Intestinal Parasites, Anemia and Nutritional Status in Young Children from Transitioning Western Amazon

Young children are particularly vulnerable to the chronic sequelae of anemia, including poor nutritional status. The aim of this study was to assess intestinal parasitic-infections and nutritional status (anemia and linear growth) in preschool children living in contemporary Amazonian communities. A cross-sectional study measured children’s intestinal parasites and hair-Hg (HHg)—biomarkers of fish consumption, hemoglobin levels, and growth (anthropometric Z-scores). Children came from traditional-living families (Itapuã), and tin-mining settlements (Bom Futuro) representing current transitioning populations. It covered 937 pre-school children (from 1 to 59 months of age) from traditional (247) and immigrant tin-mining families (688). There was a high prevalence of intestinal polyparasitic-infection in children from both communities, but mild anemia (hemoglobin concentrations) and moderate (chronic) malnutrition were more frequent in children from traditional families than in children from tin-mining settlers. Children from traditional families ate significantly more fish (HHg mean of 4.3 µg/g) than children from tin-mining families (HHg mean of 2.3 µg/g). Among traditional villagers, children showed a significant correlation (r = 0.2318; p = 0.0005) between hemoglobin concentrations and HHg concentrations. High rates of parasitic infection underlie the poverty and attendant health issues of young children in the Brazilian Amazon. The intestinal parasite burden affecting poor Amazonian children resulting from unsafe water, lack of sanitation and poor hygiene is the most urgent environmental health issue.

Hydroelectric reservoir inundation (Rio Madeira Basin, Amazon) and changes in traditional lifestyle: impact on growth and neurodevelopment of pre-school children

Objective

To assess the dependence on fish consumption of families and its impact on nutritional status and neurodevelopment of pre-school children.

Design

Cross-sectional study that measured children’s hair mercury (HHg) as an indicator of family fish consumption, growth (anthropometricZ-scores, WHO standards) and neurological (Gesell developmental scores (GDS)) development.

Setting

Traditional living conditions among families residing in the area adjacent to the Samuel Dam (Western Amazon) hydroelectric reservoir.

Subjects

Two hundred and forty-nine pre-school children (1–59 months of age) from families transitioning from the traditional Amazonian lifestyle.

Results

Family fish consumption was significantly correlated with children’s HHg concentration (Spearman’sr= 0·246,P< 0·0001); however, HHg had no significant association with growth (Z-scores). Overall, the prevalence of severe malnutrition, i.e. stunting (height-for-ageZ-score (HAZ) ≤ −3), underweight (weight-for-ageZ-score (WAZ) ≤ −3) and wasting (weight-for-heightZ-score (WHZ) ≤ −3) was 5·2 % (n13), 0 % and 0·8 % (n2), respectively. The prevalence of moderate stunting (HAZ ≥ −3 to ≤ −2), underweight (WAZ ≥ −3 to ≤ −2) and wasting (WHZ ≥ −3 to ≤ −2) was 8·8 % (n22), 2·4 % (n6) and 4·8 % (n12), respectively. Although 76 % of the children showed adequate GDS (>85), multiple regression analysis showed that fish consumption (as HHg) had no impact on GDS, but that some variables did interact significantly with specific domains (motor and language development).

Conclusions

The study showed that the families’ shift in fish consumption had no negative impact on the growth of young children and that ensuing methylmercury exposure has not been a noticeable neurodevelopmental hindrance.

Maternal fish consumption in the nutrition transition of the Amazon Basin: growth of exclusively breastfed infants during the first 5 years

BACKGROUND

Changes in fish-eating habits due to rapid urbanization in Western Amazon was used as model to investigate whether maternal fish-intake rate impacts on children's weight and height during the first 5 years.

AIM

The study examined the growth of 82 breastfed children, and maternal fish consumption (hair mercury concentrations, HHg) during pregnancy and lactation.

SUBJECTS AND METHODS

Fish consumption in mothers and children was estimated through HHg. The children were measured and weighed at birth and at 6 (exclusive breastfeeding), 36 and 60 months.

RESULTS

Fish consumption rate (HHg) had no significant impact on children's growth at the specified ages (p = 0.35). After 6 months of exclusive breastfeeding, children had the highest proportion of Z-scores <-1 SD; however, weaning (with extended breastfeeding) had a substantial impact in moving up the attained growth at 3 years. The duration of breastfeeding was significantly correlated with attained Z-scores for weight-for-age (r = 0.26; p = 0.02) and weight-for-height (r = 0.22; p = 0.04) but not for height-for-age. At 3 years most children had improved Z-scores (>-1 SD) for height-for-age (70/82), weight-for-age (74/82) and weight-for-height (74/82). At 5 years, all but one child attained Z-scores >-1.

CONCLUSION

The apparently good nutritional status of subjects is more likely due to a well balanced diet composition than to only one dietary protein source--fish.

Seasonal variation in food pattern but not in energy and nutrient intakes of rural Beninese school-aged children

BACKGROUND

Inadequate energy and nutrient intakes are a major nutritional problem in developing countries. A recent study in Beninese school-aged children in different seasons revealed a high prevalence of stunting and poor iron status that might be related to the food pattern.

OBJECTIVE

To analyse the food pattern and resulting energy and nutrient intakes of rural Beninese school-aged children in relation to season and school attendance.

SUBJECTS AND METHODS

The study was performed in northern Benin in eighty randomly selected children aged 6-8 years. Dietary intake was assessed using observed weighed records. Food, energy and nutrient intakes were measured in post- and pre-harvest seasons. Complete food consumption data sets were available for seventy-five children.

RESULTS

Food pattern showed seasonal variations. Cereals, roots and tubers were the main staple foods. Contributions of animal products to the diet were very small. The food pattern was not different for either boys v. girls or for children attending v. not attending school. Median daily energy intakes were 5.0 and 5.3 MJ in the post- and pre-harvest season, respectively. Only fat and vitamin C showed seasonal differences (P < 0.05). Energy and nutrient intakes were different for boys and girls but, unexpectedly, not for children attending v. not attending school.

CONCLUSIONS

Seasonal variations in food pattern did not result in seasonality in energy and nutrient intakes. Because the children's diet was low in animal products, protein, fat and vitamin C and high in fibre, the absorption of fat, fat-soluble vitamins, carotenoids, Fe and Zn might be low. Fe and Zn bioavailability from such a diet needs further investigation.

Fish consumption (hair mercury) and nutritional status of Amazonian Amer-Indian children

Fish are abundant and important dietary items for the Amer-Indians, and total hair-Hg (HHg) concentration is a reliable marker of fish consumption. We studied the impact of fish consumption (HHg) on the nutritional status of Indian children of Eastern Amazonia. Weight-for-height Z score (WHZ) was measured, and HHg was determined in 203 children younger than 10 years of age in three villages. There was significantly higher fish consumption in Kayabi children (16.55 microg Hg/g; SD, 11.44) than in children of the Munduruku villages of Missão-Cururu (4.76 microg Hg/g; SD, 2.09) and Kaburua (2.87 microg Hg/g; SD, 2.13). Anthropometric indices showed WHZ means of -0.27, -0.22, and 0.40, respectively, for Kayabi, Missão-Cururu and Kaburua villages. Despite a different pattern of fish-protein consumption between tribes, there was no significant correlation between WHZ and HHg concentrations (r2 = 0.0079; P < 0.2021). Dietary differences among Amazonian tribes can be traced and used in measuring health outcomes. Higher fish consumption, although important for Kayabis, was compensated by other protein sources by the Kaburua villagers.

The Impact of Dietary Intervention on the Cognitive Development of Kenyan School Children

Previous observational studies in developing countries have suggested that diet quality, particularly increased animal source food (ASF) consumption, is positively associated with child cognitive development. This report presents findings from a study in rural Kenya, designed to test the impact of three different diets on the cognitive development of school children. Twelve schools with a total of 555 Standard 1 children (equivalent to U.S. Grade 1) were randomized to one of four feeding interventions: Meat, Milk, Energy or Control (no feeding). Feeding continued for seven school terms (21 mo), and cognitive tests were administered before the commencement of feeding and during every other term of feeding. Hierarchical linear random effects models and associated methods were used to examine the effects of treatment group on changes in cognitive performance over time. Analyses revealed that children receiving supplemental food with meat significantly outperformed all other children on the Raven's Progressive Matrices. Children supplemented with meat, and children supplemented with energy, outperformed children in the Control group on tests of arithmetic ability. There were no group differences on tests of verbal comprehension. Results suggest that supplementation with animal source food has positive effects on Kenyan children's cognitive performance. However, these effects are not equivalent across all domains of cognitive functioning, nor did different forms of animal source foods produce the same beneficial effects. Implications of these findings for supplementation programs in developing countries are discussed.

Absorption of iron from unmodified maize and genetically altered, low-phytate maize fortified with ferrous sulfate or sodium iron EDTA

BACKGROUND

Reducing the phytate content in grains by genetic manipulation is a novel approach to increasing nonheme-iron absorption from mixed diets. Fractional iron absorption from a genetically modified strain of low-phytate maize (LPM) increased significantly, by 50%.

OBJECTIVE

We assessed iron absorption from porridges prepared from the same LPM (lpa-1-1 mutant) and unmodified wild-type maize (WTM), both of which were fortified with either ferrous sulfate or sodium iron EDTA.

DESIGN

Porridges providing 3.4 mg Fe were fortified with either ferrous sulfate or sodium iron EDTA to provide an additional 1 mg Fe/serving. In 14 nonanemic women, iron absorption was measured as the amount of radioiron incorporated into red blood cells (extrinsic tag method) 12 d after consumption of the study diets.

RESULTS

No significant effect of phytate content on iron absorption was found when porridge was fortified with either sodium iron EDTA or ferrous sulfate. Fractional absorption of iron from WTM porridge fortified with sodium iron EDTA (5.73%) was 3.39 times greater than that from the same porridge fortified with ferrous sulfate (1.69%). Fractional absorption of iron from the sodium iron EDTA-fortified LPM porridge (5.40%) was 2.82 times greater than that from LPM porridge fortified with ferrous sulfate (1.91%) (P<0.0001 for both comparisons, repeated-measures analysis of variance). Thus, the previously identified benefit of LPM was no longer detectable when maize porridge was fortified with additional iron.

CONCLUSION

Iron was absorbed more efficiently when the fortificant was sodium iron EDTA rather than ferrous sulfate, regardless of the type of maize.

Sodium iron EDTA [NaFe(III)EDTA] as a food fortificant does not influence absorption and urinary excretion of manganese in healthy adults

NaFe(III)EDTA is a promising iron (Fe) compound for food fortification programs because of its high Fe bioavailability from meals containing dietary inhibitors of Fe absorption such as phytic acid. However, this Fe compound is not currently used in any large-scale fortification program because of concern over its possible negative influence on the metabolism of other essential minerals or its possible influence on the absorption of potentially toxic elements, such as manganese (Mn). In this study, Mn absorption and urinary excretion were studied in adults after intake of an Fe-fortified weaning cereal labeled with 54Mn. In a crossover design, the fortification of the weaning cereal with Fe as NaFeEDTA was compared with ferrous sulfate. Manganese absorption was measured by extrapolation from whole-body retention data 10-30 d after intake, and urinary excretion of 54Mn was measured over 7 d. No significant differences in 54Mn absorption or urinary excretion were found; 1.1 +/- 0.15 and 0.91 +/- 0.35% of the ingested dose was absorbed from the cereal fortified with NaFe(III)EDTA and FeSO4, respectively. Urinary excretion of 54Mn was very low; the total radioactivity in urine represented 1.1 +/- 0.55% of the absorbed dose with NaFe(III)EDTA and 0.72 +/- 0.53% of the absorbed dose with FeSO4. Until now, Fe-fortification programs have met with only limited success. The introduction of NaFeEDTA as a food fortificant could be a useful tool to provide bioavailable Fe to vulnerable groups in the population and thus aid in combating Fe deficiency.

Preventing iron deficiency through food fortification

One way to prevent iron deficiency anemia in developing countries is through the fortification of food products with iron. In addition to avoiding undesirable color and flavor changes, the main challenge is to protect the fortification iron from potential inhibitors of iron absorption present in commonly fortified foods.

Overview and mechanisms of iron regulation

There are two major disturbances of iron balance: iron deficiency and iron overload. Iron-deficiency anemia is a major problem in developing countries and affects between 500 million and 600 million people worldwide. While iron overload is much less prevalent, it has a number of major pathologic sequelae and there have been recent suggestions that even modest increases in the body's iron stores may have pathologic associations. To understand the ways in which iron balance can be disturbed, it is necessary to have an understanding of how losses from the body are matched by the absorption of iron in different dietary settings as well as the limits of this regulatory control.

Zinc absorption in adult humans: the effect of iron fortification

The effect of Fe fortification on the absorption of Zn was studied by radioisotopic labelling of single meals, followed by measurements of whole-body retention of 65Zn at 14 d after intake. Healthy adult volunteers participated in the study. Weaning cereal, wheat bread and infant formula, foods that are all frequently Fe-fortified, were evaluated in the study. The amounts of Fe added as FeSO4 were similar to the levels in commercial products in Europe and the USA, and were 200 or 500 mg Fe/kg (weaning cereal), 65 mg Fe/kg (white wheat flour) and 12 mg Fe/l (infant formula). For comparison, Zn absorption was measured in the same subjects, from identical test meals containing no added Fe. No statistically significant differences were found when Zn absorption from the Fe-fortified test meals was compared with that from non-Fe-fortified test meals. Fractional Zn-absorption values from Fe-fortified v. non-fortified meals were 31.1 (SD 11.9) v. 30.7 (SD 7.0)% (weaning cereal; 200 mg Fe/kg), 37.7 (SD 16.6) v. 30.2 (SD 9.9)% (weaning cereal; 500 mg Fe/kg), 36.5 (SD 14.4) v. 38.2 (SD 18.1)% (bread; 65 mg Fe/kg flour) and 41.6 (SD 8.1) v. 38.9 (SD 14.5)% (infant formula; 12 mg Fe/l). The addition of Fe to foods at the currently used fortification levels was thus not associated with impaired absorption of Zn and the consumption of these Fe-fortified foods would not be expected to have a negative effect on Zn nutrition.

NaFe3+EDTA as a food fortificant: influence on zinc, calcium and copper metabolism in the rat

The general acceptance of NaFe3+EDTA for food Fe fortification has been partly restricted by concern over the influence of EDTA on the metabolism of other nutritionally important trace elements and minerals. We have investigated the influence of NaFe3+EDTA, and of increasing dietary levels of Na2EDTA, on Zn, Cu and Ca metabolism in rats fed on Zn-sufficient and Zn-deficient soya-bean-isolate-based diets. With the Zn-deficient diets, changing the dietary Fe compound from FeSO4 to NaFe(3+)-EDTA significantly (P < 0.05) increased mean apparent Zn absorption from 50.2 to 67.4%, urinary Zn excretion from 2.0 to 4.0% of intake, and Zn retention from 48.2 to 63.4%. Increasing the dietary EDTA level to 1000 mg/kg further increased Zn absorption to 78.1%, urinary Zn excretion to 15.6% of intake and Zn retention to 62.5%. Increased Zn retention was accompanied by a significant increase in weight gain indicating that the extra Zn was available for normal metabolic processes. With rats fed on the Zn-sufficient diet, NaFe3+EDTA and Na2EDTA similarly increased the absorption, urinary excretion and retention of Zn but to a lesser extent. NaFe3+EDTA, however, had no influence on the absorption, urinary excretion and retention of Cu and Ca, and additional Na2EDTA caused only minor increases in Cu absorption and retention and in the urinary excretion of Ca. We conclude that using NaFe3+EDTA as a food fortificant would have no detrimental effect on the metabolism of Zn, Cu and Ca and, in some situations, could improve Zn absorption and retention from low-bioavailability diets.