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Wang H, Yang Y, Zhou D, Bai C, Shi M. Correlation between Serum Levels of Vitamin A and Vitamin D with Disease Severity in Tic Disorder Children. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2022; 2022:7121900. [PMID: 35685731 PMCID: PMC9173974 DOI: 10.1155/2022/7121900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 05/09/2022] [Accepted: 05/19/2022] [Indexed: 11/29/2022]
Abstract
Purpose To explore and analyze the correlation between serum vitamins A and D levels and disease severity in children with tic disorder. Methods A total of 59 children with tic disorders treated in the Linping Hospital of Traditional Chinese Medicine from April 2018 to May 2021 were selected as the observation group. 55 healthy children with matched age and sex who underwent physical examination were selected as the control group. Children in the observation group were subdivided to the mild group (n = 35) and moderate-to-severe group (n = 24) according to the Yale comprehensive tic severity scale. Afterwards, they were grouped into the temporary group (n = 25), persistent group (n = 22), and Tourette's syndrome group (n = 12) according to their clinical characteristics and course of disease. The severity and serum vitamins A and D levels were collected and compared, and then, Spearman correlation analysis was performed to analyze the correlation between the severity and serum vitamins A and D levels. Results Compared with the control group, the serum vitamin A and D levels in the observation group were lower. Compared with the mild group, the serum vitamins A and D levels were lower in the moderate-to-severe group. Spearman correlation analysis revealed a significant negative correlation between disease severity and serum vitamins A and D levels. Regarding the serum D levels, the temporary group > the persistent group > Tourette's syndrome group. There was no significant difference in serum vitamin A levels among the three groups. Conclusion Vitamins A and D deficiency in children is strongly associated with tic disorders, and vitamins A and D demonstrate a negative correlation with the severity of tic disorders. Vitamin D is also linked to the clinical type of tic disorder.
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Affiliation(s)
- Helin Wang
- Department of Pediatric, Linping Hospital of Traditional Chinese Medicine, Hangzhou 311106, China
| | - Yali Yang
- Department of Pediatric, Linping Hospital of Traditional Chinese Medicine, Hangzhou 311106, China
| | - Dandan Zhou
- Department of Pediatric, Linping Hospital of Traditional Chinese Medicine, Hangzhou 311106, China
| | - Chengjie Bai
- Department of Pediatric, Linping Hospital of Traditional Chinese Medicine, Hangzhou 311106, China
| | - Minqiang Shi
- Department of Pediatric, Linping Hospital of Traditional Chinese Medicine, Hangzhou 311106, China
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Lee ACC, Cherkerzian S, Olson IE, Ahmed S, Chowdhury NH, Khanam R, Rahman S, Andrews C, Baqui AH, Fawzi W, Inder TE, Nartey S, Nelson CA, Oken E, Sen S, Fichorova R. Maternal Diet, Infection, and Risk of Cord Blood Inflammation in the Bangladesh Projahnmo Pregnancy Cohort. Nutrients 2021; 13:3792. [PMID: 34836049 PMCID: PMC8623045 DOI: 10.3390/nu13113792] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 10/15/2021] [Accepted: 10/22/2021] [Indexed: 11/16/2022] Open
Abstract
Inflammation may adversely affect early human brain development. We aimed to assess the role of maternal nutrition and infections on cord blood inflammation. In a pregnancy cohort in Sylhet, Bangladesh, we enrolled 251 consecutive pregnancies resulting in a term livebirth from July 2016-March 2017. Stillbirths, preterm births, and cases of neonatal encephalopathy were excluded. We prospectively collected data on maternal diet (food frequency questionnaire) and morbidity, and analyzed umbilical cord blood for interleukin (IL)-1α, IL-1β, IL-6, IL-8 and C-reactive protein. We determined associations between nutrition and infection exposures and cord cytokine elevation (≥75% vs. <75%) using logistic regression, adjusting for confounders. One-third of mothers were underweight (BMI < 18.5 kg/m2) at enrollment. Antenatal and intrapartum infections were observed among 4.8% and 15.9% of the sample, respectively. Low pregnancy intakes of B vitamins (B1, B2, B3, B6, B9 (folate)), fat-soluble vitamins (D, E), iron, zinc, and linoleic acid (lowest vs. middle tertile) were associated with higher risk of inflammation, particularly IL-8. There was a non-significant trend of increased risk of IL-8 and IL-6 elevation with history of ante-and intrapartum infections, respectively. In Bangladesh, improving micronutrient intake and preventing pregnancy infections are targets to reduce fetal systemic inflammation and associated adverse neurodevelopmental outcomes.
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Affiliation(s)
- Anne CC Lee
- Department of Pediatric Newborn Medicine, Brigham and Women’s Hospital, Boston, MA 02115, USA; (S.C.); (I.E.O.); (C.A.); (T.E.I.); (S.S.)
- Harvard Medical School, Boston, MA 02115, USA; (C.A.N.); (E.O.); (R.F.)
| | - Sara Cherkerzian
- Department of Pediatric Newborn Medicine, Brigham and Women’s Hospital, Boston, MA 02115, USA; (S.C.); (I.E.O.); (C.A.); (T.E.I.); (S.S.)
- Harvard Medical School, Boston, MA 02115, USA; (C.A.N.); (E.O.); (R.F.)
| | - Ingrid E Olson
- Department of Pediatric Newborn Medicine, Brigham and Women’s Hospital, Boston, MA 02115, USA; (S.C.); (I.E.O.); (C.A.); (T.E.I.); (S.S.)
| | - Salahuddin Ahmed
- Projahnmo Research Foundation, Banani, Dhaka 1213, Bangladesh; (S.A.); (N.H.C.); (S.R.)
| | | | - Rasheda Khanam
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA; (R.K.); (A.H.B.)
| | - Sayedur Rahman
- Projahnmo Research Foundation, Banani, Dhaka 1213, Bangladesh; (S.A.); (N.H.C.); (S.R.)
| | - Chloe Andrews
- Department of Pediatric Newborn Medicine, Brigham and Women’s Hospital, Boston, MA 02115, USA; (S.C.); (I.E.O.); (C.A.); (T.E.I.); (S.S.)
| | - Abdullah H Baqui
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA; (R.K.); (A.H.B.)
| | - Wafaie Fawzi
- Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA;
| | - Terrie E Inder
- Department of Pediatric Newborn Medicine, Brigham and Women’s Hospital, Boston, MA 02115, USA; (S.C.); (I.E.O.); (C.A.); (T.E.I.); (S.S.)
- Harvard Medical School, Boston, MA 02115, USA; (C.A.N.); (E.O.); (R.F.)
| | - Stephanie Nartey
- Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women’s Hospital, Boston, MA 02115, USA;
| | - Charles A Nelson
- Harvard Medical School, Boston, MA 02115, USA; (C.A.N.); (E.O.); (R.F.)
- Boston Children’s Hospital, Boston, MA 02115, USA
- Harvard Graduate School of Education, Boston, MA 02138, USA
| | - Emily Oken
- Harvard Medical School, Boston, MA 02115, USA; (C.A.N.); (E.O.); (R.F.)
- Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA;
- Harvard Pilgrim Health Care Institute, Boston, MA 02215, USA
| | - Sarbattama Sen
- Department of Pediatric Newborn Medicine, Brigham and Women’s Hospital, Boston, MA 02115, USA; (S.C.); (I.E.O.); (C.A.); (T.E.I.); (S.S.)
- Harvard Medical School, Boston, MA 02115, USA; (C.A.N.); (E.O.); (R.F.)
| | - Raina Fichorova
- Harvard Medical School, Boston, MA 02115, USA; (C.A.N.); (E.O.); (R.F.)
- Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women’s Hospital, Boston, MA 02115, USA;
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Ahmad SM, Raqib R, Huda MN, Alam MJ, Monirujjaman M, Akhter T, Wagatsuma Y, Qadri F, Zerofsky MS, Stephensen CB. High-Dose Neonatal Vitamin A Supplementation Transiently Decreases Thymic Function in Early Infancy. J Nutr 2020; 150:176-183. [PMID: 31504694 PMCID: PMC6946900 DOI: 10.1093/jn/nxz193] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 04/15/2019] [Accepted: 07/24/2019] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Vitamin A deficiency (VAD) impairs T-cell-mediated immunity. In regions where VAD is prevalent, vitamin A supplementation (VAS) reduces child mortality, perhaps by improving immune function. OBJECTIVE Our objective was to determine if neonatal VAS would improve thymic function in Bangladeshi infants, and to determine if such effects differed by sex or nutritional status (i.e., birth weight above/below the median). METHODS Three hundred and six infants were randomly assigned to 50,000 IU vitamin A (VA) or placebo (PL) within 48 h of birth. Primary outcomes were measured at multiple ages and included 1) thymic index (TI) at 1, 6, 10, and 15 wk; 2) T-cell receptor excision circles (TREC), an index of thymic output of naïve T cells; and 3) total/naïve T cells in peripheral blood at 6 wk, 15 wk, and 2 y. A mixed linear model for repeated measures was used to assess group differences at each age and identify interactions with sex and birth weight. RESULTS VAS did not significantly (P = 0.21) affect TI overall (i.e., at all ages) but decreased TI by 7.8% (P = 0.029) at 6 wk: adjusted TI means for the PL and VA groups at 1, 6, 10, and 15 wk were 4.09 compared with 3.80 cm2, 7.78 compared with 7.18 cm2, 8.11 compared with 7.84 cm2, and 7.91 compared with 7.97 cm2, respectively. VAS did not significantly (P = 0.25) affect TREC overall but decreased TREC by 19% (P = 0.029) at 15 wk: adjusted TREC means for the PL and VA groups at 6 wk, 15 wk, and 2 y were 13.6 compared with 16.1 copies/pg DNA, 19.4 compared with 15.7 copies/pg DNA, and 11.8 compared with 10.0 copies/pg DNA, respectively. VAS did not significantly affect overall total (P = 0.10) or naïve (P = 0.092) T cells: adjusted naïve T-cell means for the PL and VA groups at 6 wk, 15 wk, and 2 y were 3259 compared with 3109 cells/µL, 3771 compared with 3487 cells/µL, and 1976 compared with 1898 cells/µL, respectively. CONCLUSION In contrast to our hypothesis, VAS decreased thymic function early in infancy but health effects are presumably negligible owing to the transience and small magnitude of this effect. This trial was registered at clinicaltrials.gov as NCT01583972 and NCT02027610.
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Affiliation(s)
- Shaikh M Ahmad
- Immunobiology, Nutrition, and Toxicology Laboratory, Infectious Diseases Division, icddr,b, Mohakhali, Dhaka, Bangladesh
| | - Rubhana Raqib
- Immunobiology, Nutrition, and Toxicology Laboratory, Infectious Diseases Division, icddr,b, Mohakhali, Dhaka, Bangladesh
| | - M Nazmul Huda
- Immunobiology, Nutrition, and Toxicology Laboratory, Infectious Diseases Division, icddr,b, Mohakhali, Dhaka, Bangladesh
- USDA Western Human Nutrition Research Center at University of California, Davis, CA, USA
- Nutrition Department, University of California, Davis, CA, USA
| | - Md J Alam
- Immunobiology, Nutrition, and Toxicology Laboratory, Infectious Diseases Division, icddr,b, Mohakhali, Dhaka, Bangladesh
| | - Md Monirujjaman
- Immunobiology, Nutrition, and Toxicology Laboratory, Infectious Diseases Division, icddr,b, Mohakhali, Dhaka, Bangladesh
| | - Taslima Akhter
- Immunobiology, Nutrition, and Toxicology Laboratory, Infectious Diseases Division, icddr,b, Mohakhali, Dhaka, Bangladesh
| | - Yukiko Wagatsuma
- Department of Clinical Trials and Clinical Epidemiology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Firdausi Qadri
- Immunobiology, Nutrition, and Toxicology Laboratory, Infectious Diseases Division, icddr,b, Mohakhali, Dhaka, Bangladesh
| | - Melissa S Zerofsky
- USDA Western Human Nutrition Research Center at University of California, Davis, CA, USA
- Nutrition Department, University of California, Davis, CA, USA
| | - Charles B Stephensen
- USDA Western Human Nutrition Research Center at University of California, Davis, CA, USA
- Nutrition Department, University of California, Davis, CA, USA
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Lee AC, Mullany LC, Koffi AK, Rafiqullah I, Khanam R, Folger LV, Rahman M, Mitra DK, Labrique A, Christian P, Uddin J, Ahmed P, Ahmed S, Mahmud A, DasGupta SK, Begum N, Quaiyum MA, Saha SK, Baqui AH. Urinary tract infections in pregnancy in a rural population of Bangladesh: population-based prevalence, risk factors, etiology, and antibiotic resistance. BMC Pregnancy Childbirth 2019; 20:1. [PMID: 31892316 PMCID: PMC6938613 DOI: 10.1186/s12884-019-2665-0] [Citation(s) in RCA: 161] [Impact Index Per Article: 32.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 12/06/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Urinary tract infection (UTI) in pregnancy, including asymptomatic bacteriuria, is associated with maternal morbidity and adverse pregnancy outcomes, including preterm birth and low birthweight. In low-middle income countries (LMICs), the capacity for screening and treatment of UTIs is limited. The objective of this study was to describe the population-based prevalence, risk factors, etiology and antimicrobial resistance patterns of UTIs in pregnancy in Bangladesh. METHODS In a community-based cohort in Sylhet district, Bangladesh, urine specimens were collected at the household level in 4242 pregnant women (< 20 weeks gestation) for culture and antibiotic susceptibility testing. Basic descriptive analysis was performed, as well as logistic regression to calculate adjusted odds ratios (aOR) for UTI risk factors. RESULTS The prevalence of UTI was 8.9% (4.4% symptomatic UTI, 4.5% asymptomatic bacteriuria). Risk factors for UTI in this population included maternal undernutrition (mid-upper arm circumference <23 cm: aOR= 1.29, 95% CI: 1.03-1.61), primiparity (aOR= 1.45, 95% CI: 1.15-1.84), and low paternal education (no education: aOR= 1.56, 95% CI: 1.09-2.22). The predominant uro-pathogens were E. coli (38% of isolates), Klebsiella (12%), and staphyloccocal species (23%). Group B streptococcus accounted for 5.3% of uro-pathogens. Rates of antibiotic resistance were high, with only two-thirds of E. coli susceptible to 3rd generation cephalosporins. CONCLUSIONS In Sylhet, Bangladesh, one in 11 women had a UTI in pregnancy, and approximately half of cases were asymptomatic. There is a need for low-cost and accurate methods for UTI screening in pregnancy and efforts to address increasing rates of antibiotic resistance in LMIC.
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Affiliation(s)
- Anne Cc Lee
- Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA.
| | - Luke C Mullany
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA
| | - Alain K Koffi
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA
| | - Iftekhar Rafiqullah
- Department of Microbiology and Immunology, University of Mississippi Medical Center (UMMC), 2500 N State St, Jackson, MS, 39216, USA
| | - Rasheda Khanam
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA
| | - Lian V Folger
- Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA
| | - Mahmoodur Rahman
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68, Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh
| | - Dipak K Mitra
- North South University, Plot #15, Block #B, Bashundhara R/A, Dhaka, 1229, Bangladesh
| | - Alain Labrique
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA
| | - Parul Christian
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA
- Bill and Melinda Gates Foundation, 440 5th Avenue North, Seattle, WA, 98109, USA
| | - Jamal Uddin
- Save the Children Bangladesh, House No. CWN (A) 35, Road No. 43 Gulshan 2, Dhaka, 1212, Bangladesh
| | - Parvez Ahmed
- Institute of Epidemiology Disease Control and Research, Mohakhali, Dhaka, 1212, Bangladesh
| | - Salahuddin Ahmed
- Projahnmo Research Foundation, House: 37, Road:27, Block: A, Banani, Dhaka, 1213, Bangladesh
| | - Arif Mahmud
- School of Community Health and Policy, Morgan State University, Baltimore, MD, 21251, USA
| | - Sushil K DasGupta
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68, Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh
| | - Nazma Begum
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA
| | - Mohammad A Quaiyum
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68, Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh
| | - Samir K Saha
- Department of Microbiology, Dhaka Shishu Hospital, Sher-E-Banglanagar, Child Health Research Foundation, Dhaka, 1207, Bangladesh
| | - Abdullah H Baqui
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA
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Ahmad SM, Alam MJ, Khanam A, Rashid M, Islam S, Kabir Y, Raqib R, Steinhoff MC. Vitamin A Supplementation during Pregnancy Enhances Pandemic H1N1 Vaccine Response in Mothers, but Enhancement of Transplacental Antibody Transfer May Depend on When Mothers Are Vaccinated during Pregnancy. J Nutr 2018; 148:1968-1975. [PMID: 30517724 DOI: 10.1093/jn/nxy228] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 08/17/2018] [Indexed: 12/29/2022] Open
Abstract
Background In the growing embryo, the vitamin A requirement is tightly regulated. Maternal vitamin A deficiency during pregnancy may alter maternal immune function to accommodate the fetus. Objective Our primary objective was to determine the effect of oral vitamin A supplementation (VAS) during pregnancy and until 6 mo postpartum on pandemic H1N1-vaccine responses in mothers and their infants at 6 mo of age. Methods In this randomized controlled clinical trial, pregnant women (n = 112) during the second trimester (mean ± SD: 14 ± 1 wk) were assigned to receive either an oral dose of 10,000 IU vitamin A or placebo weekly until 6 mo postpartum. During the third trimester, mothers received a single dose of inactivated pandemic H1N1-influenza vaccine. Hemagglutination-inhibition (HAI) titer was measured in cord, infant, and maternal blood samples. Multivariate regressions with adjustments were used for data analysis. Results Seventy-six percent of women had low plasma retinol concentrations (<1.05 μmol/L) in their second trimester. VAS of mothers increased vitamin A concentrations in cord blood by 21.4% and in colostrum by 40.7%. At 6 mo postpartum, women in the vitamin A group had 38.7% higher HAI titers and a higher proportion of HAI titer of ≥1:40 of the cutoff compared with the placebo group. A total of 54.5% of infants had an HAI titer ≥1:40 at 6 mo of age, but there was no difference in HAI titer in infants between groups. Overall, HAI in cord blood did not differ between groups, but in the placebo group, cord blood HAI was negatively associated with maternal "vaccination-to-delivery intervals" (rs = -0.401; P = 0.5), and maternal VAS increased cord blood HAI 6-fold if antenatal immunization was administered ≥10 wk before delivery. Conclusions In a community with low vitamin A status, weekly maternal VAS during pregnancy and postpartum increases the breast-milk vitamin A concentration and enhances prenatal H1N1-vaccine responses in mothers, but the benefits of maternal VAS in transplacental antibody transfer may depend on the time of gestation when mothers were vaccinated. This trial was registered at clinicaltrials.gov as NCT00817661.
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Affiliation(s)
- Shaikh M Ahmad
- Infectious Diseases Division, International Center for Diarrheal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka, Bangladesh
| | - Md J Alam
- Infectious Diseases Division, International Center for Diarrheal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka, Bangladesh
| | - Afsana Khanam
- Infectious Diseases Division, International Center for Diarrheal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka, Bangladesh
| | - Mamunur Rashid
- Infectious Diseases Division, International Center for Diarrheal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka, Bangladesh
| | - Sharmin Islam
- Infectious Diseases Division, International Center for Diarrheal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka, Bangladesh
| | - Yearul Kabir
- Department of Biochemistry and Molecular Biology, University of Dhaka, Dhaka, Bangladesh
| | - Rubhana Raqib
- Infectious Diseases Division, International Center for Diarrheal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka, Bangladesh
| | - Mark C Steinhoff
- Global Health Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
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Raiten DJ, Sakr Ashour FA, Ross AC, Meydani SN, Dawson HD, Stephensen CB, Brabin BJ, Suchdev PS, van Ommen B. Inflammation and Nutritional Science for Programs/Policies and Interpretation of Research Evidence (INSPIRE). J Nutr 2015; 145:1039S-1108S. [PMID: 25833893 PMCID: PMC4448820 DOI: 10.3945/jn.114.194571] [Citation(s) in RCA: 150] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Revised: 06/08/2014] [Accepted: 10/29/2014] [Indexed: 02/06/2023] Open
Abstract
An increasing recognition has emerged of the complexities of the global health agenda—specifically, the collision of infections and noncommunicable diseases and the dual burden of over- and undernutrition. Of particular practical concern are both 1) the need for a better understanding of the bidirectional relations between nutritional status and the development and function of the immune and inflammatory response and 2) the specific impact of the inflammatory response on the selection, use, and interpretation of nutrient biomarkers. The goal of the Inflammation and Nutritional Science for Programs/Policies and Interpretation of Research Evidence (INSPIRE) is to provide guidance for those users represented by the global food and nutrition enterprise. These include researchers (bench and clinical), clinicians providing care/treatment, those developing and evaluating programs/interventions at scale, and those responsible for generating evidence-based policy. The INSPIRE process included convening 5 thematic working groups (WGs) charged with developing summary reports around the following issues: 1) basic overview of the interactions between nutrition, immune function, and the inflammatory response; 2) examination of the evidence regarding the impact of nutrition on immune function and inflammation; 3) evaluation of the impact of inflammation and clinical conditions (acute and chronic) on nutrition; 4) examination of existing and potential new approaches to account for the impact of inflammation on biomarker interpretation and use; and 5) the presentation of new approaches to the study of these relations. Each WG was tasked with synthesizing a summary of the evidence for each of these topics and delineating the remaining gaps in our knowledge. This review consists of a summary of the INSPIRE workshop and the WG deliberations.
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Affiliation(s)
- Daniel J Raiten
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, Bethesda, MD;
| | - Fayrouz A Sakr Ashour
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, Bethesda, MD
| | - A Catharine Ross
- Departments of Nutritional Sciences and Veterinary and Biomedical Science and Center for Molecular Immunology and Infectious Disease, Pennsylvania State University, University Park, PA
| | - Simin N Meydani
- Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA
| | - Harry D Dawson
- USDA-Agricultural Research Service, Beltsville Human Nutrition Research Center, Diet, Genomics, and Immunology Laboratory, Beltsville, MD
| | - Charles B Stephensen
- Agricultural Research Service, Western Human Nutrition Research Center, USDA, Davis, CA
| | - Bernard J Brabin
- Child and Reproductive Health Group, Liverpool School of Tropical Medicine, Liverpool, United Kingdom; Global Child Health Group, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Parminder S Suchdev
- Department of Pediatrics and Global Health, Emory University, Atlanta, GA; and
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Ahmad SM, Hossain MI, Bergman P, Kabir Y, Raqib R. The effect of postpartum vitamin A supplementation on breast milk immune regulators and infant immune functions: study protocol of a randomized, controlled trial. Trials 2015; 16:129. [PMID: 25872802 PMCID: PMC4389512 DOI: 10.1186/s13063-015-0654-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Accepted: 03/16/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Because of limited impact on infant morbidity, mortality, and vitamin A status, the new guideline of the World Health Organization (WHO) does not recommend postpartum vitamin A supplementation (VAS) as a public health intervention in developing countries. However, breast milk contains numerous immune-protective components that are important for infant immune development, and several of these components are regulated by vitamin A. METHODS/DESIGN Postpartum women are being enrolled within 3 days (d) of delivery at a maternity clinic located in a slum area of Dhaka city and randomized to one of four postpartum VAS regimens (32/group, total 128). The regimens are as follows: Group 1: 200,000 IU VAS at <3 d and placebo at 6 weeks postpartum; Group 2: placebo at <3 d and 200,000 IU VAS at 6 weeks postpartum; Group 3: 200,000 IU VAS, both at <3 d and 6 weeks postpartum; Group 4: placebo, both at <3 d and 6 weeks postpartum. Breast milk samples at <3 d (before supplementation) and 4 months postpartum will be used to measure vitamin A and bioactive compounds. Infant blood samples at 2 and 4 months of age will be used to measure vitamin A, as well as innate and vaccine-specific immune responses. Dietary, anthropometric, and morbidity data are also being collected. DISCUSSION This is the first placebo-controlled randomized clinical trial of postnatal vitamin A supplementation to investigate the key bioactive compounds in breast milk, important for infant immunity, in relation to dose and time point of postpartum supplementation and whether such maternal supplementation improves infant immune status during the critical period of early infancy. TRIAL REGISTRATION ClinicalTrials.gov: NCT02043223 , 5 December 2013.
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Affiliation(s)
| | - Md Iqbal Hossain
- Center for Nutrition and Food Security, icddr,b, Mohakhali, Dhaka, 1212, Bangladesh.
| | - Peter Bergman
- Karolinska University Hospital, Huddinge, S-141 86, Stockholm, Sweden.
| | - Yearul Kabir
- Department of Biochemistry and Molecular Biology, University of Dhaka, Dhaka, 1000, Bangladesh.
| | - Rubhana Raqib
- Center for Vaccine Sciences, icddr,b, Mohakhali, Dhaka, 1212, Bangladesh.
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8
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Ahmad SM, Raqib R, Qadri F, Stephensen CB. The effect of newborn vitamin A supplementation on infant immune functions: trial design, interventions, and baseline data. Contemp Clin Trials 2014; 39:269-79. [PMID: 25269669 DOI: 10.1016/j.cct.2014.09.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Revised: 09/16/2014] [Accepted: 09/19/2014] [Indexed: 12/16/2022]
Abstract
In recent years, neonatal vitamin A supplementation is considered as an essential infant-survival intervention but the evidence is not conclusive. This randomized controlled clinical trial was conducted to evaluate the effect of vitamin A on immune competence in early infancy. Results would provide a mechanistic basis for understanding the effect of this intervention on infant survival. Within 2 days of birth, infants born at one maternity clinic located in a poor slum area of Dhaka city were supplemented with either 50,000 IU vitamin A or placebo. Live attenuated oral polio vaccine (OPV) and BCG vaccine were provided after supplementation. Infants also receive diphtheria, pertussis, tetanus (TT), hepatitis B (HBV) and Haemophilus influenzae B vaccines (pentavalent combination) along with OPV at 6, 10 and 14 weeks of age. Infant thymus size, anthropometry, feeding practice and morbidity data were collected at regular interval. Infant blood samples were collected to determine T-cell-receptor excision circle (TREC), total, naïve and memory T cells and mucosal targeting lymphocytes including Treg cells. TT-, HBV-, BCG- and OPV-specific T cell blastogenic, cytokine and plasma cell antibody responses were also measured. In 16 mo enrollment period, 306 newborns, equal number of boys and girls, were enrolled. ~95% completed the 4-month follow-up period. Baseline characteristics are presented here. Anthropometry and immune assays with fresh blood samples were completed immediately while stored samples were analyzed in single batches at the end of the trial. Connecting different aspects of immunological data in early infancy will help elucidate immune competence for protecting infection. Trial registration ClinicalTrials.gov: NCT01583972.
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Affiliation(s)
| | - Rubhana Raqib
- Center for Vaccine Sciences, icddr,b, Mohakhali, Dhaka 1212, Bangladesh.
| | - Firdausi Qadri
- Center for Vaccine Sciences, icddr,b, Mohakhali, Dhaka 1212, Bangladesh.
| | - Charles B Stephensen
- USDA Western Human Nutrition Research Center at University of California, Davis, CA 95616, USA.
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Linderholm AL, Bratt JM, Schuster GU, Zeki AA, Kenyon NJ. Novel therapeutic strategies for adult obese asthmatics. Immunol Allergy Clin North Am 2014; 34:809-23. [PMID: 25282293 DOI: 10.1016/j.iac.2014.07.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Asthma is a complex syndrome that affects an estimated 26 million people in the United States but gaps exist in the recognition and management of asthmatic subgroups. This article proposes alternative approaches for future treatments of adult obese asthmatics who do not respond to standard controller therapies, drawing parallels between seemingly disparate therapeutics through their common signaling pathways. How metformin and statins can potentially improve airway inflammation is described and supplements are suggested. A move toward more targeted therapies for asthma subgroups is needed. These therapies address asthma and the comorbidities that accompany obesity and metabolic syndrome to provide the greatest therapeutic potential.
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Affiliation(s)
- Angela L Linderholm
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, University of California, Davis, 4150 V Street, Suite 3100, Davis, CA, USA
| | - Jennifer M Bratt
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, University of California, Davis, 4150 V Street, Suite 3100, Davis, CA, USA
| | - Gertrud U Schuster
- Nutrition Department, University of California, Davis, 430 West Health Sciences Drive, Davis, CA, USA; Immunity and Diseases Prevention Unit, Western Human Nutrition Research Center, United States Department of Agriculture (USDA), Agricultural Research Services (ARS), 430 West Health Sciences Drive, Davis, CA, USA
| | - Amir A Zeki
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, University of California, Davis, 4150 V Street, Suite 3100, Davis, CA, USA
| | - Nicholas J Kenyon
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, University of California, Davis, 4150 V Street, Suite 3100, Davis, CA, USA.
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10
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Raverdeau M, Mills KHG. Modulation of T cell and innate immune responses by retinoic Acid. THE JOURNAL OF IMMUNOLOGY 2014; 192:2953-8. [PMID: 24659788 DOI: 10.4049/jimmunol.1303245] [Citation(s) in RCA: 138] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Retinoic acid (RA) is produced by a number of cell types, including macrophages and dendritic cells, which express retinal dehydrogenases that convert vitamin A to its main biologically active metabolite, all-trans RA. All-trans RA binds to its nuclear retinoic acid receptors that are expressed in lymphoid cells and act as transcription factors to regulate cell homing and differentiation. RA production by CD103(+) dendritic cells and alveolar macrophages functions with TGF-β to promote conversion of naive T cells into Foxp3(+) regulatory T cells and, thereby, maintain mucosal tolerance. Furthermore, RA inhibits the differentiation of naive T cells into Th17 cells. However, Th1 and Th17 responses are constrained during vitamin A deficiency and in nuclear RA receptor α-defective mice. Furthermore, RA promotes effector T cell responses during infection or autoimmune diseases. Thus, RA plays a role in immune homeostasis in the steady-state but activates pathogenic T cells in conditions of inflammation.
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Affiliation(s)
- Mathilde Raverdeau
- Immune Regulation Research Group and Immunology Research Centre, School of Biochemistry and Immunology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin 2, Ireland
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11
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Wu J, Zhang Y, Liu Q, Zhong W, Xia Z. All-trans retinoic acid attenuates airway inflammation by inhibiting Th2 and Th17 response in experimental allergic asthma. BMC Immunol 2013; 14:28. [PMID: 23800145 PMCID: PMC3695807 DOI: 10.1186/1471-2172-14-28] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Accepted: 06/18/2013] [Indexed: 01/06/2023] Open
Abstract
Background Airway inflammation is mainly mediated by T helper 2 cells (Th2) that characteristically produce interleukin (IL)-4, IL-5, and IL-13. Epidemiological studies have revealed an inverse association between the dietary intake of vitamin A and the occurrence of asthma. Serum vitamin A concentrations are significantly lower in asthmatic subjects than in healthy control subjects. It has been reported that all-trans retinoic acid (ATRA), a potent derivative of vitamin A, regulates immune responses. However, its role in Th2-mediated airway inflammation remains unclear. We investigated the effects of ATRA in a mouse model of allergic airway inflammation. Results We found that ATRA treatment attenuated airway inflammation and decreased mRNA levels of Th2- and Th17-related transcription factors. The data showed that airway inflammation coincided with levels of Th2- and Th17-related cytokines. We also showed that ATRA inhibited Th17 and promoted inducible regulatory T-cell differentiation, whereas it did not induce an obvious effect on Th2 differentiation in vitro. Our data suggest that ATRA may interfere with the in vivo Th2 responses via T-cell extrinsic mechanisms. Conclusions Administration of ATRA dramatically attenuated airway inflammation by inhibiting Th2 and Th17 differentiation and/or functions. ATRA may have potential therapeutic effects for airway inflammation in asthmatic patients.
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Affiliation(s)
- Jinhong Wu
- Department of Pediatrics, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Ruijin 2nd Road 197, Shanghai 200025, China
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12
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Honarvar NM, Harrirchian MH, Koohdani F, Siassi F, Jafari Rad S, Abdolahi M, Bitarafan S, Salehi E, Sahraian MA, Eshraghian MR, Saboor-Yarghi AA. In vitro effect of human serum and fetal calf serum on CD4+ T cells proliferation in response to myelin oligodendrocyte glycoprotein (MOG) in correlation with RBP/TTR ratio in multiple sclerotic patients. J Mol Neurosci 2013; 50:571-6. [PMID: 23564281 DOI: 10.1007/s12031-013-9999-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2013] [Accepted: 03/10/2013] [Indexed: 12/19/2022]
Abstract
Myelin oligodendrocyte glycoprotein (MOG) is one of the autoantigens used in evaluation of the CD4(+) T cells proliferation response in multiple sclerotic patients. In cell culture, human serum (HS) is one of the promising substitutions for fetal calf serum (FCS) that can induce different autoreactivity of T cells and fluctuation of autoantibody production from B cells. Because of immunomodulatory function of vitamin A, we examined the effect of HS and FCS on CD4(+) T cells proliferation in response to MOG in correlation with serum retinol-binding protein (RBP)/transthyretin (TTR) ratio, as an indirect way to assess vitamin A status in multiple sclerotic patients. Patients' peripheral blood mononuclear cells were isolated and cultured in the presence of MOG as well as FCS and HS both separately and together. Cell proliferation was evaluated using BrdU kit. Serum RBP and TTR levels were measured by ELISA kit. FCS and HS increase CD4(+) T cell proliferation. RBP/TTR ratio has significant negative correlation with cell proliferation in the presence of MOG, HS, and FCS. HS with FCS provides an appropriate medium for autoreactivity and proliferation of CD4(+) T cells. Vitamin A has a crucial role in regulation of this pathway.
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Affiliation(s)
- Niyaz Mohammadzadeh Honarvar
- Cellular and Molecular Nutrition Department, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
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13
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Specific micronutrient concentrations are associated with inflammatory cytokines in a rural population of Mexican women with a high prevalence of obesity. Br J Nutr 2012; 109:686-94. [PMID: 22640991 DOI: 10.1017/s0007114512001912] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
It has been recognised recently that obese individuals have lower concentrations of micronutrients and this may affect the concentrations of inflammatory cytokines. A cross-sectional study was carried out to evaluate the association of specific micronutrients' status with chronic inflammation caused by obesity in 280 women (36·1 (SD 7·5) years) from seven rural communities in Mexico. Measurements of weight, height and waist circumference were made on all women and body composition was determined by dual-energy X-ray absorptiometry. Concentrations of the cytokines IL-1, TNF-α, IL-6, IL-10 and IL-12, lipid profile, and the micronutrients Zn and vitamins A, C and E were determined in fasting blood samples. Ordered logistic regression models were used to determine associations between categorised cytokine levels and micronutrients. It was found that 80% of women were overweight or obese, and had significantly higher concentrations of C-reactive protein than normal-weight women (P= 0·05). The risk of higher levels of TNF-α, IL-6, IL-10 and IL-12 was reduced significantly among women with higher Zn concentrations (OR 0·63, 95% CI 0·42, 0·96, P= 0·03; OR 0·57, 95% CI 0·39, 0·86, P= 0·025; OR 0·63, 95% CI 0·41, 0·96, P= 0·04; OR 0·62, 95% CI 0·41, 0·95, P= 0·03, respectively). Higher concentrations of vitamin A were slightly associated with reduced risks of higher levels of IL-1 and IL-12 (OR 0·97, 95% CI 0·95, 0·99, P= 0·03; OR 0·97, 95% CI 0·94, 0·99, P= 0·03, respectively); when adjusting for BMI, this association was lost. No associations were found between vitamin C or vitamin E:lipids concentrations and inflammatory cytokines. In conclusion, higher Zn concentrations are associated with reduced risks of higher concentration of inflammation markers in a population of women with a high prevalence of obesity.
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Hall JA, Grainger JR, Spencer SP, Belkaid Y. The role of retinoic acid in tolerance and immunity. Immunity 2011; 35:13-22. [PMID: 21777796 DOI: 10.1016/j.immuni.2011.07.002] [Citation(s) in RCA: 402] [Impact Index Per Article: 30.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2011] [Indexed: 01/17/2023]
Abstract
Vitamin A elicits a broad array of immune responses through its metabolite, retinoic acid (RA). Recent evidence indicates that loss of RA leads to impaired immunity, whereas excess RA can potentially promote inflammatory disorders. In this review, we discuss recent advances showcasing the crucial contributions of RA to both immunological tolerance and the elicitation of adaptive immune responses. Further, we provide a comprehensive overview of the cell types and factors that control the production of RA and discuss how host perturbations may affect the ability of this metabolite to control tolerance and immunity or to instigate pathology.
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Affiliation(s)
- Jason A Hall
- Mucosal Immunology Section, Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892, USA.
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Omata J, Fukatsu K, Murakoshi S, Moriya T, Ueno C, Maeshima Y, Okamoto K, Saitoh D, Yamamoto J, Hase K. Influence of Adding Pyrroloquinoline Quinone to Parenteral Nutrition on Gut-Associated Lymphoid Tissue. JPEN J Parenter Enteral Nutr 2011; 35:616-24. [DOI: 10.1177/0148607110395512] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Jiro Omata
- Department of Surgery, National Defense Medical College, Tokorozawa, Japan
| | | | - Satoshi Murakoshi
- Division of Traumatology, National Defense Medical College Research Institute, Tokorozawa, Japan
| | - Tomoyuki Moriya
- Department of Surgery, National Defense Medical College, Tokorozawa, Japan
| | - Chikara Ueno
- Department of Surgery, National Defense Medical College, Tokorozawa, Japan
| | - Yoshinori Maeshima
- Department of Surgery, National Defense Medical College, Tokorozawa, Japan
| | - Koichi Okamoto
- Department of Surgery, National Defense Medical College, Tokorozawa, Japan
| | - Daizoh Saitoh
- Division of Traumatology, National Defense Medical College Research Institute, Tokorozawa, Japan
| | - Junji Yamamoto
- Department of Surgery, National Defense Medical College, Tokorozawa, Japan
| | - Kazuo Hase
- Department of Surgery, National Defense Medical College, Tokorozawa, Japan
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