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Chiwila MK, Krebs NF, Manasyan A, Chomba E, Mwenechanya M, Mazariegos M, Sami N, Pasha O, Tshefu A, Lokangaka A, Goldenberg RL, Bose CL, Koso-Thomas M, Goco N, Do BT, McClure EM, Hambidge KM, Westcott JE, Carlo WA. Junk food use and neurodevelopmental and growth outcomes in infants in low-resource settings. Front Public Health 2024; 12:1308685. [PMID: 38686037 PMCID: PMC11057493 DOI: 10.3389/fpubh.2024.1308685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 03/18/2024] [Indexed: 05/02/2024] Open
Abstract
Introduction Feeding infants a sub-optimal diet deprives them of critical nutrients for their physical and cognitive development. The objective of this study is to describe the intake of foods of low nutritional value (junk foods) and identify the association with growth and developmental outcomes in infants up to 18 months in low-resource settings. Methods This is a secondary analysis of data from an iron-rich complementary foods (meat versus fortified cereal) randomized clinical trial on nutrition conducted in low-resource settings in four low- and middle-income countries (Democratic Republic of the Congo, Guatemala, Pakistan, and Zambia). Mothers in both study arms received nutritional messages on the importance of exclusive breastfeeding up to 6 months with continued breastfeeding up to at least 12 months. This study was designed to identify the socio-demographic predictors of feeding infants' complementary foods of low nutritional value (junk foods) and to assess the associations between prevalence of junk food use with neurodevelopment (assessed with the Bayley Scales of Infant Development II) and growth at 18 months. Results 1,231 infants were enrolled, and 1,062 (86%) completed the study. Junk food feeding was more common in Guatemala, Pakistan, and Zambia than in the Democratic Republic of Congo. 7% of the infants were fed junk foods at 6 months which increased to 70% at 12 months. Non-exclusive breastfeeding at 6 months, higher maternal body mass index, more years of maternal and paternal education, and higher socioeconomic status were associated with feeding junk food. Prevalence of junk foods use was not associated with adverse neurodevelopmental or growth outcomes. Conclusion The frequency of consumption of junk food was high in these low-resource settings but was not associated with adverse neurodevelopment or growth over the study period.
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Affiliation(s)
| | - Nancy F. Krebs
- University of Colorado School of Medicine, Aurora, CO, United States
| | - Albert Manasyan
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, United States
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Elwyn Chomba
- Global Network, University Teaching Hospital, Lusaka, Zambia
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, United States
| | | | - Manolo Mazariegos
- Instituto de Nutrición de Centro América y Panamá, Guatemala City, Guatemala
| | - Neelofar Sami
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Omrana Pasha
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Antoinette Tshefu
- School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Adrien Lokangaka
- School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Robert L. Goldenberg
- Department of Obstetrics and Gynecology, Columbia University, New York, NY, United States
| | - Carl L. Bose
- Department of Pediatrics, University of North Carolina, Chapel Hill, NC, United States
| | - Marion Koso-Thomas
- Eunice Kennedy Shiver National Institute of Child Health and Human Development, Bethesda, MD, United States
| | - Norman Goco
- Research Triangle Institute International, Durham, NC, United States
| | - Barbara T. Do
- Research Triangle Institute International, Durham, NC, United States
| | | | | | - Jamie E. Westcott
- University of Colorado School of Medicine, Aurora, CO, United States
| | - Waldemar A. Carlo
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, United States
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Long JM, Gatica‐Domínguez G, Westcott JE, Taren D, Tejeda G, Diba TS, Mastiholi SC, Khan US, Garcés A, Figueroa L, Lokangaka A, Goudar SS, Aziz Ali S, Hambidge KM, Krebs NF. Infant and young child feeding indicators are positively associated with length and family care indicators in the children of the Women First trial participants. Matern Child Nutr 2024; 20:e13572. [PMID: 37817452 PMCID: PMC10750017 DOI: 10.1111/mcn.13572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 08/24/2023] [Accepted: 09/13/2023] [Indexed: 10/12/2023]
Abstract
This research describes the proportion of children in four low- and middle-income countries with adequate dietary practices at 6, 12, 18 and 24 months of age and how these practices changed over time using the World Health Organisation and UNICEF's infant young child feeding (IYCF) indicators. The associations between the IYCF indicators and anthropometric z-scores from 6 to 24 months, and between the IYCF indicators and the family care indicators (FCIs) at 24 months are described. This was a longitudinal study of offspring from participants in the Women First Preconception Maternal Nutrition Trial conducted in Sud-Ubangi, Democratic Republic of Congo; Chimaltenango, Guatemala; Belagavi, North Karnataka, India; and Thatta, Sindh Province, Pakistan. The frequency of the minimum dietary diversity (MDD), minimum meal frequency (MMF), and minimum adequate diet (MAD) increased between 6 and 24 months, but even at 24 months MAD remained below 50% at all sites. MDD (β = 0.12; 95% CI = 0.04-0.22) and MMF (β = 0.10; 95% CI = 0.03-0.17) were positively associated with length-for-age z-score at 24 months. All IYCF indicators were positively associated with mean total FCI score: MDD (proportion ratio [PR] = 1.04; 95% CI = 1.02-1.07), MMF (PR = 1.02; 95% CI = 1.01-1.04), MAD (PR = 1.05; 95% CI = 1.02-1.08). Although there are multiple barriers to young children having an adequate diet, our results support a positive association between familial interactions and improved IYCF feeding practices.
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Affiliation(s)
- Julie M. Long
- Department of Pediatrics, Section of NutritionUniversity of Colorado School of MedicineAuroraColoradoUSA
| | - Giovanna Gatica‐Domínguez
- Maternal and Infant Health CenterInstituto de Nutrición de Centro América y PanamáGuatemala CityGuatemala
| | - Jamie E. Westcott
- Department of Pediatrics, Section of NutritionUniversity of Colorado School of MedicineAuroraColoradoUSA
| | - Douglas Taren
- Department of Pediatrics, Section of NutritionUniversity of Colorado School of MedicineAuroraColoradoUSA
| | - Gabriela Tejeda
- Maternal and Infant Health CenterInstituto de Nutrición de Centro América y PanamáGuatemala CityGuatemala
| | - Tshilenge S. Diba
- Kinshasa School of Public Health, Democratic Republic of CongoKinshasaDemocratic Republic of the Congo
| | - Shivanand C. Mastiholi
- Women's and Children's Health Research UnitKLE Academy of Higher Education and Research's Jawaharlal Nehru Medical CollegeBelagaviIndia
| | - Umber S. Khan
- Department of Community Health SciencesAga Khan UniversityKarachiPakistan
| | - Ana Garcés
- Maternal and Infant Health CenterInstituto de Nutrición de Centro América y PanamáGuatemala CityGuatemala
| | - Lester Figueroa
- Maternal and Infant Health CenterInstituto de Nutrición de Centro América y PanamáGuatemala CityGuatemala
| | - Adrien Lokangaka
- Kinshasa School of Public Health, Democratic Republic of CongoKinshasaDemocratic Republic of the Congo
| | - Shivaprasad S. Goudar
- Women's and Children's Health Research UnitKLE Academy of Higher Education and Research's Jawaharlal Nehru Medical CollegeBelagaviIndia
| | - Sumera Aziz Ali
- Department of Community Health SciencesAga Khan UniversityKarachiPakistan
| | - K. Michael Hambidge
- Department of Pediatrics, Section of NutritionUniversity of Colorado School of MedicineAuroraColoradoUSA
| | - Nancy F. Krebs
- Department of Pediatrics, Section of NutritionUniversity of Colorado School of MedicineAuroraColoradoUSA
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Aziz Ali S, Khan U, Abrejo F, Vollmer B, Saleem S, Hambidge KM, Krebs NF, Westcott JE, Goldenberg RL, McClure EM, Pasha O. Use of Smokeless Tobacco Before Conception and Its Relationship With Maternal and Fetal Outcomes of Pregnancy in Thatta, Pakistan: Findings From Women First Study. Nicotine Tob Res 2021; 23:1291-1299. [PMID: 33084903 PMCID: PMC8360631 DOI: 10.1093/ntr/ntaa215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 10/15/2020] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Smokeless tobacco (SLT) consumption during pregnancy has adverse consequences for the mother and fetus. We aimed to investigate the effects of maternal pre-pregnancy SLT consumption on maternal and fetal outcomes in the district of Thatta, Pakistan. AIMS AND METHODS We conducted a secondary data analysis of an individual randomized controlled trial of preconception maternal nutrition. Study participants were women of reproductive age (WRA) residing in the district of Thatta, Pakistan. Participants were asked questions regarding the usage of commonly consumed SLT known as gutka (exposure variable). Study outcomes included maternal anemia, miscarriage, preterm births, stillbirths, and low birth weight. We performed a cox-regression analysis by controlling for confounders such as maternal age, education, parity, working status, body mass index, and geographic clusters. RESULTS The study revealed that 71.5% of the women reported using gutka, with a higher proportion residing in rural areas as compared with urban areas in the district of Thatta, Pakistan. In the multivariable analysis, we did not find a statistically significant association between gutka usage and anemia [(relative risk, RR: 1.04, 95% confidence interval, CI (0.92 to 1.16)], miscarriage [(RR: 1.08, 95% CI (0.75 to 1.54)], preterm birth [(RR: 1.37, 95% CI (0.64 to 2.93)], stillbirth [(RR: 1.02, 95% CI (0.39 to 2.61)], and low birth weight [(RR: 0.96, 95% CI (0.72 to 1.28)]. CONCLUSIONS The study did not find an association between gutka usage before pregnancy and adverse maternal and fetal outcomes. In the future, robust epidemiological studies are required to detect true differences with a dose-response relationship between gutka usage both before and during pregnancy and adverse fetomaternal outcomes. IMPLICATIONS While most epidemiological studies conducted in Pakistan have focused on smoking and its adverse outcomes among males, none of the studies have measured the burden of SLT among WRA and its associated adverse outcomes. In addition, previously conducted studies have primarily assessed the effect of SLT usage during pregnancy rather than before pregnancy on adverse fetal and maternal outcomes. The current study is unique because it provides an insight into the usage of SLT among WRA before pregnancy and investigates the association between pre-pregnancy SLT usage and its adverse fetomaternal outcomes in rural Pakistan.
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Affiliation(s)
- Sumera Aziz Ali
- Department of Epidemiology, Columbia University New York, NY, USA
| | - Umber Khan
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Farina Abrejo
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Brandi Vollmer
- Department of Epidemiology, Columbia University New York, NY, USA
| | - Sarah Saleem
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - K Michael Hambidge
- Department of Pediatrics, Section of Nutrition, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Nancy F Krebs
- Department of Pediatrics, Section of Nutrition, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Jamie E Westcott
- Department of Pediatrics, Section of Nutrition, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Robert L Goldenberg
- Department of Obstetrics and Gynecology, Columbia University, New York, NY, USA
| | | | - Omrana Pasha
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Aziz Ali S, Feroz A, Abbasi Z, Aziz Ali S, Allana A, Hambidge KM, Krebs NF, Westcott JE, McClure EM, Goldenberg RL, Saleem S. Perceptions of women, their husbands and healthcare providers about anemia in rural Pakistan: Findings from a qualitative exploratory study. PLoS One 2021; 16:e0249360. [PMID: 33905421 PMCID: PMC8078764 DOI: 10.1371/journal.pone.0249360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Accepted: 03/16/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND In Pakistan, there is a dearth of literature on the perceptions of anemia among women of reproductive age (WRA). This study was undertaken to explore the perceptions of women, their husbands, and healthcare providers about anemia, its possible causes, and how anemia impacts maternal and child health in Thatta, Pakistan. METHODS A qualitative study was conducted in Thatta, Pakistan from September to December 2018. Using a pre-tested semi-structured interview (SSI), we collected data to understand their definitions of anemia through ten focus group discussions (FGDs) with women and their partners and ten primary informant interviews (KIIs) with healthcare providers. We identified six major themes: (I) Knowledge and awareness of anemia, (II) Causes and consequences of Anemia, (III) Dietary practices, (IV) Knowledge and practices regarding the use of iron-folic acid supplements, (V) Factors influencing prevention and control of anemia and (VI) Women's health behavior. We analyzed the data through thematic analysis using NVivo 10 software. RESULTS Most community members were not aware of the term anemia but described anemia as a condition characterized by 'blood deficiency' in the body. All study participants perceived anemia as an important health problem tending to cause adverse outcomes among WRA and their children. Study participants perceived gutka (chewable tobacco) consumption as an important cause of anemia. Healthcare providers identified short inter-pregnancy intervals, lack of family planning, poor health-seeking behavior, and consumption of unhealthy food as causes of anemia in the district. Consumption of unhealthy food might not be related to related to a poorer knowledge of iron-deficient foods, but economic constraints. This was further endorsed by the healthcare providers who mentioned that most women were too poor to afford iron-rich foods. All men and women were generally well versed with the sources of good nutrition to be consumed by WRA to prevent anemia. CONCLUSION The findings suggest that the government should plan to develop strategies for poverty-stricken and vulnerable rural women and plan health awareness programs to improve dietary practices, compliance with supplements, and health-seeking behavior among women of reproductive age. There is a need to develop effective counseling strategies and context-specific health education sessions to improve the health-seeking behavior of women and men in the Thatta district of Pakistan. Besides, there is need to address social determinants of health such as poverty that pushes women of poorer socioeconomic strata to eat less nutritious foods and have more anaemia. Therefore, a comprehensive and robust strategic plan need to be adopted by government that focuses not only on the awareness programs, but also aim to reduce inequities that lead to pregnant women eat iron-poor foods, which, in turn, forces them to become anemic.
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Affiliation(s)
- Sumera Aziz Ali
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City, New York, United States of America
| | - Anam Feroz
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Zahid Abbasi
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Savera Aziz Ali
- Department of Nursing, University of Alberta, Edmonton, Canada
| | - Ahreen Allana
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - K. Michael Hambidge
- Department of Pediatrics, Section of Nutrition, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States of America
| | - Nancy F. Krebs
- Department of Pediatrics, Section of Nutrition, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States of America
| | - Jamie E. Westcott
- Department of Pediatrics, Section of Nutrition, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States of America
| | - Elizabeth M. McClure
- Regional Triangulate Institute International, Research Triangle Park, North Carolina, United States of America
| | - Robert L. Goldenberg
- Department of Obstetrics and Gynecology, Columbia University, New York City, New York, United States of America
| | - Sarah Saleem
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
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5
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Dhaded SM, Hambidge KM, Ali SA, Somannavar M, Saleem S, Pasha O, Khan U, Herekar V, Vernekar S, Kumar S. Y, Westcott JE, Thorsten VR, Sridhar A, Das A, McClure E, Derman RJ, Goldenberg RL, Koso-Thomas M, Goudar SS, Krebs NF. Preconception nutrition intervention improved birth length and reduced stunting and wasting in newborns in South Asia: The Women First Randomized Controlled Trial. PLoS One 2020; 15:e0218960. [PMID: 31995570 PMCID: PMC6988936 DOI: 10.1371/journal.pone.0218960] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 05/24/2019] [Indexed: 11/22/2022] Open
Abstract
South Asia has >50% of the global burden of low birth weight (LBW). The objective was to determine the extent to which maternal nutrition interventions commenced before conception or in the 1st trimester improved fetal growth in this region. This was a secondary analysis of combined newborn anthropometric data for the South Asian sites (India and Pakistan) in the Women First Preconception Maternal Nutrition Trial. Participants were 972 newborn of mothers who were poor, rural, unselected on basis of nutritional status, and had been randomized to receive a daily lipid-based micronutrient supplement commencing ≥3 months prior to conception (Arm 1), in the 1st trimester (Arm 2), or not at all (Arm 3). An additional protein-energy supplement was provided if BMI <20 kg/m2 or gestational weight gain was less than guidelines. Gestational age was established in the 1st trimester and newborn anthropometry obtained <48-hours post-delivery. Mean differences at birth between Arm 1 vs. 3 were length +5.3mm and weight +89g. Effect sizes (ES) and relative risks (RR) with 95% CI for Arm 1 vs. 3 were: length-for-age Z-score (LAZ) +0.29 (0.11-0.46, p = 0.0011); weight-for-age Z-score (WAZ) +0.22 (0.07-0.37, p = 0.0043); weight-to-length-ratio-for-age Z-score (WLRAZ) +0.27 (0.06-0.48, p = 0.0133); LAZ<-2, 0.56 (0.38-0.82, p = 0.0032); WAZ <-2, 0.68 (0.53-0.88, p = 0.0028); WLRAZ <-2, 0.76 (0.64-0.89, p = 0.0011); small-for-gestational-age (SGA), 0.74 (0.66-0.83, p<0.0001); low birth weight 0.81 (0.66-1.00, p = 0.0461). For Arm 2 vs. 3, LAZ, 0.21 (0.04-0.38); WAZ <-2, 0.70 (0.53-0.92); and SGA, 0.88 (0.79-0.97) were only marginally different. ES or RR did not differ for preterm birth for either Arm 1 vs. 3 or 2 vs. 3. In conclusion, point estimates for both continuous and binary anthropometric outcomes were consistently more favorable when maternal nutrition supplements were commenced ≥3 months prior to conception indicating benefits to fetal growth of improving women's nutrition in this population.
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Affiliation(s)
- Sangappa M. Dhaded
- Women’s and Children’s Health Research Unit, KLE Academy of Higher Education and Research, Jawaharlal Nehru Medical College, Belagavi, Karnataka, India
| | - K. Michael Hambidge
- Pediatric Nutrition, University of Colorado School of Medicine, Aurora, Colorado, United States of America
| | | | - Manjunath Somannavar
- Women’s and Children’s Health Research Unit, KLE Academy of Higher Education and Research, Jawaharlal Nehru Medical College, Belagavi, Karnataka, India
| | | | | | | | - Veena Herekar
- Women’s and Children’s Health Research Unit, KLE Academy of Higher Education and Research, Jawaharlal Nehru Medical College, Belagavi, Karnataka, India
| | - Sunil Vernekar
- Women’s and Children’s Health Research Unit, KLE Academy of Higher Education and Research, Jawaharlal Nehru Medical College, Belagavi, Karnataka, India
| | - Yogesh Kumar S.
- Women’s and Children’s Health Research Unit, KLE Academy of Higher Education and Research, Jawaharlal Nehru Medical College, Belagavi, Karnataka, India
| | - Jamie E. Westcott
- Pediatric Nutrition, University of Colorado School of Medicine, Aurora, Colorado, United States of America
| | | | - Amaanti Sridhar
- RTI International, Durham, North Carolina, United States of America
| | - Abhik Das
- RTI International, Durham, North Carolina, United States of America
| | | | - Richard J. Derman
- Thomas Jefferson University, Philadelphia, Pennsylvania, United States of America
| | - Robert L. Goldenberg
- Department of Obstetrics/Gynecology, Columbia University Medical Center, New York, New York, United States of America
| | | | - Shivaprasad S. Goudar
- Women’s and Children’s Health Research Unit, KLE Academy of Higher Education and Research, Jawaharlal Nehru Medical College, Belagavi, Karnataka, India
| | - Nancy F. Krebs
- Pediatric Nutrition, University of Colorado School of Medicine, Aurora, Colorado, United States of America
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Gilley SP, Weaver NE, Sticca EL, Jambal P, Palacios A, Kerns ME, Anand P, Kemp JF, Westcott JE, Figueroa L, Garcés AL, Ali SA, Pasha O, Saleem S, Hambidge KM, Hendricks AE, Krebs NF, Borengasser SJ. Longitudinal Changes of One-Carbon Metabolites and Amino Acid Concentrations during Pregnancy in the Women First Maternal Nutrition Trial. Curr Dev Nutr 2020; 4:nzz132. [PMID: 32175519 PMCID: PMC7064164 DOI: 10.1093/cdn/nzz132] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 10/09/2019] [Accepted: 11/15/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Maternal dietary restriction and supplementation of one-carbon (1C) metabolites can impact offspring growth and DNA methylation. However, longitudinal research of 1C metabolite and amino acid (AA) concentrations over the reproductive cycle of human pregnancy is limited. OBJECTIVE To investigate longitudinal 1C metabolite and AA concentrations prior to and during pregnancy and the effects of a small-quantity lipid-based nutrition supplement (LNS) containing >20 micronutrients and prepregnancy BMI (ppBMI). METHODS This study was an ancillary study of the Women First Trial (NCT01883193, clinicaltrials.gov) focused on a subset of Guatemalan women (n = 134), 49% of whom entered pregnancy with a BMI ≥25 kg/m2. Ninety-five women received LNS during pregnancy (+LNS group), while the remainder did not (-LNS group). A subset of women from the Pakistan study site (n = 179) were used as a replication cohort, 124 of whom received LNS. Maternal blood was longitudinally collected on dried blood spot (DBS) cards at preconception, and at 12 and 34 wk gestation. A targeted metabolomics assay was performed on DBS samples at each time point using LC-MS/MS. Longitudinal analyses were performed using linear mixed modeling to investigate the influence of time, LNS, and ppBMI. RESULTS Concentrations of 23 of 27 metabolites, including betaine, choline, and serine, changed from preconception across gestation after application of a Bonferroni multiple testing correction (P < 0.00185). Sixteen of those metabolites showed similar changes in the replication cohort. Asymmetric and symmetric dimethylarginine were decreased by LNS in the participants from Guatemala. Only tyrosine was statistically associated with ppBMI at both study sites. CONCLUSIONS Time influenced most 1C metabolite and AA concentrations with a high degree of similarity between the 2 diverse study populations. These patterns were not significantly altered by LNS consumption or ppBMI. Future investigations will focus on 1C metabolite changes associated with infant outcomes, including DNA methylation. This trial was registered at clinicaltrials.gov as NCT01883193.
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Affiliation(s)
- Stephanie P Gilley
- Department of Pediatrics, Section of Nutrition, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Nicholas E Weaver
- Mathematical and Statistical Sciences, University of Colorado Denver, Denver, CO, USA
| | - Evan L Sticca
- Human Medical Genetics and Genomics Program, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Purevsuren Jambal
- Department of Pediatrics, Section of Nutrition, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Alexandra Palacios
- Department of Pediatrics, Section of Nutrition, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Mattie E Kerns
- Department of Pediatrics, Section of Nutrition, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Pratibha Anand
- Department of Pediatrics, Section of Nutrition, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Jennifer F Kemp
- Department of Pediatrics, Section of Nutrition, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Jamie E Westcott
- Department of Pediatrics, Section of Nutrition, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Lester Figueroa
- Institute of Nutrition in Central America and Panama, Guatemala City, Guatemala
| | - Ana Lucía Garcés
- Institute of Nutrition in Central America and Panama, Guatemala City, Guatemala
| | - Sumera A Ali
- Aga Khan University, Department of Community Health Sciences, Karachi, Pakistan
| | - Omrana Pasha
- Aga Khan University, Department of Community Health Sciences, Karachi, Pakistan
- Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Sarah Saleem
- Aga Khan University, Department of Community Health Sciences, Karachi, Pakistan
| | - K Michael Hambidge
- Department of Pediatrics, Section of Nutrition, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Audrey E Hendricks
- Mathematical and Statistical Sciences, University of Colorado Denver, Denver, CO, USA
- Human Medical Genetics and Genomics Program, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Nancy F Krebs
- Department of Pediatrics, Section of Nutrition, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Sarah J Borengasser
- Department of Pediatrics, Section of Nutrition, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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7
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Hambidge KM, Bann CM, McClure EM, Westcott JE, Garcés A, Figueroa L, Goudar SS, Dhaded SM, Pasha O, Ali SA, Derman RJ, Goldenberg RL, Koso-Thomas M, Somannavar MS, Herekar V, Khan U, Krebs NF. Maternal Characteristics Affect Fetal Growth Response in the Women First Preconception Nutrition Trial. Nutrients 2019; 11:E2534. [PMID: 31640153 PMCID: PMC6835723 DOI: 10.3390/nu11102534] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 09/28/2019] [Accepted: 10/15/2019] [Indexed: 02/02/2023] Open
Abstract
The objective of this secondary analysis was to identify maternal characteristics that modified the effect of maternal supplements on newborn size. Participants included 1465 maternal-newborn dyads in Guatemala, India, and Pakistan. Supplementation commenced before conception (Arm 1) or late 1st trimester (Arm 2); Arm 3 received usual care. Characteristics included body mass index (BMI), stature, anemia, age, education, socio-economic status (SES), parity, and newborn sex. Newborn outcomes were z-scores for length (LAZ), weight (WAZ), and weight to length ratio-for-age (WLRAZ). Mixed-effect regression models included treatment arm, effect modifier, and arm * effect modifier interaction as predictors, controlling for site, characteristics, and sex. Parity (para-0 vs. para ≥1), anemia (anemia/no anemia), and sex were significant effect modifiers. Effect size (95% CI) for Arm 1 vs. 3 was larger for para-0 vs. ≥1 for all outcomes (LAZ 0.56 (0.28, 0.84, p < 0.001); WAZ 0.45 (0.20, 0.07, p < 0.001); WLRAZ 0.52 (0.17, 0.88, p < 0.01) but only length for Arm 2 vs. 3. Corresponding effects for para ≥1 were >0.02. Arm 3 z-scores were all very low for para-0, but not para ≥1. Para-0 and anemia effect sizes for Arm 1 were > Arm 2 for WAZ and WLRAZ, but not LAZ. Arm 1 and 2 had higher WAZ for newborn boys vs. girls. Maternal nulliparity and anemia were associated with impaired fetal growth that was substantially improved by nutrition intervention, especially when commenced prior to conception.
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Affiliation(s)
- K Michael Hambidge
- Section of Nutrition, Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO 80045, USA.
| | | | | | - Jamie E Westcott
- Section of Nutrition, Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO 80045, USA.
| | - Ana Garcés
- INCAP (Instituto de Nutrición de Centro América y Panamá), Guatemala City 01011, Guatemala.
| | - Lester Figueroa
- INCAP (Instituto de Nutrición de Centro América y Panamá), Guatemala City 01011, Guatemala.
| | - Shivaprasad S Goudar
- KLE Academy of Higher Education and Research's Jawaharlal Nehru Medical College, Belagavi, Karnataka 590010, India.
| | - Sangappa M Dhaded
- KLE Academy of Higher Education and Research's Jawaharlal Nehru Medical College, Belagavi, Karnataka 590010, India.
| | - Omrana Pasha
- Department of Community Health Sciences, Aga Khan University, Karachi 74800, Pakistan.
| | - Sumera A Ali
- Department of Community Health Sciences, Aga Khan University, Karachi 74800, Pakistan.
| | - Richard J Derman
- Department of Global Affairs, Thomas Jefferson University, Philadelphia, PA 19107, USA.
| | - Robert L Goldenberg
- Department of Obstetrics and Gynecology, Columbia University, New York, NY 10032, USA.
| | | | - Manjunath S Somannavar
- KLE Academy of Higher Education and Research's Jawaharlal Nehru Medical College, Belagavi, Karnataka 590010, India.
| | - Veena Herekar
- KLE Academy of Higher Education and Research's Jawaharlal Nehru Medical College, Belagavi, Karnataka 590010, India.
| | - Umber Khan
- Department of Community Health Sciences, Aga Khan University, Karachi 74800, Pakistan.
| | - Nancy F Krebs
- Section of Nutrition, Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO 80045, USA.
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Tang M, Frank DN, Tshefu A, Lokangaka A, Goudar SS, Dhaded SM, Somannavar MS, Hendricks AE, Ir D, Robertson CE, Kemp JF, Lander RL, Westcott JE, Hambidge KM, Krebs NF. Different Gut Microbial Profiles in Sub-Saharan African and South Asian Women of Childbearing Age Are Primarily Associated With Dietary Intakes. Front Microbiol 2019; 10:1848. [PMID: 31474951 PMCID: PMC6702451 DOI: 10.3389/fmicb.2019.01848] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 07/26/2019] [Indexed: 01/20/2023] Open
Abstract
Background To compare and characterize the gut microbiota in women of childbearing age from sub-Saharan Africa (the Democratic Republic of the Congo, DRC) and South Asia (India), in relation to dietary intakes. Methods Women of childbearing age were recruited from rural DRC and India as part of the Women First (WF) preconception maternal nutrition trial. Findings presented include fecal 16S rRNA gene-based profiling of women in the WF trial from samples obtained at the time of randomization, prior to initiation of nutrition intervention and to conception. Results Stool samples were collected from 217 women (DRC n = 117; India n = 100). Alpha diversity of the gut microbiota was higher in DRC than in India (Chao1: 91 ± 11 vs. 82 ± 12, P = 6.58E-07). The gut microbial community structure was not significantly affected by any demographical or environmental variables, such as maternal BMI, education, and water source. Prevotella, Succinivibrio, and Roseburia were at relatively high abundance without differences between sites. Bifidobacterium was higher in India (4.95 ± 1.0%) than DRC (0.3 ± 0.1%; P = 2.71E-27), as was Lactobacillus (DRC: 0.2 ± 0.0%; India: 1.2 ± 0.1%; P = 2.39E-13) and Faecalibacterium (DRC: 6.0 ± 1.7%; India: 8.4 ± 2.9%; P = 6.51E-7). Ruminococcus was higher in DRC (2.3 ± 0.7%) than in India (1.8 ± 0.4%; P = 3.24E-5) and was positively associated with consumption of flesh foods. Succinivibrio was positively associated with dairy intake in India and fish/insects in DRC. Faecalibacterium was positively associated with vitamin A-rich fruits and vegetables. Overall, these observations were consistent with India being primarily vegetarian with regular fermented dairy consumption and DRC regularly consuming animal-flesh foods. Conclusion Consumption of animal-flesh foods and fermented dairy foods were independently associated with the gut microbiota while demographic variables were not, suggesting that diet may have a stronger association with microbiota than demographic characteristics.
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Affiliation(s)
- Minghua Tang
- Section of Nutrition, Department of Pediatrics, University of Colorado Denver, Aurora, CO, United States
| | - Daniel N Frank
- Division of Infectious Diseases, School of Medicine, University of Colorado Denver, Aurora, CO, United States
| | - Antoinette Tshefu
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo
| | - Adrien Lokangaka
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo
| | - Shivaprasad S Goudar
- KLE Academy of Higher Education and Research's Jawaharlal Nehru Medical College, Belagavi, India
| | - Sangappa M Dhaded
- KLE Academy of Higher Education and Research's Jawaharlal Nehru Medical College, Belagavi, India
| | - Manjunath S Somannavar
- KLE Academy of Higher Education and Research's Jawaharlal Nehru Medical College, Belagavi, India
| | - Audrey E Hendricks
- Department of Mathematical and Statistical Sciences, University of Colorado Denver, Aurora, CO, United States
| | - Diana Ir
- Division of Infectious Diseases, School of Medicine, University of Colorado Denver, Aurora, CO, United States
| | - Charles E Robertson
- Division of Infectious Diseases, School of Medicine, University of Colorado Denver, Aurora, CO, United States
| | - Jennifer F Kemp
- Section of Nutrition, Department of Pediatrics, University of Colorado Denver, Aurora, CO, United States
| | - Rebecca L Lander
- Section of Nutrition, Department of Pediatrics, University of Colorado Denver, Aurora, CO, United States
| | - Jamie E Westcott
- Section of Nutrition, Department of Pediatrics, University of Colorado Denver, Aurora, CO, United States
| | - K Michael Hambidge
- Section of Nutrition, Department of Pediatrics, University of Colorado Denver, Aurora, CO, United States
| | - Nancy F Krebs
- Section of Nutrition, Department of Pediatrics, University of Colorado Denver, Aurora, CO, United States
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Ali SA, Khan U, Abrejo F, Saleem S, Hambidge MK, Krebs NF, Westcott JE, Goldenberg RL, McClure EM, Pasha O. Challenges of Implementing an Individual Randomized Controlled Trial (Women First: Preconception Maternal Nutrition Study) in a Rural Study Site: A Case Study From Pakistan. Nutr Metab Insights 2019; 21:1178638819852059. [PMID: 31320804 PMCID: PMC6611011 DOI: 10.1177/1178638819852059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Accepted: 03/26/2019] [Indexed: 11/23/2022] Open
Abstract
Persistent global disparities in maternal and neonatal outcomes associated with poor maternal nutrition provided the genesis of the Women First (WF) study, an individually randomized controlled trial on preconceptional maternal nutrition. This article describes the challenges that arose in implementing this trial related to nutrition or diet of the mother, in District Thatta-Pakistan. During different phases of the study, we encountered problems in identifying the eligible participants, taking consent from couples, randomizing participants in different arms, conducting biweekly follow-up visits on time, ensuring compliance to the intervention, and measuring the primary outcome within the 24 hours of birth. Each challenge was itself an opportunity for the research team to address the same through effective coordination and teamwork. Moreover, with adequate resources and dedicated staff with diverse backgrounds, it was possible to implement the WF study across the widely scattered geographic clusters of District Thatta. In addition, there are some broad strategies that could be applied to other studies such as very close contact either in person or at least by talking to mothers via phones and rapport with the study participants, the study leadership of country coordinator and the field supervisors to build trust between those on front lines and the study leadership. Moreover, continuous monitoring and supervision with frequent training and refreshers were also found to be more important to assure the data quality and to meet the study targets. Community meetings were also found to be very helpful and effective to follow the participants for a long time. Researchers conducting a similar type of studies particularly in rural areas can learn many lessons from such experiences. Thus, the process of implementing the study in one of the rural areas of Pakistan provides an insight into where and how similar individual randomized trials might be deployed.
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Affiliation(s)
- Sumera Aziz Ali
- Department of Community Health Sciences, The Aga Khan University, Karachi, Pakistan
| | - Umber Khan
- Department of Community Health Sciences, The Aga Khan University, Karachi, Pakistan
| | - Farina Abrejo
- Department of Community Health Sciences, The Aga Khan University, Karachi, Pakistan
| | - Sarah Saleem
- Department of Community Health Sciences, The Aga Khan University, Karachi, Pakistan
| | - Michael K Hambidge
- Department of Pediatrics, Section of Nutrition, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Nancy F Krebs
- Department of Pediatrics, Section of Nutrition, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Jamie E Westcott
- Department of Pediatrics, Section of Nutrition, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Robert L Goldenberg
- Department of Obstetrics and Gynecology, Columbia University, New York, NY, USA
| | | | - Omrana Pasha
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Aziz Ali S, Abbasi Z, Feroz A, Hambidge KM, Krebs NF, Westcott JE, Saleem S. Factors associated with anemia among women of the reproductive age group in Thatta district: study protocol. Reprod Health 2019; 16:34. [PMID: 30885226 PMCID: PMC6423857 DOI: 10.1186/s12978-019-0688-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Accepted: 02/15/2019] [Indexed: 01/01/2023] Open
Abstract
Background Maternal anemia is a leading public health issue placing pregnant women at higher risk of low birth weight, preterm birth, perinatal mortality, and neonatal mortality. Women in developing countries are at higher risk of anemia which could be either due to micronutrient deficiencies, hemoglobinopathies, infections or other socio-demographic factors. Thus, it is highly essential to explore the factors of anemia among women of the reproductive age group in order to design suitable interventions. The primary objective of this study is to assess the biological and socio-demographic factors that are associated with anemia among the women of the reproductive age group in Thatta district. Methods An exploratory mixed method study using quantitative and qualitative approaches will be conducted in district Thatta Pakistan from September 2018 to January 2019. In the qualitative phase, data will be collected through focus group discussions and key informant interviews to understand the perceptions of women, their husbands and healthcare providers about anemia. In addition, a quantitative approach using cross-sectional study will be conducted to determine biological and socio-demographic factors associated with anemia. Approximately 150 non-pregnant women and their spouses will be included in the quantitative component of the study. In addition to thematic analysis for the qualitative component, Logistic regression will be done to calculate adjusted Odds ratios with their respective 95% CIs to assess the factors associated with anemia. Discussion The better understanding of biological, socio-demographic factors and community perceptions of anemia will help us to design strategies and interventions to better address anemia during the reproductive cycle in rural areas of Pakistan. This will help the researchers and policymakers to take the appropriate action accordingly by designing suitable approaches to address the specific type of anemia in the rural population of Pakistan. This will, in turn, reduce the chances of adverse maternal and fetal outcomes associated with anemia.
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Affiliation(s)
- Sumera Aziz Ali
- Department of Community Health Sciences, The Aga Khan University, Stadium Road, PO Box 3500, Karachi, 74800, Pakistan
| | - Zahid Abbasi
- Department of Community Health Sciences, The Aga Khan University, Stadium Road, PO Box 3500, Karachi, 74800, Pakistan
| | - Anam Feroz
- Department of Community Health Sciences, The Aga Khan University, Stadium Road, PO Box 3500, Karachi, 74800, Pakistan.
| | - K Michael Hambidge
- University of Colorado School of Medicine, 12700 E 19th Ave.; Research Complex 2, Rm 5025, Box C225, Aurora, CO, 80045, USA
| | - Nancy F Krebs
- University of Colorado School of Medicine, 12700 E 19th Ave.; Research Complex 2, Rm 5025, Box C225, Aurora, CO, 80045, USA
| | - Jamie E Westcott
- University of Colorado School of Medicine, 12700 E 19th Ave.; Research Complex 2, Rm 5025, Box C225, Aurora, CO, 80045, USA
| | - Sarah Saleem
- Department of Community Health Sciences, The Aga Khan University, Stadium Road, PO Box 3500, Karachi, 74800, Pakistan
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11
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Hambidge KM, Westcott JE, Garcés A, Figueroa L, Goudar SS, Dhaded SM, Pasha O, Ali SA, Tshefu A, Lokangaka A, Derman RJ, Goldenberg RL, Bose CL, Bauserman M, Koso-Thomas M, Thorsten VR, Sridhar A, Stolka K, Das A, McClure EM, Krebs NF. A multicountry randomized controlled trial of comprehensive maternal nutrition supplementation initiated before conception: the Women First trial. Am J Clin Nutr 2019; 109:457-469. [PMID: 30721941 PMCID: PMC6367966 DOI: 10.1093/ajcn/nqy228] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 08/07/2018] [Indexed: 12/28/2022] Open
Abstract
Background Reported benefits of maternal nutrition supplements commenced during pregnancy in low-resource populations have typically been quite limited. Objectives This study tested the effects on newborn size, especially length, of commencing nutrition supplements for women in low-resource populations ≥3 mo before conception (Arm 1), compared with the same supplement commenced late in the first trimester of pregnancy (Arm 2) or not at all (control Arm 3). Methods Women First was a 3-arm individualized randomized controlled trial (RCT). The intervention was a lipid-based micronutrient supplement; a protein-energy supplement was also provided if maternal body mass index (kg/m2) was <20 or gestational weight gain was less than recommendations. Study sites were in rural locations of the Democratic Republic of the Congo (DRC), Guatemala, India, and Pakistan. The primary outcome was length-for-age z score (LAZ), with all anthropometry obtained <48 h post delivery. Because gestational ages were unavailable in DRC, outcomes were determined for all 4 sites from WHO newborn standards (non-gestational-age-adjusted, NGAA) as well as INTERGROWTH-21st fetal standards (3 sites, gestational age-adjusted, GAA). Results A total of 7387 nonpregnant women were randomly assigned, yielding 2451 births with NGAA primary outcomes and 1465 with GAA outcomes. Mean LAZ and other outcomes did not differ between Arm 1 and Arm 2 using either NGAA or GAA. Mean LAZ (NGAA) for Arm 1 was greater than for Arm 3 (effect size: +0.19; 95% CI: 0.08, 0.30, P = 0.0008). For GAA outcomes, rates of stunting and small-for-gestational-age were lower in Arm 1 than in Arm 3 (RR: 0.69; 95% CI: 0.49, 0.98, P = 0.0361 and RR: 0.78; 95% CI: 0.70, 0.88, P < 0.001, respectively). Rates of preterm birth did not differ among arms. Conclusions In low-resource populations, benefits on fetal growth-related birth outcomes were derived from nutrition supplements commenced before conception or late in the first trimester. This trial was registered at clinicaltrials.gov as NCT01883193.
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Affiliation(s)
- K Michael Hambidge
- Department of Pediatrics, Section of Nutrition, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Jamie E Westcott
- Department of Pediatrics, Section of Nutrition, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Ana Garcés
- INCAP (Instituto de Nutrición de Centro América y Panamá), Guatemala City, Guatemala
| | - Lester Figueroa
- INCAP (Instituto de Nutrición de Centro América y Panamá), Guatemala City, Guatemala
| | - Shivaprasad S Goudar
- KLE Academy of Higher Education and Research's Jawaharlal Nehru Medical College, Belagavi, India
| | - Sangappa M Dhaded
- KLE Academy of Higher Education and Research's Jawaharlal Nehru Medical College, Belagavi, India
| | - Omrana Pasha
- Aga Khan University, Karachi, Pakistan,Johns Hopkins University, Baltimore, MD
| | | | - Antoinette Tshefu
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo
| | - Adrien Lokangaka
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo
| | | | | | - Carl L Bose
- University of North Carolina, Chapel Hill, NC
| | | | - Marion Koso-Thomas
- National Institute of Child Health and Human Development/NIH, Bethesda, MD
| | | | | | | | | | | | - Nancy F Krebs
- Department of Pediatrics, Section of Nutrition, University of Colorado Anschutz Medical Campus, Aurora, CO,Address correspondence to NFK (e-mail: )
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Long JM, Mondal P, Westcott JE, Miller LV, Islam MM, Ahmed M, Mahfuz M, Ahmed T, Krebs NF. Zinc Absorption from Micronutrient Powders Is Low in Bangladeshi Toddlers at Risk of Environmental Enteric Dysfunction and May Increase Dietary Zinc Requirements. J Nutr 2019; 149:98-105. [PMID: 30624753 PMCID: PMC6377437 DOI: 10.1093/jn/nxy245] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 08/31/2018] [Indexed: 12/20/2022] Open
Abstract
Background Environmental enteric dysfunction (EED), a chronic inflammatory disorder of the small bowel, is suspected to impair absorption of micronutrients, including zinc. Objective The objective of this study was to compare zinc absorption from micronutrient powder (MNP) over a range of zinc doses in young children screened for EED with use of the lactulose:mannitol ratio (L:M). Methods Bangladeshi children aged 18-24 mo, grouped according to high and low L:M (≥0.09 and <0.09, respectively), were randomly assigned to MNP with 0, 5, 10, or 15 mg Zn/sachet (10 subjects per dose per L:M group). Over a day, fractional absorption of zinc was measured from an MNP-fortified meal and from unfortified meals with stable isotope tracers; total daily absorbed zinc (TAZ, milligrams per day) was determined as the primary outcome. Secondary outcomes included investigation of relations of TAZ to intake, to physiologic requirement, and to other variables, including biomarkers of systemic and intestinal inflammation, using nonlinear models. TAZ was also compared with published data on child zinc absorption. Results In 74 subjects who completed the study, zinc absorption did not differ by L:M grouping. Most biomarkers of intestinal inflammation were elevated in both L:M groups. For combined L:M groups, mean ± SD TAZ for each MNP dose (0, 5, 10, and 15 mg/sachet) was 0.57 ± 0.30, 0.68 ± 0.31, 0.90 ± 0.43, and 1.0 ± 0.39 mg/d, respectively (P = 0.002), and exceeded the estimated physiologic requirement only for the 10- and 15-mg MNP doses. Zinc absorption was notably lower at all intake levels compared with published data (P < 0.0001) and was inversely related to serum α-1 acid glycoprotein and to fecal Entamoeba histolytica (P = 0.02). Conclusion Results indicate impaired absorption of zinc, which may predispose to zinc deficiency in young children with evidence of enteropathy. These findings suggest that current doses of zinc in MNP may be insufficient to yield zinc-related preventative benefits in similar settings. This study is registered at clinicaltrials.gov as NCT02758444.
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Affiliation(s)
- Julie M Long
- University of Colorado School of Medicine, Department of Pediatrics, Section of Nutrition, Aurora, CO
| | - Prasenjit Mondal
- International Center for Diarrheal Disease Research, Bangladesh (icddr,b), Nutrition and Clinical Services Division, Dhaka, Bangladesh
| | - Jamie E Westcott
- University of Colorado School of Medicine, Department of Pediatrics, Section of Nutrition, Aurora, CO
| | - Leland V Miller
- University of Colorado School of Medicine, Department of Pediatrics, Section of Nutrition, Aurora, CO
| | - M Munirul Islam
- International Center for Diarrheal Disease Research, Bangladesh (icddr,b), Nutrition and Clinical Services Division, Dhaka, Bangladesh
| | - Mondar Ahmed
- International Center for Diarrheal Disease Research, Bangladesh (icddr,b), Nutrition and Clinical Services Division, Dhaka, Bangladesh
| | - Mustafa Mahfuz
- International Center for Diarrheal Disease Research, Bangladesh (icddr,b), Nutrition and Clinical Services Division, Dhaka, Bangladesh
| | - Tahmeed Ahmed
- International Center for Diarrheal Disease Research, Bangladesh (icddr,b), Nutrition and Clinical Services Division, Dhaka, Bangladesh
| | - Nancy F Krebs
- University of Colorado School of Medicine, Department of Pediatrics, Section of Nutrition, Aurora, CO,Address correspondence to NFK (e-mail: )
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Ariff S, Krebs NF, Westcott JE, Hambidge M, Miller LV, Rizvi A, Soofi SB, Bhutta ZA. Exchangeable Zinc Pool Size at Birth in Pakistani Small for Gestational Age and Appropriate for Gestational Age Infants Do Not Differ But Are Lower Than in US Infants. J Pediatr Gastroenterol Nutr 2018; 66:496-500. [PMID: 29470320 PMCID: PMC6343844 DOI: 10.1097/mpg.0000000000001778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVES Small for gestational age (SGA) infants are more susceptible to infectious morbidity and growth faltering compared to their appropriate for gestational age (AGA) counterparts. Zinc supplementation of SGA infants may be beneficial but the underlying susceptibility to zinc deficiency of SGA infants has not been examined. METHODS In a community-based, observational, longitudinal study in a peri-urban settlement of Karachi, Pakistan, we compared the size of the exchangeable zinc pools (EZPs) in term SGA and AGA infants at birth and at 6 months of age, hypothesizing that the EZP would be lower in the SGA group. To measure EZP size, a zinc stable isotope was intravenously administered within 48 hours of birth (n = 17 and 22) at 6 months (n = 11 and 14) in SGA and AGA infants, respectively. Isotopic enrichment in urine was used to determine EZP. RESULTS No significant difference was detected in the mean (±standard deviation) EZP between SGA and AGA infants at birth, with values of 9.8 ± 3.5 and 10.1 ± 4.1 mg/kg, respectively (P = 0.86), or at 6 months. Longitudinal EZP measurements demonstrated a significant decline in EZP relative to body weight in both groups at 6 months (P < 0.001). Mean EZP (adjusted for body weight) size at birth for the combined Pakistani groups was significantly lower than AGA infants at birth in the United States (P = 0.017). CONCLUSIONS These results did not support a difference in zinc endowment between SGA and AGA Pakistani infants. They, however, do suggest lower in utero zinc transfer to the fetus in a setting where poor maternal nutritional status may confer a high susceptibility to postnatal zinc deficiency.
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Affiliation(s)
| | - Nancy F. Krebs
- Section of Nutrition, Department of Pediatrics, University of Colorado School of Medicine, Anschutz Medical Center, Aurora, CO
| | - Jamie E. Westcott
- Section of Nutrition, Department of Pediatrics, University of Colorado School of Medicine, Anschutz Medical Center, Aurora, CO
| | - Michael Hambidge
- Section of Nutrition, Department of Pediatrics, University of Colorado School of Medicine, Anschutz Medical Center, Aurora, CO
| | - Leland V. Miller
- Section of Nutrition, Department of Pediatrics, University of Colorado School of Medicine, Anschutz Medical Center, Aurora, CO
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Hambidge KM, Krebs NF, Garcés A, Westcott JE, Figueroa L, Goudar SS, Dhaded S, Pasha O, Aziz Ali S, Tshefu A, Lokangaka A, Thorsten VR, Das A, Stolka K, McClure EM, Lander RL, Bose CL, Derman RJ, Goldenberg RL, Bauserman M. Anthropometric indices for non-pregnant women of childbearing age differ widely among four low-middle income populations. BMC Public Health 2017; 18:45. [PMID: 28738791 PMCID: PMC5525260 DOI: 10.1186/s12889-017-4509-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 06/14/2017] [Indexed: 01/08/2023] Open
Abstract
Background Maternal stature and body mass indices (BMI) of non-pregnant women (NPW) of child bearing age are relevant to maternal and offspring health. The objective was to compare anthropometric indices of NPW in four rural communities in low- to low-middle income countries (LMIC). Methods Anthropometry and maternal characteristics/household wealth questionnaires were obtained for NPW enrolled in the Women First Preconception Maternal Nutrition Trial. Body mass index (BMI, kg/m2) was calculated. Z-scores were determined using WHO reference data. Results A total of 7268 NPW participated in Equateur, DRC (n = 1741); Chimaltenango, Guatemala (n = 1695); North Karnataka, India (n = 1823); and Thatta, Sindh, Pakistan (n = 2009). Mean age was 23 y and mean parity 1.5. Median (P25-P75) height (cm) ranged from 145.5 (142.2–148.9) in Guatemala to 156.0 (152.0–160.0) in DRC. Median weight (kg) ranged from 44.7 (39.9–50.3) in India to 52.7 (46.9–59.8) in Guatemala. Median BMI ranged from 19.4 (17.6–21.9) in India to 24.9 (22.3–28.0) in Guatemala. Percent stunted (<−2SD height for age z-score) ranged from 13.9% in DRC to 80.5% in Guatemala; % underweight (BMI <18.5) ranged from 1.2% in Guatemala to 37.1% in India; % overweight/obese (OW, BMI ≥25.0) ranged from 5.7% in DRC to 49.3% in Guatemala. For all sites, indicators for higher SES and higher age were associated with BMI. Lower SES women were underweight more frequently and higher SES women were OW more frequently at all sites. Younger women tended to be underweight, while older women tended to be OW. Conclusions Anthropometric data for NPW varied widely among low-income rural populations in four countries located on three different continents. Global comparisons of anthropometric measurements across sites using standard reference data serve to highlight major differences among populations of low-income rural NPW and assist in evaluating the rationale for and the design of optimal intervention trials. Trial registration ClinicalTrials.gov #NCT01883193 (18 June 2013, retrospectively registered)
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Affiliation(s)
| | | | - Ana Garcés
- INCAP (Instituto de Nutrición de Centro América y Panamá), Guatemala City, Guatemala
| | | | - Lester Figueroa
- INCAP (Instituto de Nutrición de Centro América y Panamá), Guatemala City, Guatemala
| | | | - Sangappa Dhaded
- KLE University's Jawaharlal Nehru Medical College, Belagavi, Karnataka, India
| | | | | | - Antoinette Tshefu
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo
| | - Adrien Lokangaka
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo
| | | | - Abhik Das
- RTI International, Research Triangle Park, NC, USA
| | | | | | | | - Carl L Bose
- University of North Carolina, Chapel Hill, NC, USA
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Lander RL, Hambidge KM, Krebs NF, Westcott JE, Garces A, Figueroa L, Tejeda G, Lokangaka A, Diba TS, Somannavar MS, Honnayya R, Ali SA, Khan US, McClure EM, Thorsten VR, Stolka KB. Repeat 24-hour recalls and locally developed food composition databases: a feasible method to estimate dietary adequacy in a multi-site preconception maternal nutrition RCT. Food Nutr Res 2017; 61:1311185. [PMID: 28469549 PMCID: PMC5404420 DOI: 10.1080/16546628.2017.1311185] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 03/21/2017] [Indexed: 11/25/2022] Open
Abstract
Background: Our aim was to utilize a feasible quantitative methodology to estimate the dietary adequacy of >900 first-trimester pregnant women in poor rural areas of the Democratic Republic of the Congo, Guatemala, India and Pakistan. This paper outlines the dietary methods used. Methods: Local nutritionists were trained at the sites by the lead study nutritionist and received ongoing mentoring throughout the study. Training topics focused on the standardized conduct of repeat multiple-pass 24-hr dietary recalls, including interview techniques, estimation of portion sizes, and construction of a unique site-specific food composition database (FCDB). Each FCDB was based on 13 food groups and included values for moisture, energy, 20 nutrients (i.e. macro- and micronutrients), and phytate (an anti-nutrient). Nutrient values for individual foods or beverages were taken from recently developed FAO-supported regional food composition tables or the USDA national nutrient database. Appropriate adjustments for differences in moisture and application of nutrient retention and yield factors after cooking were applied, as needed. Generic recipes for mixed dishes consumed by the study population were compiled at each site, followed by calculation of a median recipe per 100 g. Each recipe’s nutrient values were included in the FCDB. Final site FCDB checks were planned according to FAO/INFOODS guidelines. Discussion: This dietary strategy provides the opportunity to assess estimated mean group usual energy and nutrient intakes and estimated prevalence of the population ‘at risk’ of inadequate intakes in first-trimester pregnant women living in four low- and middle-income countries. While challenges and limitations exist, this methodology demonstrates the practical application of a quantitative dietary strategy for a large international multi-site nutrition trial, providing within- and between-site comparisons. Moreover, it provides an excellent opportunity for local capacity building and each site FCDB can be easily modified for additional research activities conducted in other populations living in the same area.
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Affiliation(s)
- Rebecca L Lander
- Department of Pediatrics, Section of Nutrition, University of Colorado School of Medicine, Aurora, CO, USA
| | - K Michael Hambidge
- Department of Pediatrics, Section of Nutrition, University of Colorado School of Medicine, Aurora, CO, USA
| | - Nancy F Krebs
- Department of Pediatrics, Section of Nutrition, University of Colorado School of Medicine, Aurora, CO, USA
| | - Jamie E Westcott
- Department of Pediatrics, Section of Nutrition, University of Colorado School of Medicine, Aurora, CO, USA
| | - Ana Garces
- Department of Planning, INCAP (Institute of Nutrition of Central America and Panama), Guatemala City, Guatemala
| | - Lester Figueroa
- Department of Planning, INCAP (Institute of Nutrition of Central America and Panama), Guatemala City, Guatemala
| | - Gabriela Tejeda
- Department of Planning, INCAP (Institute of Nutrition of Central America and Panama), Guatemala City, Guatemala
| | - Adrien Lokangaka
- Department of Community Health, Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo
| | - Tshilenge S Diba
- Department of Community Health, Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo
| | - Manjunath S Somannavar
- Women's and Children's Health Research Unit, KLE University's Jawaharlal Nehru Medical College, Belagavi, India
| | - Ranjitha Honnayya
- Women's and Children's Health Research Unit, KLE University's Jawaharlal Nehru Medical College, Belagavi, India
| | - Sumera A Ali
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Umber S Khan
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
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16
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Miller LV, Hambidge KM, King JC, Westcott JE, Krebs NF. Predictors of the Size of the Exchangeable Zinc Pool Differ between Children and Adults. J Nutr 2017; 147:187-194. [PMID: 27903832 DOI: 10.3945/jn.116.239541] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Revised: 08/28/2016] [Accepted: 11/03/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The size of the rapidly exchanging pool of body zinc has been suggested as having potential utility as a biomarker of zinc status. Knowledge of the relations of exchangeable zinc pool (EZP) size to relevant variables is necessary to adequately evaluate its use as a biomarker. OBJECTIVE We used regression analysis to investigate associations of EZP with age, sex, body size, and zinc nutrition variables. METHODS Data were compiled from 18 isotope tracer studies of zinc absorption in 247 children and adults (248 observations) in which EZP and relevant variables (e.g., weight, age, absorbed zinc) were measured. Linear regression analyses were performed separately on data from adults and children. RESULTS In children, EZP was most strongly associated with weight (r = 0.78). The best-fitting regression models of EZP (R2 ≥ 0.68) had weight or age and weight-for-age z score as predictors. Other variables had little effect on EZP when controlling for weight. Absorbed zinc was observed to be a predictor of EZP only in zinc intervention trials of infants. The mean EZP/wt was 4 mg/kg between 8 and 120 mo of age. In adults, EZP was observed to vary in a complex manner with (in order of importance) age, absorbed zinc, weight, sex, and plasma zinc concentration. EZP data from zinc-deprived subjects were lower than the 95% prediction interval of a model of normative data. CONCLUSIONS EZP was observed to maintain a constant size relative to weight and was influenced only slightly by other factors in children. In contrast, EZP in adults varied with several factors, including absorbed zinc, and was statistically smaller in zinc-deprived individuals. The findings suggest that EZP may have utility as an indicator of zinc status in adults, but there is less evidence for this in children. Additional data are needed to reach a definitive conclusion.
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Affiliation(s)
| | | | - Janet C King
- Children's Hospital Oakland Research Institute, Oakland, CA
| | | | - Nancy F Krebs
- University of Colorado School of Medicine, Aurora, CO; and
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17
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Chomba E, Westcott CM, Westcott JE, Mpabalwani EM, Krebs NF, Patinkin ZW, Palacios N, Hambidge KM. Zinc absorption from biofortified maize meets the requirements of young rural Zambian children. J Nutr 2015; 145:514-9. [PMID: 25733467 PMCID: PMC4770937 DOI: 10.3945/jn.114.204933] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Revised: 10/19/2014] [Accepted: 12/22/2014] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The zinc content of maize, a major global food staple, is generally insufficient alone to meet the requirements of young children. OBJECTIVES The primary objective of this study was to determine whether substitution of biofortified maize (34 μg zinc/g grain) for control maize (21 μg zinc/g) was adequate to meet zinc physiologic requirements in young children for whom maize was the major food staple. A secondary objective was to compare total daily zinc absorption when maize flour was fortified with zinc oxide to a total concentration of 60 μg zinc/g. METHODS Participants included 60 rural Zambian children with a mean age of 29 mo who were randomly assigned to receive 1 of 3 maize types (control, biofortified, or fortified) all of which were readily consumed (>100 g on 1 d). Total daily zinc intake (from maize and low-zinc relish) was determined from duplicate diet collections. Multiplication by fractional absorption of zinc, measured by a dual isotope ratio technique, determined the total daily zinc absorption on the day the test meals were given. RESULTS The mean ± SD total daily zinc intake (milligrams per day) from the biofortified maize (5.0 ± 2.2) was higher (P < 0.0001) than for the control maize (2.3 ± 0.9). Intake of zinc from the fortified maize (6.3 ± 2.6) did not differ from the biofortified maize. Fractional absorption of zinc from control maize (0.28 ± 0.10) did not differ from the biofortified maize (0.22 ± 0.06). Total daily absorption of zinc (milligrams per day) from the biofortified maize (1.1 ± 0.5) was higher (P = 0.0001) than for the control maize (0.6 ± 0.2), but did not differ from the fortified maize (1.2 ± 0.4). CONCLUSIONS These results indicate that feeding biofortified maize can meet zinc requirements and provide an effective dietary alternative to regular maize for this vulnerable population. This trial was registered at clinicaltrials.gov as NCT02208635.
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Affiliation(s)
| | - Claire M Westcott
- Section of Nutrition, Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO; and
| | - Jamie E Westcott
- Section of Nutrition, Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO; and
| | | | - Nancy F Krebs
- Section of Nutrition, Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO; and
| | - Zachary W Patinkin
- Section of Nutrition, Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO; and
| | - Natalia Palacios
- International Maize and Wheat Improvement Center, Mexico City, Mexico
| | - K Michael Hambidge
- Section of Nutrition, Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO; and
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18
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Hambidge KM, Krebs NF, Westcott JE, Garces A, Goudar SS, Kodkany BS, Pasha O, Tshefu A, Bose CL, Figueroa L, Goldenberg RL, Derman RJ, Friedman JE, Frank DN, McClure EM, Stolka K, Das A, Koso-Thomas M, Sundberg S. Preconception maternal nutrition: a multi-site randomized controlled trial. BMC Pregnancy Childbirth 2014; 14:111. [PMID: 24650219 PMCID: PMC4000057 DOI: 10.1186/1471-2393-14-111] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Accepted: 03/05/2014] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Research directed to optimizing maternal nutrition commencing prior to conception remains very limited, despite suggestive evidence of its importance in addition to ensuring an optimal nutrition environment in the periconceptional period and throughout the first trimester of pregnancy. METHODS/STUDY DESIGN This is an individually randomized controlled trial of the impact on birth length (primary outcome) of the time at which a maternal nutrition intervention is commenced: Arm 1: ≥ 3 mo preconception vs. Arm 2: 12-14 wk gestation vs. Arm 3: none.192 (derived from 480) randomized mothers and living offspring in each arm in each of four research sites (Guatemala, India, Pakistan, Democratic Republic of the Congo). The intervention is a daily 20 g lipid-based (118 kcal) multi-micronutient (MMN) supplement. Women randomized to receive this intervention with body mass index (BMI) <20 or whose gestational weight gain is low will receive an additional 300 kcal/d as a balanced energy-protein supplement. Researchers will visit homes biweekly to deliver intervention and monitor compliance, pregnancy status and morbidity; ensure prenatal and delivery care; and promote breast feeding. The primary outcome is birth length. Secondary outcomes include: fetal length at 12 and 34 wk; incidence of low birth weight (LBW); neonatal/infant anthropometry 0-6 mo of age; infectious disease morbidity; maternal, fetal, newborn, and infant epigenetics; maternal and infant nutritional status; maternal and infant microbiome; gut inflammatory biomarkers and bioactive and nutritive compounds in breast milk. The primary analysis will compare birth Length-for-Age Z-score (LAZ) among trial arms (independently for each site, estimated effect size: 0.35). Additional statistical analyses will examine the secondary outcomes and a pooled analysis of data from all sites. DISCUSSION Positive results of this trial will support a paradigm shift in attention to nutrition of all females of child-bearing age. TRIAL REGISTRATION ClinicalTrials.gov NCT01883193.
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Affiliation(s)
| | | | | | - Ana Garces
- Francisco Marroquin University, Guatemala City, Guatemala
| | | | | | | | - Antoinette Tshefu
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of Congo (DRC
| | - Carl L Bose
- University of North Carolina, Chapel Hill, NC, USA
| | | | | | | | | | | | | | | | - Abhik Das
- RTI International, Research Triangle Park, NC, USA
| | - Marion Koso-Thomas
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Rockville, MD, USA
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19
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Kodkany BS, Bellad RM, Mahantshetti NS, Westcott JE, Krebs NF, Kemp JF, Hambidge KM. Biofortification of pearl millet with iron and zinc in a randomized controlled trial increases absorption of these minerals above physiologic requirements in young children. J Nutr 2013; 143:1489-93. [PMID: 23843474 PMCID: PMC3743277 DOI: 10.3945/jn.113.176677] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Revised: 05/09/2013] [Accepted: 06/13/2013] [Indexed: 11/14/2022] Open
Abstract
Millet is unusually drought resistant and consequently there is a progressive increase in the use of these grains as a human food staple, especially in large areas of India and sub-Saharan Africa. The purpose of this study was to determine the absorption of iron and zinc from pearl millet biofortified with 2 micronutrients that are typically deficient in nonfortified, plant-based diets globally. The study was undertaken in 40 children aged 2 y in Karnataka, India (n = 21 test/19 controls). Three test meals providing ∼84 ± 17 g dry pearl millet flour were fed on a single day for zinc and 2 d for iron between 0900 and 1600 h. The quantities of zinc and iron absorbed were measured with established stable isotope extrinsic labeling techniques and analyses of duplicate diets. The mean (± SD) quantities of iron absorbed from test and control groups were 0.67 ± 0.48 and 0.23 ± 0.15 mg/d, respectively (P < 0.001). The quantities of zinc absorbed were 0.95 ± 0.47 and 0.67 ± 0.24 mg/d, respectively (P = 0.03). These data did not include absorption of the modest quantities of iron and zinc contained in snacks eaten before and after the 3 test meals. In conclusion, quantities of both iron and zinc absorbed when iron and zinc biofortified pearl millet is fed to children aged 2 y as the major food staple is more than adequate to meet the physiological requirements for these micronutrients.
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Affiliation(s)
| | - Roopa M. Bellad
- Jawaharlal Nehru Medical College, KLE University, Belgaum, Karnataka, India; and
| | | | - Jamie E. Westcott
- University of Colorado Denver, Department of Pediatrics, Section of Nutrition, Aurora, CO
| | - Nancy F. Krebs
- University of Colorado Denver, Department of Pediatrics, Section of Nutrition, Aurora, CO
| | - Jennifer F. Kemp
- University of Colorado Denver, Department of Pediatrics, Section of Nutrition, Aurora, CO
| | - K. Michael Hambidge
- University of Colorado Denver, Department of Pediatrics, Section of Nutrition, Aurora, CO
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20
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Hambidge KM, Mazariegos M, Westcott JE, Kemp JF, Miller LV, Close K, Goco N, Lei S, Krebs NF. Physiological requirements (PR) for zinc (Zn) are met with a Zn supplement but not with phytate reduction of maize‐based diets in poor indigenous Guatemalan infants aged 9 mo. FASEB J 2013. [DOI: 10.1096/fasebj.27.1_supplement.860.3] [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)
| | - Manolo Mazariegos
- Institute of Nutrition of Central America and PanamaGuatemala CityGuatemala
| | - Jamie E Westcott
- Pediatric NutritionUniversity of Colorado School of MedicineAuroraCO
| | - Jennifer F Kemp
- Pediatric NutritionUniversity of Colorado School of MedicineAuroraCO
| | - Leland V Miller
- Pediatric NutritionUniversity of Colorado School of MedicineAuroraCO
| | | | | | - Sian Lei
- Pediatric NutritionUniversity of Colorado School of MedicineAuroraCO
| | - Nancy F Krebs
- Pediatric NutritionUniversity of Colorado School of MedicineAuroraCO
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21
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Krebs NF, Hambidge KM, Ikemeri JE, Westcott JE, Kemp J, Lei S, Miller LV, Liechty E, Esamai F. Zinc (Zn) absorption from Sprinkles
TM
is not affected by iron (Fe) in Kenyan infants in malaria endemic area. FASEB J 2013. [DOI: 10.1096/fasebj.27.1_supplement.107.3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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)
- Nancy F Krebs
- Pediatric NutritionUniversity of Colorado School of MedicineAuroraCO
| | | | | | - Jamie E Westcott
- Pediatric NutritionUniversity of Colorado School of MedicineAuroraCO
| | - Jennifer Kemp
- Pediatric NutritionUniversity of Colorado School of MedicineAuroraCO
| | - Sian Lei
- Pediatric NutritionUniversity of Colorado School of MedicineAuroraCO
| | - Leland V Miller
- Pediatric NutritionUniversity of Colorado School of MedicineAuroraCO
| | - Edward Liechty
- PediatricsIndiana University School of MedicineIndianapolisIN
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22
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Hambidge KM, Bellad RM, Mahantshetti NS, Kodkany BS, Boy E, Westcott JE, Rai KN, Cherian B, Miller LV, Krebs NF. Bioavailability of iron (Fe) and zinc (Zn) from Fe and Zn biofortified pearl millet. FASEB J 2013. [DOI: 10.1096/fasebj.27.1_supplement.638.21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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)
| | | | | | | | | | - Jamie E. Westcott
- Pediatric NutritionUniversity of Colorado School of MedicineAuroraCO
| | | | | | - Leland V. Miller
- Pediatric NutritionUniversity of Colorado School of MedicineAuroraCO
| | - Nancy F. Krebs
- Pediatric NutritionUniversity of Colorado School of MedicineAuroraCO
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Krebs NF, Sheng X, Westcott JE, Hu Y, Liu S, Hambidge KM. Higher cognitive and gross motor scores in Chinese toddlers randomized to meat compared to either micro‐nutrient fortified or unfortified infant cereal as first complementary food. FASEB J 2013. [DOI: 10.1096/fasebj.27.1_supplement.355.7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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)
- Nancy F Krebs
- Pediatric NutritionUniversity of Colorado School of MedicineAuroraCO
| | - Xiaoyang Sheng
- Child and Adolescent HealthShanghai Jiao Tong University School of MedicineShanghaiPeople's Republic of China
| | - Jamie E Westcott
- Pediatric NutritionUniversity of Colorado School of MedicineAuroraCO
| | - Yan‐Qi Hu
- Child and Adolescent HealthShanghai Jiao Tong University School of MedicineShanghaiPeople's Republic of China
| | - Shan‐Shan Liu
- Child and Adolescent HealthShanghai Jiao Tong University School of MedicineShanghaiPeople's Republic of China
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24
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Hambidge KM, Mazariegos M, Westcott JE, Miller LV, Close K, Goco N, Kemp JF, Lei S, Krebs NF. Pregnancy‐specific up‐regulation of zinc (Zn) absorption does not occur in indigenous Mayan population. FASEB J 2013. [DOI: 10.1096/fasebj.27.1_supplement.860.4] [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)
| | - Manolo Mazariegos
- Institute of Nutrition of Central America and Panama (INCAP)Guatemala CityGuatemala
| | - Jamie E Westcott
- Pediatric NutritionUniversity of Colorado School of MedicineAuroraCO
| | - Leland V Miller
- Pediatric NutritionUniversity of Colorado School of MedicineAuroraCO
| | | | | | - Jennifer F Kemp
- Pediatric NutritionUniversity of Colorado School of MedicineAuroraCO
| | - Sian Lei
- Pediatric NutritionUniversity of Colorado School of MedicineAuroraCO
| | - Nancy F Krebs
- Pediatric NutritionUniversity of Colorado School of MedicineAuroraCO
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25
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Liu JR, Sheng XY, Hu YQ, Yu XG, Westcott JE, Miller LV, Krebs NF, Hambidge KM. Fecal calprotectin levels are higher in rural than in urban Chinese infants and negatively associated with growth. BMC Pediatr 2012; 12:129. [PMID: 22917269 PMCID: PMC3504525 DOI: 10.1186/1471-2431-12-129] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2012] [Accepted: 08/16/2012] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Fecal calprotectin (FC) is an established simple biomarker of gut inflammation. To examine a possible relationship between linear growth and gut inflammation, we compared fecal calprotectin levels in 6 month old infants from poor rural vs affluent urban families. METHODS The project was a cross-sectional comparison of FC from rural and urban populations in China. The relationship between length-for-age Z-score (LAZ) and FC concentrations were also compared. Single fecal samples were assayed for FC using EK-CAL ELISA kits. RESULTS The age of subjects for both locations was 6.1 ± 0.2 mo; all were apparently healthy. The mean ± SD of the LAZ for the rural and urban infants were -0.6 ± 0.9 and 0.4 ± 0.9, respectively. FC had a non-normal distribution. The median FC of 420.9 and 140.1 μg/g for rural and urban infants, respectively, were significantly different (P < 0.0001). For the rural group, linear regression analysis showed that an increase in FC of 100 μg/g was associated with a decrease of 0.06 in LAZ. CONCLUSION FC levels were significantly elevated in the rural infants and high concentrations accounted for approximately one-third of the low LAZ scores of these infants.
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Affiliation(s)
- Jin-Rong Liu
- Department of Child and Adolescent Health Care, MOE-Shanghai Key Laboratory of Children’s Environmental Health, Xinhua Hospital, ShanghaiJiao Tong University, School of Medicine, Shanghai Key Laboratory of Pediatric Gastroenterology and Nutrition, Shanghai Institute for Pediatric Research, 1665 Kongjiang Road, Shanghai 200092, China
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26
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Krebs NF, Westcott JE, Culbertson DL, Sian L, Miller LV, Hambidge KM. Comparison of complementary feeding strategies to meet zinc requirements of older breastfed infants. Am J Clin Nutr 2012; 96:30-5. [PMID: 22648720 PMCID: PMC3374732 DOI: 10.3945/ajcn.112.036046] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2012] [Accepted: 04/04/2012] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The low zinc intake from human milk at ∼6 mo of age predicts the dependence on complementary foods (CF) to meet the zinc requirements of older breastfed-only infants. OBJECTIVE The objective of this study was to compare major variables of zinc homeostasis and zinc status in 9-mo-old breastfed infants who were randomly assigned to different complementary food regimens. DESIGN Forty-five exclusively breastfed 5-mo-old infants were randomly assigned to receive commercially available pureed meats, iron-and-zinc-fortified infant cereal (IZFC), or whole-grain, iron-only-fortified infant cereal (IFC) as the first and primary CF until completion of zinc metabolic studies between 9 and 10 mo of age. A zinc stable-isotope methodology was used to measure the fractional absorption of zinc (FAZ) in human milk and CF by dual-isotope ratios in urine. Calculated variables included the dietary intake from duplicate diets and 4-d test weighing, the total absorbed zinc (TAZ) from FAZ × diet zinc, and the exchangeable zinc pool size (EZP) from isotope enrichment in urine. RESULTS Mean daily zinc intakes were significantly greater for the meat and IZFC groups than for the IFC group (P < 0.001); only intakes in meat and IZFC groups met estimated average requirements. Mean (±SEM) TAZ amounts were 0.80 ± 0.08, 0.71 ± 0.09, and 0.52 ± 0.05 mg/d for the meat, IZFC, and IFC groups, respectively (P = 0.027). Zinc from human milk contributed <25% of TAZ for all groups. The EZP correlated with both zinc intake (r = 0.43, P < 0.01) and TAZ (r = 0.54, P < 0.001). CONCLUSION Zinc requirements for older breastfed-only infants are unlikely to be met without the regular consumption of either meats or zinc-fortified foods.
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Affiliation(s)
- Nancy F Krebs
- Department of Pediatrics, Section of Nutrition, School of Medicine, University of Colorado Denver, Aurora, CO 80045, USA.
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27
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Hambidge KM, Mazariegos M, Kindem M, Wright LL, Cristobal-Perez C, Juárez-García L, Westcott JE, Goco N, Krebs NF. Infant stunting is associated with short maternal stature. J Pediatr Gastroenterol Nutr 2012. [PMID: 21866055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
The objectives were to determine the range of maternal height associated with growth velocity of older infants and the magnitude of this association in an indigent population. Maternal height and infant length-for-age z scores (LAZ) were positively correlated at both 6 (n = 412, r = 0.324) and 12 (n = 388, r = 0.335) months (P < 0.0001) and for maternal heights from 131 to 164 cm. Maternal height is independently associated with infant LAZ and stunting (LAZ <-2) at both 6 and 12 months (P < 0.001) and with linear growth velocity from 6 to 12 months (P = 0.0023).
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Affiliation(s)
- K Michael Hambidge
- Department of Pediatrics, Section of Nutrition, University of Colorado, Aurora, CO 80045, USA.
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28
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Krebs NF, Westcott JE, Culbertson D, Miller LV, Lei S, Hambidge KM. Exchangeable zinc (Zn) pool (EZP) size, but not plasma Zn, reflects absorbed Zn in breastfed infants on different complementary foods. FASEB J 2011. [DOI: 10.1096/fasebj.25.1_supplement.228.8] [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)
- Nancy F Krebs
- Pediatric NutritionUniversity of Colorado DenverAuroraCO
| | | | | | | | - Sian Lei
- Pediatric NutritionUniversity of Colorado DenverAuroraCO
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Miller LV, Sheng XY, Hambidge KM, Westcott JE, Sian L, Krebs NF. The use of dysprosium to measure endogenous zinc excretion in feces eliminates the necessity of complete fecal collections. J Nutr 2010; 140:1524-8. [PMID: 20573943 PMCID: PMC2903305 DOI: 10.3945/jn.109.116889] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The secretion of endogenous zinc (Zn) into the gut and subsequent excretion in the feces is understood to play a major role in maintaining Zn homeostasis in humans. Therefore, the measurement of endogenous Zn losses in the feces (EFZ) can be an important aspect of the study of Zn metabolism and homeostasis. The methods currently used to measure EFZ have the disadvantage of requiring complete fecal collections over multiple days. We have investigated the use of dysprosium (Dy), a nonabsorbable rare earth metal, in a method of determining EFZ that does not require complete fecal collections and permits the measurement of EFZ from several fecal samples. The method was evaluated using data from a study of free-living adult females in which Dy was administered 3-4 times/d over a period of 5 or 6 d to monitor completeness of fecal collections. The results did not differ from those obtained using an established isotope dilution method. We found that the measurement of the sample Dy:Zn ratio was useful for selecting samples for measurement. We conclude that the Dy method of determining EFZ is a valid and less burdensome alternative to current techniques.
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Affiliation(s)
- Leland V. Miller
- University of Colorado Denver, Department of Pediatrics, Section of Nutrition, Aurora, CO 80045; and Shanghai Jiao Tong University, School of Medicine, Xin-Hua Hospital, Shanghai A200092, China,To whom correspondence should be addressed. E-mail:
| | - Xiao-Yang Sheng
- University of Colorado Denver, Department of Pediatrics, Section of Nutrition, Aurora, CO 80045; and Shanghai Jiao Tong University, School of Medicine, Xin-Hua Hospital, Shanghai A200092, China
| | - K. Michael Hambidge
- University of Colorado Denver, Department of Pediatrics, Section of Nutrition, Aurora, CO 80045; and Shanghai Jiao Tong University, School of Medicine, Xin-Hua Hospital, Shanghai A200092, China
| | - Jamie E. Westcott
- University of Colorado Denver, Department of Pediatrics, Section of Nutrition, Aurora, CO 80045; and Shanghai Jiao Tong University, School of Medicine, Xin-Hua Hospital, Shanghai A200092, China
| | - Lei Sian
- University of Colorado Denver, Department of Pediatrics, Section of Nutrition, Aurora, CO 80045; and Shanghai Jiao Tong University, School of Medicine, Xin-Hua Hospital, Shanghai A200092, China
| | - Nancy F. Krebs
- University of Colorado Denver, Department of Pediatrics, Section of Nutrition, Aurora, CO 80045; and Shanghai Jiao Tong University, School of Medicine, Xin-Hua Hospital, Shanghai A200092, China
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Mazariegos M, Hambidge KM, Westcott JE, Solomons NW, Raboy V, Das A, Goco N, Kindem M, Wright LL, Krebs NF. Neither a zinc supplement nor phytate-reduced maize nor their combination enhance growth of 6- to 12-month-old Guatemalan infants. J Nutr 2010; 140:1041-8. [PMID: 20335626 PMCID: PMC2855267 DOI: 10.3945/jn.109.115154] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2009] [Revised: 10/04/2009] [Accepted: 02/28/2010] [Indexed: 11/14/2022] Open
Abstract
After age 6 mo, the combination of breast-feeding and unfortified plant-based complementary feeding provides inadequate zinc (Zn). Additionally, high phytate intakes compromise the bioavailability of zinc. Our principal objective in this randomized controlled, doubly masked trial was to determine the effect of substituting low-phytate maize, a daily 5-mg zinc supplement, or both, in infants between ages 6-12 mo on impaired linear growth velocity, a common feature of zinc deficiency. In the Western Highlands of Guatemala, 412 infants were randomized to receive low-phytate or control maize. Within each maize group, infants were further randomized to receive a zinc supplement or placebo. Length, weight, and head circumference were measured at 6, 9, and 12 mo of age. There were no significant differences between the 2 maize groups or between the Zn supplement and placebo groups and no treatment interaction was observed for length-for-age (LAZ), weight-for-length (WLZ) or head circumference Z-scores. Overall mean (+/- SD) Z-scores at 6 mo for combined treatment groups were: LAZ, -2.1 +/- 1.1; WLZ, 0.7 +/- 1.0; and head circumference Z-score, -0.7.0 +/- 1.0. At 12 mo, these had declined further to: LAZ, -2.5 +/- 1.1; WLZ, -0.0 +/- 0.9; and head circumference Z-score, -0.9 +/- 1.1; 83.3% were stunted and 2% were wasted. Low linear growth in older Guatemalan infants was not improved with either low-phytate maize or a daily 5-mg zinc supplement. Low contribution of maize to the complementary food of the infants negated any potential advantage of feeding low-phytate maize.
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Affiliation(s)
- Manolo Mazariegos
- Center for Studies of Sensory Impairments, Aging and Metabolism, Guatemala City, Guatemala 01011; Section of Nutrition, Department of Pediatrics, University of Colorado Denver, Aurora, CO 80045; USDA, Agricultural Research Service, Aberdeen, ID 83210; Research Triangle Institute, Research Triangle Park, NC 27709; National Institute of Child Health and Human Development, Rockville, MD 20852
| | - K. Michael Hambidge
- Center for Studies of Sensory Impairments, Aging and Metabolism, Guatemala City, Guatemala 01011; Section of Nutrition, Department of Pediatrics, University of Colorado Denver, Aurora, CO 80045; USDA, Agricultural Research Service, Aberdeen, ID 83210; Research Triangle Institute, Research Triangle Park, NC 27709; National Institute of Child Health and Human Development, Rockville, MD 20852
| | - Jamie E. Westcott
- Center for Studies of Sensory Impairments, Aging and Metabolism, Guatemala City, Guatemala 01011; Section of Nutrition, Department of Pediatrics, University of Colorado Denver, Aurora, CO 80045; USDA, Agricultural Research Service, Aberdeen, ID 83210; Research Triangle Institute, Research Triangle Park, NC 27709; National Institute of Child Health and Human Development, Rockville, MD 20852
| | - Noel W. Solomons
- Center for Studies of Sensory Impairments, Aging and Metabolism, Guatemala City, Guatemala 01011; Section of Nutrition, Department of Pediatrics, University of Colorado Denver, Aurora, CO 80045; USDA, Agricultural Research Service, Aberdeen, ID 83210; Research Triangle Institute, Research Triangle Park, NC 27709; National Institute of Child Health and Human Development, Rockville, MD 20852
| | - Victor Raboy
- Center for Studies of Sensory Impairments, Aging and Metabolism, Guatemala City, Guatemala 01011; Section of Nutrition, Department of Pediatrics, University of Colorado Denver, Aurora, CO 80045; USDA, Agricultural Research Service, Aberdeen, ID 83210; Research Triangle Institute, Research Triangle Park, NC 27709; National Institute of Child Health and Human Development, Rockville, MD 20852
| | - Abhik Das
- Center for Studies of Sensory Impairments, Aging and Metabolism, Guatemala City, Guatemala 01011; Section of Nutrition, Department of Pediatrics, University of Colorado Denver, Aurora, CO 80045; USDA, Agricultural Research Service, Aberdeen, ID 83210; Research Triangle Institute, Research Triangle Park, NC 27709; National Institute of Child Health and Human Development, Rockville, MD 20852
| | - Norman Goco
- Center for Studies of Sensory Impairments, Aging and Metabolism, Guatemala City, Guatemala 01011; Section of Nutrition, Department of Pediatrics, University of Colorado Denver, Aurora, CO 80045; USDA, Agricultural Research Service, Aberdeen, ID 83210; Research Triangle Institute, Research Triangle Park, NC 27709; National Institute of Child Health and Human Development, Rockville, MD 20852
| | - Mark Kindem
- Center for Studies of Sensory Impairments, Aging and Metabolism, Guatemala City, Guatemala 01011; Section of Nutrition, Department of Pediatrics, University of Colorado Denver, Aurora, CO 80045; USDA, Agricultural Research Service, Aberdeen, ID 83210; Research Triangle Institute, Research Triangle Park, NC 27709; National Institute of Child Health and Human Development, Rockville, MD 20852
| | - Linda L. Wright
- Center for Studies of Sensory Impairments, Aging and Metabolism, Guatemala City, Guatemala 01011; Section of Nutrition, Department of Pediatrics, University of Colorado Denver, Aurora, CO 80045; USDA, Agricultural Research Service, Aberdeen, ID 83210; Research Triangle Institute, Research Triangle Park, NC 27709; National Institute of Child Health and Human Development, Rockville, MD 20852
| | - Nancy F. Krebs
- Center for Studies of Sensory Impairments, Aging and Metabolism, Guatemala City, Guatemala 01011; Section of Nutrition, Department of Pediatrics, University of Colorado Denver, Aurora, CO 80045; USDA, Agricultural Research Service, Aberdeen, ID 83210; Research Triangle Institute, Research Triangle Park, NC 27709; National Institute of Child Health and Human Development, Rockville, MD 20852
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Abstract
Zinc has earned recognition recently as a micronutrient of outstanding and diverse biological, clinical, and global public health importance. Regulation of absorption by zinc transporters in the enterocyte, together with saturation kinetics of the absorption process into and across the enterocyte, are the principal means by which whole-body zinc homeostasis is maintained. Several physiologic factors, most notably the quantity of zinc ingested, determine the quantity of zinc absorbed and the efficiency of absorption. Other factors are age and the time over which zinc is ingested. Zinc from supplements has not been shown to be absorbed differently from that taken with meals that lack inhibitors of zinc absorption. The principal dietary factor known to impair zinc bioavailability is inositol hexa- (and penta-) phosphate or phytate. Modeling of zinc absorption as a function of dietary zinc and phytate accounts for >80% of the variability in the quantity of zinc absorbed. Fitting the model to new data has resulted in continual improvement in parameter estimates, which currently indicate a maximal absorption in adults of approximately 6 mg Zn/d and that the average estimated dietary requirement doubles with 1000 mg dietary phytate/d. Intestinal excretion of endogenous zinc is regulated in response to recent absorption and to zinc status. The quantitative relation of intestinal excretion of endogenous zinc to zinc absorption is currently considered to be of major importance in the determination of zinc requirements. The effects of phytate on intestinal losses of endogenous zinc merit further investigation but are probably not of the same magnitude as its inhibitory effects on absorption of exogenous zinc.
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Affiliation(s)
- K Michael Hambidge
- Department of Pediatrics, Section of Nutrition, University of Colorado Denver, Denver, CO, USA.
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Sheng XY, Hambidge KM, Miller LV, Westcott JE, Lei S, Krebs NF. Measurement of zinc absorption from meals: comparison of extrinsic zinc labeling and independent measurements of dietary zinc absorption. INT J VITAM NUTR RES 2009; 79:230-7. [PMID: 20209474 PMCID: PMC5328628 DOI: 10.1024/0300-9831.79.4.230] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Extrinsic labeling techniques are typically used to measure fractional absorption of zinc (FAZ(extrinsic)) but none have been adequately evaluated. OBJECTIVE To compare determination of the quantity of zinc absorbed (TAZ(extrinsic)) using measurements of FAZ(extrinsic) with results of simultaneous determinations of dietary zinc absorbed (TAZ(metabolic)) that are not dependent on labeling ingested food with an extrinsic tracer (modified metabolic balance technique). DESIGN (70)Zn was administered orally with all meals for 6 consecutive days to 21 healthy, free-living adult women consuming a constant diet. (68)Zn and (67)Zn were administered intravenously. FAZ(extrinsic) was measured using a dual isotope tracer ratio technique and multiplied by dietary zinc to give TAZ(extrinsic). TAZ(metabolic) was determined by addition of net absorption of zinc and endogenous fecal zinc, the latter determined by an isotope dilution technique. RESULTS TAZ(extrinsic) and TAZ(metabolic) were 3.0 +/- 1.1 mg/day and 3.1 +/- 1.1 mg/day respectively, paired t-test p = 0.492. The correlation coefficient for TAZ(extrinsic) and TAZ(metabolic) was 0.91, and for FAZ(extrinsic) and FAZ(metabolic) was 0.95. A Bland Altman analysis indicated a bias of 0.07, and the limits of agreement of -0.86 to 1.01 for TAZ(extrinsic) and TAZ(metabolic). CONCLUSION These results from two independent methods provide reasonable validation of our extrinsic labeling technique for a wide range of composite diets.
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Affiliation(s)
- Xiao-Yang Sheng
- Shanghai Jiao Tong University, School of Medicine, Xin-Hua Hospital, Department of Child and Juvenile Health Care, Shanghai, China
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Hambidge KM, Miller LV, Westcott JE, Krebs NF. Dietary reference intakes for zinc may require adjustment for phytate intake based upon model predictions. J Nutr 2008; 138:2363-6. [PMID: 19022958 PMCID: PMC2635502 DOI: 10.3945/jn.108.093823] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2008] [Revised: 07/07/2008] [Accepted: 09/25/2008] [Indexed: 11/14/2022] Open
Abstract
The quantity of total dietary zinc (Zn) and phytate are the principal determinants of the quantity of absorbed Zn. Recent estimates of Dietary Reference Intakes (DRI) for Zn by the Institute of Medicine (IOM) were based on data from low-phytate or phytate-free diets. The objective of this project was to estimate the effects of increasing quantities of dietary phytate on these DRI. We used a trivariate model of the quantity of Zn absorbed as a function of dietary Zn and phytate with updated parameters to estimate the phytate effect on the Estimated Average Requirement (EAR) and Recommended Daily Allowance for Zn for both men and women. The EAR predicted from the model at 0 phytate was very close to the EAR of the IOM. The addition of 1000 mg phytate doubled the EAR and adding 2000 mg phytate tripled the EAR. The model also predicted that the EAR for men and women could not be attained with phytate:Zn molar ratios > 11:1 and 15:1, respectively. The phytate effect on upper limits (UL) was predicted by first estimating the quantity of absorbed Zn corresponding to the UL of 40 mg for phytate-free diets, which is 6.4 mg Zn/d. Extrapolation of the model suggested, for example, that with 900 mg/d phytate, 100 mg dietary Zn is required to attain 6.4 mg absorbed Zn/d. Experimental studies with higher Zn intakes are required to test these predictions.
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Affiliation(s)
- K Michael Hambidge
- Department of Pediatrics, Section of Nutrition, University of Colorado, School of Medicine, Denver, CO 80262, USA.
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34
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Abebe Y, Bogale A, Hambidge KM, Stoecker BJ, Arbide I, Teshome A, Krebs NF, Westcott JE, Bailey KB, Gibson RS. Inadequate intakes of dietary zinc among pregnant women from subsistence households in Sidama, Southern Ethiopia. Public Health Nutr 2008; 11:379-86. [PMID: 17610755 DOI: 10.1017/s1368980007000389] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
AbstractObjectiveTo assess the prevalence of zinc inadequacy based on dietary intakes and plasma zinc concentrations and, simultaneously, the prevalence of inadequate intakes of energy, protein, calcium and iron.DesignA cross-sectional study of a convenience sample of subsistence farming households in Sidama, Southern Ethiopia.SubjectsDietary intakes were calculated from 1-day weighed food records and 40 repeats from 99 pregnant women in the third trimester using analysed values of major staple foods for zinc, iron, calcium and phytate. The distribution of observed intakes was adjusted for usual intakes and the prevalence of inadequacy estimated using the estimated average requirement (EAR) cutpoint method. Prevalence of inadequacy for zinc, protein and iron intakes were compared with those based on biochemical measures.ResultsPrevalence of zinc inadequacy was very high: 99% for US FNB EAR and 100% for IZiNCG EAR compared to 72% based on low plasma zinc concentrations. Corresponding prevalence estimates for iron were much lower: 4% for inadequate intakes based on US FNB EAR vs. 8.7% for iron deficiency anaemia (haemoglobin < 110 g l−1; ferritin < 12 μg l−1) and 32.3% for low storage iron. Prevalence of inadequacy for protein was 100% for adjusted intakes and 91% for serum albumin < 32 g l−1. For calcium, 74% were at risk for inadequate intakes.ConclusionThe high prevalence of inadequate intakes of zinc and protein was reasonably consistent with those based on biochemical measures. Such dietary deficits could be overcome by regular consumption of cellular animal protein. In contrast, both dietary and biochemical measures of iron inadequacy were low.
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Affiliation(s)
- Yewelsew Abebe
- College of Agriculture, Hawassa University, Awassa, Ethiopia
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35
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Affiliation(s)
- Hatai Ann Kraushaar
- PediatricsSection of NutritionUniversity of Colorado School of MedicineDenverCO
| | - K Michael Hambidge
- PediatricsSection of NutritionUniversity of Colorado School of MedicineDenverCO
| | - Leland V Miller
- PediatricsSection of NutritionUniversity of Colorado School of MedicineDenverCO
| | - Jamie E Westcott
- PediatricsSection of NutritionUniversity of Colorado School of MedicineDenverCO
| | - Sian Lei
- PediatricsSection of NutritionUniversity of Colorado School of MedicineDenverCO
| | - Cuong D Tran
- Gastroenterology UnitWomen's and Children's HospitalNorth AdelaideAustralia
| | - Nancy F Krebs
- PediatricsSection of NutritionUniversity of Colorado School of MedicineDenverCO
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36
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Hambidge KM, Miller LV, Westcott JE, Krebs NF. Calculating Estimated Average Requirements (EARs) for zinc (Zn) According to Dietary Phytate. FASEB J 2008. [DOI: 10.1096/fasebj.22.1_supplement.697.5] [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)
- K Michael Hambidge
- PediatricsSection of NutritionUniversity of Colorado Health Sciences CenterDenverCO
| | - Leland V Miller
- PediatricsSection of NutritionUniversity of Colorado Health Sciences CenterDenverCO
| | - Jamie E Westcott
- PediatricsSection of NutritionUniversity of Colorado Health Sciences CenterDenverCO
| | - Nancy F Krebs
- PediatricsSection of NutritionUniversity of Colorado Health Sciences CenterDenverCO
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37
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Hambidge KM, Rosado JL, Miller LV, Hotz C, Westcott JE, Garcia OP, Gonzalez K, Ortiz‐Monasterio I, Pfeiffer W, Krebs NF. Absorption of Zinc (Zn) from High Zn & Control Wheat. FASEB J 2008. [DOI: 10.1096/fasebj.22.1_supplement.149.5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [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)
- K Michael Hambidge
- PediatricsSection of NutritionUniversity of Colorado Health Sciences CenterDenverCO
| | - Jorge L Rosado
- Department of Natural ScienceUniversidad Autónoma de QuerétaroQuerétaroMexico
| | - Leland V Miller
- PediatricsSection of NutritionUniversity of Colorado Health Sciences CenterDenverCO
| | | | - Jamie E Westcott
- PediatricsSection of NutritionUniversity of Colorado Health Sciences CenterDenverCO
| | - Olga P Garcia
- Department of Natural ScienceUniversidad Autónoma de QuerétaroQuerétaroMexico
| | - Karla Gonzalez
- Department of Natural ScienceUniversidad Autónoma de QuerétaroQuerétaroMexico
| | | | | | - Nancy F Krebs
- PediatricsSection of NutritionUniversity of Colorado Health Sciences CenterDenverCO
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38
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Sheng X, Hambidge KM, Miller LV, Bailey KB, Gibson RS, Westcott JE, Lei S, Grunwald G, Krebs NF. Major parameters of zinc (Zn) homeostasis in adult women with a wide range of habitual zinc intake. FASEB J 2008. [DOI: 10.1096/fasebj.22.1_supplement.697.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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)
- Xiao‐Yang Sheng
- Child health careShanghai Jiao Tong UniversitySchool of MedicineXin‐Hua HospitalShanghaiPeople's Republic of China
- Department of PediatricUniversity of Colorado Health Science CenterDenverCO
| | - K Michael Hambidge
- Department of PediatricUniversity of Colorado Health Science CenterDenverCO
| | - Leland V Miller
- Department of PediatricUniversity of Colorado Health Science CenterDenverCO
| | | | | | - Jamie E Westcott
- Department of PediatricUniversity of Colorado Health Science CenterDenverCO
| | - Sian Lei
- Department of PediatricUniversity of Colorado Health Science CenterDenverCO
| | - Gary Grunwald
- Department of PediatricUniversity of Colorado Health Science CenterDenverCO
| | - Nancy F Krebs
- Department of PediatricUniversity of Colorado Health Science CenterDenverCO
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Hambidge KM, Miller LV, Westcott JE, Krebs NF. Modeling zinc (Zn) absorption (AZ) from single test meals (SM) as a function of dietary zinc (DZ) and phytate (DP). FASEB J 2008. [DOI: 10.1096/fasebj.22.1_supplement.697.4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [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)
- K Michael Hambidge
- PediatricsSection of NutritionUniversity of Colorado Health Sciences CenterDenverCO
| | - Leland V Miller
- PediatricsSection of NutritionUniversity of Colorado Health Sciences CenterDenverCO
| | - Jamie E Westcott
- PediatricsSection of NutritionUniversity of Colorado Health Sciences CenterDenverCO
| | - Nancy F Krebs
- PediatricsSection of NutritionUniversity of Colorado Health Sciences CenterDenverCO
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40
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Krebs NF, Mazariegos M, Westcott JE, Wright L, Das A, Goco N, Hartwell T, Solomons NW, Raboy V, Angel L, Hambidge KM. Effects of zinc (Zn) supplementation and phytate‐reduced maize in 6‐12 mo infants in Guatemala. FASEB J 2008. [DOI: 10.1096/fasebj.22.1_supplement.149.6] [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)
- Nancy F Krebs
- PediatricsSection of NutritionUniversity of Colorado Health Sciences CenterDenverCO
| | | | - Jamie E Westcott
- PediatricsSection of NutritionUniversity of Colorado Health Sciences CenterDenverCO
| | | | | | | | | | | | | | | | - K Michael Hambidge
- PediatricsSection of NutritionUniversity of Colorado Health Sciences CenterDenverCO
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Gibson RS, Abebe Y, Stabler S, Allen RH, Westcott JE, Stoecker BJ, Krebs NF, Hambidge KM. Zinc, gravida, infection, and iron, but not vitamin B-12 or folate status, predict hemoglobin during pregnancy in Southern Ethiopia. J Nutr 2008; 138:581-6. [PMID: 18287370 PMCID: PMC2440679 DOI: 10.1093/jn/138.3.581] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The etiology of anemia during pregnancy in rural Southern Ethiopia is uncertain. Intakes of animal-source foods are low and infections and bacterial overgrowth probably coexist. We therefore measured the dietary intakes of a convenience sample of Sidama women in late pregnancy who consumed either maize (n = 68) or fermented enset (Enset ventricosum) (n = 31) as their major energy source. Blood samples were analyzed for a complete blood count, vitamin B-12 and folate status, plasma ferritin, retinol, zinc, albumin, and C-reactive protein (CRP). The role of infection and gravida was also examined. Dietary intakes were calculated from 1-d weighed records. No cellular animal products were consumed. Of the women, 29% had anemia, 13% had iron deficiency anemia, 33% had depleted iron stores, and 74 and 27% had low plasma zinc and retinol, respectively. Only 2% had low plasma folate (< 6.8 nmol/L) and 23% had low plasma vitamin B-12 (< 150 pmol/L), even though 62% had elevated plasma methylmalonic acid (MMA) (> 271 nmol/L). None had elevated plasma cystathionine or total homocysteine (tHcys). Women with enset-based diets had higher (P = 0.052) plasma vitamin B-12 concentration and lower (P < 0.05) cell volume, plasma cystathionine, and retinol than women consuming maize-based diets, but mean hemoglobin, plasma ferritin, MMA, tHcys, and folate did not differ. Plasma zinc, followed by CRP (< or = 5 mg/L), gravida (< or = 4), and plasma ferritin (> or = 12 microg/L) status were major positive predictors of hemoglobin. Despite some early functional vitamin B-12 deficiency, there was no macrocytic anemia. Consumption of fermented enset may have increased vitamin B-12 levels in diet and plasma.
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Affiliation(s)
- Rosalind S. Gibson
- Department of Human Nutrition, University of Otago, Dunedin, New Zealand 9015
| | - Yewelsew Abebe
- College of Agriculture, Hawassa University, Awassa, Ethiopia
| | - Sally Stabler
- Division of Hematology, Department of Medicine, University of Colorado, Denver, CO 80262
| | - Robert H. Allen
- Division of Hematology, Department of Medicine, University of Colorado, Denver, CO 80262
| | - Jamie E. Westcott
- Section of Nutrition, Department of Pediatrics, University of Colorado, Denver, CO 80262
| | | | - Nancy F. Krebs
- Section of Nutrition, Department of Pediatrics, University of Colorado, Denver, CO 80262
| | - K. Michael Hambidge
- Section of Nutrition, Department of Pediatrics, University of Colorado, Denver, CO 80262
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Hambidge KM, Mazariegos M, Solomons NW, Westcott JE, Lei S, Raboy V, Grunwald G, Miller LV, Sheng X, Krebs NF. Intestinal excretion of endogenous zinc in Guatemalan school children. J Nutr 2007; 137:1747-9. [PMID: 17585025 DOI: 10.1093/jn/137.7.1747] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The intestine is the major route of excretion of endogenous zinc (Zn) and has a key role in maintaining Zn homeostasis. The principal objective of this paper is to provide an interpretative report of quantities of endogenous fecal Zn (EFZ) excreted by rural Guatemalan school children fed either normal or low phytate maize as their principal food staple. EFZ was measured by a Zn stable isotope technique. EFZ did not differ between control and low phytate maize groups. The overall EFZ (n = 53) was (mean +/- SD) 1.56 +/- 0.69 mg Zn/d or 0.07 +/- 0.03 mg Zn x kg body wt(-1) x d(-1). EFZ was not correlated with the quantity of Zn absorbed. The estimated EFZ at the level of absorption that matched the physiologic requirement (EFZ(PR)) did not differ from the above mean value. The EFZ(PR) of 0.07 +/- 0.03 mg Zn/kg body wt is twice the value currently used in the estimation of Dietary Reference Intakes. Supported by other recent childhood data, these results suggest that the current estimates of EFZ(PR) used in the calculation of Zn requirements for children are misleadingly low.
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Affiliation(s)
- K Michael Hambidge
- Section of Nutrition, Department of Pediatrics, University of Colorado Health Sciences Center, Denver, CO 80262, USA.
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43
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Sheng X, Hambidge KM, Krebs NF, Miller LV, Westcott JE, Lei S. Zinc (Zn) absorption: Comparison of extrinsic label with intrinsic Zn in test meals. FASEB J 2007. [DOI: 10.1096/fasebj.21.5.a171-a] [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)
- Xiao‐Yang Sheng
- Child Health CareShanghai Jiao Tong University, School of Medicine, Xin‐Hua Hospital1665 Kong‐Jiang RoadShanghaiPeople's Republic of China
| | - K Michael Hambidge
- Department of PediatricUniversity of Colorado Health Science CenterSection of Nutrition, 4200E Ninth Avenue, Campus Box C225DenverCO80262
| | - Nancy F Krebs
- Department of PediatricUniversity of Colorado Health Science CenterSection of Nutrition, 4200E Ninth Avenue, Campus Box C225DenverCO80262
| | - Leland V Miller
- Department of PediatricUniversity of Colorado Health Science CenterSection of Nutrition, 4200E Ninth Avenue, Campus Box C225DenverCO80262
| | - Jamie E Westcott
- Department of PediatricUniversity of Colorado Health Science CenterSection of Nutrition, 4200E Ninth Avenue, Campus Box C225DenverCO80262
| | - Sian Lei
- Department of PediatricUniversity of Colorado Health Science CenterSection of Nutrition, 4200E Ninth Avenue, Campus Box C225DenverCO80262
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Hambidge KM, Abebe Y, Gibson RS, Westcott JE, Miller LV, Lei S, Stoecker BJ, Arbide I, Teshome A, Bailey KB, Krebs NF. Zinc absorption during late pregnancy in rural southern Ethiopia. Am J Clin Nutr 2006; 84:1102-6. [PMID: 17093163 PMCID: PMC1987331 DOI: 10.1093/ajcn/84.5.1102] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Little is yet known about zinc absorption in late pregnancy, and no information on absorption from the total diet is available. OBJECTIVE The objective was to measure the fractional absorption of zinc (FAZ) and to estimate the total quantity of absorbed zinc (TAZ) each day during the third trimester of pregnancy in poor rural southern Ethiopian women. DESIGN The participants (n = 17) were a convenience sample from a larger study population. The third stage of pregnancy was estimated from fundal height by the Bushulo Health Center prenatal outreach program. FAZ was determined with a dual-isotope tracer ratio technique that uses measurements of urine enrichment with zinc stable isotopes administered intravenously and orally, as an extrinsic label, with all meals in 1 d. Total dietary zinc (TDZ) was calculated from weighed diet records and Ethiopian food-composition tables supported by zinc and phytate analyses of major food items for individual meals. Plasma zinc and exchangeable zinc pool size were also estimated. RESULTS Mean (+/-SD) FAZ was 0.35 +/- 0.11, TDZ was 6.0 +/- 3.2 mg/d, TAZ was 2.1 +/- 1.0 mg/d, phytate intake was 1033 +/- 843 mg/d, plasma zinc was 44.1 +/- 6.0 microg/dL, and the exchangeable zinc pool size was 142 +/- 39 mg. The molar ratio of phytate to zinc was 17:1. CONCLUSIONS Women from a poor rural population who were dependent on a moderately high-phytate diet had low TDZ and low plasma zinc concentrations in the third trimester of pregnancy. TAZ was modestly higher than that predicted but did not meet physiologic requirements.
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Affiliation(s)
- K Michael Hambidge
- Section of Nutrition, Department of Pediatrics, University of Colorado Health Sciences Center, Denver, CO, USA.
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Abstract
Zinc (Zn) nutrition is of special practical importance in infants and young children, however relatively little is known about maturation and comparative aspects of Zn absorption. The principal objective of this paper is to compare Zn absorption of term infants, preterm infants, and adults on low phytate diets. Existing data derived from using Zn stable isotopes as extrinsic labels for an entire day were modeled with saturation kinetic analysis (saturable response model). When adjusted for differences in length of small intestine, the efficiency of Zn absorption for both term (4 months) and preterm (33 weeks post-conception) infants was comparable with that for adults, suggesting early maturation of mechanisms that regulate absorption. However, infant intestinal lengths were shorter, and Zn absorptive capacity was proportionately less. Reduced capacity was matched by lower Zn requirements for normal term infants. This favorable match, however, did not occur in the preterm infant because of relatively high Zn requirements. Although intestinal conservation of endogenous Zn in these preterm infants was appropriate in relation to the quantity of Zn absorbed, it was not optimal for achieving the retention required. Normal homeostatic mechanisms in the premature infant prevented efficient absorption of the quantity of Zn required or/and optimal conservation of endogenous Zn.
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Affiliation(s)
- K Michael Hambidge
- Section of Nutrition, Department of Pediatrics, University of Colorado Health Sciences Center, Denver, CO 80262, USA.
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Krebs NF, Abebe Y, Stoecker BJ, Gibson RS, Westcott JE, Hambidge M. Intake of zinc from human milk and complementary foods by 7 month old infants from the Sidama Zone in Southern Ethiopia. FASEB J 2006. [DOI: 10.1096/fasebj.20.5.a985-b] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [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)
- Nancy F. Krebs
- PediatricsUniversity of Colorado4200 East Ninth Ave‐ Box C225DenverCO80262
| | - Yewelsew Abebe
- Rural Development & Family SciencesDebub UniversityAwassaEthiopia
| | | | | | | | - Michael Hambidge
- PediatricsUniversity of Colorado4200 East Ninth AveDenverCO80262
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Affiliation(s)
- Leland V Miller
- Pediatrics, Section of NutritionUniversity of Colorado Health Sciences Center4200 East 9th Avenue, Box C225DenverCO80262
| | - Nancy F Krebs
- Pediatrics, Section of NutritionUniversity of Colorado Health Sciences Center4200 East 9th Avenue, Box C225DenverCO80262
| | - Jamie E Westcott
- Pediatrics, Section of NutritionUniversity of Colorado Health Sciences Center4200 East 9th Avenue, Box C225DenverCO80262
| | - Michael Hambidge
- Pediatrics, Section of NutritionUniversity of Colorado Health Sciences Center4200 East 9th Avenue, Box C225DenverCO80262
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Miller LV, Sheng X, Krebs NF, Westcott JE, Lei S, Hambidge M. A method for measuring endogenous zinc in feces using dysprosium. FASEB J 2006. [DOI: 10.1096/fasebj.20.5.a996-a] [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)
- Leland V Miller
- Pediatrics, Section of NutritionUniversity of Colorado Health Sciences Center4200 East 9th Avenue, Box C225DenverCO80262
| | - Xiaoyang Sheng
- Pediatrics, Section of NutritionUniversity of Colorado Health Sciences Center4200 East 9th Avenue, Box C225DenverCO80262
| | - Nancy F Krebs
- Pediatrics, Section of NutritionUniversity of Colorado Health Sciences Center4200 East 9th Avenue, Box C225DenverCO80262
| | - Jamie E Westcott
- Pediatrics, Section of NutritionUniversity of Colorado Health Sciences Center4200 East 9th Avenue, Box C225DenverCO80262
| | - Sian Lei
- Pediatrics, Section of NutritionUniversity of Colorado Health Sciences Center4200 East 9th Avenue, Box C225DenverCO80262
| | - Michael Hambidge
- Pediatrics, Section of NutritionUniversity of Colorado Health Sciences Center4200 East 9th Avenue, Box C225DenverCO80262
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Hambidge M, Gibson RS, Cooper JC, Abebe Y, Westcott JE, Stoecker BJ, Bailey K, Krebs NF. Zinc (Zn) absorption during the third trimester in pregnant rural Southern Ethiopian women. FASEB J 2006. [DOI: 10.1096/fasebj.20.4.a629] [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)
- Michael Hambidge
- PediatricsSection of NutritionUniversity of Colorado Health Sciences Center4200 East 9th Avenue, Box C225DenverCO80262
| | - Rosalind S Gibson
- Human NutritionUniversity of OtagoUnion Street, PO Box 56Dunedin9015New Zealand
| | - Jennifer C Cooper
- PediatricsSection of NutritionUniversity of Colorado Health Sciences Center4200 East 9th Avenue, Box C225DenverCO80262
| | - Yewelsew Abebe
- Rural Development and Family SciencesDebub UniversityAwassa College of AgriculturePO Box 5AwassaEthiopia
| | - Jamie E Westcott
- PediatricsSection of NutritionUniversity of Colorado Health Sciences Center4200 East 9th Avenue, Box C225DenverCO80262
| | - Barbara J Stoecker
- Nutritional SciencesOklahoma State University203 Whitehurst HallStillwaterOK74078
| | - Kevin Bailey
- Human NutritionUniversity of OtagoUnion Street, PO Box 56Dunedin9015New Zealand
| | - Nancy F Krebs
- PediatricsSection of NutritionUniversity of Colorado Health Sciences Center4200 East 9th Avenue, Box C225DenverCO80262
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Krebs NF, Westcott JE, Butler N, Robinson C, Bell M, Hambidge KM. Effect of maternal consumption of lactobacillus GG on transfer and establishment of fecal bifidobacterial microbiota in neonates. J Pediatr Gastroenterol Nutr 2006; 42:207-14. [PMID: 16456417 DOI: 10.1097/01.mpg.0000189346.25172.fd] [Citation(s) in RCA: 213] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Establishment of the gut microbiota at birth provides a substantial source of microbial stimuli for the maturation of the immune system. Deviations in this process precede the development of specific diseases providing the rationale for the use of probiotics to counteract them. OBJECTIVE This study was designed to characterize both the mother-infant bifidobacteria transfer at birth and the development of bifidobacteria microbiota during the first weeks of life in infants whose mothers received Lactobacillus rhamnosus GG or placebo. METHODS Species-specific PCR was used to assess the fecal bifidobacterial composition of mothers before and after delivery and in infants at 5 days and 3 weeks of age. RESULTS Bifidobacterium longum was the species most commonly found in the mothers. Bifidobacterium catenulatum was the most prevalent group in infants at 5 days of age and B. longum the predominant species at 3 weeks. At 5 days of age, infants whose mothers received L. rhamnosus GG showed a significantly higher occurrence of B. breve and lower of B. adolescentis than those from the placebo group. In addition, L. rhamnosus GG consumption increased the bifidobacterial diversity in infants and reduced the Bifidobacterium microbiota similarity between mother and infant. CONCLUSIONS These results indicate that specific changes in the transfer and initial establishment of bifidobacteria in neonates take place as consequence of the consumption of L. rhamnosus GG by the mothers.
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Affiliation(s)
- Nancy F Krebs
- Section of Nutrition, Department of Pediatrics, University of Colorado School of Medicine, Health Sciences Center, 4200 East 9th Avenue, Denver, CO 80262, USA.
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