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Papers by Joe Piper

The Lancet Global Health, 2019

Background Child stunting reduces survival and impairs neurodevelopment. We tested the independen... more Background Child stunting reduces survival and impairs neurodevelopment. We tested the independent and combined effects of improved water, sanitation, and hygiene (WASH), and improved infant and young child feeding (IYCF) on stunting and anaemia in in Zimbabwe. Methods We did a cluster-randomised, community-based, 2 × 2 factorial trial in two rural districts in Zimbabwe. Clusters were defined as the catchment area of between one and four village health workers employed by the Zimbabwe Ministry of Health and Child Care. Women were eligible for inclusion if they permanently lived in clusters and were confirmed pregnant. Clusters were randomly assigned (1:1:1:1) to standard of care (52 clusters), IYCF (20 g of a small-quantity lipidbased nutrient supplement per day from age 6 to 18 months plus complementary feeding counselling; 53 clusters), WASH (construction of a ventilated improved pit latrine, provision of two handwashing stations, liquid soap, chlorine, and play space plus hygiene counselling; 53 clusters), or IYCF plus WASH (53 clusters). A constrained randomisation technique was used to achieve balance across the groups for 14 variables related to geography, demography, water access, and community-level sanitation coverage. Masking of participants and fieldworkers was not possible. The primary outcomes were infant length-forage Z score and haemoglobin concentrations at 18 months of age among children born to mothers who were HIV negative during pregnancy. These outcomes were analysed in the intention-totreat population. We estimated the effects of the interventions by comparing the two IYCF groups with the two non-IYCF groups and the two WASH groups with the two non-WASH groups, except for outcomes that had an important statistical interaction between the interventions. This trial is registered with ClinicalTrials.gov, number NCT01824940.

References 1) Iden-fying paediatric sepsis: the difficul-es in following recommended prac-ce and ... more References 1) Iden-fying paediatric sepsis: the difficul-es in following recommended prac-ce and the crea-on of our own pathway. Powell R, et al. Arch Dis Child. 2018. Jan;103(1):114 2) NICE l guideline 51. Sepsis: recogni-on, diagnosis and early management Published date: July 2016 Last updated: September 2017 3) 'So why didn't you think this baby was ill?' Decision-making in acute paediatrics. Roland D, Snelson E. Arch Dis Child Educ Pract Ed 2018 Mar, 4) 'Diagnos-c Test Accuracy of a 2-Transcript Host RNA Signature for Discrimina-ng Bacterial vs Viral Infec-on in Febrile Children' Herberg JA et al. JAMA. 2016 Aug 23-30;316(8):835-45 5) 'The accuracy of clinical symptoms and signs for the diagnosis of serious bacterial infec-on in young febrile children: prospec-ve cohort study of 15 781 febrile illnesses' Craig C et al. BMJ 2010;34 6) Evalua-ng the Pediatric Early Warning Score (PEWS) System for Admi`ed Pa-ents in the Pediatric Emergency Department,

Wellcome open research, Nov 9, 2022

Background: Neurodevelopment assessment tools for low-resource settings are urgently needed. Howe... more Background: Neurodevelopment assessment tools for low-resource settings are urgently needed. However, most available tools were developed in high-income settings and may lack cross-cultural validity. Methods: We piloted and adapted two subtests (pattern reasoning and story completion) within the Kaufman Assessment Battery for Children-2 nd edition (KABC-II) for use in rural Zimbabwean children aged 7 years old, both within the planning domain. After initial assessments of face validity, we substituted and added items in the test battery through a co-design process with fieldworkers and child development experts. To assess how successful the changes were, Ttests adjusting for unequal variances were used to compare scores between the original and adapted versions of the same subtest. ANOVA and pairwise analysis was performed to compare the performance of KABC-II subtests across domains. Intraclass correlation coefficient was calculated to explore the variability between domains. Results: Initial test scores on the planning domain were significantly lower than the other three domains of learning, sequential memory and simultaneous reasoning (P<0.001) in 50 children. Modified subtests were administered to another 20 children, who showed story Open Peer Review Approval Status AWAITING PEER REVIEW Any reports and responses or comments on the article can be found at the end of the article.

Chemical Communications, 2005

Fluorescence resonance energy transfer (FRET) between matched carbocyanine lipid analogs in the p... more Fluorescence resonance energy transfer (FRET) between matched carbocyanine lipid analogs in the plasma membrane outer leaflet of RBL mast cells was used to investigate lateral distributions of lipids and to develop a general method for quantitative measurements of lipid heterogeneity in live cell membranes. FRET measured as fluorescence quenching of long-chain donor probes such as DiO-C 18 is greater with long-chain, saturated acceptor probes such as DiI-C 16 than with unsaturated or shorter-chain acceptors with the same chromophoric headgroup compared at identical concentrations. FRET measurements between these lipid probes in model membranes support the conclusion that differential donor quenching is not caused by nonideal mixing or spectroscopic differences. Sucrose gradient analysis of plasma membrane-labeled, Triton X-100lysed cells shows that proximity measured by FRET correlates with the extent of lipid probe partitioning into detergent-resistant membranes. FRET between DiO-C 16 and DiI-C 16 is sensitive to cholesterol depletion and disruption of liquid order (Lo) by shortchain ceramides, and it is enhanced by cross linking of Lo-associated proteins. Consistent results are obtained when homo-FRET is measured by decreased fluorescence anisotropy of DiI-C 16. These results support the existence of nanometer-scale Lo/liquid disorder heterogeneity of lipids in the outer leaflet of the plasma membrane in live cells.

PLOS digital health, Feb 23, 2023

Conclusion Contrary to popular belief, infants are not unable to contract COVID nor develop only ... more Conclusion Contrary to popular belief, infants are not unable to contract COVID nor develop only mild symptoNonetheless, even though there was a SARS wave in 2019, its cause was probably not SARS-COV-2. However, it is necessary to study these waves more profoundly, not only after the pandemic started, but also before it, so that we can have a better understanding on the effects of SARS in infants and the COVID particularities in this group.

Child Care Health and Development, Oct 12, 2022

Archives of Disease in Childhood, Apr 1, 2014

The Cochrane library, Mar 30, 2017

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows:Main objec... more This is a protocol for a Cochrane Review (Intervention). The objectives are as follows:Main objectiveThe main objective is to assess the effect of interventions to improve sanitation, hygiene, water quality and supply within low‐ and middle‐income countries on child development.Secondary objectivesThe secondary objectives are to:analyse any measured effect of water, sanitation and hygiene (WASH) interventions on school or preschool enrolment and attendance;examine the feasibility of WASH interventions with regard to their implementation fidelity and participant compliance;evaluate the effect of WASH interventions on intermediary outcomes of environmental contamination, gastrointestinal diseases and reduction in the burden of water collection and water costs; andidentify any adverse impact that WASH interventions may have for participants.

International Child Health Group

Aims School-age health, growth and development are poorly characterised in low-and middle-income ... more Aims School-age health, growth and development are poorly characterised in low-and middle-income countries. School-age is both highly predictive of adult function as well as an important age for protective interventions. We developed the School-Age Health, Activity, Resilience, Anthropometry and Neurocognitive (SAHARAN) toolbox to measure growth, cognitive and physical function in rural Zimbabwe. Methods The SAHARAN toolbox was developed using a stepwise approach, with tool selection based on COSMIN principles. Growth was measured with anthropometry, knee-heel length and skinfold thicknesses. Bioimpedance analysis measured lean mass index (LMI) and phase angle. Cognition was assessed using a fine motor finger tapping task and school achievement test (SAT). The Kaufmann Assessment Battery for

PLOS Digital Health

Interest in measuring cognition in children in low-resourced settings has increased in recent yea... more Interest in measuring cognition in children in low-resourced settings has increased in recent years, but options for cognitive assessments are limited. Researchers are faced with challenges when using existing assessments in these settings, such as trained workforce shortages, less relevant testing stimuli, limitations of proprietary assessments, and inadequate parental knowledge of cognitive milestones. Tablet-based direct child assessments are emerging as a practical solution to these challenges, but evidence of their validity and utility in cross-cultural settings is limited. In this overview, we introduce key concepts of this field while exploring the current landscape of tablet-based assessments for low-resourced settings. We also make recommendations for future directions of this relatively novel field. We conclude that tablet-based assessments are an emerging and promising method of assessing cognition in young children. Further awareness and dissemination of validated tablet...

Child: Care, Health and Development

JDP conceptualized the project, performed data curation, methodology, funding acquisition, method... more JDP conceptualized the project, performed data curation, methodology, funding acquisition, methodology, formal analysis and writing. CM undertook data curation and contributed to methodology, project administration and supervision. DC undertook data curation and contributed to methodology, project administration and supervision. AJP contributed to conceptualisation, methodology, resources, supervision, visualization and writing-review and editing.

British Journal of Nutrition

HIV and severe wasting are associated with post-discharge mortality and hospital readmission amon... more HIV and severe wasting are associated with post-discharge mortality and hospital readmission among children with complicated severe acute malnutrition (SAM); however, the reasons remain unclear. We assessed body composition at hospital discharge, stratified by HIV and oedema status, in a cohort of children with complicated SAM in three hospitals in Zambia and Zimbabwe. We measured skinfold thicknesses and bioelectrical impedance analysis (BIA) to investigate whether fat and lean mass were independent predictors of time to death or readmission. Cox proportional hazards models were used to estimate the association between death/readmission and discharge body composition. Mixed effects models were fitted to compare longitudinal changes in body composition over 1 year. At discharge, 284 and 546 children had complete BIA and skinfold measurements, respectively. Low discharge lean and peripheral fat mass were independently associated with death/hospital readmission. Each unit Z-score incr...

Wellcome Open Research

Background: Neurodevelopment assessment tools for low-resource settings are urgently needed. Howe... more Background: Neurodevelopment assessment tools for low-resource settings are urgently needed. However, most available tools were developed in high-income settings and may lack cross-cultural validity. Methods: We piloted and adapted two subtests (pattern reasoning and story completion) within the Kaufman Assessment Battery for Children-2nd edition (KABC-II) for use in rural Zimbabwean children aged 7 years old, both within the planning domain. After initial assessments of face validity, we substituted and added items in the test battery through a co-design process with fieldworkers and child development experts. To assess how successful the changes were, T-tests adjusting for unequal variances were used to compare scores between the original and adapted versions of the same subtest. ANOVA and pairwise analysis was performed to compare the performance of KABC-II subtests across domains. Intraclass correlation coefficient was calculated to explore the variability between domains. Resul...

Comprehensive Reviews in Food Science and Food Safety, 2017

Sodium benzoate and potassium sorbate are extremely useful agents for food and beverage preservat... more Sodium benzoate and potassium sorbate are extremely useful agents for food and beverage preservation, yet concerns remain over their complete safety. Benzoate can react with the ascorbic acid in drinks to produce the carcinogen benzene. A few children develop allergy to this additive while, as a competitive inhibitor of D-amino acid oxidase, benzoate can also influence neurotransmission and cognitive functioning. Model organism and cell culture studies have raised some issues. Benzoate has been found to exert teratogenic and neurotoxic effects on zebrafish embryos. In addition, benzoate and sorbate are reported to cause chromosome aberrations in cultured human lymphocytes; also to be potently mutagenic toward the mitochondrial DNA in aerobic yeast cells. Whether the substantial human consumption of these compounds could significantly increase levels of such damages in man is still unclear. There is no firm evidence that it is a risk factor in type 2 diabetes. The clinical administration of sodium benzoate is of proven benefit for many patients with urea cycle disorders, while recent studies indicate it may also be advantageous in the treatment of multiple sclerosis, schizophrenia, early-stage Alzheimer's disease and Parkinson's disease. Nevertheless, exposure to high amounts of this agent should be approached with caution, especially since it has the potential to generate a shortage of glycine which, in turn, can negatively influence brain neurochemistry. We discuss here how a small fraction of the population might be rendered-either through their genes or a chronic medical condition-particularly susceptible to any adverse effects of sodium benzoate.

Measuring body composition within the SHINE trial

Introduction: School-age health, growth and development are poorly characterised in low-and middl... more Introduction: School-age health, growth and development are poorly characterised in low-and middle-income countries. We developed the School-Age Health, Activity, Resilience, Anthropometry and Neurocognitive (SAHARAN) toolbox to measure growth, cognitive and physical function in rural Zimbabwe. Methods: The SAHARAN toolbox was developed using a stepwise approach, with tool selection based on COSMIN principles. Growth was measured with anthropometry, skinfold thicknesses and bioimpedance analysis to obtain lean mass index (LMI) and phase angle. Cognition was assessed using a fine motor finger tapping task, school achievement test (SAT), and the Kaufmann Assessment Battery for Children (KABC-2) to determine the mental processing index (MPI). Physical function combined grip strength, broad jump and the 20m shuttle run test to produce a total physical score (TPS). A detailed caregiver questionnaire was performed in parallel. Results: 80 Zimbabwean children with mean (SD) age 7.6 (0.2) years had mean height-forage (HAZ) and weight-forage Z-scores (WAZ) of-0.63 (0.81) and-0.55 (0.85), respectively. For growth measures, LMI and total skinfold thicknesses were highly related to both WAZ and BMI Z-score, but not to HAZ. For physical function, TPS was associated with unit rises in HAZ (1.29, 95%CI 0.75,1.82, p<0.001), and LMI (0.50, 95%CI 0.16,0.83, p=0.004), but not skinfold thicknesses. For cognition, the SAT was highly associated with unit increases in the MPI (0.9 marks, 95%CI 0.4,1.3, p<0.001) and a child socioemotional questionnaire (8.2 marks, 95%CI 2.9,13.5, p=0.003). Phase angle was associated with 3.5 seconds quicker time to complete the finger tapping task (95%CI 0.6,6.4, p=0.02). No child outcomes were associated with socioeconomic status, nurturing, discipline, food and water insecurity, or household adversity. .

The Lancet Global Health, 2019

Background Child stunting reduces survival and impairs neurodevelopment. We tested the independen... more Background Child stunting reduces survival and impairs neurodevelopment. We tested the independent and combined effects of improved water, sanitation, and hygiene (WASH), and improved infant and young child feeding (IYCF) on stunting and anaemia in in Zimbabwe. Methods We did a cluster-randomised, community-based, 2 × 2 factorial trial in two rural districts in Zimbabwe. Clusters were defined as the catchment area of between one and four village health workers employed by the Zimbabwe Ministry of Health and Child Care. Women were eligible for inclusion if they permanently lived in clusters and were confirmed pregnant. Clusters were randomly assigned (1:1:1:1) to standard of care (52 clusters), IYCF (20 g of a small-quantity lipidbased nutrient supplement per day from age 6 to 18 months plus complementary feeding counselling; 53 clusters), WASH (construction of a ventilated improved pit latrine, provision of two handwashing stations, liquid soap, chlorine, and play space plus hygiene counselling; 53 clusters), or IYCF plus WASH (53 clusters). A constrained randomisation technique was used to achieve balance across the groups for 14 variables related to geography, demography, water access, and community-level sanitation coverage. Masking of participants and fieldworkers was not possible. The primary outcomes were infant length-forage Z score and haemoglobin concentrations at 18 months of age among children born to mothers who were HIV negative during pregnancy. These outcomes were analysed in the intention-totreat population. We estimated the effects of the interventions by comparing the two IYCF groups with the two non-IYCF groups and the two WASH groups with the two non-WASH groups, except for outcomes that had an important statistical interaction between the interventions. This trial is registered with ClinicalTrials.gov, number NCT01824940.

References 1) Iden-fying paediatric sepsis: the difficul-es in following recommended prac-ce and ... more References 1) Iden-fying paediatric sepsis: the difficul-es in following recommended prac-ce and the crea-on of our own pathway. Powell R, et al. Arch Dis Child. 2018. Jan;103(1):114 2) NICE l guideline 51. Sepsis: recogni-on, diagnosis and early management Published date: July 2016 Last updated: September 2017 3) 'So why didn't you think this baby was ill?' Decision-making in acute paediatrics. Roland D, Snelson E. Arch Dis Child Educ Pract Ed 2018 Mar, 4) 'Diagnos-c Test Accuracy of a 2-Transcript Host RNA Signature for Discrimina-ng Bacterial vs Viral Infec-on in Febrile Children' Herberg JA et al. JAMA. 2016 Aug 23-30;316(8):835-45 5) 'The accuracy of clinical symptoms and signs for the diagnosis of serious bacterial infec-on in young febrile children: prospec-ve cohort study of 15 781 febrile illnesses' Craig C et al. BMJ 2010;34 6) Evalua-ng the Pediatric Early Warning Score (PEWS) System for Admi`ed Pa-ents in the Pediatric Emergency Department,

Wellcome open research, Nov 9, 2022

Background: Neurodevelopment assessment tools for low-resource settings are urgently needed. Howe... more Background: Neurodevelopment assessment tools for low-resource settings are urgently needed. However, most available tools were developed in high-income settings and may lack cross-cultural validity. Methods: We piloted and adapted two subtests (pattern reasoning and story completion) within the Kaufman Assessment Battery for Children-2 nd edition (KABC-II) for use in rural Zimbabwean children aged 7 years old, both within the planning domain. After initial assessments of face validity, we substituted and added items in the test battery through a co-design process with fieldworkers and child development experts. To assess how successful the changes were, Ttests adjusting for unequal variances were used to compare scores between the original and adapted versions of the same subtest. ANOVA and pairwise analysis was performed to compare the performance of KABC-II subtests across domains. Intraclass correlation coefficient was calculated to explore the variability between domains. Results: Initial test scores on the planning domain were significantly lower than the other three domains of learning, sequential memory and simultaneous reasoning (P<0.001) in 50 children. Modified subtests were administered to another 20 children, who showed story Open Peer Review Approval Status AWAITING PEER REVIEW Any reports and responses or comments on the article can be found at the end of the article.

Chemical Communications, 2005

Fluorescence resonance energy transfer (FRET) between matched carbocyanine lipid analogs in the p... more Fluorescence resonance energy transfer (FRET) between matched carbocyanine lipid analogs in the plasma membrane outer leaflet of RBL mast cells was used to investigate lateral distributions of lipids and to develop a general method for quantitative measurements of lipid heterogeneity in live cell membranes. FRET measured as fluorescence quenching of long-chain donor probes such as DiO-C 18 is greater with long-chain, saturated acceptor probes such as DiI-C 16 than with unsaturated or shorter-chain acceptors with the same chromophoric headgroup compared at identical concentrations. FRET measurements between these lipid probes in model membranes support the conclusion that differential donor quenching is not caused by nonideal mixing or spectroscopic differences. Sucrose gradient analysis of plasma membrane-labeled, Triton X-100lysed cells shows that proximity measured by FRET correlates with the extent of lipid probe partitioning into detergent-resistant membranes. FRET between DiO-C 16 and DiI-C 16 is sensitive to cholesterol depletion and disruption of liquid order (Lo) by shortchain ceramides, and it is enhanced by cross linking of Lo-associated proteins. Consistent results are obtained when homo-FRET is measured by decreased fluorescence anisotropy of DiI-C 16. These results support the existence of nanometer-scale Lo/liquid disorder heterogeneity of lipids in the outer leaflet of the plasma membrane in live cells.

PLOS digital health, Feb 23, 2023

Conclusion Contrary to popular belief, infants are not unable to contract COVID nor develop only ... more Conclusion Contrary to popular belief, infants are not unable to contract COVID nor develop only mild symptoNonetheless, even though there was a SARS wave in 2019, its cause was probably not SARS-COV-2. However, it is necessary to study these waves more profoundly, not only after the pandemic started, but also before it, so that we can have a better understanding on the effects of SARS in infants and the COVID particularities in this group.

Child Care Health and Development, Oct 12, 2022

Archives of Disease in Childhood, Apr 1, 2014

The Cochrane library, Mar 30, 2017

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows:Main objec... more This is a protocol for a Cochrane Review (Intervention). The objectives are as follows:Main objectiveThe main objective is to assess the effect of interventions to improve sanitation, hygiene, water quality and supply within low‐ and middle‐income countries on child development.Secondary objectivesThe secondary objectives are to:analyse any measured effect of water, sanitation and hygiene (WASH) interventions on school or preschool enrolment and attendance;examine the feasibility of WASH interventions with regard to their implementation fidelity and participant compliance;evaluate the effect of WASH interventions on intermediary outcomes of environmental contamination, gastrointestinal diseases and reduction in the burden of water collection and water costs; andidentify any adverse impact that WASH interventions may have for participants.

International Child Health Group

Aims School-age health, growth and development are poorly characterised in low-and middle-income ... more Aims School-age health, growth and development are poorly characterised in low-and middle-income countries. School-age is both highly predictive of adult function as well as an important age for protective interventions. We developed the School-Age Health, Activity, Resilience, Anthropometry and Neurocognitive (SAHARAN) toolbox to measure growth, cognitive and physical function in rural Zimbabwe. Methods The SAHARAN toolbox was developed using a stepwise approach, with tool selection based on COSMIN principles. Growth was measured with anthropometry, knee-heel length and skinfold thicknesses. Bioimpedance analysis measured lean mass index (LMI) and phase angle. Cognition was assessed using a fine motor finger tapping task and school achievement test (SAT). The Kaufmann Assessment Battery for

PLOS Digital Health

Interest in measuring cognition in children in low-resourced settings has increased in recent yea... more Interest in measuring cognition in children in low-resourced settings has increased in recent years, but options for cognitive assessments are limited. Researchers are faced with challenges when using existing assessments in these settings, such as trained workforce shortages, less relevant testing stimuli, limitations of proprietary assessments, and inadequate parental knowledge of cognitive milestones. Tablet-based direct child assessments are emerging as a practical solution to these challenges, but evidence of their validity and utility in cross-cultural settings is limited. In this overview, we introduce key concepts of this field while exploring the current landscape of tablet-based assessments for low-resourced settings. We also make recommendations for future directions of this relatively novel field. We conclude that tablet-based assessments are an emerging and promising method of assessing cognition in young children. Further awareness and dissemination of validated tablet...

Child: Care, Health and Development

JDP conceptualized the project, performed data curation, methodology, funding acquisition, method... more JDP conceptualized the project, performed data curation, methodology, funding acquisition, methodology, formal analysis and writing. CM undertook data curation and contributed to methodology, project administration and supervision. DC undertook data curation and contributed to methodology, project administration and supervision. AJP contributed to conceptualisation, methodology, resources, supervision, visualization and writing-review and editing.

British Journal of Nutrition

HIV and severe wasting are associated with post-discharge mortality and hospital readmission amon... more HIV and severe wasting are associated with post-discharge mortality and hospital readmission among children with complicated severe acute malnutrition (SAM); however, the reasons remain unclear. We assessed body composition at hospital discharge, stratified by HIV and oedema status, in a cohort of children with complicated SAM in three hospitals in Zambia and Zimbabwe. We measured skinfold thicknesses and bioelectrical impedance analysis (BIA) to investigate whether fat and lean mass were independent predictors of time to death or readmission. Cox proportional hazards models were used to estimate the association between death/readmission and discharge body composition. Mixed effects models were fitted to compare longitudinal changes in body composition over 1 year. At discharge, 284 and 546 children had complete BIA and skinfold measurements, respectively. Low discharge lean and peripheral fat mass were independently associated with death/hospital readmission. Each unit Z-score incr...

Wellcome Open Research

Background: Neurodevelopment assessment tools for low-resource settings are urgently needed. Howe... more Background: Neurodevelopment assessment tools for low-resource settings are urgently needed. However, most available tools were developed in high-income settings and may lack cross-cultural validity. Methods: We piloted and adapted two subtests (pattern reasoning and story completion) within the Kaufman Assessment Battery for Children-2nd edition (KABC-II) for use in rural Zimbabwean children aged 7 years old, both within the planning domain. After initial assessments of face validity, we substituted and added items in the test battery through a co-design process with fieldworkers and child development experts. To assess how successful the changes were, T-tests adjusting for unequal variances were used to compare scores between the original and adapted versions of the same subtest. ANOVA and pairwise analysis was performed to compare the performance of KABC-II subtests across domains. Intraclass correlation coefficient was calculated to explore the variability between domains. Resul...

Comprehensive Reviews in Food Science and Food Safety, 2017

Sodium benzoate and potassium sorbate are extremely useful agents for food and beverage preservat... more Sodium benzoate and potassium sorbate are extremely useful agents for food and beverage preservation, yet concerns remain over their complete safety. Benzoate can react with the ascorbic acid in drinks to produce the carcinogen benzene. A few children develop allergy to this additive while, as a competitive inhibitor of D-amino acid oxidase, benzoate can also influence neurotransmission and cognitive functioning. Model organism and cell culture studies have raised some issues. Benzoate has been found to exert teratogenic and neurotoxic effects on zebrafish embryos. In addition, benzoate and sorbate are reported to cause chromosome aberrations in cultured human lymphocytes; also to be potently mutagenic toward the mitochondrial DNA in aerobic yeast cells. Whether the substantial human consumption of these compounds could significantly increase levels of such damages in man is still unclear. There is no firm evidence that it is a risk factor in type 2 diabetes. The clinical administration of sodium benzoate is of proven benefit for many patients with urea cycle disorders, while recent studies indicate it may also be advantageous in the treatment of multiple sclerosis, schizophrenia, early-stage Alzheimer's disease and Parkinson's disease. Nevertheless, exposure to high amounts of this agent should be approached with caution, especially since it has the potential to generate a shortage of glycine which, in turn, can negatively influence brain neurochemistry. We discuss here how a small fraction of the population might be rendered-either through their genes or a chronic medical condition-particularly susceptible to any adverse effects of sodium benzoate.

Measuring body composition within the SHINE trial

Introduction: School-age health, growth and development are poorly characterised in low-and middl... more Introduction: School-age health, growth and development are poorly characterised in low-and middle-income countries. We developed the School-Age Health, Activity, Resilience, Anthropometry and Neurocognitive (SAHARAN) toolbox to measure growth, cognitive and physical function in rural Zimbabwe. Methods: The SAHARAN toolbox was developed using a stepwise approach, with tool selection based on COSMIN principles. Growth was measured with anthropometry, skinfold thicknesses and bioimpedance analysis to obtain lean mass index (LMI) and phase angle. Cognition was assessed using a fine motor finger tapping task, school achievement test (SAT), and the Kaufmann Assessment Battery for Children (KABC-2) to determine the mental processing index (MPI). Physical function combined grip strength, broad jump and the 20m shuttle run test to produce a total physical score (TPS). A detailed caregiver questionnaire was performed in parallel. Results: 80 Zimbabwean children with mean (SD) age 7.6 (0.2) years had mean height-forage (HAZ) and weight-forage Z-scores (WAZ) of-0.63 (0.81) and-0.55 (0.85), respectively. For growth measures, LMI and total skinfold thicknesses were highly related to both WAZ and BMI Z-score, but not to HAZ. For physical function, TPS was associated with unit rises in HAZ (1.29, 95%CI 0.75,1.82, p<0.001), and LMI (0.50, 95%CI 0.16,0.83, p=0.004), but not skinfold thicknesses. For cognition, the SAT was highly associated with unit increases in the MPI (0.9 marks, 95%CI 0.4,1.3, p<0.001) and a child socioemotional questionnaire (8.2 marks, 95%CI 2.9,13.5, p=0.003). Phase angle was associated with 3.5 seconds quicker time to complete the finger tapping task (95%CI 0.6,6.4, p=0.02). No child outcomes were associated with socioeconomic status, nurturing, discipline, food and water insecurity, or household adversity. .