Early dietary influence on later immunocompetence

Vitamin A deficiency during rat pregnancy alters placental TNF-alpha signalling and apoptosis

PROBLEM

Vitamin A is important for immune function and deficiency is associated with adverse pregnancy outcome. In the rat, vitamin A deficiency reduces both foetal number and neonatal survival. The role of the placenta is uncertain. The effects of maternal vitamin A deficiency on placental cytokines and apoptosis have been investigated.

METHOD OF STUDY

Pregnant rats were fed either control or vitamin A free (VAF) diets (n = 4/group) from 8 weeks prior to and throughout pregnancy. Day 20 placentas from viable foetuses were examined for immunoexpression of (a) cytokines: tumour necrosis factor-alpha (TNF-alpha), TNFR1 receptor (p55), leptin and leptin receptor, (b) apoptosis: TdT-mediated dUTP nick end-labelling (TUNEL) positive cells, bax and bcl-2.

RESULTS

Placentas from VAF rats, but not controls, exhibited an infiltrate of neutrophils positive for TNF-alpha and leptin. The number of TNFR1 (p55) and TUNEL positive trophoblast cells was increased specifically in areas of neutrophil infiltration. Trophoblast giant cells in VAF placentas exhibited reduced bax but no change in bcl-2.

CONCLUSIONS

Maternal vitamin A deficiency is associated with abnormal placental apoptosis induced by neutrophil derived TNF-alpha acting through the TNFR1 (p55) and/or a change in the bcl-2/bax ratio in the trophoblast giant cells. These changes may underlie the effects of vitamin A deficiency on foetal development.

Elimination diet in cow's milk allergy: risk for impaired growth in young children

OBJECTIVE

The objective of this study was to evaluate the nutritional impact of therapeutic elimination diets and to identify risk factors predisposing infants with food allergy to poor growth.

STUDY DESIGN

We studied 100 children (mean age 7 months) with atopic dermatitis and challenge-proven cow's milk allergy and evaluated their growth during the symptomatic period before diagnosis and during the therapeutic elimination diet.

RESULTS

Clinical control of symptoms was achieved in all patients. The mean length SD score and weight-for-length index of patients decreased compared with those in healthy age-matched children, p < 0.0001 and p = 0.03, respectively. Low serum albumin was present in 6% of the patients, 24% had an abnormal urea concentration, and 8% had a low serum phospholipid docosahexaenoic acid. The delay in growth was more pronounced in a subgroup of patients with early onset than in those with later of symptoms (F = 6.665, p < 0.0001). The duration of breast-feeding correlated positively with the sum of n-3 polyunsaturated fatty acids (r = 0.39, p = 0.001) and with the relative amount of docosahexaenoic acid (r = 0.36, p = 0.002).

CONCLUSION

A delicate balance exists between the benefits and the risks of elimination diets.

Postnatal growth patterns of full-term low birth weight infants in Northeast Brazil are related to socioeconomic status

Low birth weight has many adverse consequences, some of which might be ameliorated if there is good postnatal compensatory, or catch-up, growth. We monitored growth, morbidity and feeding patterns in a cohort of 133 full-term, low birth weight infants from poor families in Pernambuco, Brazil, and investigated the relative contributions of a number of socioeconomic, maternal and infant variables to postnatal growth. Growth was measured at 4, 8, 17, 26 and 52 wk of age. Differential growth patterns were most marked during the first 8 wk of life, and the gains in z-score during this interval were strongly associated with attained z-scores at 12 months (r = 0.62 for weight and 0.64 for length). In a multivariate model, socioeconomic variables explained 21.4% of the variation in maximum gain in weight-for-age z-score achieved during the 12-month period, maternal weight explained a further 4.4%, infant birth length 4.7% and neonatal illness 5.4%. For maximum gain in length-for-age z-score, socioeconomic variables accounted for 24.4% of the variance, maternal height 4.9%, maternal smoking 3.3% and neonatal illness 3.1%. We surmise that the early differential growth patterns are set in utero and are indirectly affected prenatally by socioeconomic status.

Decreased thymus size in formula-fed infants compared with breastfed infants

The objective of this research was to investigate if breastfeeding affects the size of the thymus. Ultrasound assessment of the thymic index (a volume estimate) at birth and age 4 months in 47 healthy infants born in the hospital were used. History of feeding mode, body size and illness were registered. At 4 months the geometric mean thymic index (range) was 38.3 (16.2-83.2) in exclusively breastfed infants (n = 21), 27.3 (15.6-50.0) in partially breastfed infants (n = 13) and 18.3 (12.2-32.6) in formula fed infants (n = 13; p = 0.0001, ANOVA). This finding was independent of weight, length, sex and previous or current illness. There was no significant difference in mean thymic index at birth between the three feeding groups and mean thymic index had increased in all three groups from birth to 4 months. For the formula-fed infants it seems that the thymus remains large for a period and then decreases in size after breastfeeding has been terminated. We conclude that the thymus is considerably larger in breastfed than in formula-fed infants at the age of 4 months. The cause of this difference is unknown but human milk contains many immune modulating factors that might cause this effect.