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Developed nations have implemented several health policies regarding nutrients and toxins known to influence cognitive function. These include laws requiring Fortification of certain food products and laws establishing safe levels of pollutants (e.g. lead, mercury, and organochlorides). Comprehensive policy recommendations targeting reduction of cognitive impairment in children have been proposed.Olness, K. " Effects on brain development leading to cognitive impairment: a worldwide epidemic ," ''Journal of Developmental and Behavioral Pediatrics'' 24, no. 2 (2003): 120–30. 1 Improvements in nutrition, and in public policy in general, have been implicated in worldwide IQ increases (the Flynn Effect ). NUTRITION Malnutrition may occur during several different periods of growth, such as Pregnancy , during Breastfeeding , Infancy , or childhood. It may also happen due to deficiencies of different nutrients, such as Micronutrients , Protein or energy. This may cause different effects. Timing Although some observers have argued that the first six months of life are the most critical in the sense that malnutrition during that time period harms cognitive development more than malnutrition later in life, a study from the Philippines argue that malnutrition in the second year of life may have a larger negative impact than malnutrition in the first year of life. The Impact of Early Childhood Nutritional Status on Cognitive Development: Does the Timing of Malnutrition Matter? Paul Glewwe and Elizabeth M. King THE WORLD BANK ECONOMIC REVIEW, VOL. 15, NO. 1, 81-113 Intrauterine growth retardation Breastfeeding Gomez-Sanchiz M, Canete R, Rodero I, Baeza JE, Gonzalez JA. Another study found that breastfeeding increases 8.3 points in IQ. Masters, R. (1997). Brain biochemistry and social status: The neurotoxicity hypothesis. In E. White (Ed.), Intelligence, political inequality, and public policy (pp. 141–183). Westport, CT: Praeger. Infancy Two studies in Chile on 18 years old high-school graduates found that nutritional status during the first year of life affected IQ, scholastic achievement, and brain volume.D.M. Ivanovic et al., " Nutritional status, brain development and scholastic achievement of Chilean high-school graduates from high and low intellectual quotient and socio-economic status ," ''British Journal of Nutrition'' 87, no. 1 (January 2002): 81–92; D.M. Ivanovic et al., " Head size and intelligence, learning, nutritional status and brain development. Head, IQ, learning, nutrition and brain ," ''Neuropsychologia'' 42, no. 8 (2004): 1118–31. Micronutrients Micronutrient deficiencies (e.g. in Iodine and Iron ) influence the development of intelligence and remain a problem in the developing world. Policy recommendations to increase availability of micronutrient supplements have been made and justified in part by the potential to counteract intelligence-related developmental problems. For example, the Copenhagen Consensus , states that lack of both iodine and iron has been implicated in impaired brain development, and this can affect enormous numbers of people: it is estimated that 2 billion people (one-third of the total global population) are affected by iodine deficiency, including 285 million 6- to 12-year-old children. In developing countries, it is estimated that 40% of children aged 4 and under suffer from anaemia because of insufficient iron in their diets. Behrman, J.R., Alderman, H., and Hoddinott, J., " Hunger and Malnutrition ," Copenhagen Consensus 2004. A joint statement on vitamin and mineral deficiencies says that the severity of such deficiencies "means the impairment of hundreds of millions of growing minds and the lowering of national IQs."UNICEF and The Micronutrient Initiative, " Vitamin & Mineral Deficiency: A Global Progress Report ," March 2004. Overall, studies investigating whether cognitive function in already iron-deficient children can be improved with iron supplements have produced mixed results, possible because deficiency in critical growth periods may cause irreversible damage. However, several studies with better design have shown substantial benefits. In order to prevent iron deficiency an option is giving specific supplementation, for example as tablets. However, this is costly, distribution mechanisms are often ineffective, and Compliance is low. Fortification of staple foods (cereals, flour, sugar, salt) to deliver micronutrients to children on a large scale is probably the most sustainable and affordable option, even though commitment from governments and the food industry is needed.Saloojee, H. and Pettifor, J., Iron deficiency and impaired child development ," ''BMJ'' 323 (December 2001): 1377–78 Developed nations fortify several foods with various micronutrients. FOOD FORTIFICATION TECHNOLOGY Food Fortification: Technology and Quality Control. (FAO Food And Nutrition Paper - 60) Additional vitamin-mineral supplementation may have an effect also in the developed world. A study giving such supplementation to "working class," primarily Hispanic, 6-12 years old children in the United States for 3 months found an average increase 2 to 3 IQ points. Most of this can explained by the very large increase for a subgroup of the children, presumably because these were not adequately nourished unlike the majority. The study suggests that parents of schoolchildren whose academic performance is substandard would be well advised to seek a nutritionally oriented physician for assessment of their children's nutritional status as a possible etiology. The effect of vitamin-mineral supplementation on the intelligence of American schoolchildren: a randomized, double-blind placebo-controlled trial J Altern Complement Med. 2000 Feb;6(1):31-5. More speculatively, other nutrients may prove important in the future. Fish oil supplement to pregnant and lactating mothers has been linked to increased cognitive ability in one study.Helland IB, Smith L, Saarem K, Saugstad OD, Drevon CA. Maternal supplementation with very-long-chain n-3 fatty acids during pregnancy and lactation augments children's IQ at 4 years of age. ''Pediatrics''. 2003 Jan;111(1):e39-44. Vitamin B12 and Folate may be important for cognitive function in old age.Duthie SJ, Whalley LJ, Collins AR, Leaper S, Berger K, Deary IJ. Homocysteine, B vitamin status, and cognitive function in the elderly. ''Am J Clin Nutr''. 2002 May;75(5):908-13. Erratum in: ''Am J Clin Nutr''. 2003 Feb;77(2):523. Another study found that pregnant women who consumed 340 grams of low-mercury containing fish with fatty acids per week have benefits that outweigh the risks for Mercury Poisoning . They were less likely to have children with low verbal IQ , Motor Coordination and behavioral problems. However, foods containing high amounts of Mercury , such as Shark Swordfish , King Mackerel and Tilefish , might cause Mental Retardation . Lyketsos, Constantine G, "Should pregnant women avoid eating fish? Lessons from the Seychelle," '' The Lancet '', Volume 361, Issue 9370 , 17 May 2003, Pages 1667-1668 {Link without Title} {Link without Title} {Link without Title} {Link without Title} {Link without Title} Protein and energy malnutrition One study from developing country, Guatemala, found that poor growth during infancy, rather than low birth weight, was negatively related to adolescent performance on cognitive and achievement tests.Pollitt E, Gorman KS, Engle P, Martorell R and Rivera JA, 1993. Early Supplementary Feeding and Cognition: Effects Over Two Decades Monographs of the Society for Research in Child Development, Serial No. 235, 58(7): 122 pages. A later related very long term study looked at the effect of giving 6-24 months old children in Guatemala a high protein-energy drink as a dietary supplement. A significantly positive and fairly substantial effects was found on increasing the probability of attending school and of passing the first grade, increasing the grade attained by age 13, increasing completed schooling attainment, and for adults aged 25-40 increasing IQ test scores. Schooling, educational achievement, and cognitive functioning among young Guatemalan adults. Food Nutr Bull. 2005 Jun;26(2 Suppl 1):S46-54. Stein AD, Behrman JR, DiGirolamo A, Grajeda R, Martorell R, Quisumbing A, Ramakrishnan U. Stunting 31% of children under the age of 5 in the developing world are moderately (height-for-age is below minus 2 standard deviations) or severely stunted (below minus 3 standard deviations). The prevalence was even higher previously since the worldwide prevalence of stunting is declining by about half of a percentage point each year.[http://www.news.cornell.edu/releases/May98/stunting.ssl.html Stunted growth affects almost 40 percent of the developing world's infants, Cornell study reports A study on stunted children aged 9-24 months in Jamaica found that when aged 17-18 years they had significantly poorer scores than a non-stunted group on cognitive and educational tests and psychosocial functioning. Giving a nutritional supplementation (1 kg milk based formula each week) to these already stunted children had no significant effect on later scores, but psychosocial stimulation (weekly play sessions with mother and child) had a positive effect. Effects of early childhood psychosocial stimulation and nutritional supplementation on cognition and education in growth-stunted Jamaican children: prospective cohort study Lancet (British edition), 2005 (Vol. 966) (No. 9499) 1804-1807. Walker, S. P., Chang, S. M., Powell, C. A., Grantham-McGregor, S. M. Effects of psychosocial stimulation and dietary supplementation in early childhood on psychosocial functioning in late adolescence: follow-up of randomised controlled trial Susan P Walker, professor1, Susan M Chang, lecturer1, Christine A Powell, senior lecturer1, Emily Simonoff, professor2, Sally M Grantham-McGregor, professor3. BMJ 2006;333:472 (2 September), doi:10.1136/bmj.38897.555208.2F (published 28 July 2006) TOXINS Industrial chemicals Certain toxins, such as Lead , Mercury , Arsenic , Toluene , and PCB are well-known causes of neuro-developmental disorders. Recognition of these risks has led to evidence-based programmes of prevention, such as elimination of lead additives in petrol. Although these prevention campaigns are highly successful, most were initiated only after substantial delays. Developmental neurotoxicity of industrial chemicals . Lancet. 2006 Dec 16;368(9553):2167-78. Grandjean P, Landrigan PJ. Policies to manage lead differ between nations, particularly between the developed and developing world. Use of leaded Gasoline has been reduced or eliminated in most developed nations, and lead levels in US children have been substantially reduced by policies relating to lead reduction.Meyer, P.A., McGeehin, M.A., and Falk, H. "[http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12971691&dopt=Citation A global approach to childhood lead poisoning prevention]," ''International Journal of Hygiene and Environmental Health'' 206, nos. 4–5 (August 2003): 363–69. Even slightly elevated lead levels around the age of 24 months are associated with intellectual and academic performance deficits at age 10 years. Low-Level Lead Exposure, Intelligence and Academic Achievement: A Long-term Follow-up Study David C. Bellinger PhD, MSc1, Karen M. Stiles PhD, MN1, and Herbert L. Needleman MD1. PEDIATRICS Vol. 90 No. 6 December 1992, pp. 855-861 Certain, at least previously, widely used Organochloride s, such as Dioxins , DDT , and PCB , have been associated with cognitive deficits. In Utero Exposure to Background Concentrations of DDT and Cognitive Functioning among Preschoolers Núria Ribas-Fitó1, Maties Torrent2, Daniel Carrizo3, Laura Muñoz-Ortiz1, Jordi Júlvez1, Joan O. Grimalt3 and Jordi Sunyer1 American Journal of Epidemiology 2006 164(10):955-962 A Lancet review identified 201 chemicals with the ability to cause clinical neurotoxic effects in human adults, as described in the peer-reviewed scientific literature. Most of them are commonly used. Many additional chemicals have been shown to be neurotoxic in laboratory models. The article notes that children are more vulnerable and argues that new, precautionary approaches that recognise the unique vulnerability of the developing brain are needed for testing and control of chemicals in order to avoid the previous substantial before starting restrictions on usage. Developmental neurotoxicity of industrial chemicals . Lancet. 2006 Dec 16;368(9553):2167-78. Grandjean P, Landrigan PJ. An appendix listed furher industrial chemicals considered to be neurotoxic. Potentials for exposure to industrial chemicals suspected of causing developmental neurotoxicity Philippe Grandjean, MD, PhD, Adjunct Professor Marian Perez, MPH, Project Coordinator Department of Environmental Health, Harvard School of Public Health, Boston, MA, USA Recreational drugs Current Cannabis use was found to be significantly correlated in a dose-dependent manner with a decline in IQ scores. However, no such decline was seen in subjects who had formerly been heavy cannabis users and had stopped taking the drug. The authors concluded that cannabis does not have a long-term effect on intelligence. Effects on foetal development are minimal when compared with the well-documented adverse effects of tobacco or alcohol use. Long-term effects of exposure to cannabis. Iversen L. Curr Opin Pharmacol. 2005 Feb;5(1):69-72. Fetal Alcohol exposure, causing Fetal Alcohol Syndrome , is one of the leading known causes of mental retardation in the Western world.Abel, E.L., & Sokel, R.J. (1987). Incidence of fetal alcohol syndrome and economic impact of FAS-related anomalies: Drug alcohol syndrome and economic impact of FAS-related anomalies. ''Drug and Alcohol Dependency'', ''19(1)'', 51-70.
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