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Cusick SE, Tielsch JM, Ramsan M, Jape JK, Sazawal S, Black RE, Stoltzfus RJ. Inflammation is strongly associated with Plasmodium falciparum malaria and predicts erythropoietin, soluble transferrin receptor, and zinc protoporphyrin concentrations in severely anemic Zanzibari preschool children. FASEB J 2008. [DOI: 10.1096/fasebj.22.1_supplement.873.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Sarah E Cusick
- U.S. Centers for Disease Control and PreventionAtlantaGA
| | - James M Tielsch
- Department of International HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreMD
| | | | - Jape K Jape
- Zanzibar Malaria Control ProgramZanzibarTanzania
| | - Sunil Sazawal
- Department of International HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreMD
| | - Robert E Black
- Department of International HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreMD
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Cusick SE, Tielsch JM, Ramsan M, Jape JK, Sazawal S, Black RE, Stoltzfus RJ. Short-term effects of vitamin A and antimalarial treatment on erythropoiesis in severely anemic Zanzibari preschool children. Am J Clin Nutr 2005; 82:406-12. [PMID: 16087986 DOI: 10.1093/ajcn.82.2.406] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The pathophysiology of anemia in coastal East Africa is complex. Impaired erythropoietin production is one possible mechanism. Plasmodium falciparum malaria has been found to blunt erythropoietin production, whereas vitamin A stimulates erythropoietin production in vitro. OBJECTIVE We investigated the 72-h effects of vitamin A and the antimalarial drug sulfadoxine pyramethamine (SP) on erythropoietin production in severely anemic (hemoglobin < or = 70 g/L) preschool children in Zanzibar, a region of known vitamin A deficiency. We hypothesized that both treatments would stimulate erythropoietin production directly, within 72 h, before a change in hemoglobin would occur. DESIGN One hundred forty-one severely anemic children were identified during the baseline assessment of a morbidity substudy of a community-based micronutrient supplementation trial. All severely anemic children were randomly assigned to receive either vitamin A (100,000 or 200,000 IU depending on age) or SP at baseline; 72 h later they received the opposite treatment plus daily hematinic syrup for 90 d. Erythropoietic and parasitic indicators were assessed at baseline and again after 72 h. RESULTS After 72 h, SP reduced the malaria parasite density (by 5029 parasites/microL; P < 0.001), CRP concentrations (by 10.6 mg/L; P = 0.001), and the proportion of children infected with malaria (by 32.4%; P < 0.001). Vitamin A reduced CRP (by 9.6 mg/L; P = 0.011), serum ferritin (by 18.1 microg/L; P = 0.042), and erythropoietin (by 194.7 mIU/mL; P = 0.011) concentrations and increased the reticulocyte production index (by 0.40; P = 0.041). CONCLUSIONS Contrary to our hypothesis, vitamin A significantly decreased erythropoietin concentration. The most important effect of both vitamin A and SP was the rapid reduction of inflammation. Vitamin A also mobilized iron from stores and stimulated the production of new erythrocytes.
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Affiliation(s)
- Sarah E Cusick
- Center for Human Nutrition, Department of International Health, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
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Cusick SE, Tielsch JM, Ramsan M, Jape JK, Sazawal S, Black RE, Stoltzfus RJ. Short-term effects of vitamin A and antimalarial treatment on erythropoiesis in severely anemic Zanzibari preschool children. Am J Clin Nutr 2005. [DOI: 10.1093/ajcn/82.2.406] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Sarah E Cusick
- From the Center for Human Nutrition, Department of International Health, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (SEC, JMT, SS, REB, and RJS); the Public Health Laboratory Ivo de Carneri, Wawi, Chake Chake, Pemba Island, Zanzibar, United Republic of Tanzania (MR and JKJ); and the Division of Nutritional Sciences, Cornell University, Ithaca, NY (RJS)
| | - James M Tielsch
- From the Center for Human Nutrition, Department of International Health, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (SEC, JMT, SS, REB, and RJS); the Public Health Laboratory Ivo de Carneri, Wawi, Chake Chake, Pemba Island, Zanzibar, United Republic of Tanzania (MR and JKJ); and the Division of Nutritional Sciences, Cornell University, Ithaca, NY (RJS)
| | - Mahdi Ramsan
- From the Center for Human Nutrition, Department of International Health, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (SEC, JMT, SS, REB, and RJS); the Public Health Laboratory Ivo de Carneri, Wawi, Chake Chake, Pemba Island, Zanzibar, United Republic of Tanzania (MR and JKJ); and the Division of Nutritional Sciences, Cornell University, Ithaca, NY (RJS)
| | - Jape K Jape
- From the Center for Human Nutrition, Department of International Health, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (SEC, JMT, SS, REB, and RJS); the Public Health Laboratory Ivo de Carneri, Wawi, Chake Chake, Pemba Island, Zanzibar, United Republic of Tanzania (MR and JKJ); and the Division of Nutritional Sciences, Cornell University, Ithaca, NY (RJS)
| | - Sunil Sazawal
- From the Center for Human Nutrition, Department of International Health, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (SEC, JMT, SS, REB, and RJS); the Public Health Laboratory Ivo de Carneri, Wawi, Chake Chake, Pemba Island, Zanzibar, United Republic of Tanzania (MR and JKJ); and the Division of Nutritional Sciences, Cornell University, Ithaca, NY (RJS)
| | - Robert E Black
- From the Center for Human Nutrition, Department of International Health, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (SEC, JMT, SS, REB, and RJS); the Public Health Laboratory Ivo de Carneri, Wawi, Chake Chake, Pemba Island, Zanzibar, United Republic of Tanzania (MR and JKJ); and the Division of Nutritional Sciences, Cornell University, Ithaca, NY (RJS)
| | - Rebecca J Stoltzfus
- From the Center for Human Nutrition, Department of International Health, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (SEC, JMT, SS, REB, and RJS); the Public Health Laboratory Ivo de Carneri, Wawi, Chake Chake, Pemba Island, Zanzibar, United Republic of Tanzania (MR and JKJ); and the Division of Nutritional Sciences, Cornell University, Ithaca, NY (RJS)
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Mebrahtu T, Stoltzfus RJ, Chwaya HM, Jape JK, Savioli L, Montresor A, Albonico M, Tielsch JM. Low-dose daily iron supplementation for 12 months does not increase the prevalence of malarial infection or density of parasites in young Zanzibari children. J Nutr 2004; 134:3037-41. [PMID: 15514272 DOI: 10.1093/jn/134.11.3037] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Conflicting evidence exists on the possible role of iron supplementation in the predisposition to malaria infection or the enhancement of its clinical severity. Where anemia prevalence is >40%, current guidelines are to provide low-dose daily iron to young children for up to 18 mo. Earlier studies used doses higher than the current guidelines, intermittent doses, or have supplemented for durations < or = 4 mo. We aimed to assess the effect of low-dose, long-term iron supplementation on malaria infection using a double-blind, placebo-controlled, randomized design, and to examine possible subgroup effects by season and child age. The study was conducted in Pemba Island, Zanzibar, where Plasmodium falciparum malaria has year-round high transmission. A community-based sample of 614 children 4-71 mo old was randomly allocated to 10 mg/d iron or placebo for 12 mo. Outcome measures were the prevalence and density of malaria infection, which was assessed by blood films at monthly intervals. At baseline, 94.4% were anemic (hemoglobin < 110 g/L), 48.1% were stunted (height-for-age Z-score less than -2) and >80% had malaria-positive blood films. No significant differences in malariometric indices were observed between children in the iron-supplemented and placebo groups. Parasite density was higher in certain months and in younger children, but iron supplementation was not associated with any malarial infection outcome in any season or age subgroup. We conclude that in this environment of high malaria transmission, daily oral low-dose supplementation of iron for 12 mo did not affect the prevalence of malaria infection or parasite density.
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Affiliation(s)
- Tsedal Mebrahtu
- Department of International Health, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
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