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Dorsey AF, Roach J, Burten RB, Azcarate-Peril MA, Thompson AL. Intestinal microbiota composition and efficacy of iron supplementation in Peruvian children. Am J Hum Biol 2024:e24058. [PMID: 38420749 DOI: 10.1002/ajhb.24058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 02/15/2024] [Accepted: 02/16/2024] [Indexed: 03/02/2024] Open
Abstract
OBJECTIVE Despite repeated public health interventions, anemia prevalence among children remains a concern. We use an evolutionary medicine perspective to examine the intestinal microbiome as a pathway underlying the efficacy of iron-sulfate treatment. This study explores whether gut microbiota composition differs between anemic children who respond and do not respond to treatment at baseline and posttreatment and if specific microbiota taxa remain associated with response to iron supplementation after controlling for relevant inflammatory and pathogenic variables. METHODS Data come from 49 pre-school-aged anemic children living in San Juan de Lurigancho, Lima, Peru. We tested for differences in alpha and beta diversity using QIIME 2 and performed differential abundance testing in DESeq2 in R. We ran multivariate regression models to assess associations between abundance of specific taxa and response while controlling for relevant variables in Stata 17. RESULTS While we found no evidence for gut microbiota diversity associated with child response to iron treatment, we observed several differential abundance patterns between responders and non-responders at both timepoints. Additionally, we present support for a nonzero relationship between lower relative abundance of Barnesiellaceae and response to iron supplementation in samples collected before and after treatment. CONCLUSION While larger studies and more specific approaches are needed to understand the relationship between microbes and anemia in an epidemiological context, this study suggests that investigating nutritional status and pathogen exposure is key to better understanding the gut microbiome and impact of iron fortification.
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Affiliation(s)
- Achsah F Dorsey
- Department of Anthropology, University of Massachusetts, Amherst, Massachusetts, USA
| | - Jeff Roach
- Center for Gastrointestinal Biology and Disease (CGIBD), Department of Medicine, Division of Gastroenterology and Hepatology, School of Medicine, UNC Microbiome Core, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Rachel B Burten
- Graduate Program in Organismic and Evolutionary Biology, University of Massachusetts, Amherst, Massachusetts, USA
| | - M Andrea Azcarate-Peril
- Center for Gastrointestinal Biology and Disease (CGIBD), Department of Medicine, Division of Gastroenterology and Hepatology, School of Medicine, UNC Microbiome Core, University of North Carolina, Chapel Hill, North Carolina, USA
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Amanda L Thompson
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
- Department of Anthropology, University of North Carolina, Chapel Hill, North Carolina, USA
- Carolina Population Center, University of North Carolina, Chapel Hill, North Carolina, USA
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Dorsey AF, Penny ME, Thompson AL. Adiposity and pathogen exposure: An investigation of response to iron supplementation and hypothesized predictors in anemic pre-school-aged children living in a dual burden environment. AMERICAN JOURNAL OF PHYSICAL ANTHROPOLOGY 2021; 176:54-65. [PMID: 33852740 PMCID: PMC8376780 DOI: 10.1002/ajpa.24287] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 03/13/2021] [Accepted: 03/24/2021] [Indexed: 12/26/2022]
Abstract
OBJECTIVES Peruvians are experiencing rapid dietary and lifestyle changes, resulting in a phenomenon known as the "dual burden of disease." A common manifestation of the dual burden in individuals is the co-occurrence of overweight and anemia. Despite recent initiatives introduced to address these concerns, rates continue to be public health concerns. This study investigates the relationship between immune activation and lack of response to iron supplementation after 1 month of treatment and explores variation in body fat stores as a potential moderator between immune function and response to treatment. METHODS Data come from children, aged 2-5 years (n = 50) from a peri-urban community in Lima, Peru. Multivariate logistic regression models were used to explore the associations between response to treatment (Hb > =11.0 g/dl) after 1 month of treatment), markers of immune activation (C-reactive protein [CRP] and reported morbidity symptoms), and measures of body fat (waist-to-height ratio, triceps skinfold thickness, and body mass index [BMI]). RESULTS We found that high CRP is associated with a lack of response to iron supplementation after 1 month of treatment and that BMI z-score may moderate this association. Generally, larger body size is associated with response to iron supplementation whether or not the children in this sample have high immune activation. However, the probability of anemic children responding to iron supplementation treatment differed across adiposity measures. CONCLUSIONS Our finding suggesting that adiposity and CRP influence response to iron supplementation, furthers our understanding of the relationship between inflammation and anemia treatment in children and has both theoretical and public health implications.
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Affiliation(s)
- Achsah F Dorsey
- Department of Anthropology, University of Massachusetts, Amherst, Massachusetts, USA
| | - Mary E Penny
- Instituto de Investigación Nutricional, La Molina, Lima, Peru
| | - Amanda L Thompson
- Department of Anthropology, University of North Carolina, Chapel Hill, North Carolina, USA
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Bendabenda J, Patson N, Hallamaa L, Ashorn U, Dewey KG, Ashorn P, Maleta K. Does anthropometric status at 6 months predict the over-dispersion of malaria infections in children aged 6-18 months? A prospective cohort study. Malar J 2019; 18:143. [PMID: 31010435 PMCID: PMC6477714 DOI: 10.1186/s12936-019-2778-y] [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: 02/28/2019] [Accepted: 04/13/2019] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND In malaria-endemic settings, a small proportion of children suffer repeated malaria infections, contributing to most of the malaria cases, yet underlying factors are not fully understood. This study was aimed to determine whether undernutrition predicts this over-dispersion of malaria infections in children aged 6-18 months in settings of high malaria and undernutrition prevalence. METHODS Prospective cohort study, conducted in Mangochi, Malawi. Six-months-old infants were enrolled and had length-for-age z-scores (LAZ), weight-for-age z-scores (WAZ), and weight-for-length z-scores (WLZ) assessed. Data were collected for 'presumed', clinical, and rapid diagnostic test (RDT)-confirmed malaria until 18 months. Malaria microscopy was done at 6 and 18 months. Negative binomial regression was used for malaria incidence and modified Poisson regression for malaria prevalence. RESULTS Of the 2723 children enrolled, 2561 (94%) had anthropometry and malaria data. The mean (standard deviation [SD]) of LAZ, WAZ, and WLZ at 6 months were - 1.4 (1.1), - 0.7 (1.2), and 0.3 (1.1), respectively. The mean (SD) incidences of 'presumed', clinical, and RDT-confirmed malaria from 6 to 18 months were: 1.1 (1.6), 0.4 (0.8), and 1.3 (2.0) episodes/year, respectively. Prevalence of malaria parasitaemia was 4.8% at 6 months and 9.6% at 18 months. Higher WLZ at 6 months was associated with lower prevalence of malaria parasitaemia at 18 months (prevalence ratio [PR] = 0.80, 95% confidence interval [CI] 0.67 to 0.94, p = 0.007), but not with incidences of 'presumed' malaria (incidence rate ratio [IRR] = 0.97, 95% CI 0.92 to 1.02, p = 0.190), clinical malaria (IRR = 1.03, 95% CI 0.94 to 1.12, p = 0.571), RDT-confirmed malaria (IRR = 1.00, 95% CI 0.94 to 1.06, p = 0.950). LAZ and WAZ at 6 months were not associated with malaria outcomes. Household assets, maternal education, and food insecurity were significantly associated with malaria. There were significant variations in hospital-diagnosed malaria by study site. CONCLUSION In children aged 6-18 months living in malaria-endemic settings, LAZ, WAZ, and WLZ do not predict malaria incidence. However, WLZ may be associated with prevalence of malaria. Socio-economic and micro-geographic factors may explain the variations in malaria, but these require further study. Trial registration NCT00945698. Registered July 24, 2009, https://clinicaltrials.gov/ct2/show/NCT00945698 , NCT01239693. Registered Nov 11, 2010, https://clinicaltrials.gov/ct2/show/NCT01239693.
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Affiliation(s)
- Jaden Bendabenda
- Department of Public Health, School of Public Health, University of Malawi College of Medicine, Mahatma Gandhi Road, Private Bag 360, Blantyre 3, Malawi
- Faculty of Medicine and Life Sciences, Center for Child Health Research, University of Tampere, Tampere, Finland
| | - Noel Patson
- Department of Public Health, School of Public Health, University of Malawi College of Medicine, Mahatma Gandhi Road, Private Bag 360, Blantyre 3, Malawi
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Lotta Hallamaa
- Faculty of Medicine and Life Sciences, Center for Child Health Research, University of Tampere, Tampere, Finland
| | - Ulla Ashorn
- Faculty of Medicine and Life Sciences, Center for Child Health Research, University of Tampere, Tampere, Finland
| | - Kathryn G Dewey
- Department of Nutrition, University of California, Davis, Davis, CA, USA
| | - Per Ashorn
- Faculty of Medicine and Life Sciences, Center for Child Health Research, University of Tampere, Tampere, Finland
| | - Kenneth Maleta
- Department of Public Health, School of Public Health, University of Malawi College of Medicine, Mahatma Gandhi Road, Private Bag 360, Blantyre 3, Malawi.
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Bendabenda J, Patson N, Hallamaa L, Mbotwa J, Mangani C, Phuka J, Prado EL, Cheung YB, Ashorn U, Dewey KG, Ashorn P, Maleta K. The association of malaria morbidity with linear growth, hemoglobin, iron status, and development in young Malawian children: a prospective cohort study. BMC Pediatr 2018; 18:396. [PMID: 30593271 PMCID: PMC6309082 DOI: 10.1186/s12887-018-1378-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 12/20/2018] [Indexed: 11/20/2022] Open
Abstract
Background Although poor complementary feeding is associated with poor child growth, nutrition interventions only have modest impact on child growth, due to high burden of infections. We aimed to assess the association of malaria with linear growth, hemoglobin, iron status, and development in children aged 6–18 months in a setting of high malaria and undernutrition prevalence. Methods Prospective cohort study, conducted in Mangochi district, Malawi. We enrolled six-months-old infants and collected weekly data for ‘presumed’ malaria, diarrhea, and acute respiratory infections (ARI) until age 18 months. Change in length-for-age z-scores (LAZ), stunting, hemoglobin, iron status, and development were assessed at age 18 months. We used ordinary least squares regression for continuous outcomes and modified Poisson regression for categorical outcomes. Results Of the 2723 children enrolled, 2016 (74.0%) had complete measurements. The mean (standard deviation) incidences of ‘presumed’ malaria, diarrhea, and ARI, respectively were: 1.4 (2.0), 4.6 (10.1), and 8.3 (5.0) episodes/child year. Prevalence of stunting increased from 27.4 to 41.5% from 6 to 18 months. ‘Presumed’ malaria incidence was associated with higher risk of stunting (risk ratio [RR] = 1.04, 95% confidence interval [CI] = 1.01 to 1.07, p = 0.023), anemia (RR = 1.02, 95%CI = 1.00 to 1.04, p = 0.014) and better socio-emotional scores (B = − 0.21, 95%CI = − 0.39 to − 0.03, p = 0.041), but not with change in LAZ, haemoglobin, iron status or other developmental outcomes. Diarrhea incidence was associated with change in LAZ (B = − 0.02; 95% CI = − 0.03 to − 0.01; p = 0.009), stunting (RR = 1.02; 95% CI = 1.01 to 1.03; p = 0.005), and slower motor development. ARI incidence was not associated with any outcome except for poorer socio-emotional scores. Conclusion In this population of young children living in a malaria-endemic setting, with active surveillance and treatment, ‘presumed’ malaria is not associated with change in LAZ, hemoglobin, or iron status, but could be associated with stunting and anemia. Diarrhea was more consistently associated with growth than was malaria or ARI. The findings may be different in contexts where active malaria surveillance and treatment is not provided. Trial registration NCT00945698 (July 24, 2009) and NCT01239693 (November 11, 2010).
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Affiliation(s)
- Jaden Bendabenda
- College of Medicine, Department of Public Health, School of Public Health, University of Malawi, Mahatma Gandhi Road, Private Bag 360, Blantyre 3, Malawi. .,Faculty of Medicine and Life Sciences, Center for Child Health Research, University of Tampere, Tampere, Finland.
| | - Noel Patson
- College of Medicine, Department of Public Health, School of Public Health, University of Malawi, Mahatma Gandhi Road, Private Bag 360, Blantyre 3, Malawi.,School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Lotta Hallamaa
- Faculty of Medicine and Life Sciences, Center for Child Health Research, University of Tampere, Tampere, Finland
| | - John Mbotwa
- Department of Applied Studies, Malawi University of Science and Technology, Thyolo, Malawi.,Leeds Institute for Data Analytics, University of Leeds, Leeds, UK
| | - Charles Mangani
- College of Medicine, Department of Public Health, School of Public Health, University of Malawi, Mahatma Gandhi Road, Private Bag 360, Blantyre 3, Malawi
| | - John Phuka
- College of Medicine, Department of Public Health, School of Public Health, University of Malawi, Mahatma Gandhi Road, Private Bag 360, Blantyre 3, Malawi
| | - Elizabeth L Prado
- Department of Nutrition, University of California, Davis, Davis, CA, USA
| | - Yin Bun Cheung
- Program in Health Services and Systems Research and Centre for Quantitative Medicine, Duke-National University of Singapore Graduate Medical School, Singapore, Singapore
| | - Ulla Ashorn
- Faculty of Medicine and Life Sciences, Center for Child Health Research, University of Tampere, Tampere, Finland
| | - Kathryn G Dewey
- Department of Nutrition, University of California, Davis, Davis, CA, USA
| | - Per Ashorn
- Faculty of Medicine and Life Sciences, Center for Child Health Research, University of Tampere, Tampere, Finland
| | - Kenneth Maleta
- College of Medicine, Department of Public Health, School of Public Health, University of Malawi, Mahatma Gandhi Road, Private Bag 360, Blantyre 3, Malawi
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Peng YF, Wei YS. Associations between serum bilirubin levels and essential trace elements status in an adult population. Oncotarget 2017; 8:81315-81320. [PMID: 29113390 PMCID: PMC5655285 DOI: 10.18632/oncotarget.18351] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Accepted: 05/22/2017] [Indexed: 11/25/2022] Open
Abstract
Objective This paper aims to evaluate the relations between serum bilirubin and essential trace elements in an adult population. Results Demographic and clinical data were stratified according to the median of serum bilirubin concentrations (50th percentiles). There were statistical differences in regarding with age, body mass index, white blood count, hemoglobin, mean corpuscular hemoglobin, alanine aminotransferase, creatinine, high-sensitivity C-reactive protein, iron, zinc and copper. Studying the correlation of serum bilirubin levels with iron, zinc, copper and high-sensitivity C-reactive protein, we found positive correlations for iron and zinc, and negative correlations for high-sensitivity C-reactive protein and copper in whole participants. Similar results of correlation analysis were repeated when the further analyses were performed separately for subjects with high and low serum bilirubin concentrations. Similar results were also observed in gender-based stratified analysis. Multiple linear regression analysis revealed that serum bilirubin levels were independently correlated with serum iron, zinc and copper. Materials and Methods The cross-sectional study involved 264 healthy subjects. Conclusions The current study demonstrated that serum bilirubin within the reference range is correlated with iron, zinc and copper in an adult population, regardless of potential confounders.
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Affiliation(s)
- You-Fan Peng
- Department of Laboratory Medicine, Affiliated Hospital of Youjiang Medical University for Nationalities, Baise City, China
| | - Ye-Sheng Wei
- Department of Laboratory Medicine, Affiliated Hospital of Youjiang Medical University for Nationalities, Baise City, China
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Hadley C, Hruschka DJ. Testing ecological and universal models of body shape and child health using a global sample of infants and young children. Ann Hum Biol 2017; 44:600-606. [DOI: 10.1080/03014460.2017.1357755] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Craig Hadley
- Department of Anthropology, Emory University, Atlanta, GA, USA
| | - Daniel J. Hruschka
- School of Human Evolution and Social Change, Arizona State University, Tempe, AZ, USA
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Schmeer KK, Piperata BA. Household food insecurity and child health. MATERNAL AND CHILD NUTRITION 2016; 13. [PMID: 27126348 DOI: 10.1111/mcn.12301] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Revised: 12/30/2015] [Accepted: 01/06/2016] [Indexed: 11/29/2022]
Abstract
Food insecurity, the lack of consistent access to sufficient quality and quantity of food, affects an estimated 800 million people around the world. Although household food insecurity is generally associated with poor child nutrition and health in the USA, we know less about household food insecurity and child health in developing countries. Particularly lacking is research assessing how associations between household food insecurity and children's health outcomes may differ by child age and among children beyond age 5 years in low-income settings. We use data from a population-based sample of households with children ages 3-11 years (N = 431) in León, Nicaragua to consider how household food insecurity is associated with three measures of child health: illness, anaemia and low height-for-age. Our results provide new evidence that even mild household food insecurity is detrimental to children's health; and that child age conditions the associations between household food insecurity and child health. We find that food insecurity is especially harmful to health during early childhood, but continues to have significant associations with health into middle childhood (up to ages 7-8 years). We discuss the potential implications of these results for future child health research and policies in low-income countries. © 2016 John Wiley & Sons Ltd.
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Affiliation(s)
- Kammi K Schmeer
- Department of Sociology, The Ohio State University, Columbus, USA
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Abstract
OBJECTIVE To identify the association of household food insecurity (HFI) with anthropometric status, the risk of vitamin A deficiency and anaemia, morbidities such as cough and fever, and hospitalizations for diarrhoea and pneumonia in children under 5 years old. DESIGN Cross-sectional study using data from the 2006 Brazilian Demographic and Health Survey. HFI was measured with the Brazilian Food Insecurity Measurement Scale (EBIA). Vitamin A deficiency and anaemia were assessed in blood samples. Child morbidities were reported by the child's mother and included cough, fever, and hospitalizations for diarrhoea and pneumonia. Regression results were expressed as unadjusted and adjusted OR and corresponding 95 % CI for severe food insecurity, with statistical significance set at P<0·05. SETTING Nationally representative survey. SUBJECTS Children (n 4064) under 5 years old. RESULTS There was no association between HFI and vitamin A deficiency, pneumonia, wasting or overweight. The prevalence of cough, fever, hospitalization for diarrhoea and stunting were associated with degree of HFI severity. There was a significant association of morbidities and stunting with severe food insecurity (v. food secure). After controlling for confounders, the association between severe food insecurity (v. food secure/rest of food insecurity categories) and the prevalence of common morbidities remained strong, showing that severely food-insecure children had a greater likelihood of experiencing cough (adjusted OR=1·79) and of being hospitalized for diarrhoea (adjusted OR=2·55). CONCLUSIONS Severe HFI was associated with cough and severe diarrhoea among Brazilian children.
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Thurnham DI, Northrop-Clewes CA, Knowles J. The use of adjustment factors to address the impact of inflammation on vitamin A and iron status in humans. J Nutr 2015; 145:1137S-1143S. [PMID: 25833890 PMCID: PMC4410494 DOI: 10.3945/jn.114.194712] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Accepted: 08/21/2014] [Indexed: 01/03/2023] Open
Abstract
Many nutrient biomarkers are altered by inflammation. We calculated adjustment factors for retinol and ferritin by using meta-analyses of studies containing the respective biomarker and 2 acute phase proteins in serum, C-reactive protein (CRP), and α1-acid glycoprotein (AGP). With the use of CRP and AGP we identified 4 groups in each study: reference (CRP ≤5 mg/L, AGP ≤1 g/L), incubation (CRP >5 mg/L, AGP ≤1 g/L), early convalescence (CRP >5 mg/L, AGP >1 g/L), and late convalescence (CRP ≤5 mg/L, AGP >1 g/L). For each biomarker, ratios of the geometric means of the reference to each inflammation group concentration were used to calculate adjustment factors for retinol (1.13, 1.24, and 1.11) and ferritin (0.77, 0.53, and 0.75) for the incubation, early, and late convalescent groups, respectively. The application of the meta-analysis factors in more recent studies compares well with study-specific factors. The same method was used to calculate adjustment factors for soluble transferrin receptor (sTfR) and body iron stores (BISs) in Lao children. We found no advantage in adjusting sTfR for inflammation; in fact, adjustment decreased iron deficiency. Neither adjusted (10% <0 mg/kg) nor nonadjusted (12% <0 mg/kg) BISs detected as much iron deficiency as did ferritin (18% <12 μg/L) and adjusted ferritin (21% <12 μg/L) unless the cutoff for BISs was increased from 0 to <3 mg/kg. However, we could find no evidence that the larger number of children identified as having BISs <3 mg/kg had risks of anemia comparable to those identified by using ferritin <12 μg/L. In conclusion, both corrected and uncorrected ferritin concentrations <12 μg/L are associated with more iron deficiency and anemia than either sTfR >8.3 mg/L or BISs <0 mg/kg in Lao children.
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Affiliation(s)
- David I Thurnham
- Northern Ireland Centre for Food and Health, School of Biomedical Sciences, University of Ulster, Coleraine, United Kingdom;
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Hadley C, Decaro JA. Testing hypothesized predictors of immune activation in tanzanian infants and children: Community, household, caretaker, and child effects. Am J Hum Biol 2014; 26:523-9. [DOI: 10.1002/ajhb.22558] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Revised: 04/17/2014] [Accepted: 04/19/2014] [Indexed: 11/09/2022] Open
Affiliation(s)
- Craig Hadley
- Department of Anthropology; Emory University; Atlanta Georgia
| | - Jason A. Decaro
- Department of Anthropology; University of Alabama; Tuscaloosa Alabama
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Wessells KR, Hess SY, Rouamba N, Ouédraogo ZP, Kellogg M, Goto R, Duggan C, Ouédraogo JB, Brown KH. Associations between intestinal mucosal function and changes in plasma zinc concentration following zinc supplementation. J Pediatr Gastroenterol Nutr 2013; 57:348-55. [PMID: 23689263 PMCID: PMC4627695 DOI: 10.1097/mpg.0b013e31829b4e9e] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVES Subclinical environmental enteropathy is associated with malabsorption of fats, carbohydrates, and vitamins A, B12, and folate; however, little information is available on mineral absorption. We therefore investigated the relation between intestinal mucosal function (measured by the lactulose:mannitol permeability test and plasma citrulline concentration), and zinc (Zn) absorption, as estimated by the change in plasma Zn concentration (PZC) following short-term Zn or placebo supplementation. METHODS We conducted a randomized, partially masked, placebo-controlled trial among 282 apparently healthy children 6 to 23 months of age in Burkina Faso. After completing baseline intestinal function tests, participants received either 5 mg Zn, as zinc sulfate, or placebo, daily for 21 days. RESULTS At baseline, mean ± standard deviation PZC was 62.9 ± 11.9 μg/dL; median (interquartile range) urinary lactulose:mannitol (L:M) recovery ratio and plasma citrulline concentrations were 0.04 (0.03-0.07) and 11.4 (9.0-15.6) μmol/L, respectively. Change in PZC was significantly greater in the Zn-supplemented versus placebo group (15.6 ± 13.3 vs 0.02 ± 10.9 μg/dL; P < 0.0001), and was negatively associated with initial urinary L:M recovery ratio (-1.1 μg/dL per 50% increase in urinary L:M recovery ratio; P = 0.014); this latter relation did not differ between supplementation groups (P = 0.26). Baseline plasma citrulline concentration was not associated with change in PZC. CONCLUSIONS Although altered intestinal permeability may reduce dietary Zn absorption, it likely does not undermine the efficacy of Zn supplementation, given the large increases in PZC following short-term Zn supplementation observed in this study, even among those with increased urinary L:M recovery ratios.
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Affiliation(s)
- K. Ryan Wessells
- Department of Nutrition, University of California, Davis, Davis, CA
| | - Sonja Y. Hess
- Department of Nutrition, University of California, Davis, Davis, CA
| | - Noel Rouamba
- Institut de Recherche en Sciences de la Santé, Bobo-Dioulasso, Burkina Faso
| | | | - Mark Kellogg
- Department of Pathology, Boston Children’s Hospital, Boston, MA
| | - Rie Goto
- Division of Biological Anthropology, Department of Archaeology and Anthropology, University of Cambridge, Cambridge, UK
| | - Christopher Duggan
- Division of Gastroenterology and Nutrition, Boston Children’s Hospital, Boston, MA
| | | | - Kenneth H. Brown
- Department of Nutrition, University of California, Davis, Davis, CA
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Lin A, Arnold BF, Afreen S, Goto R, Huda TMN, Haque R, Raqib R, Unicomb L, Ahmed T, Colford JM, Luby SP. Household environmental conditions are associated with enteropathy and impaired growth in rural Bangladesh. Am J Trop Med Hyg 2013; 89:130-137. [PMID: 23629931 PMCID: PMC3748469 DOI: 10.4269/ajtmh.12-0629] [Citation(s) in RCA: 206] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
We assessed the relationship of fecal environmental contamination and environmental enteropathy. We compared markers of environmental enteropathy, parasite burden, and growth in 119 Bangladeshi children (≤ 48 months of age) across rural Bangladesh living in different levels of household environmental cleanliness defined by objective indicators of water quality and sanitary and hand-washing infrastructure. Adjusted for potential confounding characteristics, children from clean households had 0.54 SDs (95% confidence interval [CI] = 0.06, 1.01) higher height-for-age z scores (HAZs), 0.32 SDs (95% CI = -0.72, 0.08) lower lactulose:mannitol (L:M) ratios in urine, and 0.24 SDs (95% CI = -0.63, 0.16) lower immunoglobulin G endotoxin core antibody (IgG EndoCAb) titers than children from contaminated households. After adjusting for age and sex, a 1-unit increase in the ln L:M was associated with a 0.33 SDs decrease in HAZ (95% CI = -0.62, -0.05). These results are consistent with the hypothesis that environmental contamination causes growth faltering mediated through environmental enteropathy.
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Affiliation(s)
- Audrie Lin
- *Address correspondence to Audrie Lin, Division of Epidemiology, School of Public Health, University of California, 50 University Hall, #7360, Berkeley, CA 94720. E-mail:
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Early environments and the ecology of inflammation. Proc Natl Acad Sci U S A 2012; 109 Suppl 2:17281-8. [PMID: 23045646 DOI: 10.1073/pnas.1202244109] [Citation(s) in RCA: 141] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Recent research has implicated inflammatory processes in the pathophysiology of a wide range of chronic degenerative diseases, although inflammation has long been recognized as a critical line of defense against infectious disease. However, current scientific understandings of the links between chronic low-grade inflammation and diseases of aging are based primarily on research in high-income nations with low levels of infectious disease and high levels of overweight/obesity. From a comparative and historical point of view, this epidemiological situation is relatively unique, and it may not capture the full range of ecological variation necessary to understand the processes that shape the development of inflammatory phenotypes. The human immune system is characterized by substantial developmental plasticity, and a comparative, developmental, ecological framework is proposed to cast light on the complex associations among early environments, regulation of inflammation, and disease. Recent studies in the Philippines and lowland Ecuador reveal low levels of chronic inflammation, despite higher burdens of infectious disease, and point to nutritional and microbial exposures in infancy as important determinants of inflammation in adulthood. By shaping the regulation of inflammation, early environments moderate responses to inflammatory stimuli later in life, with implications for the association between inflammation and chronic diseases. Attention to the eco-logics of inflammation may point to promising directions for future research, enriching our understanding of this important physiological system and informing approaches to the prevention and treatment of disease.
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Bui VQ, Stein AD, DiGirolamo AM, Ramakrishnan U, Flores-Ayala RC, Ramirez-Zea M, Grant FK, Villalpando S, Martorell R. Associations between serum C-reactive protein and serum zinc, ferritin, and copper in Guatemalan school children. Biol Trace Elem Res 2012; 148:154-60. [PMID: 22354676 PMCID: PMC3734531 DOI: 10.1007/s12011-012-9358-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2011] [Accepted: 02/07/2012] [Indexed: 10/28/2022]
Abstract
Inflammation affects trace nutrient concentrations, but research on copper and particularly in children is limited. We assessed associations between serum C-reactive protein (CRP) and zinc, iron, copper, and other biomarkers (alkaline phosphatase, hemoglobin, and albumin), in 634 healthy 6- to 11-year-old Guatemalan schoolchildren. CRP was measured by a standardized, high-sensitive method. For significant associations with CRP, we stratified nutrient concentrations across categories of CRP and compared concentrations above and below several CRP cutoff points (0.5, 1, 3, 5, and 10 mg/L), and then adjusted values using correction factors (ratios of geometric means of the nutrients in the low and high groups). Prevalence of serum zinc (<65 μg/dL0, ferritin (<15 μg/L), and copper (<90 μg/dL) deficiency were 21%, 2.1%, and 23.8%, respectively. Median (25th and 75th percentiles) CRP was 0.56 (0.26 and 1.54) mg/L. CRP concentration was positively associated with ferritin and copper concentrations (r = 0.23 and 0.29, respectively; P < 0.0001) but not with zinc and other biomarkers (P > 0.05). Regardless of CRP cutoffs, high (> cutoff) vs. low (≤ cutoff) CRP levels had higher ferritin and copper concentrations and lower prevalence of copper deficiency of <90 μg/dL (P < 0.05). Adjustment for inflammation had the greatest influence on recalculated prevalence for the CRP 0.5 mg/L cutoff. The low ferritin prevalence hardly changed (from 2.1% to 2.5%) while the low copper prevalence changed appreciably (from 23.8% to 31.2%). In conclusion, CRP was positively associated with ferritin and copper but not with zinc concentrations. Adjustment for inflammation had little effect on low ferritin prevalence, low to begin with, and a large impact on low copper prevalence. High-sensitive CRP methods and the use of very low CRP cutoffs may be more accurate than traditional CRP methods in the adjustment of serum copper concentrations for inflammation in healthy school children.
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Affiliation(s)
- Vinh Q. Bui
- Nutrition and Health Sciences Program, Graduate Division of Biological and Biomedical Sciences, Laney Graduate School, Emory University, Atlanta, GA, USA
| | - Aryeh D. Stein
- Nutrition and Health Sciences Program, Graduate Division of Biological and Biomedical Sciences, Laney Graduate School, Emory University, Atlanta, GA, USA. Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Ann M. DiGirolamo
- Health Unit, Program Quality and Impact Division, CARE USA, Atlanta, GA, USA
| | - Usha Ramakrishnan
- Nutrition and Health Sciences Program, Graduate Division of Biological and Biomedical Sciences, Laney Graduate School, Emory University, Atlanta, GA, USA. Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Rafael C. Flores-Ayala
- Nutrition and Health Sciences Program, Graduate Division of Biological and Biomedical Sciences, Laney Graduate School, Emory University, Atlanta, GA, USA. Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Manuel Ramirez-Zea
- Institute of Nutrition of Central America and Panama (INCAP), Guatemala City, Guatemala
| | - Frederick K. Grant
- Nutrition and Health Sciences Program, Graduate Division of Biological and Biomedical Sciences, Laney Graduate School, Emory University, Atlanta, GA, USA. Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | | | - Reynaldo Martorell
- Nutrition and Health Sciences Program, Graduate Division of Biological and Biomedical Sciences, Laney Graduate School, Emory University, Atlanta, GA, USA. Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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Hadley C, Tessema F, Muluneh AT. Household food insecurity and caregiver distress: Equal threats to child nutritional status? Am J Hum Biol 2011; 24:149-57. [DOI: 10.1002/ajhb.22200] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2011] [Revised: 10/12/2011] [Accepted: 10/19/2011] [Indexed: 11/12/2022] Open
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Schmeer K. Father absence due to migration and child illness in rural Mexico. Soc Sci Med 2009; 69:1281-6. [PMID: 19699568 DOI: 10.1016/j.socscimed.2009.07.030] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2008] [Indexed: 11/30/2022]
Abstract
Little research to date has assessed the importance of the presence of fathers in the household for protecting child health, particularly in developing country contexts. Although divorce and non-marital childbearing are low in many developing countries, migration is a potentially important source of father absence that has yet to be studied in relation to child health. This study utilizes prospective, longitudinal data from Mexico to assess whether father absence due to migration is associated with increased child illness in poor, rural communities. Rural Mexico provides a setting where child illness is related to more serious health problems, and where migration is an important source of father absence. Both state- and individual-level fixed effects regression analyses are used to estimate the relationship between father absence due to migration and child illness while controlling for unobserved contextual and individual characteristics. The state-level models illustrate that the odds of children being ill are 39% higher for any illness and 51% higher for diarrhea when fathers are absent compared with when fathers are present in the household. The individual-level fixed effects models support these findings, indicating that, in the context of rural Mexico, fathers may be important sources of support for ensuring the healthy development of young children.
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Affiliation(s)
- Kammi Schmeer
- Department of Sociology, The Ohio State University, Columbus 43210-1222, USA.
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17
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McDade TW, Hayward MD. Rationale and methodological options for assessing infectious disease and related measures in social science surveys. BIODEMOGRAPHY AND SOCIAL BIOLOGY 2009; 55:159-177. [PMID: 20183903 DOI: 10.1080/19485560903382478] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Infectious disease is an important, but often overlooked, component of population health in high-income nations. Common, everyday infections exact significant costs, including school and work absenteeism, reduced productivity, and substantial health care expenditures. Infectious disease also shapes trajectories of biological risk and health and may be causally linked to chronic disease risk later in life. The size, diversity, and representativeness of samples typically employed in survey-based studies of health present exceptional opportunities for advancing scientific knowledge on the social and economic determinants of infectious disease in childhood and adulthood and to investigate the long-term consequences of infectious disease for well-being and attainment across multiple domains. A wide range of interview-based, anthropometric, and biomarker measurement options are currently available for assessing infectious exposures, inflammation, and immune function in nonclinical settings. These methods afford opportunities for innovative, transdisciplinary research on the causes and consequences of infectious disease across the life course that can address questions of interest to social, life, and biomedical scientists.
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Affiliation(s)
- Thomas W McDade
- Northwestern University, Department of Anthropology, Cells to Society: The Center on Social Disparities and Health at the Institute for Policy Research, Evanston, Illinois 60208, USA.
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18
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Impact of intestinal permeability, inflammation status and parasitic infections on infant growth faltering in rural Bangladesh. Br J Nutr 2008; 101:1509-16. [PMID: 18947438 DOI: 10.1017/s0007114508083554] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
A longitudinal study of 298 rural Bangladeshi infants found evidence of growth faltering starting at 3 months of age. Anthropometric status declined substantially in the first 2 years of life, with weight-for-height (WHZ) falling from - 0.49 to - 1.75, weight-for-age (WAZ) from - 1.18 to - 2.87 and height-for-age (HAZ) from - 1.00 to - 1.88. Higher concentrations of the acute-phase protein alpha-1-acid glycoprotein (AGP) and higher gut mucosal damage (as signified by raised lactulose:mannitol (L:M) ratios) were both associated with chronic malnutrition as indicated by poorer HAZ and WAZ scores (P = 0.011 and 0.005 for AGP and 0.039 and 0.019 for L:M ratio, respectively). Higher Hb levels were related to improved z-scores, while elevation of Giardia-specific IgM titre (GSIgM) was associated with poor WAZ and WHZ (P = 0.015 and 0.039, respectively). IgG did not show any significant association with z-scores and the L:M ratio did not correlate with any of the inflammation markers or Giardia infection. The prevalence of geohelminth infections was low (only 4 % in the total study period). However, the level of GSIgM indicated high endemicity of Giardia infection from early in life, although very few cysts were detected from stool samples. These findings suggest that rural Bangladeshi infants are being exposed to high levels of infection with concomitant gut damage and growth faltering.
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McDade TW, Reyes-García V, Tanner S, Huanca T, Leonard WR. Maintenance versus growth: investigating the costs of immune activation among children in lowland Bolivia. AMERICAN JOURNAL OF PHYSICAL ANTHROPOLOGY 2008; 136:478-84. [PMID: 18383156 DOI: 10.1002/ajpa.20831] [Citation(s) in RCA: 127] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Immune function is a central component of maintenance effort, and it provides critical protection against the potentially life threatening effects of pathogens. However, immune defenses are energetically expensive, and the resources they consume are not available to support other activities related to growth and/or reproduction. In our study we use a life history theory framework to investigate tradeoffs between maintenance effort and growth among children in a remote area of Amazonian Bolivia. Baseline concentrations of C-reactive protein (CRP) were measured in 309 2- to 10-year olds as an indicator of immune activation, and height was measured at baseline and three months later. Elevated CRP at baseline predicts smaller gains in height over the subsequent three months, with the costs to growth particularly high for 2- to 4-year olds and for those with low energy reserves (in the form of body fat) at the time of immunostimulation. These results provide evidence for a significant tradeoff between investment in immunity and growth in humans, and highlight an important physiological mechanism through which maintenance effort may have lasting effects on child growth and development.
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Affiliation(s)
- T W McDade
- Department of Anthropology, Northwestern University, Evanston, IL 60208, USA.
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20
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Impact of anti-Giardia and anthelminthic treatment on infant growth and intestinal permeability in rural Bangladesh: a randomised double-blind controlled study. Trans R Soc Trop Med Hyg 2008; 103:520-9. [PMID: 18789466 DOI: 10.1016/j.trstmh.2008.07.020] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2008] [Revised: 07/29/2008] [Accepted: 07/30/2008] [Indexed: 10/21/2022] Open
Abstract
In order to test the impact of Giardia and geohelminthic infection on infant growth faltering in Bangladesh, a randomised double-blind placebo controlled intervention of 36 weeks' duration was conducted in a rural community located 40 km northwest of Dhaka. Infants aged between 3 and 15 months were randomly assigned to either anti-Giardia and anthelminthic treatment, anti-Giardia treatment only, or a control. Weight and supine length were recorded every 4 weeks. Every 12 weeks intestinal permeability (lactulose/mannitol ratio), haemoglobin, plasma albumin, alpha-1-acid glycoprotein, IgG and Giardia-specific IgM (GSIgM) and eggs of the three common geohelminths and G. intestinalis cysts were determined. Data on 222 fully compliant infants were analysed. No significant differences in intestinal permeability, biochemical or anthropometric variables were found between the intervention groups, although there were associations between improvement in small intestinal mucosal function and better weight-for-age and weight-for-height (length) Z-scores. GSIgM titres indicated high endemicity with rapid re-infection of Giardia among infants; over 95% of infants were positive throughout the study, whereas the stool examination showed very few infants with either geohelminth eggs or Giardia cysts.
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21
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Manesh AO, Sheldon TA, Pickett KE, Carr-Hill R. Accuracy of child morbidity data in demographic and health surveys. Int J Epidemiol 2007; 37:194-200. [PMID: 17911149 DOI: 10.1093/ije/dym202] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The Demographic and Health Surveys (DHSs) have been used throughout the developing world for the last 20 years to provide data on the distribution of disease in order to inform planning. Data on child illness and death are reported by mothers and are susceptible to error. METHODS We conducted an in-depth study of the Iranian DHS carried out in 2000-2001 and reviewed 110 DHS carried out around the world to check for bias by assessing the social gradient in reported child morbidity and mortality. RESULTS We found that the reported under-5 child morbidity and mortality rates for the 28 Iranian provinces were inversely correlated (r = -0.592, P < 0.001) and that the adjusted social gradient of child morbidity implied increased illness in those who had literate vs illiterate mothers (OR = 1.26, 95% CI 1.20-1.32) compared with a decrease in mortality with increased literacy (OR = 0.52, 95% CI 0.46-0.59). Many of the other DHSs also show increased rates of reported child diarrhoea in households with higher levels of maternal education, access to piped water and urban (vs rural) dwellings, the reverse of what is found with mortality rates. CONCLUSIONS This suggests that there may be significant recall and reporting bias in under-5 childhood morbidity in DHSs. Caution should be used in the interpretation and use of data from DHSs and the survey methods should be reviewed.
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Goto R, Panter-Brick C, Northrop-Clewes CA, Manahdhar R, Tuladhar NR. Poor intestinal permeability in mildly stunted Nepali children: associations with weaning practices and Giardia lamblia infection. Br J Nutr 2007. [DOI: 10.1079/bjn2002599] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Studies in the Gambia, using the lactulose–mannitol dual-sugar intestinal permeability test (lactulose:mannitol ratio) as a non-invasive way of investigating mucosal damage, have shown that food malabsorption is significantly associated with early growth retardation. In this cross-sectional study, 210 poor urban Nepali children, 0–60 months old, were recruited and measured for height or length and weight, 167 were examined for intestinal permeability and 173 for parasite infection. Weaning and morbidity data were collected from 172 caretakers. Children were mildly stunted (mean height-for-age Z-score −1·45) and underweight (mean weight-for-age Z-score −1·62). The lactulose:mannitol ratio (0·26) was poorer than that of UK children (0·12), but similar to that found in Bengali children of the same age (0·24). Two stages of weaning, the onset supplementary feeding (6 months) and the cessation of breast-feeding (23 months), were shown to have differential impact. In children currently breast-feeding, the duration of supplementation was negatively related to lactose (P<0·001) and lactose:lactulose values (P<0·0001), indicating lactose maldigestion. In children who had ceased breast-feeding, a longer period of lactation was associated with poorer intestinal permeability (P=0·031), and poorer height-for-age (P=0·024), which was an unexpected result. No significant relationships were found between intestinal permeability and growth, or with morbidity and helminth infection, except in children withGiardia lambliawho had worse lactulose:mannitol ratios than those without (0·43v.0·25 respectively,P=0·014). It is likely that insults to the gut (e.g. Giardia) and challenges to the immune system (weaning) have a different impact in early and late infancy.
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Yousafzai AK, Filteau S, Wirz S. Feeding difficulties in disabled children leads to malnutrition: experience in an Indian slum. Br J Nutr 2007; 90:1097-106. [PMID: 14641969 DOI: 10.1079/bjn2003991] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The aim of the present study was to explore the nature, extent and probable causes of nutritional deficiencies among children with disabilities living in Dharavi, a slum in Mumbai, India. A cross-sectional study was conducted to investigate whether the nutritional status of children with disabilities, aged 2–6 years (n141), was worse than that of non-disabled sibling controls (n122) and neighbour controls (n162). Data on food patterns, anthropometry, micronutrient status and feeding difficulties reported by parents were collected. The mean weight for age of the children with disabilities (−2·44 (sd 1·39)Zscores;n120) was significantly lower (P<0·05) compared with the sibling (−1·70 (sd 1·20)Zscores;n109) and neighbour (−1·83 (sd 1·290)Zscores;n162) control groups. The children with disabilities had significantly lower (P<0·05) mean haemoglobin levels (92 (sd 23) g/l;n134) compared with siblings (102 (sd 18) g/l;n103) and neighbours (99 (sd 18) g/l;n153). Relative risk (RR) analysis indicated that the disabled children with feeding difficulties were significantly more likely (P<0·05) to be malnourished, by the indicator of weight for age (RR 1·1; 95 % CI 1·08, 1·20) compared with the disabled children without a feeding difficulty. They were also significantly more likely to be malnourished using the indicators of height for age (RR 1·3; 95 % CI 1·19, 1·43) and weight for height (RR 2·4; 95 % CI 1·78, 3·23) compared with the disabled children without a feeding difficulty. Feeding difficulties were identified as a risk factor for vulnerability to inadequate nutritional status among children with disabilities.
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Affiliation(s)
- Aisha K Yousafzai
- Centre for International Child Health, Institute of Child Health, University College London, 30 Guilford Street, London WC1N 1EH, UK.
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Thurnham DI, Mburu ASW, Mwaniki DL, De Wagt A. Micronutrients in childhood and the influence of subclinical inflammation. Proc Nutr Soc 2006; 64:502-9. [PMID: 16313694 DOI: 10.1079/pns2005468] [Citation(s) in RCA: 93] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
In the present paper biomarkers of micronutrient status in childhood and some of the factors influencing them, mainly dietary intake, requirements and inflammation will be examined. On a body-weight basis the micronutrient requirements of children are mostly higher than those of an adult, but most biomarkers of status are not age-related. A major factor that is often overlooked in assessing status is the influence of subclinical inflammation on micronutrient biomarkers. In younger children particularly the immune system is still developing and there is a higher frequency of sickness than in adults. The inflammatory response rapidly influences the concentration in the blood of several important micronutrients such as vitamin A, Fe and Zn, even in the first 24 h, whereas dietary deficiencies can be envisaged as having a more gradual effect on biomarkers of nutritional status. The rapid response to infection may be for protective reasons, i.e. conservation of reserves, or by placing demands on those reserves to mount an effective immune response. However, because there is a high prevalence of disease in many developing countries, an apparently-healthy child may well be at the incubation stage or convalescing when blood is taken for nutritional assessment and the concentration of certain micronutrient biomarkers will not give a true indication of status. Most biomarkers influenced by inflammation are known, but often they are used because they are convenient or cheap and the influence of subclinical inflammation is either ignored or overlooked. The objective of the present paper is to discuss: (1) some of the important micronutrient deficiencies in childhood influenced by inflammation; (2) ways of correcting the interference from inflammation.
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Affiliation(s)
- David I Thurnham
- Kenya Medical Research Institute, Centre for Public Health Research, Nairobi
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Abstract
Immune function is notoriously complex, and current biomedical research elaborates this complexity by focusing on the cellular and molecular mechanisms that characterize immune defenses. However, the human immune system is a product of natural selection that develops and functions in whole organisms that are integral parts of their surrounding environments. A population-level, cross-cultural, adaptationist perspective is therefore a necessary complement to the micro levels of analysis currently favored by biomedical immunology. Prior field-based research on human immunity is reviewed to demonstrate the relevance of cultural ecological factors, with an emphasis on the ecologies of nutrition, infectious disease, reproduction, and psychosocial stress. Common themes and anthropological contributions are identified in an attempt to promote future research in human ecological immunology that integrates theory and method for a more contextualized understanding of this important physiological system.
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Affiliation(s)
- Thomas W. McDade
- Department of Anthropology, Northwestern University, Evanston, Illinois 60208
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McDade TW, Leonard WR, Burhop J, Reyes-García V, Vadez V, Huanca T, Godoy RA. Predictors of C-reactive protein in Tsimane' 2 to 15 year-olds in lowland Bolivia. AMERICAN JOURNAL OF PHYSICAL ANTHROPOLOGY 2005; 128:906-13. [PMID: 16118783 DOI: 10.1002/ajpa.20222] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Infectious disease is a major global determinant of child morbidity and mortality, and energetic investment in immune defenses (even in the absence of overt disease) is an important life-history variable, with implications for human growth and development. This study uses a biomarker of immune activation (C-reactive protein) to investigate an important aspect of child health among the Tsimane', a relatively isolated Amerindian population in lowland Bolivia. Our objectives are twofold: 1) to describe the distribution of CRP by age and gender in a cross-sectional sample of 536 2-15-year-olds; and 2) to explore multiple measures of pathogen exposure, economic resources, and acculturation as predictors of increased CRP. The median blood-spot CRP concentration was 0.73 mg/l, with 12.9% of the sample having concentrations greater than 5 mg/L, indicating a relatively high degree of immune activation in this population. Age was the strongest predictor of CRP, with the highest concentrations found among younger individuals. Increased CRP was also associated with higher pathogen exposure, lower household economic resources, and increased maternal education and literacy. The measurement of CRP offers a direct, objective indicator of immune activation, and provides insights into a potentially important pathway through which environmental quality may shape child growth and health.
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Affiliation(s)
- T W McDade
- Laboratory for Human Biology Research, Department of Anthropology, Northwestern University, Evanston, Illinois 60208, USA.
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Moffat T. Diarrhea, respiratory infections, protozoan gastrointestinal parasites, and child growth in Kathmandu, Nepal. AMERICAN JOURNAL OF PHYSICAL ANTHROPOLOGY 2003; 122:85-97. [PMID: 12923907 DOI: 10.1002/ajpa.10258] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
The differential impact of diarrhea, respiratory infections, and protozoan parasitism on growth is investigated among children under five years of age living in periurban Kathmandu, Nepal. The children's parents are all carpet-making workers who live in an environment with crowded living conditions, poor sanitation, and contaminated water. Anthropometric data, both cross-sectional and longitudinal, were collected over a 9-month period. Morbidity data were gathered from maternal reports, and a subsample of children's stools were examined for gastrointestinal parasites. In a comparison of current growth status and growth velocity for children with and without diarrhea and respiratory infections, it is found that body weight is most affected by infections, particularly for children under 24 months of age. For a subsample of children whose stools were tested for parasites, there is a statistically significant association between stunting (low height-for-age) and the presence of a protozoan gastrointestinal parasite. It is concluded that although growth faltering is associated with diarrhea and respiratory infections, the impact of these infections is of less importance for long-term linear growth retardation than is infection by protozoan gastrointestinal parasites.
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Affiliation(s)
- Tina Moffat
- Department of Anthropology, McMaster University, Hamilton, Ontario L8S 4L9, Canada.
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Bani IA, Saeed AAW, Othman AAMA. Diarrhoea and child feeding practices in Saudi Arabia. Public Health Nutr 2002; 5:727-31. [PMID: 12570881 DOI: 10.1079/phn2002354] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The aim of the study was to estimate the prevalence of diarrhoea in children less than two years old and study the relationship between diarrhoeal episodes and action taken for these episodes by their mothers. DESIGN The prevalence of diarrhoeal episodes among children and its associations with sociodemographic information and anthropometric measurements of the subjects was examined. Predictive factors for morbidity-associated diarrhoeal disease and actions taken for this were explored. SETTING Primary health care centres (PHCCs) in Riyadh, Kingdom of Saudi Arabia. SUBJECTS Children less than two years of age. RESULTS Nearly a quarter of the children contracted diarrhoea during the two weeks preceding the data collection point, giving about six episodes of diarrhoea per child per year. Diarrhoea was more common in children over 6 months of age, in children who had no vaccination or follow-up cards, and in those who were taken care of by friends and neighbours if their mothers were working outside the home. The mothers of the affected children were young, married before 25 years of age with 2-6 years of formal schooling. During diarrhoeal episodes, about 25% of mothers stopped or decreased breast-feeding, 11.3% reduced the volume of fluids given to their children, and 22.7% of children were fed less solid/semi-solid foods. Mothers used oral rehydration salt in more than 40% of diarrhoeal episodes and unprescribed antibiotics were used in 17% of cases. The mothers who were not taking appropriate action included young mothers with low education level and those working outside the home. CONCLUSION Diarrhoea is common in children less than two years old in Riyadh City, and intervention based in PHCCs needs to be undertaken to correct the faulty practices of mothers during diarrhoeal episodes in their children. Health education messages should emphasise feeding during diarrhoeal episodes.
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Affiliation(s)
- Ibrahim Ahmed Bani
- Department of Community Health Sciences, Applied Medical College, King Saud University, Riyadh, Saudi Arabia.
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Panter-Brick C, Lunn PG, Baker R, Todd A. Elevated acute-phase protein in stunted Nepali children reporting low morbidity: different rural and urban profiles. Br J Nutr 2001; 85:125-31. [PMID: 11227041 DOI: 10.1079/bjn2000225] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
This study examined the associations between severity of stunting, plasma protein concentrations and morbidity of 104 Nepali boys, aged 10-14 years, living in contrasting environments. Boys from a remote village were compared with three similarly aged urban groups: poor squatters, homeless street children, and middle-class schoolchildren. All but the middle-class group were stunted, particularly village boys whose mean height-for-age z-score (-2.97, SD 0.82) indicates severe growth retardation. Stunting was significantly associated with increased plasma levels of the acute-phase protein alpha1-antichymotrypsin itself inversely related to plasma levels of albumin. Plasma ACT levels of village children (mean 1.52 g/l, SD 0.43) were three to four times higher than those of squatters and homeless street children, and five times higher than those of middle-class boys. Despite being the most severely stunted and having the most abnormal plasma protein values, village children reported the lowest burden of disease, a contradiction which may reflect exposure to sub-clinical infections or habituation to illness and low expectation of treatment. This study draws attention to the strikingly high levels of ACT and of stunting in the rural sample, and cautions on the use of uncorroborated morbidity reports across different epidemiological and socio-ecological environments. Possible mechanisms to explain the impact of illness and inflammation on growth faltering are discussed.
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Affiliation(s)
- C Panter-Brick
- Department of Anthropology, University of Durham, Durham DH1 3HN, UK.
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Northrop-Clewes CA, Rousham EK, Mascie-Taylor CN, Lunn PG. Anthelmintic treatment of rural Bangladeshi children: effect on host physiology, growth, and biochemical status. Am J Clin Nutr 2001; 73:53-60. [PMID: 11124750 DOI: 10.1093/ajcn/73.1.53] [Citation(s) in RCA: 63] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND The effect of helminth infestation on the nutrition, growth, and physiology of the host is still poorly understood. Anthelmintic treatment of children in developing countries has had varying success in terms of growth improvements. OBJECTIVE The objective of this study was to assess the effect of regular deworming on child growth, physiology, and biochemical status. DESIGN The study was a 12-mo longitudinal intervention in 123 Bangladeshi children aged 2-5 y. Treatment (mebendazole) or placebo tablets were administered every 2 mo for 8 mo and again at 12 mo. Weight, height, midupper arm circumference, intestinal permeability, plasma albumin, alpha(1)-antichymotrypsin, and total protein concentration were assessed every 2 mo. RESULTS Treatment with mebendazole reduced the prevalence of Ascaris lumbricoides from 78% to 8%, of Trichuris trichiura from 65% to 9%, and of hookworm from 4% to 0%. There was no significant difference in the growth of treated children compared with those given placebo tablets. No changes in intestinal permeability or plasma albumin were observed after deworming. Significant decreases in total protein (P<0.001) and alpha(1)-antichymotrypsin (P<0.001) were observed in the treatment group, indicating possible reductions in inflammation and immunoglobulin concentration after deworming. A significant increase in the prevalence of Giardia intestinalis (from 4% to 49%) in the treatment group was associated with a short-term reduction in weight (P = 0.02) and higher intestinal permeability (P <0.001) in infected subjects. No long-term effects of G. intestinalis on growth were observed. CONCLUSION Low-intensity helminth infections, predominantly of A. lumbricoides and T. trichiura, do not contribute significantly to the poor growth and biochemical status of rural Bangladeshi children.
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Affiliation(s)
- C A Northrop-Clewes
- Human Nutrition Research Group, School of Biomedical Sciences, University of Ulster, Coleraine, Northern Ireland, United Kingdom
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Paracha PI, Jamil A, Northrop-Clewes CA, Thurnham DI. Interpretation of vitamin A status in apparently healthy Pakistani children by using markers of subclinical infection. Am J Clin Nutr 2000; 72:1164-9. [PMID: 11063444 DOI: 10.1093/ajcn/72.5.1164] [Citation(s) in RCA: 60] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Plasma retinol concentrations are depressed by infection but are commonly used to assess vitamin A status. OBJECTIVE We measured 2 acute phase proteins, alpha(1)-antichymotrypsin (ACT) and alpha(1)-acid glycoprotein (AGP), to determine whether they could be used to assist in interpreting vitamin A status. DESIGN In 1997, a 2-stage cluster-sampling procedure was used to select 3074 apparently healthy, 6-60-mo-old children from rural and urban areas of North West Frontier Province, Pakistan. Plasma retinol, ACT, AGP, and ferritin measurements and anthropometric measurements were obtained for 2519 children. RESULTS Median plasma retinol, ACT, AGP, and ferritin concentrations were 0.86 micromol/L, 0.39 g/L, 1.14 g/L, and 5.5 microg/L, respectively. There were no significant (P: > 0.05) differences in retinol, ACT, or AGP by sex or age. Some 797 children (32%) had retinol concentrations <0.7 micromol/L and 87 (4%) had retinol concentrations <0.35 micromol/L; 274 children (11%) had elevated ACT (>0.6 g/L) and 1141 (45%) had elevated AGP (>1.2 g/L). Retinol concentration correlated with ACT (r = -0.141), AGP (r = -0.138), and ferritin (r = -0.09) (all P: < 0.001), but stepwise multiple regression indicated that these 3 variables made a minimal although quantifiable contribution to the variance of retinol (ACT, r(2) = 0.02; all 3 variables, r(2) = 0.03). CONCLUSIONS The transient depression in plasma retinol produced by subclinical infection increased the number of at-risk children by 10% (76 of 797) and 56% (49 of 87) for plasma retinol concentrations <0.7 and <0.35 micromol/L, respectively. In addition, dietary inadequacy may be responsible for retinol concentrations being approximately 16% lower in Pakistani children than in children in the United Kingdom, where dietary vitamin A is adequate.
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Affiliation(s)
- P I Paracha
- Department of Nutrition, Agricultural University and Goverment Department of Health, Peshawar, North West Frontier Province, Pakistan
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Semba RD, West KP, Natadisastra G, Eisinger W, Lan Y, Sommer A. Hyporetinolemia and acute phase proteins in children with and without xerophthalmia. Am J Clin Nutr 2000; 72:146-53. [PMID: 10871573 DOI: 10.1093/ajcn/72.1.146] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The relations among hyporetinolemia, acute phase proteins, and vitamin A status in children are unclear. OBJECTIVE The objective was to examine the relations between acute phase proteins and plasma retinol concentrations in children with and without clinical vitamin A deficiency (Bitot spots and night blindness). DESIGN The study was a nonconcurrent analysis of acute phase protein concentrations and other data from a previous clinical trial. Preschool children, 3-6 y of age, with (n = 118) and without (n = 118) xerophthalmia were assigned to receive oral vitamin A (60 mg retinol equivalent) or placebo and were seen at 5 wk. All children received oral vitamin A (60 mg retinol equivalent) at 5 wk. RESULTS At baseline, alpha(1)-acid glycoprotein (AGP) was elevated in 42.9% and 23.5% (P < 0.003) and C-reactive protein (CRP) was elevated in 17.7% and 13.7% (NS) of children with and without xerophthalmia, respectively. Hyporetinolemia (retinol < 0.7 micromol/L) occurred in 61.0% and 47.4% (P < 0.04) of children with and without xerophthalmia, respectively. A history of fever, a history of cough, and nasal discharge noted on examination were each associated with elevated acute phase proteins. Vitamin A supplementation increased plasma retinol at 5 wk but had no significant effect on concentrations of acute phase proteins. CONCLUSIONS Elevated acute phase protein concentrations and infectious disease morbidity are closely associated during vitamin A deficiency.
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Affiliation(s)
- R D Semba
- Department of Ophthalmology, School of Medicine, Johns Hopkins University, Baltimore, MD, USA.
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Beesley R, al Serouri A, Filteau SM. Measurement of C-reactive protein in dried blood sports on filter paper. Trans R Soc Trop Med Hyg 2000; 94:348-9. [PMID: 10975017 DOI: 10.1016/s0035-9203(00)90350-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- R Beesley
- Centre for International Child Health, Institute of Child Health, London, UK
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