Reference Citation Analysis: Find an Article, Find a Category, Find a Journal, Find a Scholar

For: Jørgensen MJ, Fisker AB, Sartono E, Andersen A, Erikstrup C, Lisse IM, Yazdanbakhsh M, Aaby P, Benn CS. The effect of at-birth vitamin A supplementation on differential leucocyte counts and in vitro cytokine production: an immunological study nested within a randomised trial in Guinea-Bissau. Br J Nutr 2013;109:467-77. [PMID: 23168172 DOI: 10.1017/S0007114512001304] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]

For:	Jørgensen MJ, Fisker AB, Sartono E, Andersen A, Erikstrup C, Lisse IM, Yazdanbakhsh M, Aaby P, Benn CS. The effect of at-birth vitamin A supplementation on differential leucocyte counts and in vitro cytokine production: an immunological study nested within a randomised trial in Guinea-Bissau. Br J Nutr 2013;109:467-77. [PMID: 23168172 DOI: 10.1017/S0007114512001304] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]

Number

Cited by Other Article(s)

Hooper L, Esio-Bassey C, Brainard J, Fynn J, Jennings A, Jones N, Tailor BV, Abdelhamid A, Coe C, Esgunoglu L, Fallon C, Gyamfi E, Hill C, Howard Wilsher S, Narayanan N, Oladosu T, Parkinson E, Prentice E, Qurashi M, Read L, Getley H, Song F, Welch AA, Aggett P, Lietz G. Evidence to Underpin Vitamin A Requirements and Upper Limits in Children Aged 0 to 48 Months: A Scoping Review. Nutrients 2022;14:nu14030407. [PMID: 35276767 PMCID: PMC8840537 DOI: 10.3390/nu14030407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 12/31/2021] [Accepted: 01/10/2022] [Indexed: 02/04/2023] Open

Affiliation(s)

Lee Hooper Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich NR4 7TJ, UK; (C.E.-B.); (J.B.); (J.F.); (A.J.); (B.V.T.); (A.A.); (C.C.); (L.E.); (C.F.); (E.G.); (C.H.); (S.H.W.); (N.N.); (T.O.); or (E.P.); (L.R.); (H.G.); (F.S.); (A.A.W.) Correspondence: ; Tel.: +44-1603-591268
Chizoba Esio-Bassey Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich NR4 7TJ, UK; (C.E.-B.); (J.B.); (J.F.); (A.J.); (B.V.T.); (A.A.); (C.C.); (L.E.); (C.F.); (E.G.); (C.H.); (S.H.W.); (N.N.); (T.O.); or (E.P.); (L.R.); (H.G.); (F.S.); (A.A.W.)
Julii Brainard Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich NR4 7TJ, UK; (C.E.-B.); (J.B.); (J.F.); (A.J.); (B.V.T.); (A.A.); (C.C.); (L.E.); (C.F.); (E.G.); (C.H.); (S.H.W.); (N.N.); (T.O.); or (E.P.); (L.R.); (H.G.); (F.S.); (A.A.W.)
Judith Fynn Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich NR4 7TJ, UK; (C.E.-B.); (J.B.); (J.F.); (A.J.); (B.V.T.); (A.A.); (C.C.); (L.E.); (C.F.); (E.G.); (C.H.); (S.H.W.); (N.N.); (T.O.); or (E.P.); (L.R.); (H.G.); (F.S.); (A.A.W.)
Amy Jennings Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich NR4 7TJ, UK; (C.E.-B.); (J.B.); (J.F.); (A.J.); (B.V.T.); (A.A.); (C.C.); (L.E.); (C.F.); (E.G.); (C.H.); (S.H.W.); (N.N.); (T.O.); or (E.P.); (L.R.); (H.G.); (F.S.); (A.A.W.)
Natalia Jones School of Environmental Sciences, University of East Anglia, Norwich Research Park, Norwich NR4 7TJ, UK;
Bhavesh V. Tailor Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich NR4 7TJ, UK; (C.E.-B.); (J.B.); (J.F.); (A.J.); (B.V.T.); (A.A.); (C.C.); (L.E.); (C.F.); (E.G.); (C.H.); (S.H.W.); (N.N.); (T.O.); or (E.P.); (L.R.); (H.G.); (F.S.); (A.A.W.)
Asmaa Abdelhamid Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich NR4 7TJ, UK; (C.E.-B.); (J.B.); (J.F.); (A.J.); (B.V.T.); (A.A.); (C.C.); (L.E.); (C.F.); (E.G.); (C.H.); (S.H.W.); (N.N.); (T.O.); or (E.P.); (L.R.); (H.G.); (F.S.); (A.A.W.)
Calvin Coe Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich NR4 7TJ, UK; (C.E.-B.); (J.B.); (J.F.); (A.J.); (B.V.T.); (A.A.); (C.C.); (L.E.); (C.F.); (E.G.); (C.H.); (S.H.W.); (N.N.); (T.O.); or (E.P.); (L.R.); (H.G.); (F.S.); (A.A.W.)
Latife Esgunoglu Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich NR4 7TJ, UK; (C.E.-B.); (J.B.); (J.F.); (A.J.); (B.V.T.); (A.A.); (C.C.); (L.E.); (C.F.); (E.G.); (C.H.); (S.H.W.); (N.N.); (T.O.); or (E.P.); (L.R.); (H.G.); (F.S.); (A.A.W.)
Ciara Fallon Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich NR4 7TJ, UK; (C.E.-B.); (J.B.); (J.F.); (A.J.); (B.V.T.); (A.A.); (C.C.); (L.E.); (C.F.); (E.G.); (C.H.); (S.H.W.); (N.N.); (T.O.); or (E.P.); (L.R.); (H.G.); (F.S.); (A.A.W.)
Ernestina Gyamfi Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich NR4 7TJ, UK; (C.E.-B.); (J.B.); (J.F.); (A.J.); (B.V.T.); (A.A.); (C.C.); (L.E.); (C.F.); (E.G.); (C.H.); (S.H.W.); (N.N.); (T.O.); or (E.P.); (L.R.); (H.G.); (F.S.); (A.A.W.)
Claire Hill Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich NR4 7TJ, UK; (C.E.-B.); (J.B.); (J.F.); (A.J.); (B.V.T.); (A.A.); (C.C.); (L.E.); (C.F.); (E.G.); (C.H.); (S.H.W.); (N.N.); (T.O.); or (E.P.); (L.R.); (H.G.); (F.S.); (A.A.W.)
Stephanie Howard Wilsher Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich NR4 7TJ, UK; (C.E.-B.); (J.B.); (J.F.); (A.J.); (B.V.T.); (A.A.); (C.C.); (L.E.); (C.F.); (E.G.); (C.H.); (S.H.W.); (N.N.); (T.O.); or (E.P.); (L.R.); (H.G.); (F.S.); (A.A.W.)
Nithin Narayanan Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich NR4 7TJ, UK; (C.E.-B.); (J.B.); (J.F.); (A.J.); (B.V.T.); (A.A.); (C.C.); (L.E.); (C.F.); (E.G.); (C.H.); (S.H.W.); (N.N.); (T.O.); or (E.P.); (L.R.); (H.G.); (F.S.); (A.A.W.)
Titilopemi Oladosu Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich NR4 7TJ, UK; (C.E.-B.); (J.B.); (J.F.); (A.J.); (B.V.T.); (A.A.); (C.C.); (L.E.); (C.F.); (E.G.); (C.H.); (S.H.W.); (N.N.); (T.O.); or (E.P.); (L.R.); (H.G.); (F.S.); (A.A.W.)
Ellice Parkinson School of Health Sciences, University of East Anglia, Norwich Research Park, Norwich NR4 7TJ, UK;
Emma Prentice Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich NR4 7TJ, UK; (C.E.-B.); (J.B.); (J.F.); (A.J.); (B.V.T.); (A.A.); (C.C.); (L.E.); (C.F.); (E.G.); (C.H.); (S.H.W.); (N.N.); (T.O.); or (E.P.); (L.R.); (H.G.); (F.S.); (A.A.W.)
Meysoon Qurashi Department of Medicine, Luton and Dunstable Hospital NHS Foundation Trust, Lewsey Road, Luton LU4 0DZ, UK;
Luke Read Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich NR4 7TJ, UK; (C.E.-B.); (J.B.); (J.F.); (A.J.); (B.V.T.); (A.A.); (C.C.); (L.E.); (C.F.); (E.G.); (C.H.); (S.H.W.); (N.N.); (T.O.); or (E.P.); (L.R.); (H.G.); (F.S.); (A.A.W.)
Harriet Getley Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich NR4 7TJ, UK; (C.E.-B.); (J.B.); (J.F.); (A.J.); (B.V.T.); (A.A.); (C.C.); (L.E.); (C.F.); (E.G.); (C.H.); (S.H.W.); (N.N.); (T.O.); or (E.P.); (L.R.); (H.G.); (F.S.); (A.A.W.)
Fujian Song Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich NR4 7TJ, UK; (C.E.-B.); (J.B.); (J.F.); (A.J.); (B.V.T.); (A.A.); (C.C.); (L.E.); (C.F.); (E.G.); (C.H.); (S.H.W.); (N.N.); (T.O.); or (E.P.); (L.R.); (H.G.); (F.S.); (A.A.W.)
Ailsa A. Welch Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich NR4 7TJ, UK; (C.E.-B.); (J.B.); (J.F.); (A.J.); (B.V.T.); (A.A.); (C.C.); (L.E.); (C.F.); (E.G.); (C.H.); (S.H.W.); (N.N.); (T.O.); or (E.P.); (L.R.); (H.G.); (F.S.); (A.A.W.)
Peter Aggett Lancashire School of Postgraduate Medicine and Health, University of Central Lancashire, Preston PR1 2HE, UK;
Georg Lietz Human Nutrition Research Centre, Newcastle University, Newcastle upon Tyne NE2 4HH, UK;

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Imdad A, Rehman F, Davis E, Ranjit D, Surin GSS, Attia SL, Lawler S, Smith AA, Bhutta ZA. Effects of neonatal nutrition interventions on neonatal mortality and child health and development outcomes: A systematic review. CAMPBELL SYSTEMATIC REVIEWS 2021;17:e1141. [PMID: 37133295 PMCID: PMC8356300 DOI: 10.1002/cl2.1141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]

Abstract

Background

The last two decades have seen a significant decrease in mortality for children <5 years of age in low and middle-income countries (LMICs); however, neonatal (age, 0-28 days) mortality has not decreased at the same rate. We assessed three neonatal nutritional interventions that have the potential of reducing morbidity and mortality during infancy in LMICs.

Objectives

To determine the efficacy and effectiveness of synthetic vitamin A, dextrose oral gel, and probiotic supplementation during the neonatal period.

Search Methods

We conducted electronic searches for relevant studies on the following databases: PubMed, CINAHL, LILACS, SCOPUS, and CENTRAL, Cochrane Central Register for Controlled Trials, up to November 27, 2019.

Selection Criteria

We aimed to include randomized and quasi-experimental studies. The target population was neonates in LMICs. The interventions included synthetic vitamin A supplementation, oral dextrose gel supplementation, and probiotic supplementation during the neonatal period. We included studies from the community and hospital settings irrespective of the gestational age or birth weight of the neonate.

Data Collection and Analysis

Two authors screened the titles and extracted the data from selected studies. The risk of bias (ROB) in the included studies was assessed according to the Cochrane Handbook of Systematic Reviews. The primary outcome was all-cause mortality. The secondary outcomes were neonatal sepsis, necrotizing enterocolitis (NEC), prevention and treatment of neonatal hypoglycaemia, adverse events, and neurodevelopmental outcomes. Data were meta-analyzed by random effect models to obtain relative risk (RR) and 95% confidence interval (CI) for dichotomous outcomes and mean difference with 95% CI for continuous outcomes. The overall rating of evidence was determined by the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach.

Main Results

Sixteen randomized studies (total participants 169,366) assessed the effect of vitamin A supplementation during the neonatal period. All studies were conducted in low- and middle-income (LMIC) countries. Thirteen studies were conducted in the community setting and three studies were conducted in the hospital setting, specifically in neonatal intensive care units. Studies were conducted in 10 different countries including India (four studies), Guinea-Bissau (three studies), Bangladesh (two studies), and one study each in China, Ghana, Indonesia, Nepal, Pakistan, Tanzania, and Zimbabwe. The overall ROB was low in most of the included studies for neonatal vitamin A supplementation. The pooled results from the community based randomized studies showed that there was no significant difference in all-cause mortality in the vitamin A (intervention) group compared to controls at 1 month (RR, 0.99; 95% CI, 0.90-1.08; six studies with 126,548 participants, statistical heterogeneity I 2 0%, funnel plot symmetrical, grade rating high), 6 months (RR, 0.98; 95% CI, 0.89-1.07; 12 studies with 154,940 participants, statistical heterogeneity I 2 43%, funnel plot symmetrical, GRADE quality high) and 12 months of age (RR, 1.04; 95% CI, 0.94-1.14; eight studies with 118,376 participants, statistical heterogeneity I 2 46%, funnel plot symmetrical, GRADE quality high). Neonatal vitamin A supplementation increased the incidence of bulging fontanelle by 53% compared to control (RR, 1.53; 95% CI, 1.12-2.09; six studies with 100,256 participants, statistical heterogeneity I 2 65%, funnel plot symmetrical, GRADE quality high). We did not identify any experimental study that addressed the use of dextrose gel for the prevention and/or treatment of neonatal hypoglycaemia in LMIC. Thirty-three studies assessed the effect of probiotic supplementation during the neonatal period (total participants 11,595; probiotics: 5854 and controls: 5741). All of the included studies were conducted in LMIC and were randomized. Most of the studies were done in the hospital setting and included participants who were preterm (born < 37 weeks gestation) and/or low birth weight (<2500 g birth weight). Studies were conducted in 13 different countries with 10 studies conducted in India, six studies in Turkey, three studies each in China and Iran, two each in Mexico and South Africa, and one each in Bangladesh, Brazil, Colombia, Indonesia, Nepal, Pakistan, and Thailand. Three studies were at high ROB due to lack of appropriate randomization sequence or allocation concealment. Combined data from 25 studies showed that probiotic supplementation reduced all-cause mortality by 20% compared to controls (RR, 0.80; 95% CI, 0.66-0.96; total number of participants 10,998, number needed to treat 100, statistical heterogeneity I 2 0%, funnel plot symmetrical, GRADE quality high). Twenty-nine studies reported the effect of probiotics on the incidence of NEC, and the combined results showed a relative reduction of 54% in the intervention group compared to controls (RR, 0.46; 95% CI, 0.35-0.59; total number of participants 5574, number needed to treat 17, statistical heterogeneity I 2 24%, funnel plot symmetrical, GRADE quality high). Twenty-one studies assessed the effect of probiotic supplementation during the neonatal period on neonatal sepsis, and the combined results showed a relative reduction of 22% in the intervention group compared to controls (RR, 0.78; 95% CI, 0.70-0.86; total number of participants 9105, number needed to treat 14, statistical heterogeneity I 2 23%, funnel plot symmetrical, GRADE quality high).

Authors' Conclusions

Vitamin A supplementation during the neonatal period does not reduce all-cause neonatal or infant mortality in LMICs in the community setting. However, neonatal vitamin A supplementation increases the risk of Bulging Fontanelle. No experimental or quasi-experimental studies were available from LMICs to assess the effect of dextrose gel supplementation for the prevention or treatment of neonatal hypoglycaemia. Probiotic supplementation during the neonatal period seems to reduce all-cause mortality, NEC, and sepsis in babies born with low birth weight and/or preterm in the hospital setting. There was clinical heterogeneity in the use of probiotics, and we could not recommend any single strain of probiotics for wider use based on these results. There was a lack of studies on probiotic supplementation in the community setting. More research is needed to assess the effect of probiotics administered to neonates in-home/community setting in LMICs.

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Prentice S. They Are What You Eat: Can Nutritional Factors during Gestation and Early Infancy Modulate the Neonatal Immune Response? Front Immunol 2017;8:1641. [PMID: 29234319 PMCID: PMC5712338 DOI: 10.3389/fimmu.2017.01641] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 11/09/2017] [Indexed: 12/17/2022] Open

Long-term sex-differential effects of neonatal vitamin A supplementation on in vitro cytokine responses. Br J Nutr 2017;118:942-948. [PMID: 29166972 DOI: 10.1017/s0007114517002938] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]

Haider BA, Sharma R, Bhutta ZA. Neonatal vitamin A supplementation for the prevention of mortality and morbidity in term neonates in low and middle income countries. Cochrane Database Syst Rev 2017;2:CD006980. [PMID: 28234402 PMCID: PMC6464547 DOI: 10.1002/14651858.cd006980.pub3] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]

Abstract

BACKGROUND

Vitamin A deficiency is a major public health problem in low and middle income countries. Vitamin A supplementation in children six months of age and older has been found to be beneficial, but no effect of supplementation has been noted for children between one and five months of age. Supplementation during the neonatal period has been suggested to have an impact by increasing body stores in early infancy.

OBJECTIVES

To evaluate the role of vitamin A supplementation for term neonates in low and middle income countries with respect to prevention of mortality and morbidity.

SEARCH METHODS

We used the standard search strategy of the Cochrane Neonatal Review Group to search the Cochrane Central Register of Controlled Trials (CENTRAL; 2016, Issue 2), MEDLINE via PubMed (1966 to 13 March 2016), Embase (1980 to 13 March 2016) and the Cumulative Index to Nursing and Allied Health Literature (CINAHL; 1982 to 13 March 2016). We also searched clinical trials databases, conference proceedings and reference lists of retrieved articles for randomised controlled trials and quasi-randomised trials.

SELECTION CRITERIA

Randomised and quasi-randomised controlled trials. Also trials with a factorial design.

DATA COLLECTION AND ANALYSIS

Two review authors independently assessed trial quality and extracted study data. We used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to assess the quality of evidence.

MAIN RESULTS

We included 12 trials (168,460 neonates) in this review, with only a few trials reporting disaggregated data for term infants. Therefore, we analysed data and presented estimates for term infants (when specified) and for all infants.Data for term neonates from three studies did not show a statistically significant effect on the risk of infant mortality at six months in the vitamin A group compared with the control group (typical risk ratio (RR) 0.80; 95% confidence interval (CI) 0.54 to 1.18; I2 = 63%). Analysis of data for all infants from 11 studies revealed no evidence of a significant reduction in the risk of infant mortality at six months among neonates supplemented with vitamin A compared with control neonates (typical RR 0.98, 95% CI 0.89 to 1.07; I2 = 47%). We observed similar results for infant mortality at 12 months of age with no significant effect of vitamin A compared with control (typical RR 1.04, 95% CI 0.94 to 1.15; I2 = 47%). Limited data were available for the outcomes of cause-specific mortality and morbidity, vitamin A deficiency, anaemia and adverse events.

AUTHORS' CONCLUSIONS

Given the high burden of death among children younger than five years of age in low and middle income countries, and the fact that mortality in infancy is a major contributory cause, it is critical to obtain sound scientific evidence of the effect of vitamin A supplementation during the neonatal period on infant mortality and morbidity. Evidence provided in this review does not indicate a potential beneficial effect of vitamin A supplementation among neonates at birth in reducing mortality during the first six months or 12 months of life. Given this finding and the absence of a clear indication of the biological mechanism through which vitamin A could affect mortality, along with substantial conflicting findings from individual studies conducted in settings with potentially varying levels of maternal vitamin A deficiency and infant mortality, absence of follow-up studies assessing any long-term impact of a bulging fontanelle after supplementation and the finding of a potentially harmful effect among female infants, additional research is warranted before a decision can be reached regarding policy recommendations for this intervention.

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Kandasamy R, Voysey M, McQuaid F, de Nie K, Ryan R, Orr O, Uhlig U, Sande C, O'Connor D, Pollard AJ. Non-specific immunological effects of selected routine childhood immunisations: systematic review. BMJ 2016;355:i5225. [PMID: 27737830 PMCID: PMC5063033 DOI: 10.1136/bmj.i5225] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]

Abstract

OBJECTIVE

To identify and characterise non-specific immunological effects after routine childhood vaccines against BCG, measles, diphtheria, pertussis, and tetanus.

DESIGN

Systematic review of randomised controlled trials, cohort studies, and case-control studies.

DATA SOURCES

Embase, PubMed, Cochrane library, and Trip searched between 1947 and January 2014. Publications submitted by a panel of experts in the specialty were also included.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

All human studies reporting non-specific immunological effects after vaccination with standard childhood immunisations. Studies using recombinant vaccines, no vaccine at all, or reporting only vaccine specific outcomes were excluded. The primary aim was to systematically identify, assemble, and review all available studies and data on the possible non-specific or heterologous immunological effects of BCG; measles; mumps, measles, and rubella (MMR); diphtheria; tetanus; and pertussis vaccines.

RESULTS

The initial search yielded 11 168 references; 77 manuscripts met the inclusion criteria for data analysis. In most included studies (48%) BCG was the vaccine intervention. The final time point of outcome measurement was primarily performed (70%) between one and 12 months after vaccination. There was a high risk of bias in the included studies, with no single study rated low risk across all assessment criteria. A total of 143 different immunological variables were reported, which, in conjunction with differences in measurement units and summary statistics, created a high number of combinations thus precluding any meta-analysis. Studies that compared BCG vaccinated with unvaccinated groups showed a trend towards increased IFN-γ production in vitro in the vaccinated groups. Increases were also observed for IFN-γ measured after BCG vaccination in response to in vitro stimulation with microbial antigens from Candida albicans, tetanus toxoid, Staphylococcus aureas, lipopolysaccharide, and hepatitis B. Cohort studies of measles vaccination showed an increase in lymphoproliferation to microbial antigens from tetanus toxoid and C albicans Increases in immunogenicity to heterologous antigens were noted after diphtheria-tetanus (herpes simplex virus and polio antibody titres) and diphtheria-tetanus-pertussis (pneumococcus serotype 14 and polio neutralising responses) vaccination.

CONCLUSIONS

The papers reporting non-specific immunological effects had heterogeneous study designs and could not be conventionally meta-analysed, providing a low level of evidence quality. Some studies, such as BCG vaccine studies examining in vitro IFN-γ responses and measles vaccine studies examining lymphoproliferation to microbial antigen stimulation, showed a consistent direction of effect suggestive of non-specific immunological effects. The quality of the evidence, however, does not provide confidence in the nature, magnitude, or timing of non-specific immunological effects after vaccination with BCG, diphtheria, pertussis, tetanus, or measles containing vaccines nor the clinical importance of the findings.

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Affiliation(s)

Rama Kandasamy Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Churchill Hospital, Oxford OX3 7LE, UK NIHR Oxford Biomedical Research Centre, Oxford, OX3 7LE, UK
Merryn Voysey Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Churchill Hospital, Oxford OX3 7LE, UK NIHR Oxford Biomedical Research Centre, Oxford, OX3 7LE, UK Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK
Fiona McQuaid Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Churchill Hospital, Oxford OX3 7LE, UK NIHR Oxford Biomedical Research Centre, Oxford, OX3 7LE, UK
Karlijn de Nie Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Churchill Hospital, Oxford OX3 7LE, UK NIHR Oxford Biomedical Research Centre, Oxford, OX3 7LE, UK
Rebecca Ryan Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Churchill Hospital, Oxford OX3 7LE, UK NIHR Oxford Biomedical Research Centre, Oxford, OX3 7LE, UK
Olivia Orr Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Churchill Hospital, Oxford OX3 7LE, UK NIHR Oxford Biomedical Research Centre, Oxford, OX3 7LE, UK
Ulrike Uhlig Department of Paediatrics, Children's Hospital Oxford, Oxford University Hospitals NHS Trust, Oxford, OX3 9DU, UK
Charles Sande Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Churchill Hospital, Oxford OX3 7LE, UK NIHR Oxford Biomedical Research Centre, Oxford, OX3 7LE, UK
Daniel O'Connor Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Churchill Hospital, Oxford OX3 7LE, UK NIHR Oxford Biomedical Research Centre, Oxford, OX3 7LE, UK
Andrew J Pollard Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Churchill Hospital, Oxford OX3 7LE, UK NIHR Oxford Biomedical Research Centre, Oxford, OX3 7LE, UK

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The effects of vitamin A supplementation with measles vaccine on leucocyte counts and in vitro cytokine production. Br J Nutr 2015;115:619-28. [PMID: 26678511 DOI: 10.1017/s0007114515004869] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]

Benn CS, Aaby P, Arts RJW, Jensen KJ, Netea MG, Fisker AB. An enigma: why vitamin A supplementation does not always reduce mortality even though vitamin A deficiency is associated with increased mortality. Int J Epidemiol 2015;44:906-18. [PMID: 26142161 PMCID: PMC4521135 DOI: 10.1093/ije/dyv117] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/02/2015] [Indexed: 11/12/2022] Open

Abstract

BACKGROUND

Vitamin A deficiency (VAD) is associated with increased mortality. To prevent VAD, WHO recommends high-dose vitamin A supplementation (VAS) every 4-6 months for children aged between 6 months and 5 years of age in countries at risk of VAD. The policy is based on randomized clinical trials (RCTs) conducted in the late 1980s and early 1990s. Recent RCTs indicate that the policy may have ceased to be beneficial. In addition, RCTs attempting to extend the benefits to younger children have yielded conflicting results. Stratified analyses suggest that whereas some subgroups benefit more than expected from VAS, other subgroups may experience negative effects.

METHODS AND RESULTS

We reviewed the potential modifiers of the effect of VAS. The variable effect of VAS was not explained by underlying differences in VAD. Rather, the effect may depend on the sex of the child, the vaccine status and previous supplementation with vitamin A. Vitamin A is known to affect the Th1/Th2 balance and, in addition, recent evidence suggests that vitamin A may also induce epigenetic changes leading to down-regulation of the innate immune response. Thus VAS protects against VAD but has also important and long-lasting immunological effects, and the effect of providing VAS may vary depending on the state of the immune system.

CONCLUSIONS

To design optimal VAS programmes which target those who benefit and avoid those harmed, more studies are needed. Work is ongoing to define whether neonatal VAS should be considered in subgroups. In the most recent RCT in older children, VAS doubled the mortality for males but halved mortality for females. Hence, we urgently need to re-assess the effect of VAS on older children in large-scale RCTs powered to study effect modification by sex and other potential effect modifiers, and with nested immunological studies.

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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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Guo Y, Brown C, Ortiz C, Noelle RJ. Leukocyte homing, fate, and function are controlled by retinoic acid. Physiol Rev 2015;95:125-48. [PMID: 25540140 DOI: 10.1152/physrev.00032.2013] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open

Jensen KJ, Ndure J, Plebanski M, Flanagan KL. Heterologous and sex differential effects of administering vitamin A supplementation with vaccines. Trans R Soc Trop Med Hyg 2014;109:36-45. [PMID: 25477326 PMCID: PMC4288298 DOI: 10.1093/trstmh/tru184] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open

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]

Jensen KJ, Karkov HS, Lund N, Andersen A, Eriksen HB, Barbosa AG, Kantsø B, Aaby P, Benn CS. The immunological effects of oral polio vaccine provided with BCG vaccine at birth: a randomised trial. Vaccine 2014;32:5949-56. [PMID: 25223267 DOI: 10.1016/j.vaccine.2014.08.062] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Revised: 07/11/2014] [Accepted: 08/27/2014] [Indexed: 01/13/2023]

Abstract

BACKGROUND

Vaccines may have non-specific effects. An observational study from Guinea-Bissau suggested that oral polio vaccine at birth (OPV0) provided with Bacillus Calmette-Guérin (BCG) vaccine was associated with down-regulation of the immune response to BCG vaccine 6 weeks later. Based on the previous finding, we wanted to test our a priori hypothesis that OPV would dampen the immune response to BCG, and secondarily to test immune responses to other antigens.

METHODS

The study was conducted at the Bandim Health Project in Guinea-Bissau in 2009-2010. Infants were randomised to OPV0+BCG versus BCG alone at birth, and subsequently randomised to have a blood sample taken at 2, 4 or 6 weeks post-randomisation. Excreted levels of cytokines (IL-2, IL-5, IL-10, TNF-α and IFN-γ) were measured from whole blood in vitro stimulations with a panel of recall vaccine antigens (BCG, PPD, OPV), mitogen (PHA) or innate agonists (LPS, Pam3cys, PolyI:C). Additionally, we measured the local reaction to BCG, white blood cell distribution, C-reactive protein (CRP) and retinol-binding protein (RBP). Cytokine production was analysed as the prevalence ratios of responders above the median.

RESULTS

Blood samples from 430 infants (209 OPV0+BCG; 221 BCG alone) were analysed. There were no strong differences in effects 2, 4 and 6 weeks post-randomisation and subsequent analyses were performed on the pooled data. As hypothesised, receiving OPV0+BCG versus BCG alone was associated with significantly lower prevalence of IFN-γ responses to PPD (prevalence ratio (PR): 0.84 (0.72-0.98)) and reduced IL-5 to PPD (PR: 0.78 (0.64-0.96)). No effects were observed for CPR, RBP, white blood cell distribution, or BCG scar prevalence.

CONCLUSION

The results corroborate that OPV attenuates the immune response to co-administered BCG at birth.

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Affiliation(s)

Kristoffer Jarlov Jensen Research Center for Vitamins & Vaccines (CVIVA), Bandim Health Project, Statens Serum Institut, Artillerivej 5, DK-2300 Copenhagen S, Denmark; Department of Cardiovascular and Renal Research, Faculty of Health Sciences, University of Southern Denmark, J.B. Winsløws Vej 25, 3, DK-5000 Odense C, Denmark; Bandim Health Project, INDEPTH Network, Apartado 861, 1004 Bissau codex, Guinea-Bissau.
Hanne Sophie Karkov Research Center for Vitamins & Vaccines (CVIVA), Bandim Health Project, Statens Serum Institut, Artillerivej 5, DK-2300 Copenhagen S, Denmark; Bandim Health Project, INDEPTH Network, Apartado 861, 1004 Bissau codex, Guinea-Bissau; Biopharmaceutical Research Unit, Novo Nordisk A/S, Novo Nordisk Park 1, DK-2760 Måløv, Denmark
Najaaraq Lund Research Center for Vitamins & Vaccines (CVIVA), Bandim Health Project, Statens Serum Institut, Artillerivej 5, DK-2300 Copenhagen S, Denmark
Andreas Andersen Research Center for Vitamins & Vaccines (CVIVA), Bandim Health Project, Statens Serum Institut, Artillerivej 5, DK-2300 Copenhagen S, Denmark
Helle Brander Eriksen Research Center for Vitamins & Vaccines (CVIVA), Bandim Health Project, Statens Serum Institut, Artillerivej 5, DK-2300 Copenhagen S, Denmark
Amarildo Gomes Barbosa Bandim Health Project, INDEPTH Network, Apartado 861, 1004 Bissau codex, Guinea-Bissau
Bjørn Kantsø Microbiological Diagnostics & Virology, Statens Serum Institut, Artillerivej 5, DK-2300 Copenhagen S, Denmark
Peter Aaby Bandim Health Project, INDEPTH Network, Apartado 861, 1004 Bissau codex, Guinea-Bissau
Christine Stabell Benn Research Center for Vitamins & Vaccines (CVIVA), Bandim Health Project, Statens Serum Institut, Artillerivej 5, DK-2300 Copenhagen S, Denmark; Odense Patient data Explorative Network, Institute of Clinical Research, University of Southern Denmark/Odense University Hospital, J.B. Winsløws Vej 25, 3, DK-5000 Odense C, Denmark

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Jensen KJ, Larsen N, Biering-Sørensen S, Andersen A, Eriksen HB, Monteiro I, Hougaard D, Aaby P, Netea MG, Flanagan KL, Benn CS. Heterologous immunological effects of early BCG vaccination in low-birth-weight infants in Guinea-Bissau: a randomized-controlled trial. J Infect Dis 2014;211:956-67. [PMID: 25210141 PMCID: PMC4340366 DOI: 10.1093/infdis/jiu508] [Citation(s) in RCA: 137] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open

Jensen KJ, Søndergaard M, Andersen A, Sartono E, Martins C, Garly ML, Eugen-Olsen J, Ullum H, Yazdanbakhsh M, Aaby P, Benn CS, Erikstrup C. A randomized trial of an early measles vaccine at 4½ months of age in Guinea-Bissau: sex-differential immunological effects. PLoS One 2014;9:e97536. [PMID: 24835247 PMCID: PMC4024025 DOI: 10.1371/journal.pone.0097536] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2013] [Accepted: 04/16/2014] [Indexed: 11/19/2022] Open

Abstract

Background

After measles vaccine (MV), all-cause mortality is reduced more than can be explained by the prevention of measles, especially in females.

Objective

We aimed to study the biological mechanisms underlying the observed non-specific and sex-differential effects of MV on mortality.

Methods

Within a large randomised trial of MV at 4.5 months of age blood samples were obtained before and six weeks after randomisation to early MV or no early MV. We measured concentrations of cytokines and soluble receptors from plasma (interleukin-1 receptor agonist (IL-1Ra), IL-6, IL-8, IL-10, tumor necrosis factor (TNF)-α, monocyte chemoattractant protein (MCP)-1, soluble urokinase-type plasminogen activator receptor), and secreted cytokines (interferon-γ, TNF-α, IL-5, IL-10, IL-13, IL-17) after in vitro challenge with innate agonists and recall antigens. We analysed the effect of MV in multiple imputation regression, overall and stratified by sex. The majority of the infants had previously been enrolled in a randomised trial of neonatal vitamin A. Post hoc we explored the potential effect modification by neonatal vitamin A.

Results

Overall, MV versus no MV was associated with higher plasma MCP-1 levels, but the effect was only significant among females. Additionally, MV was associated with increased plasma IL-1Ra. MV had significantly positive effects on plasma IL-1Ra and IL-8 levels in females, but not in males. These effects were strongest in vitamin A supplemented infants. Vitamin A shifted the effect of MV in a pro-inflammatory direction.

Conclusions

In this explorative study we found indications of sex-differential effects of MV on several of the plasma biomarkers investigated; in particular MV increased levels in females, most strongly in vitamin A recipients. The findings support that sex and micronutrient supplementation should be taken into account when analysing vaccine effects.

Trial Registration

clinicaltrials.gov number NCT 00168545

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Both very low- and very high in vitro cytokine responses were associated with infant death in low-birth-weight children from Guinea Bissau. PLoS One 2014;9:e93562. [PMID: 24714360 PMCID: PMC3979682 DOI: 10.1371/journal.pone.0093562] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Accepted: 03/06/2014] [Indexed: 11/19/2022] Open

Yasmeen R, Meyers JM, Alvarez CE, Thomas JL, Bonnegarde-Bernard A, Alder H, Papenfuss TL, Benson DM, Boyaka PN, Ziouzenkova O. Aldehyde dehydrogenase-1a1 induces oncogene suppressor genes in B cell populations. BIOCHIMICA ET BIOPHYSICA ACTA-MOLECULAR CELL RESEARCH 2013;1833:3218-3227. [PMID: 24080087 DOI: 10.1016/j.bbamcr.2013.09.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2013] [Revised: 09/18/2013] [Accepted: 09/19/2013] [Indexed: 12/11/2022]