Melissa Benavente
Academic and research departments
Maternal, Child and Family Health Expert Group, School of Health Sciences.About
My research project
Nutritional, economic, and environmental impacts on anaemia in Indian children from birth to age 18 yearsAnaemia is a major public health concern in developing countries; primarily affecting young children, adolescent females, and pregnant women. Anaemia in childhood and adolescence can affect physical growth and cognitive function, with likely further impacts on reproductive health in women. While many of the causes of anaemia are treatable, especially iron-deficiency which is the commonest cause, in India the anaemia prevention and control programmes have been unable to reduce its prevalence. The reasons for this are unclear, but are likely to involve many health, environmental and sociological aspects. Data-science approaches offer a new opportunity to explore this further, with the potential to reveal previously unrecognised patterns of anaemia over time.
The Pune Maternal Nutrition Study (PMNS) has recruited 800 pregnant women, across six villages around Pune city, Maharashtra, India. Over 650 children born to these women were also recruited, tracked from birth, and followed-up at 6, 12 and 18 years. This PhD will analyse data collected as part of the PMNS. The team will apply methods in epidemiology as well as methods in AI and machine learning, to these data to investigate nutritional, economic, and environmental impacts on anaemia, and both physical and cognitive development in Indian children.
The main objectives of this PhD are:
- Identify nutritional, economic, and environmental impacts on anaemia and development in children.
- Examine micronutrient trends (Iron, Folate and Vitamin B12) during pregnancy and childhood to assess and inform health programmes and policies.
- Apply machine learning and advanced analytics to identify population stratifiers and subgroups that can better direct patient management and improve outcomes.
Supervisors
Anaemia is a major public health concern in developing countries; primarily affecting young children, adolescent females, and pregnant women. Anaemia in childhood and adolescence can affect physical growth and cognitive function, with likely further impacts on reproductive health in women. While many of the causes of anaemia are treatable, especially iron-deficiency which is the commonest cause, in India the anaemia prevention and control programmes have been unable to reduce its prevalence. The reasons for this are unclear, but are likely to involve many health, environmental and sociological aspects. Data-science approaches offer a new opportunity to explore this further, with the potential to reveal previously unrecognised patterns of anaemia over time.
The Pune Maternal Nutrition Study (PMNS) has recruited 800 pregnant women, across six villages around Pune city, Maharashtra, India. Over 650 children born to these women were also recruited, tracked from birth, and followed-up at 6, 12 and 18 years. This PhD will analyse data collected as part of the PMNS. The team will apply methods in epidemiology as well as methods in AI and machine learning, to these data to investigate nutritional, economic, and environmental impacts on anaemia, and both physical and cognitive development in Indian children.
The main objectives of this PhD are:
- Identify nutritional, economic, and environmental impacts on anaemia and development in children.
- Examine micronutrient trends (Iron, Folate and Vitamin B12) during pregnancy and childhood to assess and inform health programmes and policies.
- Apply machine learning and advanced analytics to identify population stratifiers and subgroups that can better direct patient management and improve outcomes.
Publications
Background Chronic kidney disease (CKD) is common but heterogenous and is associated with multiple adverse outcomes. The National Unified Renal Translational Research Enterprise (NURTuRE)-CKD cohort was established to investigate risk factors for clinically important outcomes in persons with CKD referred to secondary care. Methods Eligible participants with CKD stages G3-4 or stages G1-2 plus albuminuria >30 mg/mmol were enrolled from 16 nephrology centres in England, Scotland and Wales from 2017 to 2019. Baseline assessment included demographic data, routine laboratory data and research samples. Clinical outcomes are being collected over 15 years by the UK Renal Registry using established data linkage. Baseline data are presented with subgroup analysis by age, sex and estimated glomerular filtration rate (eGFR). Results A total of 2996 participants was enrolled. Median (interquartile range) age was 66 (54-74) years, eGFR 33.8 (24.0-46.6) mL/min/1.73 m(2) and urine albumin to creatinine ratio 209 (33-926) mg/g; 58.5% were male. Of these participants, 1883 (69.1%) were in high-risk CKD categories. Primary renal diagnosis was CKD of unknown cause in 32.3%, glomerular disease in 23.4% and diabetic kidney disease in 11.5%. Older participants and those with lower eGFR had higher systolic blood pressure and were less likely to be treated with renin-angiotensin system inhibitors (RASi) but were more likely to receive a statin. Female participants were less likely to receive a RASi or statin. Conclusions NURTuRE-CKD is a prospective cohort of persons who are at relatively high risk of adverse outcomes. Long-term follow-up and a large biorepository create opportunities for research to improve risk prediction and to investigate underlying mechanisms to inform new treatment development.
Graphical Abstract
Background. Many non-modifiable factors are associated with poorer health-related quality of life (HRQoL) experienced by people with chronic kidney disease (CKD). We hypothesize that potentially modifiable factors for poor HRQoL can be identified among CKD patients, providing potential targets for intervention. Method. The National Unified Renal Translational Research Enterprise Chronic Kidney Disease (NURTuRE-CKD) cohort study recruited 2996 participants from nephrology centres with all stages of non-dialysis-dependent CKD. Baseline data collection for sociodemographic, anthropometric, biochemical and clinical information, including Integrated Palliative care Outcome Scale renal, Hospital Anxiety and Depression score (HADS) and the 5-level EuroQol-5D (EQ-5D-5L) as HRQoL measure, took place between 2017 and 2019. EQ-5D-5L dimensions (mobility, self-care, usual activities, pain/discomfort, anxiety/depression) were mapped to an EQ-5D-3L value set to derive index value. Multivariable mixed effects regression models, adjusted for known factors affecting HRQoL with recruitment region as a random effect, were fit to assess potentially modifiable factors associated with index value (linear) and within each dimension (logistic). Results. Among the 2958/2996 (98.7%) participants with complete EQ-5D data, 2201 (74.4%) reported problems in at least one EQ-5D-5L dimension. Multivariable linear regression identified independent associations between poorer HRQoL (EQ-5D-3L index value) and obesity (body mass index >= 30.0 kg/m2, beta -0.037, 95% CI -0.058 to -0.016, P = .001), HADS depression score >= 8 (beta -0.159, -0.182 to -0.137, P < .001), anxiety score >= 8 (beta -0.090, -0.110 to -0.069, P < .001), taking >= 10 medications (beta -0.065, -0.085 to -0.046, P < .001), sarcopenia (beta -0.062, -0.080 to -0.043, P < .001) haemoglobin