Does increased duration of exclusive breastfeeding protect against Helicobacter pylori Infection? The Newcastle Thousand Families Cohort Study at age 49-51 years

Helicobacter pylori Infection in a Pediatric Population from Romania: Risk Factors, Clinical and Endoscopic Features and Treatment Compliance

Background and Objectives: The aim of this study was to investigate the association between H. pylori positivity with specific symptoms, risk factors and endoscopic patterns among the pediatric population in northeastern Romania. Materials and Methods: A prospective study was performed in 18 months on 185 children aged 6−18 years with an indication for upper digestive endoscopy. Demographic, anamnestic, symptomatic, endoscopic and histologic data were recorded. Results: Of 116 H. pylori-positive children, the most affected group was 15−17 years. Most (65.5%) of them were girls, with a significant association (p < 0.001). The majority (66.4%) lived in a rural area and 47.4% of children had an unsafe source of water and lived in overcrowded houses with no basic sanitary comfort. The most frequent symptom was epigastric pain (56.9%), and the main endoscopic appearance was nodularity and hyperemia. Patients diagnosed with H. pylori started triple-therapy treatment for 14 days. Only 13.8% stopped the treatment, mainly because of a misunderstanding of the treatment protocol (9.5%). Conclusions: Romanian teen girls living in rural areas are at high risk for H. pylori infection. Epigastric pain and endoscopic nodularity of the gastric mucosa were associated with the infection. As the resistance of the bacteria is unknown in our country, future research is needed in order to improve the eradication rate.

Helicobacter pylori seropositivity protects against childhood asthma and inversely correlates to its clinical and functional severity

BACKGROUND

In recent years, the prevalence of asthma has risen in developed countries, and its extent related to a change in our indigenous microbiota. Helicobacter pylori disappearance across the population represents a fundamental change in our human microbiota and has preceded the rise in asthma prevalence.

OBJECTIVE

To assess the relationship between childhood asthma and Helicobacter pylori infection.

METHODS

Quantitative determination of Helicobacter pylori IgG among 90 asthmatic children and 90 - age and gender - matched non-atopic, non-asthmatic healthy children was performed using ELISA in serum of all participants.

RESULTS

Helicobacter pylori IgG seropositivity was found in 25.6% of asthmatics compared to 44.4% of controls. Asthmatics showed lower median Helicobacter pylori IgG titre compared to healthy controls. We also detected a significant inverse relationship between Helicobacter pylori IgG titre and asthma severity.

CONCLUSION

Helicobacter pylori seropositivity protects against childhood asthma and inversely correlates to its clinical and functional severity.

Breastfeeding and risk of infections at 6 years

BACKGROUND

Previous studies have shown that breastfeeding is associated with reductions in the risk of common infections among infants; however, whether breastfeeding confers longer term protection is inconclusive.

METHODS

We linked data from the 2005-2007 IFPS II (Infant Feeding Practices Study II) and follow-up data collected when the children were 6 years old. Multivariable logistic regression was used, controlling for sociodemographic variables, to examine associations of initiation, duration, exclusivity of breastfeeding, timing of supplementing breastfeeding with formula, and breast milk intensity (proportion of milk feedings that were breast milk from age 0-6 months) with maternal reports of infection (cold/upper respiratory tract, ear, throat, sinus, pneumonia/lung, and urinary) and sick visits in the past year among 6-year-olds (N = 1281).

RESULTS

The most common past-year infections were colds/upper respiratory tract (66%), ear (25%), and throat (24%) infections. No associations were found between breastfeeding and colds/upper respiratory tract, lung, or urinary tract infections. Prevalence of ear, throat, and sinus infections and number of sick visits differed according to breastfeeding duration, exclusivity, and timing of supplementing breastfeeding with formula (P < .05). Among children ever breastfed, children breastfed for ≥9 months had lower odds of past-year ear (adjusted odds ratio [aOR]: 0.69 [95% confidence interval (95% CI): 0.48-0.98]), throat (aOR: 0.68 [95% CI: 0.47-0.98]), and sinus (aOR: 0.47 [95% CI: 0.30-0.72]) infections compared with those breastfed >0 to <3 months. High breast milk intensity (>66.6%) during the first 6 months was associated with lower odds of sinus infection compared with low breast milk intensity (<33.3%) (aOR: 0.53 [95% CI: 0.35-0.79]).

CONCLUSIONS

This prospective longitudinal study suggests that breastfeeding may protect against ear, throat, and sinus infections well beyond infancy.

Breast-feeding and Helicobacter pylori infection: systematic review and meta-analysis

Objective

To quantify the association between breast-feeding and Helicobacter pylori infection, among children and adolescents.

Design

We searched MEDLINETM and ScopusTM up to January 2013. Summary relative risk estimates (RR) and 95 % confidence intervals were computed through the DerSimonian and Laird method. Heterogeneity was quantified using the I2 statistic.

Setting

Twenty-seven countries/regions; four low-income, thirteen middle-income and ten high-income countries/regions.

Subjects

Studies involving samples of children and adolescents, aged 0 to 19 years.

Results

We identified thirty-eight eligible studies, which is nearly twice the number included in a previous meta-analysis on this topic. Fifteen studies compared ever v. never breast-fed subjects; the summary RR was 0·87 (95 % CI 0·57, 1·32; I2=34·4 %) in middle-income and 0·85 (95 % CI 0·54, 1·34; I2=79·1 %) in high-income settings. The effect of breast-feeding for ≥4–6 months was assessed in ten studies from middle-income (summary RR=0·66; 95 % CI 0·44, 0·98; I2=65·7 %) and two from high-income countries (summary RR=1·56; 95 % CI 0·57, 4·26; I2=68·3 %). Two studies assessed the effect of exclusive breast-feeding until 6 months (OR=0·91; 95 % CI 0·61, 1·34 and OR=1·71; 95 % CI 0·66, 4·47, respectively).

Conclusions

Our results suggest a protective effect of breast-feeding in economically less developed settings. However, further research is needed, with a finer assessment of the exposure to breast-feeding and careful control for confounding, before definite conclusions can be reached.

Deprivation, timing of preschool infections and H. pylori seropositivity at age 49-51 years: the Newcastle Thousand Families birth cohort

Background

Helicobacter pylori infection is acquired in early childhood and persists for life (or until eradication treatment is taken). Seropositivity of H. pylori at age 49-51 years was assessed in relation to socio-economic deprivation in early life and the timing of other childhood infections common at that time.

Methods

Prospectively collected socio-economic and morbidity data from the Newcastle Thousand Families study, a birth cohort established in 1947. H. pylori IgG seropositivity was assessed at 49-51 years and examined in relation to both whether the individual had been diagnosed with one of measles, mumps or chicken pox, and, if so, the age at first infection. This was done in logistic regression models, allowing adjustment for socio-economic status and housing quality in childhood.

Results

Adult H. pylori status was strongly linked to disadvantaged socio-economic status in early life (p ≤ 0.002), unlike measles, mumps and chicken pox which showed no associations. Early measles infection was independently associated with H. pylori seropositivity (p = 0.01).

Conclusions

Of the four infectious diseases that we have studied, it appears that H. pylori differs from the others by the strength of association with socio economic deprivation in early childhood.

Our findings further highlight the complex interaction between measles, childhood infections and other non-microbiological factors that occur within a whole population. These data suggest a strong association between H. pylori and deprivation and raise the possibility of an interaction between early measles exposure and increased risk of exposure to H. pylori infection.

Nutrition and human health from a sex-gender perspective

Nutrition exerts a life-long impact on human health, and the interaction between nutrition and health has been known for centuries. The recent literature has suggested that nutrition could differently influence the health of male and female individuals. Until the last decade of the 20th century, research on women has been neglected, and the results obtained in men have been directly translated to women in both the medicine and nutrition fields. Consequently, most modern guidelines are based on studies predominantly conducted on men. However, there are many sex-gender differences that are the result of multifactorial inputs, including gene repertoires, sex steroid hormones, and environmental factors (e.g., food components). The effects of these different inputs in male and female physiology will be different in different periods of ontogenetic development as well as during pregnancy and the ovarian cycle in females, which are also age dependent. As a result, different strategies have evolved to maintain male and female body homeostasis, which, in turn, implies that there are important differences in the bioavailability, metabolism, distribution, and elimination of foods and beverages in males and females. This article will review some of these differences underlying the impact of food components on the risk of developing diseases from a sex-gender perspective.

Peptides from Pisum sativum L. enzymatic protein digest with anti-adhesive activity against Helicobacter pylori: structure-activity and inhibitory activity against BabA, SabA, HpaA and a fibronectin-binding adhesin

SCOPE

Identification of anti-adhesive peptides against Helicobacter pylori obtained by enzymatic hydrolysis of seed proteins from Pisum sativum L. (Fabaceae).

METHODS AND RESULTS

Bioassay-guided fractionation of protein tryptic digest by ultrafiltration, size exclusion chromatography (SEC) and reversed phase chromatography (RPC) were used. Identification of bioactive peptides was achieved by MALDI-TOF-MS. Adhesion of H. pylori was monitored by two different assays, using a quantitative in vitro assay on human AGS cells with evaluation of bacterial binding by flow cytometry, beside a semi-quantitative in situ adhesion assay using FITC-labelled H. pylori on human stomach tissue sections. From two highly active fractions (F3, F3.3) two anti-adhesive peptides (S3, S5) were identified. Neither F3 nor S3 or S5 had any cytotoxic effect against H. pylori. By hemagglutination assay and semiquantitative dot blot overlay assay with immobilized ligands it was shown that F3 interacts specifically with H. pylori adhesins BabA, SabA, HpaA and a fibronectin-binding adhesin, while S3 and S5 inhibit only BabA. It was demonstrated that BabA, usually interacting with carbohydrate motifs such as fucosylated blood group antigens, interacts with the peptide moieties.

CONCLUSION

Bioactive peptides from pea protein could be applied as functional ingredients for protecting infants and children against infections such as H. pylori.

Birth weight and early socio-economic disadvantage as predictors of sex hormones and sex hormone binding globulin in men at age 49-51 years

OBJECTIVES

A number of associations have been shown between early growth and later sex hormone levels in women, but less is known about this relationship in men. This study investigated life-course predictors of sex hormones in men in the Newcastle Thousand Families birth cohort.

METHODS

The Newcastle Thousand Families Study is a prospective study initiated in 1947. At age 49-51 years, 574 study members returned detailed self-completion questionnaires and 412 attended for clinical examination, including 172 men in whom blood samples were taken. Estradiol, follicle stimulating hormone (FSH), luteinizing hormone (LH), testosterone, and sex hormone binding globulin (SHBG) were measured. Free testosterone concentrations were also calculated.

RESULTS

Social class at birth independently predicted FSH and LH, with higher levels with increasing socioeconomic disadvantage. SHBG was higher with increasing standardized birth weight and lower with increasing contemporary body mass index (BMI). BMI also predicted LH, SHBG, and testosterone. None of the variables included within this analysis were significant predictors of estradiol. No other associations were seen with any of the variables included from across the life-course.

CONCLUSIONS

Our findings suggest that birth weight may be positively associated with SHBG and early socioeconomic status may be related to FSH and LH in men. These novel findings are independent of contemporary BMI. Given the links between sex hormones, SHBG and disease outcomes such as type II diabetes and osteoporosis, it is possible that sex hormones may play a mediating role in the associations between circumstances in early life and later risk of chronic disease.

Transmission pathway of Helicobacter pylori: does food play a role in rural and urban areas?

Helicobacter pylori is a Gram-negative microaerophilic bacterium that has colonized the human gastric mucosa. This infection is very common and affects more than half of the human population. The prevalence is however unbalanced between rural developing areas (more than 80%) and urban developed areas (less than 40%). H. pylori is responsible for several pathologies, such as gastritis, peptic ulcer and gastric cancer but its transmission pathway is still not clear. The risk factors for H. pylori infection include poor social and economic development; poor hygienic practices; absence of hygienic drinking water; and unsanitary prepared food. There is evidence supporting a gastro-oral, oral-oral and faecal-oral transmission, but no predominant mechanism of transmission has been yet identified. Transmission may occur in a vertical mode (e.g. from parents to child) or in a horizontal mode (across individuals or from environmental contamination). In either case, the involvement of water and food cannot be excluded as vehicles or sources of infection. Indirect evidence of presence of H. pylori in water and food, namely the detection of its DNA and survival studies after artificial contamination of food and water has been described. This paper reviews data both favourable and against the role of water and food in the transmission of H. pylori, exploring their role as a potential transmission vehicle for person-to-person and food-chain transmission. The likelihood of the transmission pathway in developing rural and developed urban areas appears to be different. In developed areas, person-to-person transmission within families appears to be dominant, while in the rural developing areas the transmission pathway appears to be more complex. In this later case, the transmission by contaminated food, water, or via intensive contact between infants and non-parental caretakers may have a greater influence than within-family transmission.

Sex differences in the association between infant feeding and blood cholesterol in later life: the Newcastle thousand families cohort study at age 49-51 years

Previous studies have suggested an association between being breastfed and later cholesterol levels. We investigated whether duration of total and exclusive breastfeeding were related to circulating total, HDL and LDL cholesterol and triglyceride measures at age 50, and whether such associations differ between men and women. Members of the Newcastle thousand families study were followed from birth in 1947. Men (n = 179) and 226 women (n = 226) with blood cholesterol and triglyceride measures at age 50 and with prospectively recorded duration of both total and exclusive breastfeeding were included. Neither total duration nor duration of exclusive breastfeeding were associated with the outcome measures when analysing both sexes together. However, in sex specific analyses significant associations between duration of exclusive breastfeeding and both total and LDL cholesterol (adjusted regression coefficient (r) per 30 days = 0.12 mmol/l (95% CI 0.04-0.20) P = 0.004 for total cholesterol and adjusted r per 30 days = 0.10 mmol/l (95% CI 0.02-0.18) P = 0.016 for LDL cholesterol) were seen for women with no significant associations observed in men. Significant interactions between duration of exclusive breastfeeding and sex were seen for total and LDL cholesterol (P = 0.02 and P = 0.03, respectively) with a near-significant interaction for HDL cholesterol (P = 0.06). In all cases, greater increases in cholesterol with increasing duration of exclusive breastfeeding were seen for women than for men. In conclusion, the association between breastfeeding and adult cholesterol levels differs between men and women and in women remains a significant association even after adjustment for potential confounders. However, our findings may not reflect the situation in younger generations.

Initiation of breastfeeding and prevalence of exclusive breastfeeding at hospital discharge in urban, suburban and rural areas of Zhejiang China

BACKGROUND

Rates of exclusive breastfeeding in China are relatively low and below national targets. The aim of this study was to document the factors that influence exclusive breastfeeding initiation in Zhejiang, PR China.

METHODS

A cohort study of infant feeding practices was undertaken in Zhejiang Province, an eastern coastal region of China. A total of 1520 mothers who delivered in four hospitals located in city, suburb and rural areas during late 2004 to 2005 were enrolled in the study. Multivariate logistic regression analysis was used to explore factors related to exclusive breastfeeding initiation.

RESULTS

On discharge from hospital, 50.3% of the mothers were exclusively breastfeeding their infants out of 96.9% of the mothers who had earlier initiated breastfeeding. Exclusive breastfeeding was positively related to vaginal birth, baby's first feed being breast milk, mother living in the suburbs or rural areas, younger age of mother, lower maternal education level and family income.

CONCLUSION

The exclusive breastfeeding rate in Zhejiang is only 50.3% on discharge and does not reach Chinese or international targets. A number of behaviours have been identified in the study that could be potentially incorporated into health promotion activities.

A new model for the transmission of Helicobacter pylori: role of environmental reservoirs as gene pools to increase strain diversity

Twenty-five years after the first successful cultivation and isolation of Helicobacter pylori, the scientific community is still struggling to understand the way(s) this bacterium is transmitted among the human population. Here, both epidemiologic and microbiologic evidence addressing this matter is reviewed and explored to conclude that most H. pylori successful colonizations are derived from direct person-to-person contact and that even though exposure of humans to H. pylori from environmental sources is a very common event, in most occasions the host is able to fight off infection. In addition, under a new model developed here, we propose that the near elimination of environmental reservoirs is the main responsible for the lower prevalence observed in the more industrialized countries by acting on two levels: by decreasing the number of direct infections and by diminishing the number of intraspecies recombination events for producing strain variation within H. pylori.

Epidemiology of Helicobacter pylori infection

Differences may occur in the mode of transmission of Helicobacter pylori between developed and developing countries: direct human-to-human contacts have been suggested as the primary route in the former while the fecal-oral route, also, through contaminated water, in the latter. Data on intrafamilial transmission of H. pylori among children continue to be produced. The importance of low socioeconomic conditions on the acquisition of H. pylori infection has been confirmed in a number of population-based studies. Due to the improvement of living standards, the prevalence of the infection has fallen dramatically in many countries. It varies from 8.9 to 72.8% among children from developed and developing countries, respectively, the re-infection rate being also significantly higher in the latter. Conflicting data have been reported on the effect of breastfeeding against H. pylori colonization in infancy as well as on the occupational risk for acquiring H. pylori. This review summarizes recent results from the literature on these topics.

Breast feeding and future health

PURPOSE OF REVIEW

This review discusses the long-term health effects of breast feeding, based on the most relevant publications from the second half of 2004 and 2005.

RECENT FINDINGS

The positive effect of breast feeding on later cognitive function continues to be the most consistent and important effect. Also, breast feeding is likely to protect against some immune-related diseases later in life, such as type 1 diabetes, coeliac disease, inflammatory bowel diseases and perhaps cancer. The evidence for an effect on allergic disease continues to be inconclusive. Furthermore, breast feeding seems to be associated with a lower blood pressure and serum cholesterol, but there is no clear association with cardiovascular disease or death. Most new studies and meta-analyses show a protective effect against later obesity, but this seems to be small. A new hypothesis suggests that breast feeding programmes the insulin-like growth factor axis and results in higher growth velocity later in childhood.

SUMMARY

Evidence is increasing that breast feeding, beyond its well-established beneficial effects during the breast-feeding period, also confers long-term benefits. These effects are not strong at the individual level, but are likely to be of importance at the population level. Since the majority of the studies are observational, however, it is difficult to prove causality.