Increase in serum beta-carotene following dark green leafy vegetable supplementation in Mebendazole-treated school children in Bangladesh

Once-Daily Low Inflammatory Foods Everyday (LIFE) Smoothie or the Full LIFE Diet Lowers C-Reactive Protein and Raises Plasma Beta-Carotene in 7 Days

Serum C-reactive protein (CRP), a marker of systemic inflammation, is associated with increased risk for numerous inflammation-driven chronic diseases. A prior longitudinal study showed that the Low Inflammatory Foods Everyday (LIFE) diet, which is rich in dark green leafy vegetables (DGLV), lowered CRP over a mean follow-up period of 6 months. In this retrospective study, we investigate whether patients who consume the LIFE diet or their regular diet plus one component of the LIFE diet (LIFE smoothie), experience reductions in high-sensitivity CRP (hsCRP) in 7 days. Sixteen patients in a community practice met inclusion criteria. Patient compliance was assessed by patient interviews and measurements of beta-carotene, which is abundant in DGLV. Following the interventions, CRP decreased in both the LIFE diet (−0.47 mg/L, P = .02) and smoothie groups (−1.2 mg/L, P = .04). No statistically significant difference in reduction was observed between groups ( P = .18). Plasma beta-carotene increased in both groups (+23.2, P = .02; +20.6, P = .006, respectively). These findings suggest that the LIFE diet or a regular American diet supplemented with the LIFE smoothie may quickly reduce systemic inflammation and the risk of many chronic diseases.

Dietary vitamin A intakes among pregnant women attending antenatal care in health facilities in Dessie Town, North East Ethiopia

BACKGROUND

Vitamin A plays an important role in vision, cellular differentiation, embryonic development, reproduction, growth and the immune system. Women who live in developing countries face a risk of undernutrition during pregnancy as a result of poverty, poor diet quality and quantity, and a high fertility rate. This poor dietary problem could reflect the high risk of vitamin A deficiency in women. The present study aimed to determine the adequacy of vitamin A among pregnant women following antenatal care in health facilities of Dessie Town, Ethiopia, January 2017.

METHODS

Health facility-based cross-sectional study was conducted among 390 women who attended antenatal care in Dessie Town. Food groups from the Food and Agriculture Organization based on 24-h dietary recall were used to measure dietary intake of vitamin A and dietary diversity of women. Adequacy of vitamin A was determined from the nutrient adequacy ratio after obtaining reports of nutrient intake from food composition tables version III and IV in terms of B carotene and retinol equivalent, respectively, based on the estimated average requirement recommendation of vitamin A, 370 retinol equivalent day^-1 for pregnant women. Multivariable logistic regression analysis was performed to identify associated factors of vitamin A adequacy.

RESULTS

Adequacy of vitamin A among pregnant women was 41.8%, with an average nutrient adequacy ratio of 0.9. The mean dietary intake of vitamin A was 290.1 µg day^-1 . The predictors for adequacy of vitamin A were high and medium women diversity scores (adjusted odds ratio = 2.92; 95% confidence interval = 1.50-5.70) and (adjusted odds ratio = 1.87; 95% confidence interval = 1.11-3.16).

CONCLUSIONS

In the present study, adequacy of vitamin A was low and was affected by the dietary diversity score. A focus on food-based approaches, especially regarding educating pregnant women to diversify their diet, is crucial for reducing the risk of vitamin A deficiency. Vitamin A is crucial micronutrient for the health of women and fetus, being essential for morphological, ocular and functional developments, as well as fetal organ and skeletal growth. Its requirement is greater during pregnancy and its deficiencies lead to maternal and child mortality and development. The dietary intake of vitamin A among pregnant women remains below the current recommendation. Inadequate intake of vitamin A Pregnant women Heath facility Dessie, Ethiopia.

Soil-transmitted helminthiasis in four districts in Bangladesh: household cluster surveys of prevalence and intervention status

Background

In 2016, after 8 years of twice-annual nationwide preventive chemotherapy (PC) administration to school-age children (SAC), the Bangladesh Ministry of Health & Family Welfare (MOHFW) sought improved impact and intervention monitoring data to assess progress toward the newly adopted goal of eliminating soil-transmitted helminthiasis (STH) as a public health problem.

Methods

We surveyed four Bangladeshi districts between August and October 2017. We conducted a multi-stage, cluster-sample, household survey which produced equal-probability samples for preschool-age children (PSAC; 1–4 years), SAC (5–14 years), and adults (≥ 15 years). Standardized questionnaires were administered, using Android-based smart phones running an Open Data Kit application. Stool samples were collected and testing for STH prevalence and infection intensity used the Kato-Katz technique.

Results

In all, 4318 stool samples were collected from 7164 participants. Estimates of STH prevalence by risk group in three of the four surveyed districts ranged from 3.4 to 5.0%, all with upper, 1-sided 95% confidence limits < 10%. However, STH prevalence estimates in Sirajganj District ranged from 23.4 to 29.1%. Infections in that district were spatially focal; four of the 30 survey clusters had > 50% prevalence in at least one risk group. Among all tested specimens, Ascaris lumbricoides was the most common STH parasite [8.2% (n = 352)], followed by Trichuris trichiura [0.9% (n = 37)], and hookworm [0.6% (n = 27)]. In each district, PC coverage among SAC was above the 75% program target but did not exceed 45% among PSAC in any district. Improved sanitation at home, school, or work was over 90% in all districts.

Conclusions

In the three low-prevalence districts, the MOHFW is considering decreasing the frequency of mass drug administration, per World Health Organization (WHO) guidelines. Also, the MOHFW will focus programmatic resources and supervisory efforts on Sirajganj District. Despite considering WHO guidance, the MOHFW will not expand PC administration to women of reproductive age partly due to the low prevalence of hookworm and T. trichiura, the STH parasites that contribute most to morbidity in that risk group. Data collected from surveys such as ours would help effectively guide future STH control efforts in Bangladesh and elsewhere.

Anthelmintic drugs for treating ascariasis

BACKGROUND

Ascaris lumbricoides is a common infection, and mainly affects children living in low-income areas. Water and sanitation improvement, health education, and drug treatment may help break the cycle of transmission, and effective drugs will reduce morbidity.

OBJECTIVES

To compare the efficacy and safety of anthelmintic drugs (albendazole, mebendazole, ivermectin) for treating people with Ascaris infection.

SEARCH METHODS

We searched the Cochrane Infectious Disease Group Specialized Register, CENTRAL, MEDLINE, Embase, LILACS, three other databases, and reference lists of included studies, without language restrictions, up to 4 July 2019.

SELECTION CRITERIA

Randomized controlled trials (RCT) that compared albendazole, mebendazole, and ivermectin in children and adults with confirmed Ascaris infection.

DATA COLLECTION AND ANALYSIS

Two review authors independently assessed studies for inclusion, assessed risk of bias, and extracted data from the included trials. A third review author checked the quality of data extraction. We used the Cochrane 'Risk of bias' assessment tool to determine the risk of bias in included trials. We used risk ratios (RRs) with 95% confidence intervals (CIs) to compare dichotomous outcomes in treatment and control groups. We used the fixed-effect model for studies with low heterogeneity and the random-effects model for studies with moderate to high heterogeneity. We assessed the certainty of the evidence using the GRADE approach. We used the control rate average to provide illustrative cure rates in the comparison groups.

MAIN RESULTS

We included 30 parallel-group RCTs, which enrolled 6442 participants from 17 countries across Africa, Asia, Central America and the Caribbean, and South America. Participants were from 28 days to 82 years of age, recruited from school, communities, and health facilities. Twenty studies were funded or co-funded by manufacturers, while 10 studies were independent of manufacturer funding. Twenty-two trials had a high risk of bias for one or two domains (blinding, incomplete outcome data, selective reporting). Single dose of albendazole (four trials), mebendazole (three trials) or ivermectin (one trial) was compared to placebo. Parasitological cure at 14 to 60 days was high in all the studies (illustrative cure of 93.0% in the anthelmintic group and 16.1% in the placebo group; RR 6.29, 95% CI 3.91 to 10.12; 8 trials, 1578 participants; moderate-certainty evidence). Single dose of albendazole is as effective as multiple doses of albendazole (illustrative cure of 93.2% with single dose, 94.3% with multiple doses; RR 0.98, 95% CI 0.92 to 1.05; 3 trials, 307 participants; high-certainty evidence); or as single dose of mebendazole (illustrative cure of 98.0% with albendazole, 96.9% with mebendazole; RR 1.01, 95% CI 1.00 to 1.02; 6 trials, 2131 participants; high-certainty evidence). Studies did not detect a difference between a single dose of albendazole and a single dose of ivermectin (cure rates of 87.8% with albendazole, 90.2% with ivermectin; RR 0.99, 95% CI 0.91 to 1.08; 3 trials, 519 participants; moderate-certainty evidence). Across all the studies, failure after single dose of albendazole ranged from 0.0% to 30.3%, mebendazole from 0.0% to 22.2%, and ivermectin from 0.0% to 21.6%. The egg reduction rate (ERR) measured up to 60 days after the treatment was high in all treated groups, regardless of the anthelmintic used (range 96% to 100%). It was not possible to evaluate parasitological cure by classes of infection intensity. No included trials reported complication or serious adverse events. Other adverse events were apparently similar among the compared anthelmintic groups (moderate- to low-certainty evidence). The most commonly reported other adverse events were nausea, vomiting, abdominal pain, diarrhoea, headache, and fever.

AUTHORS' CONCLUSIONS

Single-dose of albendazole, mebendazole, and ivermectin all appeared effective against Ascaris lumbricoides infection, yielding high parasitological cure and large reductions in eggs excreted, with no differences detected between them. The drugs appear to be safe to treat children and adults with confirmed Ascaris infection. There is little to choose between drugs and regimens in terms of cure or adverse events.

Rising Plasma Beta-Carotene Is Associated With Diminishing C-Reactive Protein in Patients Consuming a Dark Green Leafy Vegetable-Rich, Low Inflammatory Foods Everyday (LIFE) Diet

Chronic inflammation contributes to a number of chronic diseases and can be assessed with C-reactive protein (CRP). In this longitudinal retrospective chart review, we investigate whether patients intensively counseled to eat a specific diet high in dark green leafy vegetables, and thus high beta-carotene, have reductions in plasma high-sensitivity CRP (hsCRP). We term this the Low Inflammatory Foods Everyday (LIFE) diet. Forty-three patients in a community practice instructed to eat the LIFE diet met inclusion criteria. The CRP levels were measured at least twice over the course of up to a year. Adherence to the diet was objectively assessed by measurement of plasma beta-carotene, which is abundant in dark green leafy vegetables, and subjectively by serial interviews. The change in beta-carotene was inversely correlated with change in CRP (r = -0.68, P < .0001). Additionally, patients subjectively classified as adherent had higher beta-carotene (P < .0001) and lower CRP (P = .002) as compared with patients who were classified as nonadherent. These longitudinal findings suggest that adherence to the LIFE diet leads to increased beta-carotene and decreased CRP. Thus, this type of diet may reduce risk or severity of chronic diseases involving inflammation.

Skin Carotenoid Response to a High-Carotenoid Juice in Children: A Randomized Clinical Trial

BACKGROUND

Previous studies have shown an increase in serum carotenoid status among children when fed carotenoids. This study looked at the effect and dose-response of a known amount of carotenoid consumption on change in skin carotenoid status among children.

METHODS

Participants were children aged 5 to 17 years from Cache County, UT (n=58). Children were randomly assigned to one of three groups: high (n=18) or low (n=18) dose of a carotenoid-rich juice (2.75 mg carotenoids/30 mL juice), or placebo juice (n=22). Children were asked to drink an assigned dose of the juice (30 to 120 mL/day) based on the weight of the child and group assignment, every day for 8 weeks. Skin carotenoids were measured every 2 weeks by resonance Raman spectroscopy. Participants were asked to maintain their usual diet throughout the study. Usual diet was assessed using three averaged 24-hour recalls; diet constancy was measured using food frequency questionnaires administered at baseline, Week 4, and Week 8. Repeated measures analysis of variance was used to assess the group differences in skin carotenoid status over time.

RESULTS

The high-dose and low-dose groups had mean±standard deviation increases in skin carotenoid status of 11,515±1,134 and 10,009±1,439 Raman intensity counts, respectively (both P values <0.001, for change in means compared with baseline) at Week 8, although they showed significant change from baseline by Week 2. The placebo group's change of 985 Raman intensity counts was not statistically significant. The difference in change between the 2 experimental groups was not significant at Week 2, 4, 6, or 8.

CONCLUSIONS

Consumption of 30 to 120 mL (2.75 to 11 mg carotenoids) of a carotenoid-rich juice significantly increased skin carotenoid status over an 8-week period among children aged 5 to 17 years. The amount of carotenoids found in this amount of juice is equal to the amount found in approximately 23 to 92 g cooked carrots per day.

Benefit of vitamin A supplementation on ascaris reinfection is less evident in stunted children

Despite the common coexistence of vitamin A deficiency and Ascaris infection in preschool children in developing countries, and despite the widespread use of vitamin A supplements, remarkably little is understood about the impact of vitamin A supplementation on this gastrointestinal nematode. The Ministry of Health of Panama recently initiated a vitamin A supplementation program in rural indigenous populations. We took advantage of this initiative to assess the benefit of 200,000 IU (60 mg retinol) vitamin A on reinfection with Ascaris following deworming. Baseline stool exams, anthropometry, and socio-economic data were collected for 328 preschool children from 12-60 mo of age (106 supplemented within previous 3 mo and 222 unsupplemented within previous 6 mo). All children were dewormed with albendazole, and reinfection levels were monitored 3 and 5 mo later. Baseline prevalence of Ascaris was 79.5%. Stepwise regression showed that Ascaris intensity was lower in Vit A-supplemented children at baseline and 3 mo after deworming, but not after 5 mo. As 61% of the children were stunted, the impact of supplementation on Ascaris reinfection was examined separately for stunted and children of normal height. Prevalence and intensity of Ascaris at baseline and 3 mo after deworming were lower in children of normal height, but in stunted children the benefit was restricted to those who were dewormed within 6 wk of supplementation. Our study provides evidence that combined vitamin A supplementation and deworming reduces Ascaris reinfection in children living in areas of chronic parasitosis, but that the duration of the benefit is less in stunted children.

Plasma alpha1-acid glycoprotein can be used to adjust inflammation-induced hyporetinolemia in vitamin A-sufficient, but not vitamin A-deficient or -supplemented rats

We examined the association between alpha(1)-acid glycoprotein (AGP), all-trans-retinol (retinol), and albumin concentrations in a longitudinal animal model of IL-6-induced inflammation. Vitamin A-sufficient (VAS) male Sprague-Dawley rats were administered recombinant human IL-6 [n = 4, 65 mug/(kg.d)] or PBS (n = 4) continuously for 7 d via osmotic minipumps. Plasma samples were obtained daily and concentrations of retinol, AGP, albumin, and total protein were measured. Compared with both baseline and controls, retinol and albumin decreased (P < 0.05), AGP increased (P < 0.05), and total protein concentrations were unaffected in IL-6-treated rats. In vitamin A-deficient (VAD) rats, AGP concentrations were significantly lower at all time points and increased only to one-third of that in VAS rats. The AGP cut-off value indicative of inflammation was 0.11 g/L (i.e., 95% upper limit of baseline concentrations). After 20.5 h, there was an inverse linear correlation between AGP concentrations and the relative change in retinol to baseline (y = -0.18x + 0.48, r = -0.84, P < 0.001). However, changes in AGP and albumin were not correlated (P = 0.94). The application of this function to retinol concentrations in rats from separate experiments showed that hyporetinolemia cannot be adjusted using plasma AGP in VAD or vitamin A-supplemented rats. In conclusion, correcting inflammation-induced hyporetinolemia using an acute-phase protein requires longitudinally derived data, knowledge of vitamin A status, and a common underlying mechanism of change.

Comparison of the effects of supplemental red palm oil and sunflower oil on maternal vitamin A status

BACKGROUND

Conflicting results have been reported on the ability of dietary carotenoids to improve vitamin A status in lactating women. Red palm oil is one of the richest dietary sources of beta-carotene.

OBJECTIVE

We aimed to determine the efficacy of red palm oil in increasing retinol and provitamin A status in pregnant and lactating women.

DESIGN

Ninety rural, pregnant Tanzanian women from 3 randomly selected villages were recruited during their third trimester to participate in 3 dietary intervention groups: a control group, who were encouraged to maintain the traditional practice of eating staples with dark-green leafy vegetables, and 2 study groups, who were given either sunflower or red palm oil for use in household food preparations. The intervention lasted 6 mo. Plasma samples were collected at the third trimester and 1 and 3 mo postpartum, and breast-milk samples were collected 1 and 3 mo postpartum.

RESULTS

Supplementation with red palm oil, which is rich in provitamin A, increased alpha- and beta-carotene concentrations significantly (P < 0.001) in both plasma and breast milk. Plasma retinol concentrations were similar in all dietary groups. Breast-milk retinol concentrations tended to decrease from 1 to 3 mo postpartum in the control group, but were maintained in both oil groups. The difference in change in breast-milk retinol concentration between the red palm oil group and the control group was significant (P = 0.041).

CONCLUSIONS

Consumption of red palm oil increases concentrations of alpha- and beta-carotene in both breast milk and serum and maintains breast-milk retinol concentrations. Sunflower oil consumption seems to conserve breast-milk retinol similarly to consumption of red palm oil. Breast-milk retinol might be maintained through increased dietary intake of these vegetable oils and use of mild cooking preparation methods (such as the addition of oil at the end of cooking and avoidance of frying).