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Environmental Risk Factors and Child Nutritional Status and Survival in a Context of Climate Variability and Change

Much of the population in the developing world resides in rural areas, is dependent on local agriculture for survival, and thus directly subject to increasingly volatile and variable climatic patterns. Poverty limits options for adaptation to unpredictable weather and resultant food insecurity; these concerns are particularly salient in an era of climate change, which threatens to roll back years of development gains. Examining the association between the growing environment and child survival and nutrition is important in this context. Using NASA's satellite remote sensing data with Demographic and Health Surveys (DHS) data from four West African countries (Mali, Burkina Faso, Guinea and Benin), we assess the association between a climate-related environmental variable (vegetation index - NDVI) and child survival and nutrition. NDVI had a positive association with child survival and nutrition in countries with a wide distribution of NDVI values. NDVI was more likely to be positively associated with wasting rather than stunting. We find that environmental factors can be important for child survival and nutrition outcomes in specific contexts. Additional research is needed to further explore the ways NDVI can be used to inform our understanding of the environment's impact on child survival and nutrition.

Environment↗

NASA HRP Food and Nutrition Risk Strategy

The Human Health Countermeasures (HHC) Element of NASA’s Human Research Program (HRP), along with other organizations within NASA, conduct research and capability developments to buy down the risk of performance decrement and crew illness due to inadequate food and nutrition. Food and nutrition are critical for health and performance both in low Earth orbit and on exploration missions. On the International Space Station (ISS), crewmembers share a defined set of pantry foods, and have limited preference and shelf-life foods (e.g. fruits and vegetables) from resupply missions. Exploration design reference missions (DRMs) will likely be more constrained than missions to ISS, where those crewmembers would be subject to a more restricted food system due to resource limitations. HRP food and nutrition research consists of studies to close the following research gaps: determination of the nutritional requirements to maintain health and performance for the defined DRMs, determining the nutrient content, safety, and acceptability of the spaceflight food system specific to DRM and vehicle constraints, development of countermeasures either within or in addition to the food system to mitigate decrements to health and performance by DRM, and the validation and integration of food system countermeasures in analogs and in flight. The current spaceflight food system is shelf-stable, consisting of freeze-dried foods, thermostabilized foods, natural form foods, and powdered beverages. Crops represent a food system countermeasure that has the potential to supplement the pre-packaged food system. As an applied research program, HRP goals for crop research are centered around three main themes: nutrition, safety, and acceptability. As crops advance through Crop Readiness Level evaluations, HHC partners with the sponsoring organization to ensure that HRP goals are met for crops to be consumed in spaceflight.

food↗

The nutrition advisor expert system

The Nutrition Advisor Expert System (NAES) is an expert system written in the C Language Integrated Production System (CLIPS). NAES provides expert knowledge and guidance into the complex world of nutrition management by capturing the knowledge of an expert and placing it at the user's fingertips. Specifically, NAES enables the user to: (1) obtain precise nutrition information for food items; (2) perform nutritional analysis of meal(s), flagging deficiencies based upon the U.S. Recommended Daily Allowances; (3) predict possible ailments based upon observed nutritional deficiency trends; (4) obtain a top ten listing of food items for a given nutrient; and (5) conveniently upgrade the data base. An explanation facility for the ailment prediction feature is also provided to document the reasoning process.

Huse, Scott M.↗

Nutritional Support

Adequate nutritional status is critical for maintenance of crew health during extended- duration space flight and postflight rehabilitation. Nutrition issues relate to intake of required nutrients, physiological adaptation to weightlessness, psychological adaptation to extreme environments, and countermeasures to ameliorate the negative effects of space flight. Thus, defining the nutrient requirements for space flight and ensuring provision and intake of those nutrients are critical issues for crew health and mission success. Specialized nutritional requirements have only been considered for what are referred to here as extended- duration flights, i.e., those greater than 30 days in length. While adequate nutrition is important on the 1- to 3-week Shuttle flights, intakes of specific nutrients above or below space specific requirements for this period will not produce cause for concern. Thus, Shuttle flights have always used the recognized nutritional requirements for adult men and women. In this chapter, long-duration flights will be further differentiated into orbital missions (e.g., International Space Station) and interplanetary exploration missions.

Smith, Scott M.↗

Nutrition Issues for Space Exploration

Optimal nutrition will be critical for crew members who embark on space exploration missions. Nutritional assessment provides an opportunity to ensure that crew members begin their missions in optimal nutritional status, to document changes in status during a mission, and to assess changes after landing to facilitate return of the crew to their normal status as soon as possible after landing. Nutritional assessment provides the basis for intervention, if it is necessary, to maintain optimal status throughout the mission. We report here our nutritional assessment of the US astronauts who participated in the first twelve International Space Station missions.

Smith, Scott↗

Nutritional Status Assessment

Nutritional Status Assessment (Nutrition) is the most comprehensive inflight study done by NASA to date of human physiologic changes during long-duration space flight; this includes measures of bone metabolism, oxidative damage, nutritional assessments, and hormonal changes. This study will impact both the definition of nutritional requirements and development of food systems for future space exploration missions to the Moon and Mars. This experiment will also help to understand the impact of countermeasures (exercise and pharmaceuticals) on nutritional status and nutrient requirements for astronauts.

Smith, Scott M.↗

Nutritional Concerns of Spaceflight

Nutrition has played a critical role throughout the history of exploration, and space exploration is no exception. While a one- to two-week flight aboard the Space Shuttle might be analogous to a camping trip, adequate nutrition is absolutely critical while spending several months on the International Space Station (Figure 1) or several years on a mission to another planet. To ensure adequate nutrition, space nutrition specialists must know how much of the individual nutrients astronauts need, and these nutrients must be available in the spaceflight food system. To complicate matters, these spaceflight nutritional requirements are influenced by many of the physiological changes that occur during spaceflight. In this chapter, we describe some of these changes, their impact on crew health, and ways NASA is investigating how to minimize these changes. We also review the space food systems, issues involved in setting up a cafeteria in a weightless environment, and information about dietary intake of nutrients during space missions

Smith, Scott M.↗

2013 Nutrition Risk Evidence Review Panel

The 2013 Nutrition Risk Standing Review Panel (from here on referred to as the SRP) met for a site visit in Houston, TX on November 20 - 21, 2013. The SRP reviewed the new Evidence Report for the Risk Factor of Inadequate Nutrition (from here on referred to as the 2013 Nutrition Evidence Report), as well as the Research Plan for this Risk. Overall, the SRP thinks the well-qualified research team has compiled an excellent summary of background information in the 2013 Nutrition Evidence Report. The SRP would like to commend the authors in general and particularly note that while the 2013 Nutrition Evidence Report has been written using a single nutrient approach, the research plan takes a much more integrated and physiologically based approach.

Source record↗

2013 Nutrition Risk Research Plan Review Final Report

The 2013 Nutrition Risk Standing Review Panel (from here on referred to as the SRP) was impressed by the degree of progress the nutrition discipline has made with the research plan presented since the 2012 Nutrition Risk SRP WebEx/teleconference. The scientists and staff associated with the nutrition discipline have, in addition, continued their impressive publication track record. Specifically the SRP found that the novel and important progress in the ocular health research area (Gap N7.3) represents an important advance in understanding the etiology and potential countermeasures for this condition and thinks that the work will not only be valuable for vision, but may have implications for cardiovascular health, as well. The SRP also considered the bone countermeasure data presented a potentially valuable tool for investigating bone metabolism under the unique conditions of space travel, specifically the innovation of variable use of stable Ca isotopes for bone synthesis and equal contribution for bone to investigate bone metabolism, as well as, the impact of the advanced resistive exercise device (ARED) on body composition during spaceflight. Finally, the SRP considers the planned Integrated Nutrition task to be an important and necessary strategic part of the research plan. The SRP is concerned that the risks observed in previous research on Low Earth Orbit (LEO) may not capture all the risks of longer duration flight beyond LEO. In particular, the SRP believes that there may be a much greater likelihood of an intensified chronic inflammatory response compared to the very minimal evidence seen to date and that modest effects seen in LEO, such as the reduction in appetite, may not predict an absence in longer duration flight out of LEO. The added complications of longer duration flight, greater bio-behavioral stress, radiation exposure, poorer communication, and inability to respond to unforeseen exigencies may create different risks. Thus, preparation for potential anticipated problems on long duration missions should be considered now while countermeasures can be developed even in the absence of sure knowledge as to their likelihood. Overall, the SRP thinks that all the Gaps presently in the research plan are appropriate and relevant, but there are a few missing Gaps that will help expand the research plan.

Source record↗

Nutritional Status Assessment (SMO 016E)

The Nutritional Status Assessment Supplemental Medical Objective was initiated to expand nominal clinical nutrition testing of ISS astronauts, and to gain a better understanding of the time course of changes in nutritional status during flight. The primary activity of this effort was collecting blood and urine samples during flight for analysis after return to Earth. Samples were subjected to a battery of tests. The resulting data provide a comprehensive survey of how nutritional status and related systems are affected by 4-6 months of space flight. Analysis of these data has yielded many findings to date, including: Vision. Documented evidence that biochemical markers involved in one-carbon metabolism were altered in crewmembers who experienced vision-related issues during and after flight (1). Iron, Oxidative Stress, and Bone. In-flight data document a clear association of increased iron stores, markers of oxidative damage to DNA, and bone loss (2). Exercise. Documented that well-nourished crewmembers performing heavy resistance exercise returned from ISS with bone mineral densities unchanged from preflight (3). Furthermore, the response of bone to space flight and exercise countermeasures was the same in men and women (4). Body Mass. Crewmembers lose 2-5% of their body mass in the first month of flight, and maintain the lower body mass during flight (5). Additionally, the two devices to measure body mass on orbit, the SLAMMD and BMMD, provide similar results (5). Cytokines. Findings indicated that a pattern of persistent physiological adaptations occurs during space flight that includes shifts in immune and hormonal regulation (6). Fish/Bone. Documented a relationship between fish intake and bone loss in astronauts (that is, those who ate more fish lost less bone) (7). Vitamin K. Documented that in generally well-fed and otherwise healthy individuals, vitamin K status and bone vitamin K-dependent proteins are unaffected by space flight (and bed rest) (8). Testosterone. Documented that blood concentrations of testosterone were unchanged during flight, but a transient decline occurred after landing (9). Calcium. Nutrition SMO data contributed to the ISS Program by helping understand how and why the Urine Processor Assembly clogged with calcium sulfate precipitate (10). Sample Processing. Ground-based analytical testing results have also been published (11).

Smith, S. M.↗

Nutrition Requirements, Standards, and Operating Bands for Exploration Missions

The challenge was brought forward in early 2005 to define the nutritional requirements for Exploration missions, and to define the relevant standards and associated operating bands related to nutrition. This document is the result of this charge. An extensive review of existing knowledge was conducted with participation of intramural and extramural experts, and the findings are summarized herein. In short, the approach taken was to define the nutrient intake requirements, that is, the amount of each nutrient expected to be available in the food system. The standards are defined as markers of nutritional status, with optimal (green), sub-optimal (yellow), and critical (red) levels for each. For many of the nutrient requirements, it is not known if they are altered during space flight. Furthermore, in many cases the intake of a nutrient may act as a countermeasure to one or more negative effects of space flight, but these potential countermeasures, too, are not well defined. Thus, we have also documented herein the areas where further research is required. Accordingly, while this document is intended as a comprehensive summary of our knowledge to date, it is expected that this is the first edition of these requirements and standards. As we learn more about space-flight nutrition, and as relationships between disease and nutrients are further defined in Earth-based populations, this document, and the approach to nutrition in the space rogram, will need to be updated accordingly.

Neubek, Deborah J.↗

Planning strategies for development of effective exercise and nutrition countermeasures for long-duration space flight

Exercise and nutrition represent primary countermeasures used during space flight to maintain or restore maximal aerobic capacity, musculoskeletal structure, and orthostatic function. However, no single exercise, dietary regimen, or combination of prescriptions has proven entirely effective in maintaining or restoring cardiovascular and musculoskeletal functions to preflight levels after prolonged space flight. As human space flight exposures increase in duration, identification, assessment, and development of various effective exercise- and nutrition-based protective procedures will become paramount. The application of adequate dietary intake in combination with effective exercise prescription will be based on identification of basic physiologic stimuli that maintain normal function in terrestrial gravity, and understanding how specific combinations of exercise characteristics (e.g., duration, frequency, intensity, and mode) can be combined with minimal nutritional requirements that mimic the stimuli normally produced by living in Earth's gravity environment. This can be accomplished only with greater emphasis of research on ground-based experiments targeted at understanding the interactions between caloric intake and expenditure during space flight. Future strategies for application of nutrition and exercise countermeasures for long-duration space missions must be directed to minimizing crew time and the impact on life-support resources.

Review↗

Nutrition in space

The authors review studies conducted to define nutritional requirements for astronauts during space flight and to assess nutrition before, during, and after space flight. Topics include space food systems, research and limitations on spacecraft, physiological adaptation to weightlessness, energy requirements, dietary intake during space flight, bone demineralization, gastrointestinal function, blood volume, and nutrition requirements for space flight. Benefits of space-related nutrition research are highlighted.

Review↗

Skylab nutritional studies

Precise nutritional specifications arising from both physiological and experimental requirements necessitated a comprehensive study of the chemical composition of the Skylab food supply. Each of the approximately seventy different food items was analyzed for digestible and non-digestible carbohydrate, and for protein, amino acids, fat, fatty acids, vitamins and minerals. Menus were formulated to provide at least the National Research Council's Recommended Dietary Allowance of all essential nutrients and, in addition, to provide constant daily intakes of calcium, phosphorus, magnesium, sodium, potassium and protein. In general, the crew members adhered to their programmed menus. The ability to swallow and digest food was unaffected by prolonged weightlessness. Taste acuity also appeared to be undiminished in flight. The bone and muscle changes which occurred in previous flights were more pronounced in Skylab. It is concluded that these changes did not develop as a result of nutritional deficit. If such changes are nutritionally related, they point to the existence of nutritional requirements in weightlessness which differ quantitatively from those observed on earth.

long duration↗

Nutritional markers and proteome in patients undergoing treatment for pulmonary tuberculosis differ by geographic region

Contemporary phase 2 TB disease treatment clinical trials have found that microbiologic treatment responses differ between African versus non-African regions, the reasons for which remain unclear. Understanding host and disease phenotypes that may vary by region is important for optimizing curative treatments. We characterized clinical features and the serum proteome of phase 2 TB clinical trial participants undergoing treatment for smear positive, culture-confirmed TB, comparing host serum protein expression in clinical trial participants enrolled in African and Non-African regions. Serum samples were collected from 289 participants enrolled in the Centers for Disease Control and Prevention TBTC Study 29 (NCT00694629) at time of enrollment and at the end of the intensive phase (after 40 doses of TB treatment). After a peptide level proteome analysis utilizing a unique liquid chromatography IM-MS platform (LC-IM-MS) and subsequent statistical analysis, a total of 183 core proteins demonstrated significant differences at both baseline and at week 8 timepoints between participants enrolled from African and non-African regions. The majority of the differentially expressed proteins were upregulated in participants from the African region, and included acute phase proteins, mediators of inflammation, as well as coagulation and complement pathways. Downregulated proteins in the African population were primarily linked to nutritional status and lipid metabolism pathways. We have identified differentially expressed nutrition and lipid pathway proteins by geographic region in TB patients undergoing treatment for pulmonary tuberculosis, which appear to be associated with differential treatment responses. Future TB clinical trials should collect expanded measures of nutritional status and further evaluate the relationship between nutrition and microbiologic treatment response.

59 BASIC BIOLOGICAL SCIENCES↗

Data collection and preparation of authoritative reviews on space food and nutrition research

The collection and classification of information for a manually operated information retrieval system on the subject of space food and nutrition research are described. The system as it currently exists is designed for retrieval of documents, either in hard copy or on microfiche, from the technical files of the MSC Food and Nutrition Section by accession number, author, and/or subject. The system could readily be extended to include retrieval by affiliation, report and contract number, and sponsoring agency should the need arise. It can also be easily converted to computerized retrieval. At present the information retrieval system contains nearly 3000 documents which consist of technical papers, contractors' reports, and reprints obtained from the food and nutrition files at MSC, Technical Library, the library at the Texas Medical Center in Houston, the BMI Technical Libraries, Dr. E. B. Truitt at MBI, and the OSU Medical Libraries. Additional work was done to compile 18 selected bibliographies on subjects of immediate interest on the MSC Food and Nutrition Section.

Source record↗

Skylab nutritional studies

Precise nutritional specifications arising from both physiological and experimental requirements necessitated a comprehensive study of the chemical composition of the Skylab food supply. Each of the approximately 70 different food items was analyzed for digestible and nondigestible carbohydrate, and for protein, amino acids, fat, fatty acids, vitamins, and minerals. Menus were formulated to provide at least the National Research Council's Recommended Dietary Allowance of all essential nutrients and, in addition, to provide constant daily intakes of calcium, phosphorus, magnesium, sodium, potassium and protein. In general, the crewmembers adhered to their programmed menus. The ability to swallow and digest food was unaffected by prolonged weightlessness. Taste acuity also appeared to be undiminished inflight. The bone and muscle changes which occurred in previous flights were more pronounced in Skylab. It is concluded that these changes did not develop as a result of nutritional deficit. If such changes are nutritionally related, they point to the existence of nutritional requirements in weightlessness which differ quantitatively from those observed on earth.

Rambaut, P. C.↗

Nutritional Requirements for Space Station Freedom Crews

The purpose of this report was to set preliminary nutritional requirements for crewmembers flying from 90 to 180 day missions on Space Station Freedom. Specific recommendations included providing crewmembers with in flight feedback on nutritional intake, weight and strength, and incorporating issues of energy intake, body weight, body composition, strength, and protein intake in the flight medicine program. Exercise must be considered an integral part of any plan to maintain nutritional status, especially those modes that stress the skeleton and maintain body weight. Nutrient intake, amount of exercise, and drugs ingested must be recorded daily; high priority should be given to development of fully automated record systems that minimize astronauts' effort. A system of nutritional supplements should be developed to provide a method for reducing intake deficits that become apparent. Finally, post flight monitoring should include bone density, muscle mass and function, and iron status at three and six months after landing.

Lane, Helen W.↗