1. Innovative methodologies: Using brain imaging to evaluate nutritional intervention strategies in resource-poor settings Sophie E. Moore Group Leader: Maternal & Child Nutrition MRC Human Nutrition Research

2. Cognitive development in infancy and early childhood has been associated with a range of socioeconomic indicators in later life Achieving optimal brain development during the early phases of development in thus critical for human capital Thompson RA & Nelson CA. Am Psychol. 2001:56;5-15.

3. Hypothesised relations between poverty, child development and school achievement Poverty Growth failure Poor cognitive, motor, socio- emotional development Poor school achievement Nutritional deficiencies/infections Poor care and home stimulation Primary caretaker Stress/depression Low responsivity Low education Adapted from: Grantham-McGregor S. et al. Lancet 2007:369;60-70

4. Effect size for comparisons of children born with or without IUGR at term Walker S. et al, Lancet. 2007:369;145-57

5. Testing early cognitive development

6. Issues with behavioural assessments Reliability and validity: Most assessment scales are normed on Western samples and may not translate directly to other settings Early identification of pathology and evaluation of interventions: Must wait until it has reached the point of observable behaviour Objectivity during administration: Differences between administrators Parents’ reports of behaviour are likely subjective Administration time: Often 45+ mins

7. Optimising head circumference growth for brain development Mean (95% CI) HC for age z-scores. (males – blue; step curves show the mean at each time point). Data from the ENID Trial.

8. Functional Near Infrared Spectroscopy (fNIRS) 1. Source & detector probes 2. Shine & detect light 3. Measure changes in HbO2(red) and HHb (blue) inresponse to neuronal activation

9. 0-2 months4-8 months 12-16 months18-24 months

10. Stimulus Presentation

11. Results from Gambian infants Response to Social Visual StimuliResponse to Social Auditory Stimuli Optical Imaging demonstrated that Gambian infants showed significant brain activation in the temporal cortex in response to social visual and auditory stimuli These results are the same as those seen in a UK study with infants of a similar age Activated Brain Region Lloyd-Fox et al. Nat Sci Reports. 2014:4;4740.

12. Benefits of fNIRS Reliability and validity cross culturally Early identification – can be administered with newborns Objectivity during administration Administration time – cap placement & acquisition in <15 min

13. Conclusions & future application of fNIRS research fNIRS is an innovative means to measure neurocognitive function in infants and young children in a resource-poor setting Cross-sectional and longitudinal studies revealed distinct regions of the posterior superior temporal and inferior frontal cortex activated by either visual or auditory social stimuli fNIRS may be used to elucidate typical and atypical brain development from birth and hence investigate the effects of nutritional insults and interventions in global health studies

14. www.globalfnirs.org Global fNIRS