfunction (48.0%). These findings indicate that post-COVID-19 patients experience a range of chemosensory, trigeminal, and salivary disturbances, occurring in various combinations.

• Hasanaliyeva, Gultekin; Sufar, Enas Khalid; Wang, Juan; Rempelos, Leonidas; Volakakis, Nikolaos & Iversen, Per Ole [Show all 7 contributors for this article] (2023). Effects of Agricultural Intensification on Mediterranean Diets: A Narrative Review. Foods. 12(20). doi: 10.3390/foods12203779. Full text in Research Archive Show summary

  Introduction: Mediterranean diets (MedDiets) are linked to substantial health benefits. However, there is also growing evidence that the intensification of food production over the last 60 years has resulted in nutritionally relevant changes in the composition of foods that may augment the health benefits of MedDiets. Objective: To synthesize, summarize, and critically evaluate the currently available evidence for changes in food composition resulting from agricultural intensification practices and their potential impact on the health benefits of MedDiets. Methods: We summarized/synthesized information from (i) systematic literature reviews/meta-analyses and more recently published articles on composition differences between conventional and organic foods, (ii) desk studies which compared food composition data from before and after agricultural intensification, (iii) recent retail and farm surveys and/or factorial field experiments that identified specific agronomic practices responsible for nutritionally relevant changes in food composition, and (iv) a recent systematic literature review and a small number of subsequently published observational and dietary intervention studies that investigated the potential health impacts of changes in food composition resulting from agricultural intensification. Results and Discussion: There has been growing evidence that the intensification of food production has resulted in (i) lower concentrations of nutritionally desirable compounds (e.g., phenolics, certain vitamins, mineral micronutrients including Se, Zn, and omega-3 fatty acids, α-tocopherol) and/or (ii) higher concentrations of nutritionally undesirable or toxic compounds (pesticide residues, cadmium, omega-6 fatty acids) in many of the foods (including wholegrain cereals, fruit and vegetables, olive oil, dairy products and meat from small ruminants, and fish) that are thought to contribute to the health benefits associated with MedDiets. The evidence for negative health impacts of consuming foods from intensified conventional production systems has also increased but is still limited and based primarily on evidence from observational studies. Limitations and gaps in the current evidence base are discussed. Conclusions: There is now substantial evidence that the intensification of agricultural food production has resulted in a decline in the nutritional quality of many of the foods that are recognized to contribute to the positive health impacts associated with adhering to traditional MedDiets. Further research is needed to quantify to what extent this decline augments the positive health impacts of adhering to a traditional MedDiet.

• Stover, Patrick J.; Field, Martha S.; Andermann, Mark L.; Bailey, Regan L.; Batterham, Rachel L. & Cauffman, Elizabeth [Show all 14 contributors for this article] (2023). Neurobiology of eating behavior, nutrition, and health. Journal of Internal Medicine. ISSN 0954-6820. 294(5), p. 582–604. doi: 10.1111/joim.13699. Full text in Research Archive Show summary

  Abstract Eating behavior and food‐related decision making are among the most complex of the motivated behaviors, and understanding the neurobiology of eating behavior, and its developmental dynamics, is critical to advancing the nutritional sciences and public health. Recent advances from both human and animal studies are revealing that individual capacity to make health‐promoting food decisions varies based on biological and physiological variation in the signaling pathways that regulate the homeostatic, hedonic, and executive functions; past developmental exposures and current life‐stage; the food environment; and complications of chronic disease that reinforce the obese state. Eating rate drives increased calorie intake and represents an important opportunity to lower rates of food consumption and energy intake through product reformulation. Understanding human eating behaviors and nutrition in the context of neuroscience can strengthen the evidence base from which dietary guidelines are derived and can inform policies, practices, and educational programs in a way that increases the likelihood they are adopted and effective for reducing rates of obesity and other diet‐related chronic disease.

• Rempelos, Leonidas; Wang, Juan; Sufar, Enas Khalid; Almuayrifi, Mohammed Saleh Bady; Knutt, Daryl & Leifert, Halima [Show all 18 contributors for this article] (2023). Breeding Bread-Making Wheat Varieties for Organic Farming Systems: The Need to Target Productivity, Robustness, Resource Use Efficiency and Grain Quality Traits. Foods. 12(6). doi: 10.3390/foods12061209. Full text in Research Archive Show summary

  Agronomic protocols (rotation, tillage, fertilization and crop protection) commonly used in organic and conventional crop production differ significantly and there is evidence that modern varieties developed for conventional high-input farming systems do not have the combination of traits required for optimum performance in organic farming systems. Specifically, there is evidence that prohibition on the use of water-soluble, mineral N, P and K fertilizers and synthetic pesticide inputs in organic farming results in a need to revise both breeding and selection protocols. For organic production systems, the focus needs to be on the following: (i) traits prioritized by organic farmers such as high nutrient use efficiency from organic fertilizer inputs, competitiveness against weeds, and pest and disease resistance, (ii) processing quality parameters defined by millers and bakers and (iii) nutritional quality parameters demanded by organic consumers. In this article, we review evidence from variety trials and factorial field experiments that (i) studied to what extent there is a need for organic farming focused breeding programs, (ii) investigated which traits/trait combinations should be targeted in these breeding programs and/or (iii) compared the performance of modern varieties developed for the conventional sector with traditional/older varieties favored by organic farmers and/or new varieties developed in organic farming focused breeding programs. Our review focuses on wheat because there have been organic and/or low-input farming focused wheat breeding programs for more than 20 years in Europe, which has allowed the performance of varieties/genotypes from organic/low-input and conventional farming focused breeding programs to be compared.

• Meshkovska, Biljana; Gebremariam, Mekdes; Atukunda, Prudence; Iversen, Per Ole; Wandel, Margareta & Lien, Nanna (2023). Barriers and facilitators to implementation of nutrition-related actions in school settings in low- and middle-income countries (LMICs): a qualitative systematic review using the Consolidated Framework for Implementation Research (CFIR). Implementation Science Communications. 4(1). doi: 10.1186/s43058-023-00454-y. Full text in Research Archive Show summary

  Background Low- and middle-income countries (LMICs) are particularly vulnerable to the double burden of malnutrition: co-existence of underweight, overweight, obesity, and/or diet-related non-communicable diseases. Nutrition-related double-duty actions in school settings have been identified as one of the ways to address this challenge. However, to be able to take full advantage of the potential impact, it is important to understand their implementation as well. The aim of this paper is to systematically review qualitative research on barriers and facilitators to the implementation of nutrition-related actions in the school settings in LMICs. Methods The following databases were searched: EMBASE, ERIC, MEDLINE, Global Health and PsycInfo (all on Ovid), Scopus (Elsevier), the Web of Science Social Sciences Citation Index, and Global Index Medicus from the World Health Organization. Of the 4253 identified records, 4030 were excluded after the abstract and title screen, leaving 223 for the full-text screen. A final 36 papers were included in this review. The consolidated framework for implementation research (CFIR) was used in the analysis. Results We identified barriers and facilitators to implementation linked to the following CFIR constructs/sub-constructs: design quality and packaging, cost (intervention characteristics); target group needs and resources, cosmopolitanism, external policy and incentives (outer setting); structural characteristics, readiness for implementation (inner setting); knowledge and beliefs (characteristics of individuals) and engaging, executing (process). All identified constructs apart from target group needs and resources, knowledge and beliefs, and engaging were predominantly barriers. Available resources were the most prevalent barriers across studies. Conclusion This review identified barriers and facilitators to the implementation of nutrition-related actions based on qualitative articles in the school setting in LMICs, using the CFIR. Schools face continuous challenges in regard to funding and the government sector may have a role to play not only by offering financial assistance, but also through policy-making that would support healthy eating practices on school grounds.

• Barin, Agnese; Das, Ranjit K.; Bastani, Nasser Ezzatkhah; Iversen, Per Ole & Duttaroy, Asim Kanti (2023). Extracts of tamarillo, horned melon, and raspberry, but not extract of pear, inhibit human blood platelet aggregation: Investigating the underlying factors for their differential mechanisms. Journal of Functional Foods. ISSN 1756-4646. 110. doi: 10.1016/j.jff.2023.105847. Full text in Research Archive Show summary

  In addition to their roles in thrombosis, hyperactive platelets contribute to atherosclerosis. Since anti-platelet drugs are not recommended for the vulnerable population with hyperactive platelets to reduce the risk of cardiovascular disease, a search is on to find alternative dietary antiplatelets that can be safely used. We here describe that in a dose-dependent manner, sugar-free extracts of tamarillo, horned melon (kiwano), and raspberry inhibited ADP-induced platelet aggregation in platelet-rich plasma, whereas pear extract had no effects. Furthermore, analysis of untargeted metabolites revealed the presence of platelet inhibitory components such as benzoic acid, caffeic acid, and gallic acid in the sugar-free extracts of tamarillo, raspberry, and kiwano but absent in pear extract. All these three fruit extracts inhibited the platelet production of TxB2 and the release of platelet factor 4. Our work suggests that these fruits inhibit platelet aggregation partly due to anti-platelet compounds such as benzoic, caffeic, and gallic acids.

• Pedersen, Sigrid; Kverneland, Magnhild; Rudi, Knut; Gervin, Kristina; Landmark, Cecilie Johannessen & Iversen, Per Ole [Show all 7 contributors for this article] (2023). Decreased serum concentrations of antiseizure medications in children with drug resistant epilepsy following treatment with ketogenic diet. Epilepsia Open. 8(3), p. 858–866. doi: 10.1002/epi4.12746. Full text in Research Archive Show summary

  Objective To examine the potential influence of a ketogenic diet on serum concentrations of antiseizure medications (ASMs) in children with drug resistant epilepsy. Methods We investigated the serum concentrations of ASMs in 25 children with drug resistant epilepsy, 2–13 years of age, treated with a classical ketogenic diet for 12 weeks. The patients were recruited from the National Centre for Epilepsy from August 15th, 2017, to January 24th, 2022. Changes in ASM serum concentrations were analyzed using a mixed effect model analysis. Significance level was set at P < 0.05 for all comparisons. Results The participants used 12 different ASMs during the study. The mean number of ASMs was 2.4 (±SD 0.7). None of the participants changed the type or dose of the ASMs during the intervention period. The serum concentrations of clobazam (n = 9, P = 0.002), desmethylclobazam (n = 9, P = 0.010), and lamotrigine (n = 6, P = 0.016) decreased significantly during the dietary treatment. The analytes with the largest reduction in serum concentration after 12 weeks of dietary treatment were clobazam (mean change −38%) and desmethylclobazam (mean change −37%). We found no significant change in the serum concentrations of levetiracetam, topiramate, and valproic acid. Significance We identified a significant decrease in the serum concentrations of clobazam, desmethylclobazam, and lamotrigine following a 12-week ketogenic diet intervention in children with drug resistant epilepsy. An unintended decrease in the serum concentrations of ASMs may render the patient prone to seizures. Measurements of ASM serum concentrations might be useful in patients on a ketogenic diet, especially in patients with lack of efficacy of the dietary treatment.

• Iversen, Per Ole & Fogelholm, Mikael (2023). Fluid and water balance: a scoping review for the Nordic Nutrition Recommendations 2023. Food & Nutrition Research (FNR). ISSN 1654-6628. 67. doi: 10.29219/fnr.v67.9975. Full text in Research Archive Show summary

  Water, being an essential nutrient, is crucial for all life. Adequate maintenance of body water compartments is required for optimal fluid balance, which is a prerequisite for cellular homeostasis and blood pressure regulation. Water balance is the result of dietary intake of both fluids and foods as well as metabolically produced water, excretion from the kidneys and losses from other sources (e.g. sweat and feces). The water content in food items varies considerably and ranges from about 5% in nuts to 90% in many fruits and vegetables. Intake of drinking water and beverages also provides varying amounts of water. In everyday life assessment of water balance (i.e. hydration status) is challenging as clinical observations are inaccurate. There is no data regarding drinking water intake in the Nordic or Baltic countries.

• Molteberg, Ellen; Thorsby, Per Medbøe; Kverneland, Magnhild; Iversen, Per Ole; Selmer, Kaja Kristine & Hofoss, Dag [Show all 8 contributors for this article] (2023). Stress biomarkers in adult patients with drug-resistant epilepsy on a modified Atkins diet: A prospective study. Epilepsia Open. 8, p. 1331–1339. doi: 10.1002/epi4.12808. Full text in Research Archive Show summary

  Abstract Objective Ketogenic diets like the modified Atkins diet (MAD) are increasingly used in patients with refractory epilepsy. For epilepsy patients, stress is a well‐known seizure‐precipitating factor. New possibilities for measuring biomarkers of stress are now available. The purpose of this study was to investigate the impact of MAD on endocrine stress biomarkers. Methods Forty‐nine patients with drug‐resistant epilepsy were investigated at baseline and after 12 weeks on MAD. Cortisol and cortisol‐binding globulin (CBG) were measured and free cortisol index (FCI) calculated. We also measured metanephrine, normetanephrine, and methoxytyramine, all markers of epinephrine, norepinephrine, and dopamine, respectively. Changes were analyzed according to sex and antiseizure medications. The different markers at baseline and after 12 weeks of MAD treatment were correlated with seizure frequency and weight loss, respectively. Results The change in total cortisol was modest after 12 weeks on the diet (from 432.9 nmol/L (403.1–462.7)) to 422.6 nmol/L (384.6–461.0), P  = 0.6). FCI was reduced (from 0.39 (0.36–0.42) to 0.34 (0.31–0.36), P  = 0.001). CBG increased during the study (from 1126.4 nmol/L (1074.5–1178.3) to 1272.5 nmol/L (1206.3–1338.7), P  &lt; 0.001). There were no changes in the metanephrines after 12 weeks on the diet. The decrease in FCI was significant only in women, and only observed in patients using nonenzyme‐inducing ASMs. We did not find any correlation between cortisol, CBG, or FCI levels and seizure frequency. Significance After being on MAD for 12 weeks, FCI decreased significantly. The reduction in FCI may reflect reduced stress, but it may also be an effect of increased CBG. The reasons behind these alterations are unknown. Possibly, the changes may be a result of a reduction in insulin resistance and thyroid hormone levels. Treatment with MAD does not seem to influence “fight or flight” hormones.

• Kisali, Eka; Iversen, Per Ole & Makani, Julie (2023). Low vitamin B<inf>12</inf> blood levels in sickle cell disease: Data from a large cohort study in Tanzania. British Journal of Haematology. ISSN 0007-1048. 204, p. 1047–1053. doi: 10.1111/bjh.19265. Full text in Research Archive Show summary

  Summary Sickle cell disease (SCD) is associated with high rates of undernutrition and stunting. Undernutrition in combination with chronic haemolysis may lead to deficiencies in micronutrients necessary for erythropoiesis. Here we examined selected levels of ferritin, vitamins B 2 , B 6 , B 9 and B 12 , and vitamin C that were measured in blood samples from 820 SCD patients from Tanzania with no history of hospital admission, infections or painful episodes in the previous 30 days. We studied children (0–8 years), early adolescents (9–14 years), late adolescents (15–17 years) and adults (≥18 years). Severely low levels of vitamin B 12 were observed across the four age groups. Despite the lowered vitamin B 12 concentrations, total homocysteine concentrations were normal across both genders in all age groups. We found no significant gender‐related differences between the other measured micronutrients. In this large SCD population, spanning the whole life cycle, a low level of vitamin B 12 was consistently found across both genders and all age groups. Given the pivotal role of vitamin B 12 in cellular metabolism, particularly in erythropoiesis, more studies are required to unravel how to better detect clinically relevant vitamin B 12 deficiency among SCD patients, and thus to identify more precisely those who need supplementation of vitamin B 12 .

• Gudmundstuen, Anne Marte; Efficace, Fabio; Tjønnfjord, Geir Erland; Skaarud, Kristin Aneta Joan; Cottone, Francesco & Hjermstad, Marianne Jensen [Show all 7 contributors for this article] (2023). The prognostic value of patient-reported outcomes in allogeneic hematopoietic stem cell transplantation: exploratory analysis of a randomized nutrition intervention trial. Annals of Hematology. ISSN 0939-5555. 102(4), p. 927–935. doi: 10.1007/s00277-023-05149-x. Full text in Research Archive Show summary

  Whether patient-reported outcomes (PROs) can predict overall survival (OS) and non-relapse mortality (NRM) among recipients of allogeneic stem cell transplantation (allo-HSCT), is unclear. We performed an exploratory analysis of the prognostic value of patient-reported outcomes (PROs) among 117 recipients of allogeneic stem cell transplantation (allo-HSCT) who participated in a randomized nutrition intervention trial. Cox proportional hazards models were used to investigate possible associations between PROs collected pre-allo-HSCT (baseline) using scores from the EORTC Quality of Life Questionnaire-Core 30 (QLQ-C30) and 1-year overall survival (OS), whereas logistic regression was used to study associations between these PROs and 1-year non-relapse mortality (NRM). Multivariable analyses indicated that only the Hematopoietic Cell Transplantation Comorbidity Index (HCT-CI) and the European Bone Marrow Transplantation (EBMT) risk score were associated with 1-year OS. In the multivariable model including clinical-sociodemographic factors for 1-year NRM, our analysis showed that living alone (p=0.009), HCT-CI (p=0.016), EBMT risk score (p=0.002), and stem cell source (p=0.046) could be associated with 1-year NRM. Moreover, in the multivariable model, our analysis showed that only appetite loss from the QLQ-C30 was associated with 1-year NRM (p=0.026). In conclusion, in this specific setting, our analysis suggests that the commonly used HCT-CI and EBMT risk scores could be predictive for both 1-year OS and 1-year NRM, whereas baseline PROs in general were not.

• Ahmed, Md Montasir; Muhoozi, Grace Kyamazima Mehangye; Atukunda, Prudence; Westerberg, Ane Cecilie; Iversen, Per Ole & Wangen, Knut Reidar (2023). Cognitive development among children in a low-income setting: Cost-effectiveness analysis of a maternal nutrition education intervention in rural Uganda. PLOS ONE. 18(8). doi: 10.1371/journal.pone.0290379. Full text in Research Archive Show summary

  Inadequate nutrition and insufficient stimulation in early childhood can lead to long-term deficits in cognitive and social development. Evidence for policy and decision-making regarding the cost of delivering nutrition education is lacking in low and middle-income countries (LMIC). In rural Uganda, we conducted a cluster-randomized controlled trial (RCT) examining the effect of a maternal nutrition education intervention on developmental outcomes among children aged 6–8 months. This intervention led to significantly improved cognitive scores when the children reached the age of 20–24 months. When considering the potential for this intervention’s future implementation, the desired effects should be weighed against the increased costs. This study therefore aimed to assess the cost-effectiveness of this education intervention compared with current practice. Health outcome data were based on the RCT. Cost data were initially identified by reviewing publications from the RCT, while more detailed information was obtained by interviewing researchers involved in processing the intervention. This study considered a healthcare provider perspective for an 18-months’ time horizon. The control group was considered as the current practice for the future large-scale implementation of this intervention. A cost-effectiveness analysis was performed, including calculations of incremental cost-effectiveness ratios (ICERs). In addition, uncertainty in the results was characterized using one-way and probabilistic sensitivity analyses. The ICER for the education intervention compared with current practice was USD 16.50 per cognitive composite score gained, with an incremental cost of USD 265.79 and an incremental cognitive composite score of 16.11. The sensitivity analyses indicated the robustness of these results. The ICER was sensitive to changes in cognitive composite score and the cost of personnel. The education intervention can be considered cost-effective compared with the current practice. The outcome of this study, including the cost analysis, health outcome, cost-effectiveness, and sensitivity analysis, can be useful to inform policymakers and stakeholders about effective resource allocation processes in Uganda and possibly other LMIC.

• Luhulla, Koga; Ahlam, Nasser; Kakumbula, Helen; Iversen, Per Ole & Chamba, Clara (2023). Prevalence and Factors associated with Platelet Refractoriness among Tanzanian Patients – A Cross-Sectional Study from The National Reference Hospital. Tanzania Medical Journal. ISSN 0856-0714. 34, p. 31–47. Full text in Research Archive
• Nahalomo, Aziiza; Iversen, Per Ole; Andreassen, Bård A.; Kaaya, Archileo Natigo; Rukooko, Archangel Byaruhanga & Rukundo, Peter Milton (2023). Food insecurity, dietary diversity and the right to adequate food among households in landslide-prone communities in Eastern Uganda: A cohort study. PLOS ONE. 18(4). doi: 10.1371/journal.pone.0283078. Full text in Research Archive Show summary

  We assessed food insecurity, dietary diversity and the right to adequate food among households in communities in Eastern Uganda that were affected by major landslides in 2010 and 2018. A prospective cohort study was applied to select 422 households during May-August (the food-plenty season) of 2019. In January-March (the food-poor season) of 2020, 388 households were re-assessed. Socio-demographic, food security, dietary diversity and right to adequate food data were collected using structured questionnaires. Four focus groups discussions and key informant interviews with 10 purposively sampled duty-bearers explored issues of food insecurity, dietary and the right to adequate food. The affected households had significantly higher mean (SE) food insecurity scores than controls, both during the food plenty season: 15.3 (0.5) vs. 10.8 (0.5), and during food-poor season: 15.9 (0.4) vs. 12.5 (0.0). The affected households had significantly lower mean (SE) dietary diversity scores than controls during the food plenty season: 5.4 (0.2) vs. 7.5 (0.2) and during the food poor season: 5.2 (0.2) vs. 7.3 (0.1). Multivariate analyses showed that the disaster event, education and main source of livelihood, were significantly associated with household food security and dietary diversity during the food-plenty season whereas during the food-poor season, the disaster event and education were associated with household food security and dietary diversity. During both food seasons, the majority of affected and control households reported to have consumed unsafe food. Cash-handout was the most preferred for ensuring the right to adequate food. Comprehension and awareness of human rights principles and state obligations were low. The severity of food-insecurity and dietary diversity differed significantly between the affected and control households during both food seasons. Moreover, the right to adequate food of landslide victims faced challenges to its realization. There is need for policy and planning frameworks that cater for seasonal variations, disaster effects and right to adequate food in order to reduce landslide victims’ vulnerability to food insecurity and poor dietary diversity. In the long-term, education and income diversification program interventions need to be integrated into disaster recovery programs since they are central in enhancing the resilience of rural livelihoods to shocks and stressors on the food system.

• Steinskog, Eli Sihn Samdal; Finne, Kenneth; Enger, Marianne; Helgeland, Lars; Iversen, Per Ole & Mccormack, Emmet Matin [Show all 8 contributors for this article] (2023). Isolation of lymph shows dysregulation of STAT3 and CREB pathways in the spleen and liver during leukemia development in a rat model. Microcirculation. ISSN 1073-9688. 30(2-3), p. 1–15. doi: 10.1111/micc.12800. Full text in Research Archive
• Ali, Maryan Mohamed; Gedde-Dahl, Tobias; Osnes, Liv T. N.; Perrier, Flavie; Veierød, Marit Bragelien & Tjønnfjord, Geir Erland [Show all 7 contributors for this article] (2023). Extracorporeal Photopheresis as Graft-versus-Host Disease Prophylaxis: A Randomized Controlled Trial. Transplantation and Cellular Therapy (TCT). ISSN 2666-6375. 29(6), p. 364.e1–364.e11. doi: 10.1016/j.jtct.2023.02.023. Full text in Research Archive Show summary

  Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is the sole curative option for many patients diagnosed with hematologic malignancies. A major obstacle is graft-versus-host disease (GVHD), causing significant morbidity and mortality. Extracorporeal photopheresis (ECP) is an increasingly applied treatment for GVHD, owing in part to its favorable safety profile. In contrast, reports on the use of ECP to prevent GVHD are rare, and randomized controlled trials (RCTs) are lacking. We conducted an RCT to assess whether ECP applied post-transplantation could prevent the development of GVHD within the first year of transplantation. We enrolled 157 patients (age 18 to 74 years) with a hematologic malignancy undergoing their first allo-HSCT, randomized as 76 to the intervention group and 81 to the control group. ECP was initiated directly on engraftment and was planned twice weekly for 2 weeks, then once weekly for 4 weeks. GVHD, relapse, and death were analyzed by Cox regression analysis. During the first year, 45 patients in the intervention group and 52 control patients developed GVHD (hazard ratio [HR], .82; 95% confidence interval [CI], .55 to 1.22; P = .32). There were no differences in acute or chronic GVHD or its organ distribution in this intention-to-treat RCT. A per-protocol analysis revealed a significant difference in GVHD between the intervention group (per-protocol; n = 39 of 76) and the control group (n = 77), 46% versus 68%, respectively (HR, .47; 95% CI, .27 to .80; P = .006). Relapse occurred in 15 patients in the intervention group and in 11 control patients (HR, 1.38; 95% CI, .64 to 3.01; P = .42). GVHD-free relapse-free survival, event-free survival, overall survival, and nonrelapse mortality did not differ significantly between the 2 study groups. There also was no significant difference in immune reconstitution between the 2 groups. This first intention-to-treat RCT investigating ECP as GVHD prophylaxis in allo-HSCT for hematologic malignancy does not support the use of ECP as an adjunct to standard drug-based GVHD prophylaxis.

• Dusingizimana, Theogene; Ramilan, Thiagarajah; Weber, Janet L.; Iversen, Per Ole; Mugabowindekwe, Maurice & Ahishakiye, Jeannine [Show all 7 contributors for this article] (2023). Predictors for achieving adequate antenatal care visits during pregnancy: a cross-sectional study in rural Northwest Rwanda. BMC Pregnancy and Childbirth. 23:69, p. 1–9. doi: 10.1186/s12884-023-05384-0. Full text in Research Archive Show summary

  Background Inadequate antenatal care (ANC) in low-income countries has been identified as a risk factor for poor pregnancy outcome. While many countries, including Rwanda, have near universal ANC coverage, a significant proportion of pregnant women do not achieve the recommended regimen of four ANC visits. The present study aimed to explore the factors associated with achieving the recommendation, with an emphasis on the distance from household to health facilities. Methods A geo-referenced cross-sectional study was conducted in Rutsiro district, Western province of Rwanda with 360 randomly selected women. Multiple logistic regression analysis including adjusted odd ratio (aOR) were performed to identify factors associated with achieving the recommended four ANC visits. Results The majority (65.3%) of women had less than four ANC visits during pregnancy. We found a significant and negative association between distance from household to health facility and achieving the recommended four ANC visits. As the distance increased by 1 km, the odds of achieving the four ANC visits decreased by 19% (aOR = 0.81, P = 0.024). The odds of achieving the recommended four ANC visits were nearly two times higher among mothers with secondary education compared with mothers with primary education or less (aOR = 1.90, P = 0.038). In addition, mothers who responded that their household members always seek health care when necessary had 1.7 times higher odds of achieving four ANC visits compared with those who responded as unable to seek health care (aOR = 1.7, P = 0.041). Furthermore, mothers from poor households had 2.1 times lower odds of achieving four ANC visits than mothers from slightly better-off households (aOR = 2.1, P = 0.028). Conclusions Findings from the present study suggest that, in Rutsiro district, travel distance to health facility, coupled with socio-economic constraints, including low education and poverty can make it difficult for pregnant women to achieve the recommended ANC regimen. Innovative strategies are needed to decrease distance by bringing ANC services closer to pregnant women and to enhance ANC seeking behaviour. Interventions should also focus on supporting women to attain at least secondary education level as well as to improve the household socioeconomic status of pregnant women, with a particular focus on women from poor households.

• Kverneland, Magnhild; Nakken, Karl Otto; Hofoss, Dag; Skogan, Annette Holth; Iversen, Per Ole & Selmer, Kaja Kristine [Show all 7 contributors for this article] (2023). Health-related quality of life in adults with drug-resistant focal epilepsy treated with modified Atkins diet in a randomized clinical trial. Epilepsia. ISSN 0013-9580. 64(5). doi: 10.1111/epi.17585. Full text in Research Archive Show summary

  Abstract Ketogenic diet, a high‐fat, low‐carbohydrate diet, is an established treatment for patients with severe epilepsy. We have previously reported a moderate reduction in seizure frequency after treatment with a modified Atkins diet. This study aimed to see whether dietary therapy impacts patients' health‐related quality of life (HRQOL). In a randomized controlled design, we compared the change in self‐reported HRQOL among adults with difficult‐to‐treat epilepsy after a 12‐week diet intervention. Thirty‐nine patients with drug‐resistant focal epilepsy (age = 16–65 years) were randomized to eat a modified Atkins diet with maximum 16 g of carbohydrate per day (diet group, n  = 19) or to continue eating habitual diet (control group, n  = 20). No changes to the other epilepsy treatments were allowed. Patient‐reported HRQOL was assessed with the Quality of Life in Epilepsy Inventory‐89 (QOLIE‐89). The diet group experienced a statistically significant improvement in mean total score of QOLIE‐89 of 10 points compared to controls ( p  = .002). Moreover, although not statistically significant when using a cutoff of 50% seizure reduction, our data suggest an association between diet‐induced reduction in seizure frequency and improvement in HRQOL. The improvement in HRQOL was not associated with diet‐induced weight reduction.

• Wilkinson, Andrew; Wilkinson, John N.; Shotton, Peter; Sufar, Enas Khalid; Hasanaliyeva, Gultekin & Volakakis, Nikolaos [Show all 13 contributors for this article] (2023). Improving Crop Health, Performance, and Quality in Organic Spring Wheat Production: The Need to Understand Interactions between Pedoclimatic Conditions, Variety, and Fertilization. Agronomy. 13(9). doi: 10.3390/agronomy13092349. Full text in Research Archive Show summary

  Organic wheat production systems have lower yields compared with intensive conventional production and often do not achieve the grain protein content and quality thresholds set by millers and bakers. In contrast, organic production methods were reported to result in higher concentrations of nutritionally desirable micronutrients and lower concentrations of the toxic metal Cd in wheat grain and wholegrain flour. However, although N-availability and variety characteristics are known to affect both gain yields and bread-making quality, the exact reasons for the yield gap and differences in grain processing and nutritional quality between organic and conventional spring wheat production in the UK are poorly understood. The overall aim of this study was therefore to determine to what extent changes in variety choice and fertilization regimes may reduce the yield gap and improve processing quality without affecting nutritional quality in organic spring wheat production. To achieve this aim, we compared crop health, yield, grain processing, and nutritional quality parameters in spring wheat produced using (i) six contrasting spring wheat varieties grown with a standard fertilization regime and (ii) one variety widely used by organic farmers (Paragon) with nine different fertilization regimes in (iii) three UK sites/farms with contrasting pedoclimatic conditions. Significant differences in foliar disease severity, grain yield, and quality parameters were detected between six contrasting spring wheat varieties when grown under organic management regimes. Specifically, the varieties Paragon and Tybalt were identified as the best-performing varieties with respect to foliar disease resistance and grain yield under organic farming conditions and also produced high processing and nutritional quality across the three UK sites. However, the highest grain yields were obtained by Paragon at the Gilchester site and Tybalt at the Sheepdrove and Courtyard sites, while the highest protein contents were produced by Tybalt at the Gilchester site and Paragon at the Sheepdrove and Courtyard sites, which suggests that there is a need for site-specific wheat variety selection in the UK organic sector. Although organic fertilizer input type and level also affected wheat performance, differences between fertilization regimes were smaller than those observed between the five contrasting varieties, which suggests that improvements in spring wheat breeding/selection have a greater potential for increasing crop yield and quality in the organic sector compared with changes to fertilization practices. Overall, results suggest it is feasible to breed/select spring wheat varieties that combine high protein, vitamin E, and micronutrients with low toxic metal (Cd, Pb) concentrations when produced under organic farming conditions. These findings also support the hypothesis that differences in variety choice by organic and conventional farmers have contributed to the differences in nutritional quality between organic and conventional wheat products reported in previous studies.

• Strømmen, Kenneth; Lyche, Jan Ludvig; Moltu, Sissel Jennifer; Müller, Mette Helen Bjørge; Blakstad, Elin Wahl & Brække, Kristin [Show all 12 contributors for this article] (2022). Estimated daily intake of phthalates, parabens, and bisphenol A in hospitalised very low birth weight infants. Chemosphere. ISSN 0045-6535. 309(Part 1). doi: 10.1016/j.chemosphere.2022.136687. Full text in Research Archive Show summary

  Very low birth weight infants (VLBW, birth weight (BW) < 1500 g) are exposed to phthalates, parabens and bisphenol A (BPA) early in life. We estimated daily intake (EDI) of these excipients in 40 VLBW infants the first and fifth week of life while hospitalised. Based on urinary samples collected in 2010, EDI was calculated and compared to the tolerable daily intake (TDI) with hazard quotients (HQs) evaluated. A HQ > 1 indicates that EDI exceeded TDI with increased risk of adverse health effects. EDI was higher in VLBW infants compared to term-born infants and older children. VLBW infants born at earlier gestational age (GA), or with lower BW, had higher EDI than infants born at later GA or with higher BW. First week median EDI for BPA was higher than TDI in 100% of infants, in 75% for di(2-ethylhexyl) phthalate (DEHP), 90% for the sum of butyl benzyl phthalate (BBzP), di-n-butyl phthalate (DnBP), DEHP and di-iso-nonyl phthalate (DiNP) = ∑BBzP+DnBP+DEHP+DiNP, and in 50% of infants for propylparaben (PrPa), indicating increased risk of adverse effects. Fifth week EDI remained higher than TDI in all infants for BPA, in 75% for DEHP and ∑BBzP+DnBP+DEHP+DiNP, and 25% of infants for PrPa, indicating prolonged risk. Maximum EDI for di-iso-butyl phthalate was higher than TDI suggesting risk of adverse effects at maximum exposure. VLBW infants born earlier than 28 weeks GA had higher EDI, above TDI, for PrPa compared to infants born later than 28 weeks GA. Infants with late-onset septicaemia (LOS) had higher EDI for DEHP, ∑BBzP+DnBP+DEHP+DiNP and BPA, above TDI, compared to infants without LOS. More 75% of the infants' EDI for DEHP and ∑BBzP+DnBP+DEHP+DiNP, 25% for PrPa, and 100% of infants' EDI for BPA, were above TDI resulting in HQs 1, indicating increased risk of adverse health effects.

• Rempelos, Leonidas; Wang, Juan; Baranski, Marcin; Watson, Anthony; Volakakis, Nikolaos & Hadall, Catherine [Show all 17 contributors for this article] (2022). Diet, but not food type, significantly affects micronutrient and toxic metal profiles in urine and/or plasma; a randomized, controlled intervention trial. American Journal of Clinical Nutrition. ISSN 0002-9165. 116(5), p. 1278–1290. doi: 10.1093/ajcn/nqac233. Full text in Research Archive Show summary

  ABSTRACT Background Observational studies have linked Mediterranean Diets (MedDiets) and organic food consumption with positive health outcomes, which may be explained by higher mineral micronutrient and phenolic intake and lower dietary exposure to toxic compounds. Objectives We aimed to determine the effects of diet and food type (organic compared with conventional) on urinary excretion (UE) and/or plasma concentrations of mineral micronutrients, phenolics, and toxic metals. Methods Healthy adult participants were randomly allocated to a conventional (n = 14) or an intervention (n = 13) group. During a 2-wk period, the intervention group consumed a MedDiet made entirely from organic foods, whereas the conventional group consumed a MedDiet made from conventional foods. Before and after the intervention period, both groups consumed their habitual Western diets made from conventional foods. The primary outcome was UE and/or plasma concentrations of selected mineral micronutrients, toxic metals, and phenolic markers. In addition, we monitored diets using food diaries. The participants were aware of study group assignment, but the study assessors were not. Results Changing from a Western Diet to a MedDiet for 2 wk resulted in significant increases in UE of total phenolics and salicylic acid (by 46% and 45%, respectively), the mineral micronutrients Co, I, and Mn (by 211%, 70%, and 102%, respectively), and the toxic metal Ni (by 42%), and plasma Se concentrations (by 14%). However, no significant effects of food type (organic compared with conventional) were detected. Redundancy analysis identified vegetables, coffee, wine, and fruit as positive drivers for UE of phenolic markers and mineral micronutrients, and fish consumption as a positive driver for UE of Cd and Pb. Conclusions Although small effects of food type cannot be ruled out, our study suggests that only changing to a MedDiet with higher fruit and vegetable, and lower meat, consumption results in a large increase in phenolic and mineral micronutrient intakes. This trial was registered at clinicaltrials.gov as NCT03254537.

• Stover, Patrick; Field, Martha; Brawley, H; Angelin, Bo; Iversen, Per Ole & Fruhbeck, Gemma (2022). Nutrition and stem cell integrity in aging. Journal of Internal Medicine. ISSN 0954-6820. 292(4), p. 541–690. doi: 10.1111/joim.13507. Full text in Research Archive
• Polašek, Ozren; Wazny, Kerri; Adeloye, Davies; Song, Peige; Chan, Kit Y & Bojude, Danladi A [Show all 50 contributors for this article] (2022). Research priorities to reduce the impact of COVID-19 in low- and middle-income countries. Journal of Global Health. ISSN 2047-2978. 12, p. 1–14. doi: 10.7189/jogh.12.09003. Full text in Research Archive Show summary

  Background The COVID-19 pandemic has caused disruptions to the functioning of societies and their health systems. Prior to the pandemic, health systems in low- and middle-income countries (LMIC) were particularly stretched and vulnerable. The International Society of Global Health (ISoGH) sought to systematically identify priorities for health research that would have the potential to reduce the impact of the COVID-19 pandemic in LMICs. Methods The Child Health and Nutrition Research Initiative (CHNRI) method was used to identify COVID-19-related research priorities. All ISoGH members were invited to participate. Seventy-nine experts in clinical, translational, and population research contributed 192 research questions for consideration. Fifty-two experts then scored those questions based on five pre-defined criteria that were selected for this exercise: 1) feasibility and answerability; 2) potential for burden reduction; 3) potential for a paradigm shift; 4) potential for translation and implementation; and 5) impact on equity. Results Among the top 10 research priorities, research questions related to vaccination were prominent: health care system access barriers to equitable uptake of COVID-19 vaccination (ranked 1st), determinants of vaccine hesitancy (4th), development and evaluation of effective interventions to decrease vaccine hesitancy (5th), and vaccination impacts on vulnerable population/s (6th). Health care delivery questions also ranked highly, including: effective strategies to manage COVID-19 globally and in LMICs (2nd) and integrating health care for COVID-19 with other essential health services in LMICs (3rd). Additionally, the assessment of COVID-19 patients’ needs in rural areas of LMICs was ranked 7th, and studying the leading socioeconomic determinants and consequences of the COVID-19 pandemic in LMICs using multi-faceted approaches was ranked 8th. The remaining questions in the top 10 were: clarifying paediatric case-fatality rates (CFR) in LMICs and identifying effective strategies for community engagement against COVID-19 in different LMIC contexts. Interpretation Health policy and systems research to inform COVID-19 vaccine uptake and equitable access to care are urgently needed, especially for rural, vulnerable, and/or marginalised populations. This research should occur in parallel with studies that will identify approaches to minimise vaccine hesitancy and effectively integrate care for COVID-19 with other essential health services in LMICs. ISoGH calls on the funders of health research in LMICs to consider the urgency and priority of this research during the COVID-19 pandemic and support studies that could make a positive difference for the populations of LMICs.

• Nahalomo, Aziiza; Iversen, Per Ole; Andreassen, Bård A.; Kaaya, Archileo Natigo; Rukooko, Archangel Byaruhanga & Rukundo, Peter Milton (2022). Seasonality- and disaster effects on food variety and food insecurity coping strategies among a landslide-prone cohort. Clinical Nutrition ESPEN. ISSN 2405-4577. 52, p. 229–239. doi: 10.1016/j.clnesp.2022.11.005. Full text in Research Archive
• Nahalomo, Aziiza; Iversen, Per Ole; Andreassen, Bård A.; Kaaya, Archileo Natigo; Rukooko, Archangel Byaruhanga & Tushabe, Gerald [Show all 8 contributors for this article] (2022). Malnutrition and Associated Risk Factors among Children 6-59 Months Old in the Landslide-Prone Bududa District, Eastern Uganda: A Cohort Study. Current Developments in Nutrition (CDN). 6(2), p. 1–15. doi: 10.1093/cdn/nzac005. Full text in Research Archive
• Iversen, Per Ole; Hankin, Alexandra Renee; Horn, Joachim; Thorkild, Pedersen & Frøen, Hege (2022). Deep Compartment Syndrome Without Myonecrosis: A Case Report on a Rare Complication of Sickle Cell Disease. Cureus - Journal of Medical Science. doi: 10.7759/cureus.29164. Full text in Research Archive Show summary

  Compartment syndrome is a rare manifestation of vaso-occlusive crisis, a serious complication of sickle cell disease (SCD), which is an inherited hemoglobinopathy. During a visit to Norway, an otherwise healthy, 20-year-old male from Ghana was admitted to Oslo University Hospital (Day 1) because of increasing pain in the hip and thighs that did not respond adequately to non-opioid painkillers. Despite initial treatment with intravenous fluids and opioids, his pain intensified. Careful clinical inspection supported by an MRI examination revealed focal, high-signal-intensity muscle edema of the anterior compartment of the thigh, almost exclusively limited to the vastus intermedius muscles. There were no MRI findings or blood biochemistry evidence for myonecrosis or rhabdomyolysis, and a diagnosis of deep compartment syndrome appeared to be the most likely explanation for his pain. We decided to continue with a conservative treatment approach, and the patient did not undergo a fasciotomy or blood transfusion therapy. On Day 7 after admission, his condition improved markedly, and he was discharged on Day 11 whereupon he returned to Ghana. This case is a reminder that, although rare, deep compartment syndrome can be a severe manifestation of vaso-occlusive crisis in SCD and should be considered in patients with severe, deep muscular pain in the absence of other explanatory factors.

• Hjertholm, Katrine Gjermundnes; Holmboe-Ottesen, Gerd; Mdala, Ibrahimu; Shi, Zumin & Iversen, Per Ole (2022). The impact of dietary diversity and seasonality in food availability on the quantile distribution of birth size among pregnant women in rural Malawi – a cross-sectional study. BMC Pregnancy and Childbirth. 22(1), p. 602–602. doi: 10.1186/s12884-022-04924-4. Full text in Research Archive Show summary

  Background Dietary diversity scores can be used as a proxy for dietary intakes and for assessment of nutrient adequacy. Studies from low-resource settings have found maternal dietary diversity scores to be associated with neonatal birth size. We here investigated the relationship between the dietary diversity score among pregnant mothers and birth size of their offspring across quantiles of the birth size variables; birth weight, length, abdominal circumference, and head circumference. We also investigated if seasonality affects birth size across different quantiles. Methods Dietary intake and anthropometric data were collected from 190 pregnant women and their neonates in rural Malawi through two agricultural seasons. Dietary data was collected using 24-hour recall interviews and was categorized into the 10-food group dietary diversity score proposed for women by the Food and Agriculture Organization. Neonatal anthropometrics were collected upon delivery at health facilities. Quantile regression analyses were used to investigate associations between dietary diversity scores and birth size, as well as between seasonality and birth size. Results We found that neonatal abdominal circumference was 0.9 cm larger during the post-harvest season compared to the pre-harvest season among neonates in the 25th quantile. Birth weight was 281.4 g higher for those born during the post-harvest season in the 90th quantile. For a one-unit increase in maternal dietary diversity score, birth weight increased by 56.7 g among those in the 25th quantile and neonatal head circumference increased by 0.2 cm for those in the 70th quantile. However, these findings did not remain significant when considering the cluster effect of the neonatal anthropometric data. Conclusions Our findings indicate that the relationship between seasonality and birth size differs across the distribution of birth size. Investigating the effect of seasonality across the distribution of birth size could be important to identify vulnerable subgroups and develop better, targeted interventions to improve maternal and child nutrition and health.

• Pedersen, Sigrid; Kverneland, Magnhild; Nakken, Karl Otto; Rudi, Knut; Iversen, Per Ole & Gervin, Kristina [Show all 7 contributors for this article] (2022). Genome-wide decrease in DNA methylation in adults with epilepsy treated with modified ketogenic diet: A prospective study. Epilepsia. ISSN 0013-9580. 63(9), p. 2413–2426. doi: 10.1111/epi.17351. Full text in Research Archive Show summary

  Objective The aim of this study was to investigate the impact of the modified ketogenic diet on DNA methylation in adults with epilepsy. Methods In this prospective study, we investigated the genome-wide DNA methylation in whole blood in 58 adults with epilepsy treated with the modified ketogenic for 12 weeks. Patients were recruited from the National Center for Epilepsy, Norway, from March 1, 2011 to February 28, 2017. DNA methylation was analyzed using the Illumina Infinium MethylationEPIC BeadChip array. Analysis of variance and paired t-test were used to identify differentially methylated loci after 4 and 12 weeks of dietary treatment. A false discovery rate approach with a significance threshold of <5% was used to adjust for multiple comparisons. Results We observed a genome-wide decrease in DNA methylation, both globally and at specific sites, after 4 and 12 weeks of dietary treatment. A substantial share of the differentially methylated positions (CpGs) were annotated to genes associated with epilepsy (n = 7), lipid metabolism (n = 8), and transcriptional regulation (n = 10). Furthermore, five of the identified genes were related to inositol phosphate metabolism, which may represent a possible mechanism by which the ketogenic diet attenuates seizures. Significance A better understanding of the modified ketogenic diet's influence at the molecular level may be the key to unraveling the mechanisms by which the diet can ameliorate seizures and possibly to identifying novel therapeutic targets for epilepsy.

• Katenga-Kaunda, Lilián Ziyenda; Iversen, Per Ole; Kamudoni, Penjani Rhoda; Holmboe-Ottesen, Gerd & Fjeld, Heidi E (2022). Food-based nutrition counselling and education intervention for improved diets of pregnant women in rural Malawi: A qualitative study of factors influencing dietary behaviour change. Public Health Nutrition (PHN). ISSN 1368-9800. doi: 10.1017/S1368980022000593. Full text in Research Archive Show summary

  Objective: We wanted to identify factors related to dietary behavioural change among impoverished pregnant women in the face of nutrition education and counselling, describing what creates an enabling environment and barriers for dietary change. Design: We used qualitative data from a cluster-randomised maternal education trial and conducted a thematic analysis using a social ecological framework to describe the factors that influenced dietary adherence. Setting: Mangochi district in rural Malawi. Participants: We interviewed ten pregnant women and conducted four sets of focus group discussions with twenty-two significant family members (husbands and mothers-in-law) and twelve counsellors. Results: The participants’ experiences showed that the main barriers of adherence to the intervention were taste, affordability and poverty. The use of powders and one-pot dishes, inclusion of both women and significant family members and a harmonisation with local food practices enabled adherence to the intervention. We found it crucial to focus the dietary education and counselling intervention on locally available ingredients and food processing methods. Conclusions: Use of contextualised food-based solutions to combat maternal malnutrition was observed to be relatively cheap and sustainable. However, there is need for more research on local foods used as nutrition supplements. We suggest that investments need to be directed not only to nutrition education and counselling but also to the enabling factors that enhance adherence. The original cluster-randomised controlled trial was registered with Clinical trials.gov ID: NCT03136393.

• Molteberg, Ellen; Taubøll, Erik; Kverneland, Magnhild; Iversen, Per Ole; Selmer, Kaja Kristine & Nakken, Karl Otto [Show all 8 contributors for this article] (2022). Substantial early changes in bone and calcium metabolism among adult pharmacoresistant epilepsy patients on a modified Atkins diet. Epilepsia. ISSN 0013-9580. 63(4), p. 880–891. doi: 10.1111/epi.17169. Full text in Research Archive Show summary

  Abstract Objective The aim of this study was to investigate whether the modified Atkins diet (MAD), a variant of the ketogenic diet, has an impact on bone- and calcium (Ca) metabolism. Methods Two groups of adult patients with pharmacoresistant epilepsy were investigated. One, the diet group (n = 53), was treated with MAD for 12 weeks, whereas the other, the reference group (n = 28), stayed on their habitual diet in the same period. All measurements were performed before and after the 12 weeks in both groups. We assessed bone health by measuring parathyroid hormone (PTH), Ca, 25-OH vitamin D (25-OH vit D), 1,25-OH vitamin D (1,25-OH vit D), phosphate, alkaline phosphatase (ALP), and the bone turnover markers procollagen type 1 N-terminal propeptide (P1NP) and C-terminal telopeptide collagen type 1 (CTX-1). In addition, we examined the changes of sex hormones (estradiol, testosterone, luteinizing hormone, follicle-stimulating hormone), sex hormone-binding globulin, and leptin. Results After 12 weeks of MAD, we found a significant reduction in PTH, Ca, CTX-1, P1NP, 1,25-OH vit D, and leptin. There was a significant increase in 25-OH vit D. These changes were most pronounced among patients <37 years old, and in those patients with the highest body mass index (≥25.8 kg/m²), whereas sex and type of antiseizure medication had no impact on the results. For the reference group, the changes were nonsignificant for all the analyses. In addition, the changes in sex hormones were nonsignificant. Significance Twelve weeks of MAD treatment leads to significant changes in bone and Ca metabolism, with a possible negative effect on bone health as a result. A reduced level of leptin may be a triggering mechanism. The changes could be important for patients on MAD, and especially relevant for those patients who receive treatment with MAD at an early age before peak bone mass is reached.

• Quamme, Siri Hundstad & Iversen, Per Ole (2022). Prevalence of child stunting in Sub-Saharan Africa and its risk factors. Clinical Nutrition Open Science. 42, p. 49–61. doi: 10.1016/j.nutos.2022.01.009. Full text in Research Archive Show summary

  Background & Aims Child stunting (impaired height-for-age) is a marker of chronic undernutrition and results from insufficient energy and nutrient uptakes. Stunting has severe consequences for future physical and mental development. A WHO target is to reduce the prevalence of stunting by 40% within 2025. In contrast to other parts of the world, stunting has been a major public health problem in many African countries for a long time. Here we present a narrative review on stunting during the last 20 years among children ≤ 5 years in Sub-Saharan Africa (SSA), where stunting is rampant. Methods We identified 13 articles from 2000-2020 based on pre-defined criteria. Results Children in SSA are highly affected by stunting, with an average prevalence of 41%. Stunting is significantly higher in children >1 year, in boys, in low birth weight, in shorter interpregnancy interval, in mothers with lower education, and in poor and food insecure households. Maternal education, feeding practices and environmental factors (e.g. climate change) are important risk factors. Conclusions Although the prevalence of stunting has been reduced over the last two decades, great effort remains to reach the global target. Policies and interventions should target education for women, child feeding practices and environmental factors including climate change.

• Muhoozi, Grace Kyamazima Mehangye; Li, Kelvin; Atukunda, Prudence; Skaare, Anne B; Willumsen, Tiril & Enersen, Morten [Show all 11 contributors for this article] (2022). Child saliva microbiota and caries: a randomized controlled maternal education trial in rural Uganda. Scientific Reports. 12(1). doi: 10.1038/s41598-022-11979-y. Full text in Research Archive Show summary

  Abstract Undernutrition is a public health challenge in sub-Saharan countries, including Uganda. In a previous randomized controlled trial (RCT) with a nutrition, hygiene and stimulation education intervention among mothers of 6 months’ old children, we found less caries in the intervention group when the children were 36 months of age. We now examined the effects of (i) the intervention on the microbiota, (ii) microbiota on caries, and (iii) the intervention and microbiota on caries. The original RCT comprised 511 mother/child pairs whereas in the current study we had access to data from 344/511 (67%) children aged 36 months. The saliva microbiota was determined using 16S rRNA gene sequencing. Carious lesions (a proxy for dental health) were identified using close-up intra-oral photographs of the upper front teeth. Statistical models were used to determine host-microbiota associations. The intervention had a significant effect on the microbiota, e.g. an increase in Streptococcus abundance and decreases in Alloprevotella and Tannerella . Significant associations between the microbiota and dental caries were identified: Positive associations of Capnocytophaga and Tannerella suggest that these taxa may be deleterious to dental health while negative associations of Granulicatella , Fusobacterium , and Abiotrophia suggest taxa potentially beneficial or benign contributors to dental health. Based on taxonomic profiles, the effects of the intervention and microbiota on dental health may be independent of one another. Educational interventions with emphasis on nutrition and oral hygiene may provide a feasible strategy to decrease progression of childhood caries in low-resource settings.

• Koroma, Aminata; Ellie, Mariama; Bangura, Kadiatu; Iversen, Per Ole; Henrixson, David & Stephenson, Kevin [Show all 7 contributors for this article] (2022). Supplementary feeding and infection control in pregnant adolescents—A secondary analysis of a randomized trial among malnourished women in Sierra Leone. Maternal & Child Nutrition. ISSN 1740-8695. 19(1). doi: 10.1111/mcn.13456. Full text in Research Archive Show summary

  Undernutrition during pregnancy in adolescence confers a high risk of maternal morbidity and adverse birth outcomes, particularly in low-resource settings. In a secondary analysis, we hypothesized that younger undernourished pregnant adolescents (<18 years) would benefit more than undernourished pregnant adults (>20 years) from the intervention of supplementary food and anti-infective treatments. The original trial in Sierra Leone enrolled 236 younger adolescents (<18 years), 454 older adolescents (aged 18–19 years), and 741 adults (≥20 years), all with a mid-upper arm circumference ≤23 cm. Younger adolescents had lower final fundal height as well as smaller newborns (−0.3 kg; 95% confidence interval [CI], −0.3, −0.2; p < 0.001) and shorter newborns (−1.1 cm; 95% CI, −1.5, −0.7; p < 0.001) than adults. The intervention's effect varied significantly between maternal age groups: adults benefited more than younger adolescents with respect to newborn birth weight (difference in difference, 166 g; 95% CI, 26, 306; interaction p = 0.02), birth length (difference in difference, 7.4 mm; 95% CI, 0.1, 14.8; interaction p = 0.047), and risk for low birth weight (<2.5 kg) (interaction p = 0.019). The differences in response persisted despite adjustments for maternal anthropometry, the number of prior pregnancies, and human immunodeficiency virus status. Older adolescents similarly benefited more than younger adolescents, though differences did not reach statistical significance. In conclusion, newborns born to younger adolescent mothers had worse outcomes than those born to adult mothers, and adults and their newborns benefited more from the intervention than younger adolescents.

• Engh, Marit Stokke; Muhoozi, Grace Kyamazima Mehangye; Ngari, Moses; Skaare, Anne B; Westerberg, Ane Cecilie & Iversen, Per Ole [Show all 8 contributors for this article] (2022). Long-Term Effects of a Randomized Maternal Education Trial in Rural Uganda: Implications for Child Oral Health. American Journal of Tropical Medicine and Hygiene. ISSN 0002-9637. 107(4), p. 939–947. doi: 10.4269/ajtmh.22-0248. Full text in Research Archive Show summary

  The aim was to examine oral health among 5–6-year-old children whose mothers participated in a 6 months’ cluster-randomized education trial in rural Uganda starting when their children were 6–8 months old. The education focused on nutrition, oral hygiene, and child stimulation. In the current follow-up study, 357/511 (70%) children from the original trial were available for data collection (200 in the intervention and 157 in the control group). Molar caries was assessed on intraoral photographs. Children and/or caregivers answered a WHO health questionnaire for collection of oral data. Dental practices were compared between the intervention and control group using multilevel mixed effect logistic regression accounting for clustering. The children in the intervention group had less caries compared with the control group: 41% versus 60% (odds ratio [OR] 0.46; 95% confidence intervals [CI] 0.24–0.86, P = 0.02). The use of toothbrush to clean teeth was more frequent in the intervention than in the control group: 66% versus 38% (OR 3.39; 95% CI 1.54–7.45, P = 0.003), as was high teeth-cleaning frequency: 74% versus 62% (OR 1.72; 95% CI 1.09–2.69, P = 0.02). Self-reported problems such as toothache (10% versus 19%), difficulty biting (12% versus 24%) and chewing food (8.5% versus 18%) were significantly less frequent among children in the intervention compared with the control group. No significant differences were found in dietary habits. Our data shows that an educational intervention adjusted to a low-resource setting, provided in infancy, resulted in improved oral hygiene and reduced development of dental caries among children aged 5–6 years.

• Rempelos, Leonidas; Wang, J; Baranski, Marcin; Watson, A; Volakakis, Nikolaos & Hoppe, H [Show all 18 contributors for this article] (2021). Diet (habitual Western versus Mediterranean) and food type (organic versus conventional) affect urinary pesticide residue excretion profiles in healthy individuals; results of a randomized, controlled dietary intervention trial. American Journal of Clinical Nutrition. ISSN 0002-9165. doi: 10.1093/ajcn/nqab308. Full text in Research Archive
• Katenga-Kaunda, Lillian Ziyenda; Kamudoni, Penjani Rhoda; Holmboe-Ottesen, Gerd; Fjeld, Heidi E; Mdala, Ibrahimu & Shi, Zumin [Show all 7 contributors for this article] (2021). Enhancing nutrition knowledge and dietary diversity among rural pregnant women in Malawi: a randomized controlled trial. BMC Pregnancy and Childbirth. 21. doi: 10.1186/s12884-021-04117-5. Full text in Research Archive Show summary

  Background In many sub-Saharan African countries, such as Malawi, antenatal care (ANC) services do not deliver sufficient nutrition awareness to improve adequate dietary intake in pregnancy. We therefore compared the effects of supplementary nutrition education and dietary counselling with routine ANC service on nutrition knowledge and dietary intakes among Malawian pregnant women. Methods We used data from a two-armed cluster randomised controlled trial (RCT) of which the intervention group received supplementary nutrition education, dietary counselling and routine ANC services whereas the controls received only routine ANC services. The RCT was conducted in 10 control and 10 intervention villages in Mangochi, Southern Malawi and included pregnant women between their 9th and 16th gestational weeks. We examined the changes in nutrition knowledge and dietary diversity from enrolment (baseline) to study end-point of the RCT (two weeks before expected delivery). We used three linear multilevel regression models with random effects at village level (cluster) to examine the associations between indicators of nutrition knowledge and diet consumption adjusted for selected explanatory variables. Results Among 257 pregnant women enrolled to the RCT, 195 (76%) were available for the current study. The supplementary nutrition education and counselling led to significant improvements in nutrition knowledge, dietary diversity and nutrition behaviour in the intervention group compared with controls. Most women from both study groups had a moderate consumption of diversified foods at study end-point. A significant positive association between nutrition knowledge and consumption of a diversified diet was only observed in the intervention group. Conclusions Nutrition knowledge and dietary diversity improved in both study groups, but higher in the intervention group. Increased nutrition knowledge was associated with improved dietary diversity only in the intervention women, who also improved their nutrition perceptions and behaviour. Antenatal nutrition education needs strengthening to improve dietary intakes in pregnancy in this low resource-setting. Trial registration Clinical trials.gov ID: NCT03136393 (registered on 02/05/2017).

• Atukunda, Prudence; Eide, Wenche Barth; Kardel, Kristin Reimers; Iversen, Per Ole & Westerberg, Ane Cecilie (2021). Unlocking the potential for achievement of the UN Sustainable Development Goal 2 – “Zero Hunger” - in Africa: Targets, strategies, synergies and challenges. Food & Nutrition Research (FNR). ISSN 1654-6628. 65. doi: 10.29219/fnr.v65.7686. Full text in Research Archive Show summary

  Background: The UN Sustainable Development Goal (SDG) 2 (‘Zero Hunger’) aims to end all forms of hunger and malnutrition by 2030. Thus, a range of different strategies are needed to facilitate the achievement of SDG 2 to overcome challenges and enable synergies between various SDG targets. Objective: The aim of this review is to highlight Africa’s progress toward SDG 2, including targets, strategies, synergies and challenges. Methods: We scrutinized published research articles in peer-reviewed journals, UN reports and in-country Africa reports (between 2015 and 2020) that were relevant to the current topic. Results: Several hunger indicators are showing slow progress or even deterioration in Africa. The prevalence of undernourishment in the general population was 19.1% in 2019 and is expected to increase to 25.7% by 2030. Improvements in child stunting in several regions in Africa are slow, especially in sub-Saharan Africa where about 34% of under-fives were stunted in 2012 and 31% in 2019. In Eastern Africa, stunting prevalence decreased from 38% in 2012 to 34% in 2019. Major drivers of hunger are poor governance and state fragility, war and conflicts, increasing inequality, weak economic development, climate change, biodegradation – and now lately the Covid 19 pandemic – factors that all increase food insecurity. Conclusion: Africa is off track to reach SDG – ‘Zero Hunger’ – by 2030. Current efforts and progress are insufficient. Africa must champion the SDG agenda on a national, regional and global level to facilitate synergies to unlock the potential for reaching ‘Zero Hunger’ throughout the continent.

• Kakwangire, Paul; Moss, Cami; Matovu, Nicholas; Atukunda, Prudence; Westerberg, Ane Cecilie & Iversen, Per Ole [Show all 7 contributors for this article] (2021). The association between dietary diversity and development among children under 24 months in rural Uganda: Analysis of a cluster-randomised maternal education trial. Public Health Nutrition (PHN). ISSN 1368-9800. 24(13), p. 4286–4296. doi: 10.1017/S136898002100077X. Full text in Research Archive Show summary

  Objective: To assess the association between dietary diversity and development among children under 24 months in rural Uganda and to establish other factors that could be associated with development among these children. Design: A secondary data analysis of a cluster-randomised controlled maternal education trial (n 511) was conducted on a sub-sample of 385 children. We used adjusted ORs (AORs) to assess the associations of dietary diversity scores (DDS) and other baseline factors assessed at 6–8 months with child development domains (communication, fine motor, gross motor, personal–social and problem solving) at 20–24 months of age. Setting: Rural areas in Kabale and Kisoro districts of south-western Uganda. Participants: Children under 24 months. Results: After multivariable analysis, DDS at 6–8 months were positively associated with normal fine motor skills development at 20–24 months (AOR = 1·18; 95 % CI 1·01, 1·37; P = 0·02). No significant association was found between DDS and other development domains. Children who were not ill at 6–8 months had higher odds of developing normal communication (AOR = 1·73; 95 % CI 1·08, 2·77) and gross motor (AOR = 1·91; 95 % CI 1·09, 3·36) skills than sick children. Girls had lower odds of developing normal gross motor skills compared with boys (AOR = 0·58; 95 % CI 0·33, 0·98). Maternal/caregiver nutritional education intervention was positively associated with development of gross motor, fine motor and problem-solving skills (P-values < 0·05). Conclusions: We found an association between child DDS at 6–8 months and improvement in fine motor skills development at 20–24 months. Child illness status, maternal/caregiver nutritional education intervention and sex were other significant baseline predictors of child development at 20–24 months.

• Iversen, Per O.; Ngari, Moses; Westerberg, Ane C.; Muhoozi, Grace & Atukunda, Prudence (2021). Child stunting concurrent with wasting or being overweight: A 6-y follow up of a randomized maternal education trial in Uganda. Nutrition - The International Journal of Applied and Basic Nutritional Sciences. ISSN 0899-9007. 89, p. 1–3. doi: 10.1016/j.nut.2021.111281. Full text in Research Archive Show summary

  Objectives There is paucity of longitudinal data on combined anthropometric deficiencies in children. Herein, we present data on child stunting concurrent with wasting or being overweight among children in a 6-y follow-up study of a maternal education trial in rural Uganda. Methods We previously performed a randomized controlled trial where half of 511 mothers of 6- to 8-mo children were given a 6-mo education concerning nutrition, hygiene, and child stimulation. Anthropometry and prevalence of stunting with wasting or being overweight were determined. We applied multilevel mixed-effect logistic regression models and χ2 statistic to assess the effects of the intervention and trend in prevalence over time, respectively. Results Complete data sets were obtained from 307 of 511 children (60%). The prevalence of stunting and wasting or being overweight was <7% both, and did not change significantly over time. Notably, the prevalence of concurrent stunting and being overweight was significantly reduced in the intervention group compared with the controls among children age 36 mo and 60 to 72 mo, with corresponding odds ratios at 0.24 (95% confidence interval, 0.06–0.90) and 0.10 (95% confidence interval, 0.01–0.82), respectively. Conclusions The prevalence of stunting concurrent with wasting or being overweight remained low during the observation period. The intervention may have reduced concurrent stunting and being overweight over time.

• Wang, Juan; Baranski, Marcin; Hasanaliyeva, Gultakin; Korkut, Recep; Kalee, Hassan A. & Leifert, Alice [Show all 16 contributors for this article] (2021). Effect of irrigation, fertiliser type and variety on grain yield and nutritional quality of spelt wheat (Triticum spelta) grown under semi-arid conditions. Food Chemistry. ISSN 0308-8146. 358. doi: 10.1016/j.foodchem.2021.129826. Full text in Research Archive
• Bøhn, Siv Kjølsrud; Thune, Inger; Flote, Vidar Gordon; Frydenberg, Hanne; Bertheussen, Gro Falkener & Husøy, Anders [Show all 12 contributors for this article] (2021). Effects of a One-Year Physical Activity Intervention on Markers of Hemostasis among Breast Cancer Survivors - A Randomized Controlled Trial. TH Open. 5(1), p. e14–e23. doi: 10.1055/s-0040-1721782. Full text in Research Archive Show summary

  Introduction: Physical activity may reduce the development of breast cancer. Whereas hypercoagulability has been linked to adverse outcomes in breast cancer patients, the effects of physical activity on their hemostatic factors are unknown. The study aimed to assess whether long-term (1 year) physical activity can affect hemostatic factors in breast cancer patients. Methods: Fifty-five women (35–75 years) with invasive breast cancer stage I/II were randomized to a physical activity intervention (n = 29) lasting 1 year or to a control group (n = 26), and analyzed as intention to treat. Fibrinogen, factor VII antigen, tissue factor pathway inhibitor, and von Willebrand factor (VWF) antigen as well as prothrombin fragment 1 + 2, the endogenous thrombin potential and D-dimer, were measured in plasma before intervention (baseline), and then after 6 and 12 months. Results: Maximal oxygen uptake (measure of cardiorespiratory fitness) decreased the first 6 months among the controls, but remained stable in the intervention group. We found no significant differences between the two study groups regarding any of the hemostatic factors, except a significantly higher increase in factor VII antigen in the intervention group. The effect of the intervention on VWF was, however, significantly affected by menopausal stage, and a significant effect of the intervention was found on VWF among postmenopausal women, even after adjustment for dietary intake. Conclusion: Long-term physical activity had no effect on the majority of the hemostatic factors measured, but led to increased plasma concentrations of factor VII antigen and prevented an increase in VWF concentration after breast cancer treatment in postmenopausal women. The clinical impact of these findings for risk of vascular thrombosis warrants further studies.

• Dusingizimana, Theogene; Weber, Janet L.; Ramilan, Thiagarajah; Iversen, Per Ole & Brough, Louise (2021). A mixed-methods study of factors influencing access to and use of micronutrient powders in Rwanda. Global Health: Science and Practice (GHSP). ISSN 2169-575X. 9(2), p. 274–285. doi: 10.9745/GHSP-D-20-00422. Full text in Research Archive Show summary

  The World Health Organization recommends point-of-use fortification with multiple micronutrients powder (MNP) for foods consumed by children aged 6–23 months in populations where anemia prevalence among children under 2 years or under 5 years of age is 20% or higher. In Rwanda, anemia affects 37% of children under 5 years. The MNP program was implemented to address anemia, but research on factors affecting the implementation of the MNP program is limited. We conducted a mixed-methods study to examine the factors influencing access to and use of MNP among mothers (N=379) in Rutsiro district, northwest Rwanda. Inductive content analysis was used for qualitative data. Logistic regression analysis was used to determine factors associated with the use of MNP. Qualitative results indicated that the unavailability of MNP supplies and distribution issues were major barriers to accessing MNP. Factors influencing the use of MNP included mothers' perceptions of side effects and health benefits of MNP, as well as inappropriate complementary feeding practices. Mothers of older children (aged 12–23 months) were more likely to use MNP than those of younger children (aged 6–11 months) (adjusted odds ratio [aOR]=3.63, P<.001). Mothers whose children participated in the supplementary food program were nearly 3 times more likely to use MNP than those whose children had never participated in the program (aOR=2.84, P=.001). Increasing household hunger score was significantly associated with lower odds of using MNP (aOR=0.80, P=.038). Mechanisms to monitor MNP supply and program implementation need to be strengthened to ensure mothers have access to the product. MNP program implementers should address gaps in complementary feeding practices and ensure mothers have access to adequate complementary foods.

• Hendrixon, T; Smith, K; Lasowski, P; Callaghan-Gillespie, M; Weber, J & Papathakis, P [Show all 9 contributors for this article] (2021). A novel intervention combining supplementary food and infection-control measures to improve birth outcomes in undernourished pregnant women in Sierra Leone: A randomized, controlled clinical effectiveness trial. PLoS Medicine. ISSN 1549-1277. 18(9), p. e1003618–e1003618. doi: 10.1371/journal.pmed.1003618. Full text in Research Archive Show summary

  Background Innovations for undernourished pregnant women that improve newborn survival and anthropometry are needed to achieve the Sustainable Development Goals 1 and 3. This study tested the hypothesis that a combination of a nutritious supplementary food and several proven chemotherapeutic interventions to control common infections would increase newborn weight and length in undernourished pregnant women. Methods and findings This was a prospective, randomized, controlled clinical effectiveness trial of a ready-to-use supplementary food (RUSF) plus anti-infective therapies compared to standard therapy in undernourished pregnant women in rural Sierra Leone. Women with a mid-upper arm circumference (MUAC) ≤23.0 cm presenting for antenatal care at one of 43 government health clinics in Western Rural Area and Pujehun districts were eligible for participation. Standard of care included a blended corn/soy flour and intermittent preventive treatment for malaria in pregnancy (IPTp). The intervention replaced the blended flour with RUSF and added azithromycin and testing and treatment for vaginal dysbiosis. Since the study involved different foods and testing procedures for the intervention and control groups, no one except the authors conducting the data analyses were blinded. The primary outcome was birth length. Secondary outcomes included maternal weight gain, birth weight, and neonatal survival. Follow-up continued until 6 months postpartum. Modified intention to treat analyses was undertaken. Participants were enrolled and followed up from February 2017 until February 2020. Of the 1,489 women enrolled, 752 were allocated to the intervention and 737 to the standard of care. The median age of these women was 19.5 years, of which 42% were primigravid. Twenty-nine women receiving the intervention and 42 women receiving the standard of care were lost to follow-up before pregnancy outcomes were obtained. There were 687 singleton live births in the intervention group and 657 in the standard of care group. Newborns receiving the intervention were 0.3 cm longer (95% confidence interval (CI) 0.09 to 0.6; p = 0.007) and weighed 70 g more (95% CI 20 to 120; p = 0.005) than those receiving the standard of care. Those women receiving the intervention had greater weekly weight gain (mean difference 40 g; 95% CI 9.70 to 71.0, p = 0.010) than those receiving the standard of care. There were fewer neonatal deaths in the intervention (n = 13; 1.9%) than in the standard of care (n = 28; 4.3%) group (difference 2.4%; 95% CI 0.3 to 4.4), (HR 0.62 95% CI 0.41 to 0.94, p = 0.026). No differences in adverse events or symptoms between the groups was found, and no serious adverse events occurred. Key limitations of the study are lack of gestational age estimates and unblinded administration of the intervention. Conclusions In this study, we observed that the addition of RUSF, azithromycin, more frequent IPTp, and testing/treatment for vaginal dysbiosis in undernourished pregnant women resulted in modest improvements in anthropometric status of mother and child at birth, and a reduction in neonatal death. Implementation of this combined intervention in rural, equatorial Africa may well be an important, practical measure to reduce infant mortality in this context.

• Atukunda, Prudence; Ngari, Moses M.; Chen, Xi; Westerberg, Ane C.; Iversen, Per Ole & Muhoozi, Grace (2021). Longitudinal assessments of child growth: A six-year follow-up of a cluster-randomized maternal education trial. Clinical Nutrition. ISSN 0261-5614. 40(9), p. 5106–5113. doi: 10.1016/j.clnu.2021.08.007. Full text in Research Archive Show summary

  Background & aims Child growth impairments are rampant in sub-Saharan Africa. To combat this important health problem, long-term follow-up studies are needed to examine possible benefits and sustainability of various interventions designed to correct inadequate child growth. Our aim was to perform a follow-up study of children aged 60–72 months whose mothers participated in a two-armed cluster-randomized education intervention trial lasting 6 months in rural Uganda when their children were 6–8 months old with data collection at 20–24 and at 36 months. The education focused on nutrition, hygiene, and child stimulation. Methods We measured growth using anthropometry converted to z-scores according to WHO guidelines. We also included assessments of body composition using bioimpedance. We used multilevel mixed effect linear regression models with maximum likelihood method, unstructured variance-covariance structure, and the cluster as a random effect component to compare data from the intervention (receiving the education and routine health care) with the control group (receiving only routine health care). Results Of the 511 children included in the original trial, data from 166/263 (63%) and 141/248 (57%) of the children in the intervention and control group, respectively, were available for the current follow-up study. We found no significant differences in any anthropometrical z-score between the two study groups at child age of 60–72 months, except that children in the intervention group had lower (P = 0.006) weight-for-height z-score than the controls. There were no significant differences in the trajectories of z-scores or height growth velocity (cm/year) from baseline (start of original trial) to child age of 60–72 months. Neither did we detect any significant difference between the intervention and control group regarding body composition (fat mass, fat free mass, and total body water) at child age 60–72 months. Separate gender analyses had no significant impact on any of the growth or body composition findings. Conclusion In this long-term study of children participating in a randomized maternal education trial, we found no significant impact of the intervention on anthropometrical z-scores, height growth velocity or body composition.

• Hasanaliyeva, Gulatikin; Chatzidimitrou, Eleni; Wang, J.; Baranski, M; Volakakis, Nikolaos & Pakos, P [Show all 15 contributors for this article] (2021). Effect of organic and conventional Production Methods on Fruit Yield and Nutritional Quality Parameters in Table Grapes made from three traditional Cretan Grape Varieties; Results from a Farm Survey. Foods. 10(2). doi: 10.3390/foods10020476. Full text in Research Archive Show summary

  The antioxidants found in grapes and wine have been linked to health benefits in humans, but may be affected by agronomic parameters, grape type/variety, and processing. Here, we report results of a farm survey which investigated the effects of production system (organic vs. conventional) and grape variety on fruit yield, total antioxidant activity/capacity (TAA, assessed by the Trolox Equivalent Antioxidant Capacity (TEAC) and 2,2-diphenyl-1-picrylhydrazyl (DPPH) radical scavenging assays), and total concentrations of total phenolics (TPC) and anthocyanins (TAC) in grapes of one red (Kotsifali) and two white (Villana and/or Vidiano) traditional Cretan grape varieties. Analysis of variance (ANOVA) results showed that grape variety choice had a more substantial effect on TPC, TAA, and TAC than primary production protocols, and significant interactions were identified between production system and grape variety choice for TAATEAC. Specifically, TAATEAC was significantly (57%) higher in organic than conventional Vidiano grapes, while there was no significant effect of production system on TAATEAC in Kotsifali and Villana grapes. As expected from previous studies, the TAC was substantially higher in red Kotsifali grapes. Redundancy analysis (RDA) identified grape variety as the only strong explanatory variable/driver for yield, TPC, TAA, and TAC of table grapes, and positive associations were detected between the variety Vidiano and both TPC and TAATEAC. All other explanatory variables included in the RDA (including supplementary irrigation, orchard orientation, production system, soil type, vineyard age, plant density, and fertiliser inputs) explained only a small proportion of the additional variation.

• Strømmen, Kenneth; Lyche, Jan Ludvig; Moltu, Sissel; Müller, Mette Helen Bjørge; Blakstad, Elin Wahl & Almaas, Astrid Nylander [Show all 12 contributors for this article] (2021). High urinary concentrations of parabens and bisphenol A in very low birth weight infants. Chemosphere. ISSN 0045-6535. 271, p. 1–9. doi: 10.1016/j.chemosphere.2021.129570. Full text in Research Archive Show summary

  Very low birth weight infants (VLBW; birth weight < 1500 g) are treated with pharmaceuticals and medical equipment containing parabens and bisphenol A (BPA). Parabens are used in pharmaceuticals, whereas BPA in medical equipment where concentrations are rarely reported in hospitalised VLBW infants. We measured urinary concentrations of parabens and BPA and hypothesised high and increasing concentrations in infants born at lower gestational ages (GAs), and among infants with bronchopulmonary dysplasia (BPD) and late-onset septicaemia (LOS) due to higher exposure from pharmaceuticals and medical equipment. Urinary samples were collected during the first (n = 38) and fifth (n = 36) week of life. Methylparaben, ethylparaben, propylparaben, butylparaben, and BPA concentrations were measured using ultra high-performance liquid chromatography coupled to tandem mass spectrometry. VLBW infants had very high urinary concentrations of parabens and BPA compared to term infants and older children. The Σ paraben concentration was higher than detected in previous studies on premature infants. Lower GA at birth was associated with higher concentrations of parabens and BPA. Infants born before 28 weeks GA had higher first week concentrations of propylparaben (38.6 vs. 9.05 ng/mL, p = 0.007), butylparaben (0.28 vs. 0.09 ng/mL, p = 0.05) and fifth week concentrations of BPA (15.1 vs. 6.02 ng/mL, p = 0.02) than infants born after 28 weeks GA. Infants with LOS and BPD had higher fifth week concentrations of BPA than infants without LOS and BPD (LOS: 14.2 vs. 6.77 ng/mL, p = 0.07; BPD: 18.6 vs. 7.62 ng/mL, p = 0.05).

• Kort, Remco; Schlosser, Job; Vazquez, Alan; Atukunda, Prudence; Muhoozi, Grace Kyamazima Mehangye & Wacoo, Alex [Show all 10 contributors for this article] (2021). Model selection reveals the butyrate-producing gut bacterium Coprococcus eutactus as predictor for language development in three-year-old rural Ugandan children. Frontiers in Microbiology. 12. doi: 10.3389/fmicb.2021.681485. Full text in Research Archive Show summary

  Introduction: The metabolic activity of the gut microbiota plays a pivotal role in the gut-brain axis through the effects of bacterial metabolites on brain function and development. In this study we investigated the association of gut microbiota composition with language development of 3-year-old rural Ugandan children. Methods: We studied the language ability in 139 children of 36 months in our controlled maternal education intervention trial to stimulate children’s growth and development. The dataset includes 1170 potential predictors, including anthropometric and cognitive parameters at 24 months, 542 composition parameters of the children’s gut microbiota at 24 months and 621 of these parameters at 36 months. We applied a novel computationally efficient version of the all-subsets regression methodology and identified predictors of language ability of 36-months-old children scored according to the Bayley Scales of Infant and Toddler Development (BSID-III). Results: The best three-term model, selected from more than 266 million models, includes the predictors Coprococcus eutactus at 24 months of age, Bifidobacterium at 36 months of age, and language development at 24 months. The top 20 four-term models, selected from more than 77 billion models, consistently include C. eutactus abundance at 24 months, while 14 of these models include the other two predictors as well. Mann–Whitney U tests suggest that the abundance of gut bacteria in language non-impaired children (n = 78) differs from that in language impaired children (n = 61). While anaerobic butyrate-producers, including C. eutactus, Faecalibacterium prausnitzii, Holdemanella biformis, Roseburia hominis are less abundant, facultative anaerobic bacteria, including Granulicatella elegans, Escherichia/Shigella and Campylobacter coli, are more abundant in language impaired children. The overall predominance of oxygen tolerant species in the gut microbiota was slightly higher in the language impaired group than in the non-impaired group (P = 0.09). Conclusion: Application of the all-subsets regression methodology to microbiota data established a correlation between the relative abundance of the anaerobic butyrate-producing gut bacterium C. eutactus and language development in Ugandan children. We propose that the gut redox potential and the overall bacterial butyrate-producing capacity in the gut are important factors for language development.

• Rempelos, Leonidas; Baranski, Marcin; Wang, Juan; Adams, Timothy N.; Adebusuyi, Kolawole & Beckman, Jeremy J. [Show all 44 contributors for this article] (2021). Integrated soil and crop management in organic agriculture: A logical framework to ensure food quality and human health? Agronomy. 11(12). doi: 10.3390/agronomy11122494. Full text in Research Archive Show summary

  The environmental and biodiversity benefits of organic farming are widely recognized, but there is still controversy about the effects of organic production methods on the nutritional composition of food and human health. In the first part of this article therefore, we critically review the evidence that organic farming methods improve the nutritional quality of food crops. Moreover, we summarize our current understanding of how quality gains are linked to the implementation of the “innovations” introduced into conventional crop production during the intensification or “green revolution” of agriculture over the last 100 years. In the second part of the article, we critically review the evidence for the range of health benefits related to organic food consumption. Specifically, we describe and discuss the results from: (i) dietary intervention studies which have found that organic food consumption substantially reduces pesticide exposure in humans and affects feed intake, growth, hormone balances and immune system responsiveness in animal models; (ii) human cohort/epidemiological studies which have reported significant positive associations between organic food consumption and the lower incidence of a range of diseases including obesity, metabolic syndrome, cancer, hypospadias, pre-eclampsia, eczema and middle ear infections in infants; (iii) interactions and trade-offs between diet (e.g., whole-grain, fruit and vegetables and reduced red-meat consumption) and food types (organic versus conventional) concerning public health and future food security. The article also identifies knowledge gaps and highlights the need for (i) long-term, factorial field experiments to understand the relative effects of agronomic and pedoclimatic drivers on crop quality and safety, and (ii) clinical trials and additional human cohort studies to confirm the positive health outcomes linked to organic food consumption. The main conclusions from our review are that there is growing evidence that (i) agricultural intensification has resulted in a reduction in the nutritional quality of food and the sustainability of food production, and (ii) organic farming practices not only improve food quality and human health, but also food security. This is particularly true where current nutritional guidelines (increasing whole-grain, fruit and vegetable products, while reducing red-meat consumption) are implemented.

• Kvam, Ann Kristin; Torp, Henrik Andreas & Iversen, Per Ole (2021). Life-Threatening Acute Chest Syndrome in a Patient With Sickle Cell Disease After Switching From Hydroxyurea Therapy to Partial Exchange Transfusions: A Case Report. Cureus - Journal of Medical Science. 13(12). doi: 10.7759/cureus.20236. Full text in Research Archive Show summary

  Acute chest syndrome (ACS) is a severe form of vaso-occlusive crisis, which is a main feature of sickle cell disease (SCD), an inherited hemoglobinopathy. Traditionally, hydroxyurea has been the treatment of choice for SCD to prevent vaso-occlusive crises including ACS. However, hydroxyurea may be contraindicated, for example, in patients wanting to have children. We here present a young male with SCD who wanted to become a father and developed a life-threatening episode of ACS following discontinuation of hydroxyurea and switching to partial exchange blood transfusions. The patient, aged 32 years and originally from Bahrain, had been diagnosed with homozygous SCD, alpha-thalassemia, and glucose-6-phosphate dehydrogenase deficiency as a child. He had an episode of ACS with moderate severity in 2008, after which he started using hydroxyurea. From 2008 until the present, he did not experience any episodes of ACS. About six months before the present episode, he stopped using hydroxyurea and switched to partial exchange transfusions, aiming to keep hemoglobin S (HbS) below 30%. The interval between the transfusions was typically about seven to eight weeks. On the evening (day 1) before hospital admission, he developed typical symptoms and signs of vaso-occlusive crisis, and during the first day in the hospital (HbS about 55%), his pulmonary function deteriorated, and he also developed cerebral symptoms (somnolence and confusion). On suspicion of ACS, a full blood exchange transfusion was administered on day 3. He then gradually recovered clinically, and his laboratory values also normalized. He was discharged on day 10. Subsequent follow-up visits at the outpatient clinic the following month were unremarkable. Possibly, this severe episode of ACS was triggered by switching from hydroxyurea therapy to partial exchange transfusions with too long intervals between the transfusions. This novel case is a compelling reminder of the possible perils that may accompany the discontinuation of hydroxyurea, the best-documented therapy in SCD.

• Barański, Marcin; Średnicka-Tober, Dominika; Rempelos, Leonidas; Hasanaliyeva, Gultakin; Gromadzka-Ostrowska, Joanna & Skwarło-Sońta, Krystyna [Show all 17 contributors for this article] (2021). Feed composition differences resulting from organic and conventional farming practices affect physiological parameters in wistar rats-results from a factorial, two-generation dietary intervention trial. Nutrients. 13(2), p. 1–34. doi: 10.3390/nu13020377. Full text in Research Archive Show summary

  Recent human cohort studies reported positive associations between organic food consumption and a lower incidence of obesity, cancer, and several other diseases. However, there are very few animal and human dietary intervention studies that provide supporting evidence or a mechanistic understanding of these associations. Here we report results from a two-generation, dietary intervention study with male Wistar rats to identify the effects of feeds made from organic and conventional crops on growth, hormonal, and immune system parameters that are known to affect the risk of a number of chronic, non-communicable diseases in animals and humans. A 2 × 2 factorial design was used to separate the effects of contrasting crop protection methods (use or non-use of synthetic chemical pesticides) and fertilizers (mineral nitrogen, phosphorus and potassium (NPK) fertilizers vs. manure use) applied in conventional and organic crop production. Conventional, pesticide-based crop protection resulted in significantly lower fiber, polyphenol, flavonoid, and lutein, but higher lipid, aldicarb, and diquat concentrations in animal feeds. Conventional, mineral NPK-based fertilization resulted in significantly lower polyphenol, but higher cadmium and protein concentrations in feeds. Feed composition differences resulting from the use of pesticides and/or mineral NPK-fertilizer had a significant effect on feed intake, weight gain, plasma hormone, and immunoglobulin concentrations, and lymphocyte proliferation in both generations of rats and in the second generation also on the body weight at weaning. Results suggest that relatively small changes in dietary intakes of (a) protein, lipids, and fiber, (b) toxic and/or endocrine-disrupting pesticides and metals, and (c) polyphenols and other antioxidants (resulting from pesticide and/or mineral NPK-fertilizer use) had complex and often interactive effects on endocrine, immune systems and growth parameters in rats. However, the physiological responses to contrasting feed composition/intake profiles differed substantially between the first and second generations of rats. This may indicate epigenetic programming and/or the generation of “adaptive” phenotypes and should be investigated further.

• Bakken, Line & Iversen, Per Ole (2021). The impact of malaria during pregnancy on low birth weight in East-Africa: a topical review. Malaria Journal. 20(1). doi: 10.1186/s12936-021-03883-z. Full text in Research Archive Show summary

  Background Globally, approximately 15% of all babies are born with low birth weight (< 2.5 kg) and ≥ 90% of them are born in low- and middle-income countries. Malaria infection in pregnancy remains a public health concern as it can affect both the mother and the newborn. Notably, it increases the risk of newborns with low birth weight. The World Health Organization (WHO) recommends intermittent preventive treatment with ≥ 3 doses of sulfadoxine-pyrimethamine (SP) during pregnancy in areas with moderate to high malaria transmission in Africa. The aim of this topical review is to give an overview of the impact of malaria infection during pregnancy on low birth weight, with focus on East Africa where malaria is endemic. Methods Eleven studies were selected according to a predefined set of criteria. Results Three studies showed a significant reduction in the prevalence of low birth weight with intermittent preventive treatment with SP, whereas four studies found no significant impact of such treatment on low birth weight. The number of SP doses and compliance to this treatment may in part explain these discrepancies. Pregnant women with frequent symptomatic malaria infection had significantly higher risk of placental malaria. Conclusion The WHO recommendation of ≥ 3 doses of intermittent preventive treatment with SP during pregnancy seem effective in preventing low birth weight, but treatment compliance is a challenge. Malaria prophylaxis is important during pregnancy, especially in endemic areas of malaria, such as East Africa.

• Skaarud, Kristin Aneta Joan; Hov, Johannes Espolin Roksund; Hansen, Simen Hyll; Kummen, Martin; Valeur, Jørgen & Seljeflot, Ingebjørg [Show all 12 contributors for this article] (2021). Mortality and microbial diversity after allogenic hematopoietic stem cell transplantation: secondary analysis of a randomized nutritional intervention trial. Scientific Reports. 11. doi: 10.1038/s41598-021-90976-z. Full text in Research Archive Show summary

  Gut mucosal barrier injury is common following allogeneic hematopoietic stem cell transplantation (allo-HSCT) and associated with poor clinical outcomes. Diet is critical for microbial diversity, but whether nutritional support affects microbiota and outcome after allo-HSCT is unknown. We present a secondary analysis of a randomized controlled nutritional intervention trial during allo-HSCT. We investigated if the intervention influenced gut microbiota, short-chain fatty acids (SCFAs), and markers of gut barrier functions, and if these parameters were associated with clinical outcomes. Fecal specimens were available from 47 recipients, and subjected to 16S rRNA gene sequencing. We found no significant differences between the intervention group and controls in investigated parameters. We observed a major depletion of microbiota, SCFAs, and altered markers of gut barrier function from baseline to 3 weeks post-transplant. One-year mortality was significantly higher in patients with lower diversity at 3 weeks post-HSCT, but not related to diversity at baseline. The relative abundance of Blautia genus at 3 weeks was higher in survivors. Fecal propionic acid was associated with survival. Markers of gut barrier functions were less strongly associated with clinical outcomes. Possibly, other strategies than dietary intervention are needed to prevent negative effects of gut microbiota and clinical outcomes after allo-HSCT.

• Tvedt, Tor Henrik Anderson; Skaarud, Kristin Aneta Joan; Tjønnfjord, Geir Erland; Gedde-Dahl, Tobias; Iversen, Per Ole & Bruserud, Øystein (2020). The systemic metabolic profile early after allogeneic stem cell transplantation: Effects of adequate energy support administered through enteral feeding tube. Biology of Blood and Marrow Transplantation. ISSN 1083-8791. 26(2), p. 380–391. doi: 10.1016/j.bbmt.2019.10.005. Full text in Research Archive Show summary

  Patients undergoing allogeneic stem cell transplantation usually require nutritional support. There is no consensus on whether enteral support through tube feeding should be preferred. A recent randomized study could not detect any difference between enteral and parenteral feeding with regard to post-transplant outcomes, whereas 2 retrospective studies described an association between enteral feeding and a favorable post-transplant outcome. We compared pre- and post-transplant plasma metabolomic profiles for 10 patients receiving mainly enteral nutritional support and 10 patients receiving mainly parenteral support. Samples were collected before conditioning and 3 weeks post-transplant; 824 metabolites were analyzed using mass spectrometry. The pretransplant metabolite profiles showed a significant overlap between the 2 groups. Post-transplant samples for both patient groups showed an increase of secondary bile acids and endocannabinoids, whereas reduced levels were seen for food preservatives, plasmalogens, and retinol metabolites. The main post-transplant differences between the groups were decreased levels of fatty acids and markers of mitochondrial activation in the control group, indicating that these patients had insufficient energy intake. A significant effect was also seen for heme/bilirubin metabolism for the parenteral support. To conclude, allotransplant recipients showed altered metabolic profiles early after transplantation; this was mainly due to the conditioning/transplantation/reconstitution, whereas the type of nutritional support had minor effects.

• Dusingizimana, Theogene; Weber, Janet L; Ramilan, Thiagarajah; Iversen, Per Ole & Brough, Louise (2020). A qualitative analysis of infant and young child feeding practices in rural Rwanda. Public Health Nutrition (PHN). ISSN 1368-9800. p. 1–10. doi: 10.1017/S1368980020001081. Full text in Research Archive Show summary

  Objective: To explore and gain an in-depth understanding of the factors influencing child feeding practices among rural caregivers in Rwanda. Design: In-depth semi-structured qualitative interviews were conducted. Purposive sampling was used to recruit participants. Interviews were audio-recorded, transcribed verbatim and coded. Data were analysed inductively using thematic analysis. Setting: Rutsiro District, Western Province, Rwanda. Participants: Participants included twenty-four mothers (median age 32 years) with children 6–23 months old. Results: We identified five key themes: (i) breast-feeding practices and role in food supply; (ii) family v. children’s food preparations; (iii) food classification systems and their influence on child feeding decisions; (iv) child feeding during diarrhoeal episodes and (v) influence of poverty on child feeding practices and child care. Conclusions: Mothers’ infant and young child feeding decisions are informed by information both from health workers and from traditional/own knowledge. Navigating through this information sometimes creates conflicts which results in less than optimal child feeding. A nutrition educational approach that is cognisant of maternal perceptions should be employed to improve child feeding practices. Efforts to improve child feeding practices must be complemented by programmes that enhance household economic opportunities and access to foods.

• Wang, Juan; Hasanalieva, Gultakin; Wood, Liza; Markellou, Emilia; Iversen, Per Ole & Bernhoft, Aksel [Show all 14 contributors for this article] (2020). Effects of wheat species (Triticum aestivum vs T. spelta), farming system (organic vs conventional) and flour type (wholegrain vs white) on composition of wheat flour; results of a retail survey in the UK and Germany 1. Mycotoxin content. Food Chemistry. ISSN 0308-8146. 327. doi: 10.1016/j.foodchem.2020.127011. Full text in Research Archive
• Wang, Juan; Hasanalieva, Gultakin; Wood, Liza; Anagnostopoulos, Christos; Ampadogiannis, Georgios & Bempelou, Eleftheria [Show all 14 contributors for this article] (2020). Effect of wheat species (Triticum aestivum vs T. spelta), farming system (organic vs conventional) and flour type (wholegrain vs white) on composition of wheat flour – Results of a retail survey in the UK and Germany – 3. Pesticide residue content. Food chemistry: X.. 7. doi: 10.1016/j.fochx.2020.100089. Full text in Research Archive
• Wacoo, Alex; Atukunda, Prudence; Muhoozi, Grace Kyamazima Mehangye; Braster, Martin; Wagner, Marijke & Broek, Tim van den [Show all 10 contributors for this article] (2020). Aflatoxins: Occurrence, Exposure, and Binding to Lactobacillus Species from the Gut Microbiota of Rural Ugandan Children. Microorganisms. 8(3). doi: 10.3390/microorganisms8030347. Full text in Research Archive Show summary

  Chronic exposure of children in sub-Saharan Africa to aflatoxins has been associated with low birth weight, stunted growth, immune suppression, and liver function damage. Lactobacillus species have been shown to reduce aflatoxin contamination during the process of food fermentation. Twenty-three Lactobacillus strains were isolated from fecal samples obtained from a cohort of rural Ugandan children at the age of 54 to 60 months, typed by 16S rRNA gene sequencing, and characterized in terms of their ability to bind aflatoxin B1 in vitro. Evidence for chronic exposure of these children to aflatoxin B1 in the study area was obtained by analysis of local foods (maize flour and peanuts), followed by the identification of the breakdown product aflatoxin M1 in their urine samples. Surprisingly, Lactobacillus in the gut microbiota of 140 children from the same cohort at 24 and 36 months showed the highest positive correlation coefficient with stunting among all bacterial genera identified in the stool samples. This correlation was interpreted to be associated with dietary changes from breastfeeding to plant-based solid foods that pose an additional risk for aflatoxin contamination, on one hand, and lead to increased intake of Lactobacillus species on the other.

• Katenga-Kaunda, Lillian Ziyenda; Iversen, Per Ole; Holmboe-Ottesen, Gerd; Fjeld, Heidi E; Mdala, Ibrahimu & Kamudoni, Penjani Rhoda (2020). Dietary intake and processes of behaviour change in a nutrition education intervention for pregnant women in rural Malawi: a cluster-randomised controlled trial. Public Health Nutrition (PHN). ISSN 1368-9800. 23(13), p. 2345–2354. doi: 10.1017/s1368980020000294. Full text in Research Archive Show summary

  Objective: To examine if increased intake of locally available nutrient-dense foods among pregnant women improved the quality of their dietary intake and if use of the Theory of Planned Behaviour could explain changes in their dietary behaviour. Design: We used data from a randomised controlled trial where the intervention group received nutrition education and dietary counselling. We promoted the use of recipes that utilised powders to enhance dietary diversity. We examined how the intervention achieved changes in dietary intakes and used mixed effects logistic regression models with random effects at village level to explore changes over time of the outcomes, adjusted for selected explanatory variables. Setting: The study was conducted in twenty villages in rural Malawi. Participants: Data from 257 pregnant women who were enrolled during late first trimester and followed until birth. Results: The intervention achieved improvements in the Dietary Diversity Score (DDS) and the Six Food Group Pyramid (SFG) score, especially in intakes of micronutrient-rich foods. A third of the women in the intervention group attained optimal DDS, whereas about 50 % attained optimal SFG. The theorised behaviour mediators (i.e. nutrition attitudes, nutrition behaviour control and subjective norm) that had improved were also significantly associated with high DDS. Conclusions: Improved dietary intakes were achieved through promoting the use of locally available nutrient-dense foods. Attainment of high DDS was a consequence of the women’s belief in the effectiveness of the proposed nutrition recommendations. We identified critical personal and environmental constraints related to dietary intakes during pregnancy in a low-resource setting.

• Iversen, Per Ole; Lueder, Thomas Gero von; Kardel, Kristin Reimers & Lien, Katarina (2020). Cardiac Dimensions and Function are not Altered among Females with the Myalgic Encephalomyelitis/Chronic Fatigue Syndrome. Healthcare. 8(4). doi: 10.3390/healthcare8040406. Full text in Research Archive Show summary

  Background: Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a debilitating condition associated with several negative health outcomes. A hallmark of ME/CFS is decreased exercise capacity and often profound exercise intolerance. The causes of ME/CSF and its related symptoms are unknown, but there are indications of a dysregulated metabolism with impaired glycolytic vs oxidative energy balance. In line with this, we recently demonstrated abnormal lactate accumulation among ME/CFS patients compared with healthy controls after exercise testing. Here we examined if cardiac dimensions and function were altered in ME/CFS, as this could lead to increased lactate production. Methods: We studied 16 female ME/CFS patients and 10 healthy controls with supine transthoracic echocardiography, and we assessed cardiac dimensions and function by conventional echocardiographic and Doppler analysis as well as novel tissue Doppler and strain variables. Results: A detailed analyses of key variables of cardiac dimensions and cardiac function revealed no significant differences between the two study groups. Conclusion: In this cohort of well-described ME/CFS patients, we found no significant differences in echocardiographic variables characterizing cardiac dimensions and function compared with healthy controls.

• Mwaiswelo, Richard; Mawala, William; Iversen, Per Ole; Montalembert, Mariane De; Luzzatto, Lucio & Makani, Julie (2020). Sickle cell disease and malaria: decreased exposure and asplenia can modulate the risk from Plasmodium falciparum. Malaria Journal. doi: 10.1186/s12936-020-03212-w. Full text in Research Archive Show summary

  Background Patients with sickle cell disease (SCD), an inherited haemoglobinopathy, have increased risk of malaria, at least in part due to impaired splenic function. Infection with Plasmodium falciparum in SCD patients can trigger painful vaso-occlusive crisis, increase the severity of anaemia, and contribute to early childhood mortality. Case presentation A 17 year-old Tanzanian male with known SCD was admitted to Muhimbili National Hospital, a tertiary referral centre in Dar-es-Salaam, following an attack of malaria. From 2004 to 2007 the patient had lived in USA, and from 2010 to 2016 in France where, on account of hypersplenism and episodes of splenic sequestrations, in 2014 the spleen was removed. After appropriate clinical and laboratory assessment the patient was re-started on hydroxyurea; and anti-malarial-prophylaxis with proguanil was instituted. The patient has remained well and malaria-free for the following 15 months. Conclusion SCD patients are highly vulnerable to malaria infection, and impaired splenic function is a feature of SCD patients, even in those who still anatomically have a spleen. This patient had a surgical splenectomy and, in addition, had probably lost some of the acquired malaria-immunity by having lived for several years in malaria-free areas. This patient is a compelling reminder that long-term anti-malarial prophylaxis should be offered to all patients with SCD who live in malaria-endemic areas.

• Mtenga, Janeth; Orf, Kate; Zheng, Jiexin; Chamba, Clara; Chuwa, Harrison & Luoga, Frederick [Show all 9 contributors for this article] (2020). Haematopoietic stem cell transplantation in Tanzania. British Journal of Haematology. ISSN 0007-1048. doi: 10.1111/bjh.17106. Full text in Research Archive Show summary

  Haematopoietic stem cell transplantation (HSCT) is a much‐needed service in Tanzania, to provide curative therapy for sickle cell disease (SCD), aplastic anaemia and haematological malignancies. The experience of other countries with limited resources has demonstrated that it is possible to set up such a service within similar economic and healthcare settings. This article summarises the current progress that has been made towards setting up an HSCT service in Tanzania and highlights the areas that require more work and investment to make the service a reality.

• Ngari, Moses M.; Obiero, Christina; Mwangome, Martha; Nyaguara, Amek; Mturi, Neema & Murunga, Sheila [Show all 11 contributors for this article] (2020). Mortality during and following hospital admission among school-aged children: a cohort study. Wellcome Open Research. 5, p. 1–26. doi: 10.12688/WELLCOMEOPENRES.16323.2. Full text in Research Archive Show summary

  Despite a remarkable decline in global child mortality, more than 6 million children died in 2018, of which 0.9 million (15%) deaths occurred among children aged 5 to 14 years, mostly in low- and middle-income countries (LMICs)1,2. Public health efforts to improve survival are generally directed towards children <5 years old2–4. Despite there being no specific new health interventions targeting children aged 5 to 14 years, their mortality risk from 1990 to 2016 declined by 51% globally4. However, since 2000, the annual rate of mortality reduction in this group (2.7%) has been lower than amongst children <5 years old (4.0%)4. Children ≥5 years old may be admitted with different conditions than younger children and their risks for inpatient or post-discharge mortality may also differ. However, there are only limited data describing reasons for admission and mortality-patterns in LMICs. Among school-aged children admitted to six Kenyan hospitals in 2013, 3.5% of children aged 5 to 9 years and 5.0% of children 10 to 14 years died5. Infectious diseases such as malaria were the main reported causes of death in children ≥5 years2,5,6. Post-discharge mortality is increasingly recognized as a significant contributor to the burden of mortality among under-fives in LMICs and adults in resource-rich settings7–9. The most recent systematic review (2018) of paediatric post-discharge mortality in LMICs did not identify any studies focusing specifically on school-aged children7,8. Of 24 studies reviewed, four included children ≥5 years old. A study in Bangladesh with a sample size of 74 children aged 24 to 72 months did not report the number of children who were ≥5 years old10. A large study in Kenya among children 0 to 15 years old (N=14,971) reported that 16% (88/535) of all post-hospital discharge deaths were among children aged 5 to 14 years11 and two studies from Uganda with children aged 2 months to 12 years reported ~1% and 3.8% children dying after discharge, respectively, but were not disaggregated by age group12,13. Since the latest systematic review (2018)7, four more studies have evaluated paediatric post-discharge mortality in LMICs3,14–16. Hau et al. included children aged 2 to 12 years followed-up for 12 months after discharge from two hospitals in Tanzania and found that 16% (26/161) of children aged 5 to12 years died after hospital discharge3. Post-discharge mortality risk was reported to be higher than that of children <5 years (hazard ratio 2.44 (95%CI, 1.37 to 4.34)3. The commonest diagnoses at admission were malaria and sickle cell disease3. The second study from southern Mozambique included 18,023 children aged <15 years, of which 83/3,816 (2.2%) aged ≥5 years died within three months after discharge14. The third study was from Kenya, but excluded children ≥5 years old15. The fourth study from Tanzania included children aged 2 to 12 years, of whom 47/466 (10%) died one year after hospital discharge, but deaths were not disaggregated by age16. We aimed to describe the reasons for hospitalisation, underlying illnesses, and the clinical characteristics and features associated with mortality during hospitalisation and for one year after discharge among children 5 to 12 years old admitted to a rural hospital in Kenya.

• Hasanaliyeva, Gulatikin; Chatzidimitrou, Eleni; Wang, Juan; Baranski, Marcin; Volakakis, Nikolaos & Seal, Chris [Show all 12 contributors for this article] (2020). Effects of Production Region, Production Systems and Grape Type/Variety on Nutritional Quality Parameters of Table Grapes; Results from a UK Retail Survey. Foods. 16(9). doi: 10.3390/foods9121874. Full text in Research Archive Show summary

  Grapes contain high concentrations of secondary metabolites and antioxidants that have been linked to a reduction of several chronic diseases. Here, we report results of a UK retail survey, which investigated the effect of the production region (Mediterranean vs. South Africa), grape type (white vs. red vs. black) and variety, and production system (organic vs. conventional) on antioxidant activity and concentrations of phenolic compounds in table grapes. Black grapes had ~180% total antioxidant activity (TAA), ~60% higher total phenolic content (TPC) and ~40 times higher anthocyanin concentrations (TAC) than white grapes, while red grapes had intermediate levels of TAA, TPC and TAC. The effects of season and production system and differences between varieties of the same grape type were substantially smaller. Grapes imported from Mediterranean countries in summer had a 14% higher TPC and ~20% higher TAA than grapes imported from South Africa in winter, and organic grapes had a 16% higher TPC and 22% higher TAA, but ~30% lower TAC than conventional grapes. Significant differences in TPC, TAA and/or TAC between organic and conventional grapes could only be detected for specific grape types, varieties and/or sampling years.

• Dusingizimana, Theogene; Weber, Janet L; Ramilan, Thiagarajah; Iversen, Per Ole & Brough, Louise (2020). An empirical analysis of the factors associated with height-for-age z-scores of children aged 6-23 months in northwest Rwanda: the role of care practices related to child feeding and health. British Journal of Nutrition. ISSN 0007-1145. 1(12). doi: 10.1017/S0007114520004961. Full text in Research Archive
• Wang, Juan; Chatzidimitriouc, Eleni; Wood, Liza; Hasanalieva, Gultakin; Markelou, Emilia & Iversen, Per Ole [Show all 15 contributors for this article] (2020). Effect of wheat species (Triticum aestivum vs T. spelta), farming system (organic vs. conventional) and flour type (wholegrain vs white) on composition of wheat flour - Results of a retail survey in the UK and Germany - 2. Antioxidant activity, and phenolic and mineral content. Food Chemistry. ISSN 0308-8146. 6. doi: 10.1016/j.fochx.2020.100091. Full text in Research Archive Show summary

  There is strong evidence for health benefits from whole-grain wheat consumption and these have been linked to their higher fibre, antioxidant/(poly)phenolic and mineral contents. However, there is still scientific controversy about the relative effect of wheat species (Triticum aestivum vs T. spelta) and production methods (conventional vs organic) on the nutritional composition of wheat. The retail survey reported here showed that, the use of spelt varieties and organic production results in significantly higher (between 10 and 64%) levels of phenolics and some minerals in wheat flour. However, the relative effect of removing the outer bran and germ during milling was substantially larger; levels of antioxidant activity, and many phenolic compounds and mineral nutrients were 2–5 times higher in whole-grain than white flour. Organic flour contained higher concentrations of the undesirable metals Al and Ni (12% and 81% respectively), and spelt flour had 28% higher concentrations of the toxic metal Cd.

• Iversen, Per Ole; Atukunda, Prudence; Kort, Remco; Ueland, Per Magne; Westerberg, Ane Cecilie & Muhoozi, Grace Kyamazima Mehangye (2020). No associations between microbiota signaling substances and cognitive, language and motor development among three-year-old rural Ugandan children. Acta Paediatrica. ISSN 0803-5253. 109(11), p. 2339–2341. doi: 10.1111/apa.15330. Full text in Research Archive
• Mpinganzima, Clarisse; Haaland, Alf; Holm, Anne Guro Vreim; Thein, Swee Lay; Tjønnfjord, Geir Erland & Iversen, Per Ole (2020). Two Consecutive Episodes of Severe Delayed Hemolytic Transfusion Reaction in a Sickle Cell Disease Patient. Case Reports in Hematology. ISSN 2090-6560. doi: 10.1155/2020/2765012. Full text in Research Archive Show summary

  Patients with sickle cell disease (SCD) suffer from anemia and painful vaso-occlusive crisis (VOC) and sometimes need blood transfusions. Delayed hemolytic transfusion reaction (DHTR) is a rare life-threatening complication observed in SCD and mimics VOC. We describe a female SCD patient undergoing three surgical procedures during which DHTR developed following the first two. Prior to a planned tonsillectomy, she received transfusion and three days after surgery developed severe hemolysis as well as pain and respiratory symptoms. On suspicion of VOC, she received additional transfusions and became hemodynamically unstable, and her hemolytic anemia worsened. Gradually, she recovered and could be discharged after two weeks; DHTR was not suspected. Sixteen months later, an arthroplasty was performed due to avascular necrosis, and again she was transfused preoperatively. Similar to the initial surgery, she developed symptoms and signs of VOC after three days, but this time, DHTR was suspected and further transfusions were withheld. Although immunosuppressive medication did not alleviate the condition, she improved on combined treatment with darbepoietin, rituximab, and eculizumab. Six months later, a second arthroplasty was performed uneventfully after prophylaxis with rituximab and without transfusion. DHTR should be considered in the presence of severe, unexplained hemolysis following a recent transfusion, and additional transfusions in this setting should be given only on vital indication.

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• Sundsbarm, Sebastian; Bye, Asta; Tjønnfjord, Geir Erland; Iversen, Per Ole & Skaarud, Kristin Aneta Joan (2026). Nutrition impact symptoms and nutritional status in adult allo-HSCT recipients during 1-year follow-up. Bone Marrow Transplantation. ISSN 0268-3369. 61(S1), p. 1041–1098. doi: 10.1038/s41409-026-02887-0. Full text in Research Archive Show summary

  Background: Nutrition impact symptoms (NIS) are contributors to impaired nutritional status in allo-HSCT patients. However, the impact of patients’ reported NIS on nutritional status are poorly described. This study investigated changes in NIS and nutritional status, and associations between NIS and nutritional status during a 1-year follow-up of allo-HSCT patients. Methods: We used data from 117 patients (57 intervention, 60 control) who participated in a randomized controlled nutritional intervention trial. Linear mixed models were used to analyse changes in NIS over time. Ordinal logistic regressions were used to analyse associations between NIS and nutritional status. Results: Nausea and vomiting and constipation were significantly lower in the intervention group than the control group during 1-year follow-up (p = 0.015 and p < 0.001, respectively). Initially, nutritional status declined in both study groups post-allo-HSCT but improved over time. Significantly fewer patients in the intervention group were malnourished at 3 weeks (p = 0.020) and 6 weeks post-transplantation (p = 0.028). Associations between NIS and nutritional status varied over time and differed between the study groups at 6 weeks post-transplantation (OR 3.702, 95% CI: (1.355, 10.100), p = 0.011). Conclusions: In conclusion, our findings emphasize the need for long term monitoring of symptoms and nutritional status in allo-HSCT patients, supporting individualized nutritional assessments as part of long-term care strategies. Disclosure: Geir Erland Tjønnfjord has received research grants from Mundipharma and Alexion Pharmaceuticals, advisory board honoraria from Alexion Pharmaceuticals and Johnson & Johnson, and lecture honoraria from Novartis, Johnson & Johnson, Alexion Pharmaceuticals, and Mundipharma. The other authors declare no competing interest.

• Klevmoen, Marianne; Mulder, Janneke W.C.M.; Bogsrud, Martin Prøven; Retterstøl, Kjetil; Vesterbekkmo, Elisabeth Kleivhaug & Pedersen, Eva Ringdal [Show all 16 contributors for this article] (2025). Prospective study on breastfeeding, lipid profile and cardiovascular risk markers in women with familial hypercholesterolaemia: study protocol for the FH-FEMINA study. doi: 10.1136/bmjopen-2024-092208. Full text in Research Archive
• Kardel, Kristin Reimers; Iversen, Per Ole; Kaaya, Archileo Natigo; Muhoozi, Grace Kyamazima Mehangye; Veierød, Marit Bragelien & Wangen, Knut Reidar [Show all 8 contributors for this article] (2024). A pragmatic randomized trial to examine the effect of combining healthy diet with mindfulness cognitive therapy to reduce depressive symptoms among university students in a low-resource setting: protocol for the NutriMind Project. BMC Psychiatry. 24, p. 1–8. doi: 10.1186/s12888-024-06056-9. Full text in Research Archive Show summary

  Background Mental health disorders still rank as leading causes of morbidity worldwide despite increasing awareness and improvements in treatment. Notably, low- and middle-income countries like Uganda, are disproportionately affected by such disorders. The burden of depressive symptoms in these countries is particularly high among students, aggravated by poverty, malnutrition, and inadequate public health governance, yet it is clearly under-researched, making it hard to achieve several of UN Sustainability Development Goals. Current treatment options are insufficient to tackle the increased burden of depressive disease. This is more challenging for low-resource regions especially in Sub-Saharan Africa, suggesting the need for alternative treatments that can swiftly be applied if proven effective. The main aim of this randomized controlled trial (RCT) is therefore to examine if a low-cost healthy diet (based on local Ugandan foods) combined with easy-to access mindfulness cognitive therapy can reduce depressive symptoms among university students in Uganda. Methods We will recruit female and male students at Makerere University, the largest public university in Uganda, to an open, intention-to-treat, two-armed RCT. Those who score above a predefined threshold on a self-reported assessment of depressive symptoms, measured by the Center for Epidemiological Studies – Depression score (CES-D), are eligible for study inclusion and will be randomized to either an intervention (n = 125) or a control (n = 125) group. The intervention group will receive educational group-based sessions on how to prepare a Mediterranean-type of healthy diet and how to adhere to the principles of mindfulness-based cognitive therapy. Outcome measures include self-reported depression symptoms, quality of life, and dietary intakes. In addition we will perform a cost-effectiveness analysis. The RCT intervention will last 9 months, followed by additional 15 months with regular data collections. Discussion We here describe a novel approach to treat depressive symptoms among university students living in resource constraint settings, by combining a healthy diet with low threshold psychotherapy. If this intervention succeeds, our project can be viewed as a step towards evidence-based behavior practices for young adults with a common mental disorder (depression) that are beneficial to public mental health initiatives and management. Trial registration The RCT is registered in ClinicalTrials.gov (ID: NCT05848973). The date of registration was August 14, 2023.

• Singh, Preet Bano; Nazar, Mahnoor; Rogn, Åsmund & Iversen, Per Ole (2024). Dental caries and other oral complications in patients after hematopoietic stem cell transplantation. Full text in Research Archive
• Rogn, Åsmund; Jensen, Janicke Liaaen; Iversen, Per Ole & Singh, Preet Bano (2024). Correction to: Post-COVID-19 patients suffer from chemosensory, trigeminal, and salivary dysfunctions (Scientific Reports, (2024), 14, 1, (3455), 10.1038/s41598-024-53919-y). Scientific Reports. 14(1). doi: 10.1038/s41598-024-59915-6. Full text in Research Archive
• Vinnes, Erik Wilhelm; Lillemoen, Paul Kjetel Soldal; Klingenberg, Olav Inge; Fjeld, Bente; Iversen, Per Ole & Brodwall, Kristoffer [Show all 7 contributors for this article] (2023). Sigdcellesykdom – kliniske manifestasjoner og diagnostikk. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 143(3). doi: 10.4045/tidsskr.22.0353. Full text in Research Archive Show summary

  Sigdcellesykdom er en sykdomsgruppe med en rekke typiske akutte og kroniske manifestasjoner. Sigdcellesykdom har vært uvanlig i den nordeuropeiske befolkningen, men grunnet endret demografi er dette en sykdom som også norske klinikere bør være oppmerksomme på. I denne kliniske oversiktsartikkelen ønsker vi å gi en kortfattet introduksjon til sigdcellesykdom, med vekt på etiologi, patofysiologi, klinisk bilde og hvordan diagnosen stilles basert på laboratorieundersøkelser.

• Troensegaard, Hannibal; Khoury, Janette; Westerberg, Ane Cecilie; Tonstad, Serena; Lennep, Jeanine Roeters van & Veierød, Marit Bragelien [Show all 9 contributors for this article] (2023). Protocol for a 20-year follow-up after a randomized controlled trial of a Mediterranean diet in pregnancy: maternal and offspring risk factors for cardiovascular disease. Frontiers in Pediatrics. 11. doi: 10.3389/fped.2023.1256815. Full text in Research Archive Show summary

  Background: An inadequate maternal diet during pregnancy can impair offspring health and may increase the risk of cardiovascular disease later in life. The purpose of the proposed study is to assess the risk factors associated with cardiovascular disease in both mothers and their offspring 20 years following their participation in a Mediterranean diet intervention trial during pregnancy. Methods: The “Cardiovascular Risk Reduction Diet In Pregnancy” (CARRDIP) study was a randomized controlled trial performed between 1999 and 2001. The participants were randomized to adhere to either a Mediterranean diet or their regular diet during pregnancy. An extensive amount of data such as diet information, ultrasound measurements, anthropometry, and biomarkers from these mothers during pregnancy and their offspring in the neonatal period were collected. The mother–offspring pairs (n = 269) from the CARRDIP study will be invited to participate in a clinical examination and blood sample collection. This follow-up study, conducted 20 years after the original CARRDIP study, will investigate cardiovascular risk factors in mothers and offspring. The primary outcome will be the blood pressure of the offspring. In addition, the study will explore various aspects of cardiovascular health, including metabolic and inflammatory status, clinical history, and body composition of the participants. Discussion: Previous studies investigating the effects of nutrition during pregnancy on maternal and offspring health have been either observational studies, animal studies, or randomized controlled trials with a follow-up period of less than 5 years. This project aims to study the long-term effects of dietary intervention during pregnancy on maternal and offspring cardiovascular risk markers.

• Strømmen, Kenneth; Lyche, Jan Ludvig; Moltu, Sissel; Müller, Mette Helen Bjørge; Blakstad, Elin Wahl & Almaas, Astrid Nylander [Show all 12 contributors for this article] (2021). Corrigendum to “High urinary concentrations of parabens and bisphenol A in very low birth weight infants”. Chemosphere. ISSN 0045-6535. 275. doi: 10.1016/j.chemosphere.2021.130613. Full text in Research Archive
• Kakwangire, Paul; Friberg, Prudence Atukunda; Muhoozi, Grace Kyamazima Mehangye & Iversen, Per Ole (2025). Effects of a maternal education intervention on child development and maternal depression: Long-term follow-up of a cluster-randomized trial in rural Uganda. Universitetet i Oslo. ISSN 9788234806902. Full text in Research Archive Show summary

  Early childhood represents a pivotal phase for cognitive, emotional, and physical development. However, children residing in low-resource rural environments face an elevated risk of undernutrition and associated developmental delays. Few studies have examined whether maternal education interventions can produce long-term benefits for child development and maternal mental health. The aim of this thesis was to assess the long-term effects of a maternal education intervention on child development (cognition and attention) eight years later, identify early-life predictors of developmental outcomes, and evaluate maternal depressive symptoms six years after the intervention. The original CHNUDEV trial was a cluster-randomized controlled study conducted in rural southwestern Uganda between 2013 and 2014, enrolling 511 mother-child pairs. The intervention provided education sessions on nutrition, hygiene, oral health, and child stimulation when children were 6-8 months old. Follow-up assessments were conducted at six and eight years post-intervention. Child cognition and attention were measured using the Kaufman Assessment Battery for Children, Second Edition and the Test of Variables of Attention. Maternal depressive symptoms were assessed using the Beck Depression Inventory-II and the Center for Epidemiological Studies Depression Scale. Children in the intervention group had significantly higher scores on short-term memory, visual processing, fluid reasoning, and overall cognitive ability compared to children in the control group. Intervention group children also showed better attention performance. Baseline factors such as maternal education, child sex, and nutritional and developmental status were significantly associated with cognitive outcomes at eight years. Mothers in the intervention group reported fewer depressive symptoms at six years, although differences were borderline statistically significant. Overall, the study demonstrates that a low-cost maternal education intervention can lead to sustained improvements in child development and may support better maternal mental health in low-resource settings. These findings highlight the value of integrating nutrition, hygiene, and child stimulation education into community based health programs to promote long-term benefits for both children and caregivers.

• Koroma, Aminata Shamit; Manary, Mark & Iversen, Per Ole (2025). Integrated Nutritional and Healthcare Interventions to Combat Maternal Undernutrition and Enhance Infant Birth Outcomes in Resource-Limited Rural Sierra Leone. Universitetet i Oslo. ISSN 9788234806575. Full text in Research Archive Show summary

  Background Undernutrition remains a leading cause of poor maternal and neonatal health outcomes, with severe implications for growth, development, and survival. Addressing this challenge is particularly pressing in countries like Sierra Leone, where limited resources and high rates of malnutrition, infections, and inadequate healthcare pose significant barriers to maternal and child health. This thesis explores the impact of integrated nutritional and anti-infective interventions on maternal and child undernutrition in resource-constrained, malaria-endemic rural settings, mainly focusing on the child’s first 1,000 days of life. The research aimed to assess the effectiveness of innovative interventions designed to improve health outcomes for these undernourished populations, emphasizing sustainability and scalability. Study Populations and Methodology The thesis is based on a series of randomized controlled trials and secondary analyses conducted across 43 health clinics in Sierra Leone. The first study evaluated the effects of providing Ready-to-Use Supplementary Food (RUSF) enriched with long-chain fatty acids and choline, combined with anti-infective measures, on maternal and neonatal health outcomes. A secondary analysis examined differences in birth outcomes among younger adolescent mothers (<18 years), older adolescents (18–19 years), and adult mothers (≥20 years). Another study assessed the utility of Mid Upper Arm Circumference (MUAC) for identifying low-birth-weight infants and neonatal mortality risk in settings without weighing facilities. Additional studies evaluated the impact of exclusive breastfeeding practices on infant growth and survival and the effectiveness of Ready-to-Use Therapeutic Food (RUTF) and antibiotics in treating High-Risk Moderate Acute Malnutrition (HR-MAM) in children. The acceptability and feasibility of an enriched maternalRUSF formulation were also tested through a 2x2 crossover design. Main Results Enriched RUSF and anti-infective treatments improved maternal weight gain, newborn birth outcomes, and child survival rates. Younger adolescent mothers faced poorer birth outcomes compared to older mothers, underlining the need for targeted interventions for this vulnerable group. MUAC proved to be an effective tool for identifying low-birth-weight infants and those at risk of neonatal mortality. Exclusive breastfeeding was confirmed as a life-saving practice, significantly improving infant growth and survival. For children with HR-MAM, treatment with RUTF and antibiotics enhanced short-term recovery, but required longer-term solutions for sustained benefits. Enriched RUSF with long-chain fatty acids and choline showed high acceptability, potentially improving maternal and fetal health. Conclusion This thesis highlights the effectiveness of integrated nutritional and anti-infective interventions in improving maternal and child health outcomes in resource-limited settings. Combining enriched RUSF and targeted anti-infective measures led to better maternal weight gain, enhanced newborn growth metrics, and increased survival rates. Adolescent mothers were identified as a particularly vulnerable group, emphasizing the need for customized interventions to tackle their specific challenges. MUAC was validated as a practical and dependable tool for identifying at-risk newborns in low-resource environments. Exclusive breastfeeding was confirmed as a life-saving practice, significantly improving infant health and survival. While utilizing RUTF and antibiotics for HR-MAM resulted in short-term recovery improvements, the findings stress the need for sustainable, long-term interventions. The high acceptance of enriched RUSF showcases its potential as a scalable solution to combat maternal and child undernutrition. It provides valuable insights for future policies and programs to break the malnutrition cycle.

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