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BackgroundAdolescence is a critical period of maturation when nutrient needs are high, especially among adolescents entering pregnancy. Using individual-level data from 140,000 participants, we examined socioeconomic, nutrition, and pregnancy and birth outcomes for adolescent mothers (10-19 years) compared to older mothers in low and middle-income countries.MethodsThis study was conducted between March 16, 2018 and May 25, 2021. Data were obtained from 20 randomised controlled trials of micronutrient supplementation in pregnancy. Stratified analyses were conducted by age (10-14 years, 15-17 years, 18-19 years, 20-29 years, 30-39 years, 40+ years) and geographical region (Africa, Asia). Crude and confounder-adjusted means, prevalence and relative risks of pregnancy, nutrition and birth outcomes were estimated using multivariable linear and log-binomial regression models with 95% confidence intervals.FindingsAdolescent mothers comprised 31.6% of our data. Preterm birth, small-for-gestational age (SGA), low birthweight (LBW) and newborn mortality followed a U-shaped trend in which prevalence was highest among the youngest mothers (10-14 years) and then reduced gradually, but increased again for older mothers (40+ years). When compared to mothers aged 20-29 years, there was a 23% increased risk of preterm birth, a 60% increased risk of perinatal mortality, a 63% increased risk of neonatal mortality, a 28% increased risk of LBW, and a 22% increased risk of SGA among mothers 10-14 years. Mothers 40+ years experienced a 22% increased risk of preterm birth and a 103% increased risk of stillbirth when compared to the 20-29 year group.InterpretationThe youngest and oldest mothers suffer most from adverse pregnancy and birth outcomes. Policy and programming agendas should consider both biological and socioeconomic/environmental factors when targeting these populations.FundingBill and Melinda Gates Foundation (Grant No: OP1137750).

ContextApproximately 7.3 million births occur annually among adolescents in low- and middle-income countries. Pregnant adolescents constitute a nutritionally vulnerable group that could benefit from intervention to mitigate the mortality and adverse birth outcomes associated with adolescent pregnancy.ObjectiveThe aim of this systematic review and meta-analysis was to assess the following: (1) the effect of multiple-micronutrient (MMN) supplementation vs iron and folic acid (IFA) supplementation among adolescents on maternal morbidity, birth outcomes, and mortality outcomes, (2) the effects of MMN supplementation in adolescents compared with the effects in adult women, and (3) the effect modification, if any, of MMN supplementation by baseline and geographic characteristics of adolescents.Data sourcesMEDLINE and Cochrane databases were searched, along with the reference lists of relevant reviews.Study selectionMultiple-micronutrient supplementation trials in pregnancy that were conducted in a low- or middle-income country and had included at least 100 adolescents (10-19 years of age) were eligible for inclusion. Two independent reviewers assessed study eligibility.Data extractionThirteen randomized controlled trials conducted in Africa and Asia were identified from 1792 reviews and 1578 original trials. Individual-level data was shared by study collaborators and was checked for completeness and extreme values. One- and two-stage individual participant data meta-analyses were conducted using data from randomized controlled trials of MMN supplementation.ResultsA total of 15 283 adolescents and 44 499 adult women with singleton births were included in the individual participant data meta-analyses of MMN supplementation vs IFA supplementation. In adolescents, MMN supplementation reduced low birth weight (1-stage OR = 0.87, 95%CI 0.77-0.97; 2-stage OR = 0.81; 95%CI 0.74-0.88), preterm birth (1-stage OR = 0.88, 95%CI 0.80-0.98; 2-stage OR = 0.86, 95%CI 0.79-0.95), and small-for-gestational-age births (1-stage OR = 0.90, 95%CI 0.81-1.00; 2-stage OR = 0.86, 95%CI 0.79-0.95) when compared with IFA supplementation. The effects of MMN supplementation did not differ between adolescents and older women, although a potentially greater reduction in small-for-gestational-age births was observed among adolescents. Effect modification by baseline characteristics and geographic region was inconclusive.ConclusionsMultiple-micronutrient supplementation can improve birth outcomes among pregnant adolescents in low- and middle-income countries. Policy related to antenatal care in these settings should prioritize MMN supplementation over the currently recommended IFA supplementation for all pregnant women, especially adolescents.

The boron isotopic composition of tourmaline and hambergite (Be2BO3[OH,F]) from peraluminous (n = 12), peralkaline (n = 1), and peralkaline nepheline syenite (n = 16) pegmatites has been measured by secondary ion mass spectrometry, for which a new hambergite reference material was developed. The focus of this study is on nepheline syenite pegmatites from the Larvik Plutonic Complex (Norway) and one peralkaline pegmatite related to the nearby Eikeren-Skrim Complex (Norway), where we investigate the source of boron as being from magmatic vs. external fluids. Tourmaline-hambergite mineral pairs were also analysed from peraluminous pegmatite localities (Russia, Tajikistan, and Pakistan) to test for systematic B-isotope fractionation between these two minerals. Tourmaline and hambergite from peraluminous granitic pegmatites have light boron ratios (δ11B = −12.9to −1.0‰) associated with S-type granites, whereas peralkaline granitic and nepheline syenite pegmatites have boron ratios (δ11B = −1.7 to 11.8‰), which we interpret is a result of heavy‑boron enrichment from external fluids. Our data show that hambergite tracks isotope variations of its geochemical setting and could therefore be used as a proxy mineral in place of tourmaline when geochemical stability favours hambergite. The results suggest a slight but consistent partitioning of B-isotopes between tourmaline and hambergite, with Δ11B = δ11Btourmaline−δ11Bhambergite in the range of approximately −3‰ to −5‰. Boron is in trigonal coordination with oxygen in both of these mineral phases as verified by NMR. Single crystal XRD analyses of tourmaline and hambergite reveal consistent longer distances of tourmaline relative to hambergite. We attribute the boron isotopic fractionation to the longer bond-lengths in tourmaline compared with hambergite.

Niobium is usually considered to be one of the least mobile elements during alteration of rocks in geological processes and is thought to only be mobile at elevated temperatures and/or pressures. Since niobium is assumed to be unaffected by weathering it can be used in geochemical-evolution calculations to estimate the loss of material from the weathering of rocks. There are roughly a hundred niobium-bearing minerals, including those in the pyrochlore group, which comprises the main ores for Nb and Ta. Furthermore, pyrochlores are identified as potential hosts for nuclear waste because of their resistance to weathering. Here we show that niobium can be highly mobile even at near-surface geochemical conditions as a soluble and unreactive polyoxometalate ion. Discovery of the first natural hexaniobate minerals, all formed at near-surface conditions, provides evidence that niobium is being actively leached out of nearby primary minerals and easily transported as polyoxometalate ions. In addition, we show how Nb and Ta can be fractionated during low-temperature processes.

Background Despite possible benefits for growth, milk is costly to include in foods for undernourished children. Furthermore, the relative effects of different milk components, milk protein (MP), and whey permeate (WP) are unclear. We aimed to assess the effects of MP and WP in lipid-based nutrient supplement (LNS), and of LNS itself, on linear growth and body composition among stunted children. Methods and findings We performed a randomized, double-blind, 2 x 2 factorial trial among 12 to 59 months old stunted children in Uganda. Children were randomized to 4 formulations of LNS with MP or soy protein isolate and WP or maltodextrin (100 g/day for 12 weeks) or no supplementation. Investigators and outcome assessors were blinded; however, participants were only blinded to the ingredients in LNS. Data were analyzed based on intention-to-treat (ITT) using linear mixed-effects models adjusted for age, sex, season, and site. Primary outcomes were change in height and knee-heel length, and secondary outcomes included body composition by bioimpedance analysis (ISRCTN13093195). Between February and September 2020, we enrolled 750 children with a median age of 30 (interquartile range 23 to 41) months, with mean (± standard deviation) height-for-age z-score (HAZ) -3.02 ± 0.74 and 12.7% (95) were breastfed. The 750 children were randomized to LNS (n = 600) with or without MP (n = 299 versus n = 301) and WP (n = 301 versus n = 299), or no supplementation (n = 150); 736 (98.1%), evenly distributed between groups, completed 12-week follow-up. Eleven serious adverse events occurred in 10 (1.3%) children, mainly hospitalization with malaria and anemia, all deemed unrelated to the intervention. Unsupplemented children had 0.06 (95% confidence interval, CI [0.02, 0.10]; p = 0.015) decline in HAZ, accompanied by 0.29 (95% CI [0.20, 0.39]; p < 0.001) kg/m.sup.2 increase in fat mass index (FMI), but 0.06 (95% CI [-0.002; 0.12]; p = 0.057) kg/m.sup.2 decline in fat-free mass index (FFMI). There were no interactions between MP and WP. The main effects of MP were 0.03 (95% CI [-0.10, 0.16]; p = 0.662) cm in height and 0.2 (95% CI [-0.3, 0.7]; p = 0.389) mm in knee-heel length. The main effects of WP were -0.08 (95% CI [-0.21, 0.05]; p = 220) cm and -0.2 (95% CI [-0.7; 0.3]; p = 403) mm, respectively. Interactions were found between WP and breastfeeding with respect to linear growth (p < 0.02), due to positive effects among breastfed and negative effects among non-breastfed children. Overall, LNS resulted in 0.56 (95% CI [0.42, 0.70]; p < 0.001) cm height increase, corresponding to 0.17 (95% CI [0.13, 0.21]; p < 0.001) HAZ increase, and 0.21 (95% CI [0.14, 0.28]; p < 0.001) kg weight increase, of which 76.5% (95% CI [61.9; 91.1]) was fat-free mass. Using height-adjusted indicators, LNS increased FFMI (0.07 kg/m.sup.2, 95% CI [0.0001; 0.13]; p = 0.049), but not FMI (0.01 kg/m.sup.2, 95% CI [-0.10, 0.12]; p = 0.800). Main limitations were lack of blinding of caregivers and short study duration. Conclusions Adding dairy to LNS has no additional effects on linear growth or body composition in stunted children aged 12 to 59 months. However, supplementation with LNS, irrespective of milk, supports linear catch-up growth and accretion of fat-free mass, but not fat mass. If left untreated, children already on a stunting trajectory gain fat at the expense of fat-free mass, thus nutrition programs to treat such children should be considered. Trial registration ISRCTN13093195, Author(s): Joseph Mbabazi 1,2, Hannah Pesu 1, Rolland Mutumba 1,2, Suzanne Filteau 3, Jack I. Lewis 1, Jonathan C. Wells 4, Mette F. Olsen 1,5, André Briend 1,6, Kim F. [...]

BackgroundAnti-retroviral therapy (ART) regimes for HIV are associated with raised levels of circulating triglycerides (TG) in western populations. However, there are limited data on the impact of ART on cardiometabolic risk in sub-Saharan African (SSA) populations.MethodsPooled analyses of 14 studies comprising 21 023 individuals, on whom relevant cardiometabolic risk factors (including TG), HIV and ART status were assessed between 2003 and 2014, in SSA. The association between ART and raised TG (>2.3 mmol/L) was analysed using regression models.FindingsAmong 10 615 individuals, ART was associated with a two-fold higher probability of raised TG (RR 2.05, 95% CI 1.51-2.77, I2=45.2%). The associations between ART and raised blood pressure, glucose, HbA1c, and other lipids were inconsistent across studies.InterpretationEvidence from this study confirms the association of ART with raised TG in SSA populations. Given the possible causal effect of raised TG on cardiovascular disease (CVD), the evidence highlights the need for prospective studies to clarify the impact of long term ART on CVD outcomes in SSA.

Anti-retroviral therapy (ART) regimes for HIV are associated with raised levels of circulating triglycerides (TG) in western populations. However, there are limited data on the impact of ART on cardiometabolic risk in sub-Saharan African (SSA) populations. Pooled analyses of 14 studies comprising 21 023 individuals, on whom relevant cardiometabolic risk factors (including TG), HIV and ART status were assessed between 2003 and 2014, in SSA. The association between ART and raised TG (>2.3 mmol/L) was analysed using regression models. Among 10 615 individuals, ART was associated with a two-fold higher probability of raised TG (RR 2.05, 95% CI 1.51-2.77, I2=45.2%). The associations between ART and raised blood pressure, glucose, HbA1c, and other lipids were inconsistent across studies. Evidence from this study confirms the association of ART with raised TG in SSA populations. Given the possible causal effect of raised TG on cardiovascular disease (CVD), the evidence highlights the need for prospective studies to clarify the impact of long term ART on CVD outcomes in SSA.

The two new minerals igelströmite, Fe 3+ (Sb 3+ Pb 2+)O 4 , and manganoschafarzikite, Mn 2+ Sb 23+ O 4 , are found in the Långban Fe–Mn deposit, in open fractures in a fine-grained hematite ore, with minor amounts of aegirine, a serpentine-group mineral, fluorcalcioroméite, baryte, nadorite, mimetite and other late-stage minerals. Igelströmite is named after the Swedish geologist–mineralogist Lars Johan Igelström (1822–1897). Mohs hardness = 3–4 and Dcalc= 6.33(1) and 5.37(2) g cm -3 for igelströmite and manganoschafarzikite, respectively. Cleavage is distinct on {110}. Both minerals are brittle, with an uneven to conchoidal fracture. The chemical formulae obtained from microprobe data are (Fe 0.593+ Mn 0.292+ As 0.063+ Fe 0.062+)Σ=1.00 (Sb 1.243+ Pb 0.652+ As 0.113+)Σ=2.00 O 4 and (Mn 0.642+ Fe 0.252+ Mg 0.08)Σ=0.97 (Sb 1.973+ As 0.033+ Pb 0.012+)Σ=2.01 O 4. The crystal structures for igelströmite and manganoschafarzikite have been refined in space group P 4 2 /mbc from single-crystal X-ray diffraction data to R 1 = 3.73 % and 1.51 %, respectively, giving the following sets of unit-cell parameters: a= 8.4856(2), 8.65159(8) Å; c= 6.0450(3), 5.97175(9); and V= 435.27(3), 446.986(11) Å 3 for Z = 4. Both minerals are isostructural with minium, Pb 4+ Pb 22+ O 4 , where Pb 4+ O 6 forms distorted octahedra, which connect via trans-edges to form rutile-like ribbons along c. The Pb 2+ atoms appear in trigonal, flattened PbO 3 pyramids, which are linked via corners to form zigzag (PbO 2)n chains. The minium group, of general formula MX2 O 4 (X= As 3+ , Sb 3+ , Pb 2+), presently consists of the minerals minium, trippkeite, schafarzikite, igelströmite and manganoschafarzikite. For future new members, it is recommended to consider the X cation content for the root name and add prefixes to indicate the dominant metal at the M position. [ABSTRACT FROM AUTHOR]