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Kortekangas E, Fan YM, Chaima D, Lehto KM, Malamba-Banda C, Matchado A, Chingwanda C, Liu Z, Ashorn U, Cheung YB, Dewey KG, Maleta K, Ashorn P. Associations between Gut Microbiota and Intestinal Inflammation, Permeability and Damage in Young Malawian Children. J Trop Pediatr 2022; 68:6527323. [PMID: 35149871 PMCID: PMC8846364 DOI: 10.1093/tropej/fmac012] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Environmental enteric dysfunction (EED) is common in low- and middle-income countries and associated with childhood undernutrition. The composition of gut microbiota has been implicated in the pathogenesis of EED. Our aim was to assess the associations between gut microbiota and EED biomarkers in rural Malawian children. We hypothesized that there would be an inverse association between microbiota maturity and diversity and fecal concentrations of EED biomarkers. METHODS We used data from fecal samples collected at 6, 18 and 30 months from 611 children who were followed up during a nutrition intervention trial. The primary time point for analysis was 18 months. Microbiota data were obtained through 16S rRNA sequencing and variables included microbiota maturity and diversity, phylogenetic dissimilarity and relative abundances of individual taxa. EED biomarkers included calprotectin (marker of inflammation), alpha-1 antitrypsin (intestinal permeability) and REG1B (intestinal damage). RESULTS There was an inverse association between microbiota maturity and diversity and fecal concentrations of all 3 EED biomarkers at 18 months (p≤0.001). The results were similar at 30 months, while at 6 months inverse associations were found only with calprotectin and alpha-1 antitrypsin concentrations. At 18 months, EED biomarkers were not associated with phylogenetic dissimilarity, but at 6 and 30 months several associations were observed. Individual taxa predicting EED biomarker concentrations at 18 months included several Bifidobacterium and Enterobacteriaceae taxa as well as potentially displaced oral taxa. CONCLUSIONS Our findings support the hypothesis of an inverse association between microbiota maturity and diversity and EED in rural Malawian children.
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Affiliation(s)
- Emma Kortekangas
- Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere 33014, Finland,Correspondence: Emma Kortekangas, Tampere Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Global Health, Tampere University, Arvo Ylpön katu 34, Arvo building, Tampere 33014, Finland. Tel: +358-3-355-111. Fax +358-3-213-4473. E-mail <>
| | - Yue-Mei Fan
- Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere 33014, Finland
| | - David Chaima
- School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Kirsi-Maarit Lehto
- Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere 33014, Finland
| | - Chikondi Malamba-Banda
- School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Andrew Matchado
- School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi,Department of Nutrition and Institute for Global Nutrition, University of California Davis, Davis, CA 95616, USA
| | - Chilungamo Chingwanda
- School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Zhifei Liu
- Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere 33014, Finland
| | - Ulla Ashorn
- Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere 33014, Finland
| | - Yin Bun Cheung
- Program in Health Services & Systems Research and Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore 169857, Singapore
| | - Kathryn G Dewey
- Department of Nutrition and Institute for Global Nutrition, University of California Davis, Davis, CA 95616, USA
| | - Kenneth Maleta
- School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Per Ashorn
- Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere 33014, Finland,Department of Pediatrics, Tampere University Hospital, Tampere 33520, Finland
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George CM, Perin J, Parvin T, Bhuyian MSI, Thomas ED, Monira S, Zohura F, Hasan MT, Alam M, Tofail F. Diarrhea Prevalence and Child Growth Faltering Are Associated with Subsequent Adverse Child Developmental Outcomes in Bangladesh (CHoBI7 Program). Am J Trop Med Hyg 2022; 106:233-238. [PMID: 34724631 PMCID: PMC8733517 DOI: 10.4269/ajtmh.21-0767] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 08/01/2021] [Indexed: 01/03/2023] Open
Abstract
Millions of young children annually are not meeting their developmental potential in low- and middle-income countries. Previous studies have shown that diarrheal diseases during early life are associated with subsequent malnutrition. This prospective cohort study of 576 children under 5 years was conducted in urban Dhaka, Bangladesh, to investigate the association between diarrhea prevalence, child growth, and child cognitive developmental outcomes. Height and weight were measured at baseline and a 12-month follow-up. Diarrhea prevalence was assessed through monthly surveillance visits. Developmental outcomes were assessed by communication, fine motor, gross motor, personal social, problem-solving, and combined developmental scores measured by the Extended Ages and Stages Questionnaire (EASQ) at the 12-month follow-up visit. To assess the association between diarrhea prevalence, child growth, and child cognitive developmental outcomes, linear regression models were fit using generalized estimating equations to account for clustering at the household level and to approximate 95% CIs. Diarrhea prevalence was negatively associated with change in height-for-age (HAZ) Z-scores from baseline to the 12-month follow-up (coefficient -0.85 [95% CI: -1.42, -0.28]). Diarrhea prevalence was a significant predictor of combined EASQ Z-scores with and without baseline stunting included in the model (-0.89 [95% CI: -1.67, -0.09] [baseline stunting included]) and (-0.88 [95% CI: -1.69, -0.07]). Change in HAZ from baseline to the 12-month follow-up was positively associated with follow-up combined EASQ Z-scores (0.28 [95% CI: 0.15, 0.42]). High diarrhea prevalence and linear growth faltering were associated with negative cognitive developmental outcomes among children residing in urban Dhaka, Bangladesh. Furthermore, high diarrhea prevalence was associated with negative child cognitive developmental outcomes with stunting included in the model, suggesting an effect of diarrhea on cognition independent of stunting.
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Affiliation(s)
- Christine Marie George
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland;,Address correspondence to Christine Marie George, Associate Professor, Department of International Health, Program in Global Disease Epidemiology and Control, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Room E5535, Baltimore, MD 21205-2103. E-mail:
| | - Jamie Perin
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Tahmina Parvin
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Centre for Nutrition and Food Security (CNFS), Dhaka, Bangladesh
| | - Md Sazzadul Islam Bhuyian
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Centre for Nutrition and Food Security (CNFS), Dhaka, Bangladesh
| | - Elizabeth D. Thomas
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Shirajum Monira
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Centre for Nutrition and Food Security (CNFS), Dhaka, Bangladesh
| | - Fatema Zohura
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Centre for Nutrition and Food Security (CNFS), Dhaka, Bangladesh
| | - M. Tasdik Hasan
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Centre for Nutrition and Food Security (CNFS), Dhaka, Bangladesh
| | - Munirul Alam
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Centre for Nutrition and Food Security (CNFS), Dhaka, Bangladesh
| | - Fahmida Tofail
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Centre for Nutrition and Food Security (CNFS), Dhaka, Bangladesh
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Qiu L, Wang J, Ren F, Shen L, Li F. Can fecal calprotectin levels be used to monitor infant milk protein allergies? Allergy Asthma Clin Immunol 2021; 17:132. [PMID: 34903286 PMCID: PMC8670270 DOI: 10.1186/s13223-021-00636-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 11/26/2021] [Indexed: 11/10/2022] Open
Abstract
Background Milk protein allergy is one of the most common food allergies in infants. We aimed to test whether fecal calprotectin can be used to monitor food allergies in infants by comparing the fecal calprotectin levels in infants with a milk protein allergy before and after an intervention treatment. Methods The study was designed as a prospective case–control trial. Stool samples were collected at follow-up, and the concentration of fecal calprotectin was determined using an enzyme-linked immunosorbent assay. The infant’s weight and length were measured. Results The allergic group comprised 90 milk-allergic infants (41 boys, 49 girls), and the nonallergic group comprised 90 nonallergic infants (51 boys, 39 girls). Compared with the fecal calprotectin level in the nonallergic group (median: 141 μg/g), that in the allergic group (median: 410 μg/g) was significantly higher (z = − 9.335, p < 0.001). After two dietary interventions and treatments, the fecal calprotectin levels of the infants with a milk protein allergy at the first (median: 253 μg/g) and second follow-up visits (median: 160 μg/g) were significantly lower than those before the intervention (z = − 7.884, p < 0.001 and z = − 8.239, p < 0.001, respectively). The growth index values (LAZ and WAZ) of the infants with a milk protein allergy at the first and second follow-up visits were significantly higher than those before dietary intervention (p < 0.05). Fecal calprotectin was negatively and significantly correlated with the WLZ and WAZ at the second follow-up visit (Spearman’s rho = − 0.234, p = 0.01 and Spearman’s rho = − 0.193, p = 0.03, respectively). Conclusion The level of fecal calprotectin in infants with a milk protein allergy decreased after dietary intervention and seems to be a promising biological indicator for monitoring intestinal allergies.
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The Use of Fecal Calprotectin Testing in Paediatric Disorders: A Position Paper of the European Society for Paediatric Gastroenterology and Nutrition Gastroenterology Committee. J Pediatr Gastroenterol Nutr 2021; 72:617-640. [PMID: 33716293 DOI: 10.1097/mpg.0000000000003046] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVES The aim of the study was to review the evidence regarding the clinical use and value of fecal calprotectin (FC) measurements in different gastrointestinal disorders in children. METHODS A literature search was conducted in the PubMed, MEDLINE, EMBASE, and Cochrane databases until October 31, 2019. Subtopics were identified and each assigned to individual authors. RESULTS A total of 28 recommendations were voted on using the nominal voting technique. Recommendations are given related to sampling, measurement methods, and results interpretation. The 14 authors anonymously voted on each recommendation using a 9-point scale (1 strongly disagree to 9 fully agree). Consensus was considered achieved if at least 75% of the authors voted 6, 7, 8, or 9. CONCLUSIONS Consensus was reached for all recommendations. Limitations for the use of FC in clinical practice include variability in extraction methodology, performance of test kits as well as the need to establish local reference ranges because of the influence of individual factors, such as age, diet, microbiota, and drugs. The main utility of FC measurement at present is in the diagnosis and monitoring of inflammatory bowel disease (IBD) as well as to differentiate it from functional gastrointestinal disorders (FAPDs). FC, however, has neither utility in the diagnosis of infantile colic nor to differentiate between functional and organic constipation. A rise in FC concentration, may alert to the risk of developing necrotizing enterocolitis and help identifying gastrointestinal involvement in children with Henoch-Schönlein purpura. FC measurement is of little value in Cow's Milk Protein Allergy, coeliac disease (CD), and cystic fibrosis. FC does neither help to distinguish bacterial from viral acute gastroenteritis (AGE), nor to diagnose Helicobacter Pylori infection, small intestinal bacterial overgrowth (SIBO), acute appendicitis (AA), or intestinal polyps.
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George CM, Cirhuza LB, Kuhl J, Williams C, Coglianese N, Thomas E, Bauler S, François R, Saxton R, Presence AS, Birindwa A, Jean Claude BR, Perin J, Mirindi P. Child Mouthing of Feces and Fomites and Animal Contact are Associated with Diarrhea and Impaired Growth Among Young Children in the Democratic Republic of the Congo: A Prospective Cohort Study (REDUCE Program). J Pediatr 2021; 228:110-116.e1. [PMID: 32918918 DOI: 10.1016/j.jpeds.2020.09.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 08/04/2020] [Accepted: 09/04/2020] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To identify exposure pathways to fecal pathogens that are significant contributors to diarrheal diseases and impaired growth in young children, and to evaluate scalable interventions to reduce fecal contamination from these pathways. STUDY DESIGN Reducing Enteropathy, Undernutrition, and Contamination in the Environment (REDUCE) was a prospective cohort study of 370 children <5 years of age was conducted in Walungu Territory, South Kivu, Democratic Republic of the Congo. Child mouthing behaviors were assessed through caregiver reports and 5-hour structured observations. Caregiver reports of child contact with animals and child diarrhea were also obtained. Anthropometric measurements were collected at baseline and at a 6-month follow-up. RESULTS Children observed putting soil in their mouth during structured observation at baseline had a significantly higher odds of diarrhea at the 6-month follow-up (OR, 1.79; 95% CI, 1.04 to 3.07). Children observed mouthing feces during structured observation had a significant reduction in height-for-age z-score (HAZ) from baseline to the 6-month follow-up (ΔHAZ, -0.69; 95% CI, -1.34 to -0.04). A significant reduction in HAZ was also observed for children with caregiver reports of touching guinea pigs (-0.33; 95% CI, -0.58 to -0.08) and rabbits (-0.34; 95% CI, -0.64 to -0.04) and children with feces in their sleeping space during unannounced spot checks (-0.41; 95% CI, -0.74 to -0.09). CONCLUSIONS These findings emphasize the urgent need for infant water, sanitation, and hygiene interventions targeting child mouthing behaviors, fecal contamination in child living spaces, and child contact with domestic animals to reduce exposure to fecal pathogens among susceptible populations.
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Affiliation(s)
- Christine Marie George
- Department of International Health, Johns Hopkins School Bloomberg of Public Health, Baltimore, MD.
| | - Lucien Bisimwa Cirhuza
- Food for the Hungry, Phoenix, AZ; Unit for Research and Training in Ecology and Control of Infectious Diseases, Microbiology Department, Faculty of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Jennifer Kuhl
- Department of International Health, Johns Hopkins School Bloomberg of Public Health, Baltimore, MD
| | - Camille Williams
- Department of International Health, Johns Hopkins School Bloomberg of Public Health, Baltimore, MD
| | | | - Elizabeth Thomas
- Department of International Health, Johns Hopkins School Bloomberg of Public Health, Baltimore, MD
| | | | - Ruthly François
- Department of International Health, Johns Hopkins School Bloomberg of Public Health, Baltimore, MD
| | - Ronald Saxton
- Department of International Health, Johns Hopkins School Bloomberg of Public Health, Baltimore, MD
| | | | | | | | - Jamie Perin
- Department of International Health, Johns Hopkins School Bloomberg of Public Health, Baltimore, MD
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6
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Monira S, Bhuyian MSI, Parvin T, Uddin IM, Zohura F, Hasan MT, Biswas SK, Hasan K, Masud J, Rashid M, Rahman Z, Papri N, Rafique R, Islam A, Barman I, Jubyda FT, Johura F, Sultana M, Sanin KI, Sack DA, Perin J, Alam M, George C. Child mouthing of soil and presence of animals in child sleeping spaces are associated with growth faltering among young children in Dhaka, Bangladesh (CHoBI7 Program). Trop Med Int Health 2020; 25:1016-1023. [DOI: 10.1111/tmi.13417] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Shirajum Monira
- International Centre for Diarrhoeal Disease Research, Bangladesh Dhaka Bangladesh
| | | | - Tahmina Parvin
- International Centre for Diarrhoeal Disease Research, Bangladesh Dhaka Bangladesh
| | - Ismat Minhaj Uddin
- International Centre for Diarrhoeal Disease Research, Bangladesh Dhaka Bangladesh
| | - Fatema Zohura
- International Centre for Diarrhoeal Disease Research, Bangladesh Dhaka Bangladesh
| | - M. Tasdik Hasan
- International Centre for Diarrhoeal Disease Research, Bangladesh Dhaka Bangladesh
| | - Shwapon K. Biswas
- International Centre for Diarrhoeal Disease Research, Bangladesh Dhaka Bangladesh
| | - Khaled Hasan
- International Centre for Diarrhoeal Disease Research, Bangladesh Dhaka Bangladesh
| | - Jahed Masud
- International Centre for Diarrhoeal Disease Research, Bangladesh Dhaka Bangladesh
| | - Mahamud‐ur Rashid
- International Centre for Diarrhoeal Disease Research, Bangladesh Dhaka Bangladesh
| | - Zillur Rahman
- International Centre for Diarrhoeal Disease Research, Bangladesh Dhaka Bangladesh
| | - Nowshin Papri
- International Centre for Diarrhoeal Disease Research, Bangladesh Dhaka Bangladesh
| | - Raisa Rafique
- International Centre for Diarrhoeal Disease Research, Bangladesh Dhaka Bangladesh
| | - Aminul Islam
- International Centre for Diarrhoeal Disease Research, Bangladesh Dhaka Bangladesh
| | - Indrajeet Barman
- International Centre for Diarrhoeal Disease Research, Bangladesh Dhaka Bangladesh
| | - Fatema Tuz Jubyda
- International Centre for Diarrhoeal Disease Research, Bangladesh Dhaka Bangladesh
| | - Fatema‐Tuz Johura
- International Centre for Diarrhoeal Disease Research, Bangladesh Dhaka Bangladesh
| | - Marzia Sultana
- International Centre for Diarrhoeal Disease Research, Bangladesh Dhaka Bangladesh
| | - Kazi Istiaque Sanin
- International Centre for Diarrhoeal Disease Research, Bangladesh Dhaka Bangladesh
| | - David A. Sack
- Department of International Health Johns Hopkins Bloomberg School of Public Health Baltimore MD USA
| | - Jamie Perin
- Department of International Health Johns Hopkins Bloomberg School of Public Health Baltimore MD USA
| | - Munirul Alam
- International Centre for Diarrhoeal Disease Research, Bangladesh Dhaka Bangladesh
| | - Christine George
- Department of International Health Johns Hopkins Bloomberg School of Public Health Baltimore MD USA
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7
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Parvin T, Minhaj Uddin I, Islam Bhuyian MS, Saxton R, Zohura F, Sultana M, Johura FT, Monira S, Hasan MT, Papri N, Haque MA, Biswas SK, Sack DA, Perin J, Alam M, George CM. Prospective cohort study of child mouthing of faeces and fomites in Dhaka, Bangladesh (CHoBI7 Program). Trop Med Int Health 2020; 25:976-984. [PMID: 32406964 DOI: 10.1111/tmi.13413] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVE To characterise childhood mouthing and handling behaviours and to assess the association between hand-to-object and object-to-mouth contacts and diarrhoea prevalence in young children in urban Dhaka, Bangladesh. METHODS A prospective cohort study was conducted among 494 children under 5 years of age in Dhaka, Bangladesh. This study was nested within the randomised controlled trial of the Cholera Hospital-Based Intervention for 7 Days (CHoBI7) mobile health (mHealth) program. The CHoBI7 mHealth program focuses on promoting handwashing with soap and water treatment to diarrhoea patients and their household members through mobile messages and a single in person visit. Mouthing and handling of faeces and fomites among young children was measured by five-hour structured observation and caregiver reports. Diarrhoea surveillance data was collected monthly for 12 months. RESULTS Fifty five percent of caregivers reported that their child put a visibly dirty fomite (object or soil) in their mouth in the past week. Caregivers reported that 50% of children had mouthed visibly dirty objects, 26% had mouthed dirt, and 2% had mouthed faeces. Forty five percent of children were observed mouthing a visibly dirty fomite during structured observation, 40% of children were observed mouthing a visibly dirty object, 10% were observed mouthing soil, and one child (0.2%) was observed mouthing faeces. Mouthing of visibly dirty fomites was highest for children 12-18 months of age with 69% of these children having caregiver reports and 54% having observed events. Children with caregiver reports of mouthing faeces had a significantly higher odds of diarrhoea over the subsequent month (Odds Ratio: 4.54; 95% Confidence Interval: 1.06, 19.48). CONCLUSION These findings demonstrate that mouthing of contaminated fomites among young children is frequent in urban environments in Bangladesh, and that mouthing faeces is associated with a significantly higher odds of diarrhoea. Interventions are urgently needed to protect young children from faecal pathogens in their play spaces.
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Affiliation(s)
- Tahmina Parvin
- International Center for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Ismat Minhaj Uddin
- International Center for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | | | - Ronald Saxton
- Department of International Health, Johns Hopkins School of Public Health, Baltimore, MD, USA
| | - Fatema Zohura
- International Center for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Marzia Sultana
- International Center for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Fatema-Tuz Johura
- International Center for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Shirajum Monira
- International Center for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Md Tasdik Hasan
- International Center for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.,University of Liverpool, Liverpool, UK
| | - Nowshin Papri
- International Center for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Md Ahshanul Haque
- International Center for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Shwapon K Biswas
- International Center for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.,Rangpur Medical College and Hospital, Rangpur, Bangladesh
| | - David A Sack
- Department of International Health, Johns Hopkins School of Public Health, Baltimore, MD, USA
| | - Jamie Perin
- Department of International Health, Johns Hopkins School of Public Health, Baltimore, MD, USA
| | - Munirul Alam
- International Center for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Christine Marie George
- International Center for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
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8
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Hinnouho GM, Wessells KR, Barffour MA, Sayasone S, Arnold CD, Kounnavong S, Hess SY. Impact of Different Strategies for Delivering Supplemental Zinc on Selected Fecal Markers of Environmental Enteric Dysfunction among Young Laotian Children: A Randomized Controlled Trial. Am J Trop Med Hyg 2020; 103:1416-1426. [PMID: 32618258 PMCID: PMC7543857 DOI: 10.4269/ajtmh.20-0106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
The objective of this study was to assess the impact of different strategies for delivering supplemental zinc on fecal myeloperoxidase (MPO), neopterin (NEO), and calprotectin (CAL) among young Laotian children. In a double-blind controlled trial, children aged 6-23 months were randomized to receive either daily preventive zinc (PZ) tablets (7 mg/day), daily micronutrient powder (MNP; containing 10 mg zinc and 14 other micronutrients), therapeutic zinc (TZ) supplements for diarrhea treatment (20 mg/day for 10 days), or daily placebo powder and followed for ∼36 weeks. Stool samples were collected at baseline and endline. Fecal MPO, NEO, and CAL concentrations were determined in a randomly selected subsample of 720 children using commercially available ELISA kits. At baseline, the mean age was 14.1 ± 4.9 months and prevalence of stunting was 39%. The endline prevalence of stunting was 43%; there was no overall treatment effect on physical growth in the parent trial. At endline, the mean (95% CI) MPO in the PZ group was 1,590 [1,396; 1,811] ng/mL and did not differ from that in the MNP (1,633 [1,434; 1,859] ng/mL), TZ (1,749 [1,535; 1,992] ng/mL), and control (1,612 [1,415; 1,836] ng/mL) groups (P = 0.749). Similarly, there was no overall treatment effect on NEO and CAL concentrations (P = 0.226 and 0.229, respectively). In this population, the provision of PZ or TZ supplements or MNP had no impact on growth or environmental enteric dysfunction (EED) as assessed by fecal MPO, NEO, and CAL. Additional research is needed to better understand the etiology and proposed mechanisms of EED pathogenesis.
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Affiliation(s)
- Guy-Marino Hinnouho
- Helen Keller International, Washington, District of Columbia.,Department of Nutrition, Institute for Global Nutrition, University of California, Davis, Davis, California
| | - K Ryan Wessells
- Department of Nutrition, Institute for Global Nutrition, University of California, Davis, Davis, California
| | - Maxwell A Barffour
- Public Health Program, College of Health and Human Services, Missouri State University, Springfield, Missouri.,Department of Nutrition, Institute for Global Nutrition, University of California, Davis, Davis, California
| | - Somphou Sayasone
- Lao Tropical and Public Health Institute, Vientiane, Lao People's Democratic Republic
| | - Charles D Arnold
- Department of Nutrition, Institute for Global Nutrition, University of California, Davis, Davis, California
| | - Sengchanh Kounnavong
- Lao Tropical and Public Health Institute, Vientiane, Lao People's Democratic Republic
| | - Sonja Y Hess
- Department of Nutrition, Institute for Global Nutrition, University of California, Davis, Davis, California
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9
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Perin J, Burrowes V, Almeida M, Ahmed S, Haque R, Parvin T, Biswas S, Azmi IJ, Bhuyian SI, Talukder KA, Faruque AG, Stine OC, George CM. A Retrospective Case-Control Study of the Relationship between the Gut Microbiota, Enteropathy, and Child Growth. Am J Trop Med Hyg 2020; 103:520-527. [PMID: 32431271 DOI: 10.4269/ajtmh.19-0761] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
The microbial communities residing in the child gut are thought to play an important role in child growth, although the relationship is not well understood. We examined a cohort of young children from Mirzapur, Bangladesh, prospectively over 18 months. Four fecal markers of environmental enteropathy (EE) (high levels of alpha-1-antitrypsin, calprotectin, myeloperoxidase, and neopterin) were examined and anthropometric measures obtained from a cohort of 68 children. The 16S rRNA gene of bacterial DNA was sequenced from stool samples and used to estimate amplicon sequence variants (ASVs). We age-matched children with poor growth to children with normal growth within 1 month and compared the change in abundance and diversity of ASVs over time. Elevated EE markers and poor linear growth in children were associated with changes in microbial communities in the gut. There were increased amounts of Escherichia/Shigella and Proteobacteria and decreased amounts of Prevotella associated with poorly growing children consistent with the mounting evidence supporting the relationship between intestinal inflammation, child growth, and changes in gut microbiota composition. Future research is needed to investigate this association among young children in low- and middle-income countries.
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Affiliation(s)
- Jamie Perin
- Johns Hopkins School of Public Health, Baltimore, Maryland
| | | | | | - Shahnawaz Ahmed
- International Center for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Rashidul Haque
- International Center for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Tahmina Parvin
- International Center for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Shwapon Biswas
- International Center for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Ishrat J Azmi
- International Center for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Sazzadul Islam Bhuyian
- International Center for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Kaisar A Talukder
- International Center for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Abu G Faruque
- International Center for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
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Sheng X, Wang J, Li F, Ouyang F, Ma J. Effects of dietary intervention on vitamin B 12 status and cognitive level of 18-month-old toddlers in high-poverty areas: a cluster-randomized controlled trial. BMC Pediatr 2019; 19:334. [PMID: 31519167 PMCID: PMC6743151 DOI: 10.1186/s12887-019-1716-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Accepted: 09/09/2019] [Indexed: 12/13/2022] Open
Abstract
Background The local diet in high-poverty areas in China is mainly vegetarian, and children may be more vulnerable to vitamin B12 deficiency. Objective The aims of this study were to explore the vitamin B12 status of toddlers living in high-poverty areas of China and to observe the effects of different complementary foods on the vitamin B12 status and cognitive level of these toddlers. Methods The study was nested within a cluster-randomized controlled trial implemented in 60 administrative villages (clusters) of Xichou County in which infants aged 6 months old were randomized to receive 50 g/d of pork (meat group), an equi-caloric fortified cereal supplement (fortified cereal group) or local cereal supplement (local cereal group) for one year. At 18 months, a subsample of the 180 toddlers (60 from each group) was randomly tested for serum vitamin B12 and total homocysteine (tHcy) levels, and their neurodevelopment was evaluated. Results The median serum concentrations of vitamin B12 and tHcy were 360.0 pg/mL and 8.2 μmol/L, respectively, in children aged 18 months. Serum vitamin B12 concentrations less than 300 pg/mL were found in 62 (34.4%) children, and concentrations less than 200 pg/mL were found in 30 (16.7%) children. The median vitamin B12 concentration was significantly different among the three groups (P < 0.001). The highest vitamin B12 level was demonstrated in the fortified cereal group (509.5 pg/mL), followed by the meat group (338.0 pg/mL) and the local cereal group (241.0 pg/mL). Vitamin B12 concentration was positively correlated with the cognitive score (P < 0.001) and the fine motor score (P = 0.023) of the Bayley Scales of Infant Development, 3rd Edition (BSID III) screening test. Compared to the local cereal group, children in the meat group had higher cognitive scores (P < 0.05). Conclusion In poor rural areas of China, vitamin B12 deficiency in toddlers was common due to low dietary vitamin B12 intake. Fortified cereal and meat could help improve the vitamin B12 status of children and might improve their cognitive levels. Trial registration The larger trial in which this study was nested was registered at clinical trials.gov as NCT00726102. It was registered on July 31, 2008.
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Affiliation(s)
- Xiaoyang Sheng
- Department of Children and Adolescents Health Care, Xin Hua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Institute for Pediatric Research, MOE-Shanghai Key Laboratory of Children's Environmental Health, No.1665, Kongjiang Road, Yangpu District, Shanghai, 200092, China
| | - Junli Wang
- Department of Children and Adolescents Health Care, Xin Hua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Institute for Pediatric Research, MOE-Shanghai Key Laboratory of Children's Environmental Health, No.1665, Kongjiang Road, Yangpu District, Shanghai, 200092, China
| | - Feng Li
- Department of Children and Adolescents Health Care, Xin Hua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Institute for Pediatric Research, MOE-Shanghai Key Laboratory of Children's Environmental Health, No.1665, Kongjiang Road, Yangpu District, Shanghai, 200092, China
| | - Fengxiu Ouyang
- Ministry of Education and Shanghai Key Laboratory of Children's Environmental Health, Xin Hua Hospital, School of Medicine, Shanghai Jiao Tong University, No.1665, Kongjiang Road, Yangpu District, Shanghai, 200092, China
| | - Jingqiu Ma
- Shanghai Institute for Pediatric Research, Xin Hua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Key Laboratory of Pediatric Gastroenterology and Nutrition, No.1665, Kongjiang Road, Yangpu District, Shanghai, 200092, China.
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Sheng X, Sun X, Li F, Wang J, Ma J. Linear growth failure induced by systemic inflammation inhibiting IGF-1/IGFBP axis in rats with asymptomatic colitis. BMC Gastroenterol 2019; 19:96. [PMID: 31221091 PMCID: PMC6585116 DOI: 10.1186/s12876-019-1023-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 06/13/2019] [Indexed: 01/17/2023] Open
Abstract
Background Children in poor areas show significant growth retardation that does not improve with an adequate supply of energy and nutrients, which may be related to asymptomatic intestinal infection caused by poor sanitation. Our objective was to explore the mechanism of intestinal inflammation inhibiting growth in the setting of asymptomatic colitis. Methods Forty-eight 3-week-old Wistar rats were randomly divided into three groups: the control group, colitis group (with asymptomatic colitis induced by 2.5% trinitrobenzenesulphonic acid) and pair-fed group (daily food intake matched to the pair in the colitis group). The linear growth was assessed, and the plasma levels of hormone and systemic cytokines were detected and compared by independent two-sample t-test or one-way ANOVA among groups. Results At d5, the increases in the body length of the control, colitis and pair-fed groups were 1.65 ± 0.34 cm, 1.10 ± 0.30 cm and 1.38 ± 0.26 cm, respectively, and the increase in the body length in the colitis group was significantly less than that in the control group (P < 0.05). There were significant differences in the levels of hormone and cytokines among three groups (P < 0.05). Compared with the control group, rats in the colitis group exhibited linear growth failure, as well as higher expression of calprotectin, tumour necrosis factor-α, interleukin-6 and insulin-like growth factor binding protein 2, lower insulin-like growth factor-1 and insulin-like growth factor binding protein 3, and lower expression of nuclear factor kappa B in hepatocytes. Conclusions In addition to undernutrition, the systemic inflammatory response caused by asymptomatic colitis may inhibit the linear growth of rats by its influence on the insulin-like growth factor/insulin-like growth factor binding protein axis. Electronic supplementary material The online version of this article (10.1186/s12876-019-1023-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Xiaoyang Sheng
- Department of Children and Adolescents Health Care, Xin Hua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Institute for Pediatric Research, MOE-Shanghai Key Laboratory of Children's Environmental Health, No.1665, Kongjiang Road, Yangpu District, Shanghai, 200092, China
| | - Xueqing Sun
- Department of Biochemistry and Molecular Cell Biology, Shanghai Jiao Tong University School of Medicine, 280 S. South Chongqing Road, Shanghai, 200025, China
| | - Feng Li
- Department of Children and Adolescents Health Care, Xin Hua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Institute for Pediatric Research, MOE-Shanghai Key Laboratory of Children's Environmental Health, No.1665, Kongjiang Road, Yangpu District, Shanghai, 200092, China
| | - Junli Wang
- Department of Children and Adolescents Health Care, Xin Hua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Institute for Pediatric Research, MOE-Shanghai Key Laboratory of Children's Environmental Health, No.1665, Kongjiang Road, Yangpu District, Shanghai, 200092, China
| | - Jingqiu Ma
- Shanghai Institute for Pediatric Research, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Key Laboratory of Pediatric Gastroenterology and Nutrition, No.1665, Kongjiang Road, Yangpu District, Shanghai, 200092, China.
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12
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Jha AK, Chaudhary M, Dayal VM, Kumar A, Jha SK, Jha P, Purkayastha S, Ranjan R. Optimal cut-off value of fecal calprotectin for the evaluation of ulcerative colitis: An unsolved issue? JGH OPEN 2018; 2:207-213. [PMID: 30483591 PMCID: PMC6207035 DOI: 10.1002/jgh3.12074] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 06/10/2018] [Accepted: 06/23/2018] [Indexed: 12/12/2022]
Abstract
Introduction There is variability in the fecal calprotectin (FCP) cut‐off level for the prediction of ulcerative colitis (UC) disease activity and differentiation from irritable bowel disease (IBS‐D). The FCP cut‐off levels vary from country to country. Aims We aimed to assess FCP as a marker of disease activity in patients with UC. We determined the optimal FCP cut‐off value for differentiating UC and IBS‐D. Methods In a prospective study, we enrolled 76 UC and 30 IBS‐D patients. We studied the correlation of FCP with disease activity/extent as well as its role in differentiating UC from IBS‐D. We also reviewed literature regarding the optimal FCP cut‐off level for the prediction of disease activity and differentiation from IBS‐D patients. Results Sensitivity, specificity, positive predictive value, and negative predictive value of FCP (cut‐off level, 158 μg/g) for the prediction of complete mucosal healing (using Mayo endoscopic subscore) were 90, 85, 94.7, and 73.3%, respectively. Sensitivity, specificity, positive predictive value, and negative predictive value of FCP (cut‐off level, 425 μg/g) for the prediction of inactive disease (Mayo Score ≤ 2) were 94.3, 88.7, 86.2, and 95.4%, respectively. We also found a FCP cut‐off value of 188 μg/g for the differentiation of UC from IBS‐D. Conclusions The study reveals the large quantitative differences in FCP cut‐off levels in different study populations. This study demonstrates a wide variation in FCP cut‐off levels in the initial diagnosis of UC as well as in follow‐up post‐treatment. Therefore, this test requires validation of the available test kits and finding of appropriate cut‐off levels for different study populations.
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Affiliation(s)
- Ashish Kumar Jha
- Department of Gastroenterology Indira Gandhi Institute of Medical Sciences Patna India
| | - Madhur Chaudhary
- Department of Gastroenterology Indira Gandhi Institute of Medical Sciences Patna India
| | - Vishwa Mohan Dayal
- Department of Gastroenterology Indira Gandhi Institute of Medical Sciences Patna India
| | - Amarendra Kumar
- Department of Gastroenterology Indira Gandhi Institute of Medical Sciences Patna India
| | - Sanjeev Kumar Jha
- Department of Gastroenterology Indira Gandhi Institute of Medical Sciences Patna India
| | - Praveen Jha
- Department of Gastroenterology Indira Gandhi Institute of Medical Sciences Patna India
| | - Shubham Purkayastha
- Department of Gastroenterology Indira Gandhi Institute of Medical Sciences Patna India
| | - Ravish Ranjan
- Department of Gastroenterology Indira Gandhi Institute of Medical Sciences Patna India
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George CM, Burrowes V, Perin J, Oldja L, Biswas S, Sack D, Ahmed S, Haque R, Bhuiyan NA, Parvin T, Bhuyian SI, Akter M, Li S, Natarajan G, Shahnaij M, Faruque AG, Stine OC. Enteric Infections in Young Children are Associated with Environmental Enteropathy and Impaired Growth. Trop Med Int Health 2017; 23:26-33. [PMID: 29121442 DOI: 10.1111/tmi.13002] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To investigate the relationship between faecal contamination in child play spaces, enteric infections, environmental enteropathy (EE) and impaired growth among young children. METHODS A prospective cohort study was conducted of 203 children 6-30 months of age in rural Bangladesh. Stool samples were analysed by quantitative PCR for Shigella, Enterotoxigenic Escherichia coli (ETEC), Campylobacter jejuni, Giardia intestinalis and Cryptosporidium spp. Four faecal markers of intestinal inflammation were also measured: alpha-1-antitrypsin, myeloperoxidase, neopterin and calprotectin. Child growth was measured at baseline and 9 months after enrolment. E. coli was measured in soil in child play spaces. RESULTS Forty-seven percent of study children had three or more enteric pathogens in their stool. Thirty five percent (71/203) of children had Shigella, 30% (61/203) had ETEC, 73% (148/203) had C. jejuni, 79% (160/203) had Giardia intestinalis and none had Cryptosporidium. Children with ETEC had significantly higher calprotectin concentrations (Coefficient: 1.35, 95% Confidence Interval [CI]: 1.005, 1.82). Children with Shigella had a significantly higher odds of being stunted at our 9-month follow-up (OR: 2.01, 95% CI: 1.02, 3.93). Children with Giardia intestinalis had significantly higher E.coli counts in the soil collected from their play spaces (OR: 1.23, 95% CI: 1.02, 1.48). CONCLUSION Enteric infections were significantly associated with EE and impaired growth in rural Bangladesh. These findings provide further evidence to support the hypothesis that contaminated soil in child play spaces can lead to enteric infections, many of which are likely subclinical, resulting in EE and impaired growth in young children.
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Affiliation(s)
- Christine Marie George
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Vanessa Burrowes
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jamie Perin
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Lauren Oldja
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Shwapon Biswas
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh.,Department of Internal Medicine, Rangpur Medical College Hospital, Rangpur, Bangladesh
| | - David Sack
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Shahnawaz Ahmed
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Rashidul Haque
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Nurul Amin Bhuiyan
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Tahmina Parvin
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | | | - Mahmuda Akter
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Shan Li
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Gayathri Natarajan
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Mohammad Shahnaij
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Abu G Faruque
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - O Colin Stine
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA
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Praharaj I, Revathy R, Bandyopadhyay R, Benny B, Azharuddin Ko M, Liu J, Houpt ER, Kang G. Enteropathogens and Gut Inflammation in Asymptomatic Infants and Children in Different Environments in Southern India. Am J Trop Med Hyg 2017; 98:576-580. [PMID: 29231154 PMCID: PMC5929183 DOI: 10.4269/ajtmh.17-0324] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Children in poor environmental conditions are exposed early and often to enteric pathogens, but within developing countries, heterogeneity in enteropathogen exposure in different settings and communities is rarely addressed. We tested fecal samples from healthy infants and children from two different environments in the same Indian town for gut enteropathogens and biomarkers of gut inflammation. A significantly higher proportion of infants and children from a poor semi-urban neighborhood (93%) had one or more enteropathogens than those from a medical college campus (71.7%). Infants and children from the poor neighborhood had an average of 3.3 (95% confidence interval [CI]: 2.9-3.7) enteropathogens compared with an average of 1.4 (95% CI: 1.0-1.7) enteropathogens in campus infants/children. Viral and bacterial infections, including enteroviruses, adenoviruses, Campylobacter spp., and diarrhegenic Escherichia coli were more common and fecal biomarkers of inflammation were higher in the poor neighborhood. The findings demonstrate significant difference in the asymptomatic carriage of gut enteropathogens and gut inflammatory biomarkers in infants and children from two different environments within the same town in south India.
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Affiliation(s)
- Ira Praharaj
- Wellcome Trust Research Laboratory, Division of Gastrointestinal Sciences, Christian Medical College, Vellore, Tamil Nadu, India
| | - R Revathy
- Wellcome Trust Research Laboratory, Division of Gastrointestinal Sciences, Christian Medical College, Vellore, Tamil Nadu, India
| | - Rini Bandyopadhyay
- Wellcome Trust Research Laboratory, Division of Gastrointestinal Sciences, Christian Medical College, Vellore, Tamil Nadu, India
| | - Blossom Benny
- Wellcome Trust Research Laboratory, Division of Gastrointestinal Sciences, Christian Medical College, Vellore, Tamil Nadu, India
| | - Mohammed Azharuddin Ko
- Wellcome Trust Research Laboratory, Division of Gastrointestinal Sciences, Christian Medical College, Vellore, Tamil Nadu, India
| | - Jie Liu
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, Virginia
| | - Eric R Houpt
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, Virginia
| | - Gagandeep Kang
- Wellcome Trust Research Laboratory, Division of Gastrointestinal Sciences, Christian Medical College, Vellore, Tamil Nadu, India
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15
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Abstract
The global impact of childhood malnutrition is staggering. The synergism between malnutrition and infection contributes substantially to childhood morbidity and mortality. Anthropometric indicators of malnutrition are associated with the increased risk and severity of infections caused by many pathogens, including viruses, bacteria, protozoa, and helminths. Since childhood malnutrition commonly involves the inadequate intake of protein and calories, with superimposed micronutrient deficiencies, the causal factors involved in impaired host defense are usually not defined. This review focuses on literature related to impaired host defense and the risk of infection in primary childhood malnutrition. Particular attention is given to longitudinal and prospective cohort human studies and studies of experimental animal models that address causal, mechanistic relationships between malnutrition and host defense. Protein and micronutrient deficiencies impact the hematopoietic and lymphoid organs and compromise both innate and adaptive immune functions. Malnutrition-related changes in intestinal microbiota contribute to growth faltering and dysregulated inflammation and immune function. Although substantial progress has been made in understanding the malnutrition-infection synergism, critical gaps in our understanding remain. We highlight the need for mechanistic studies that can lead to targeted interventions to improve host defense and reduce the morbidity and mortality of infectious diseases in this vulnerable population.
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Wit JM, Himes JH, van Buuren S, Denno DM, Suchdev PS. Practical Application of Linear Growth Measurements in Clinical Research in Low- and Middle-Income Countries. Horm Res Paediatr 2017; 88:79-90. [PMID: 28196362 PMCID: PMC5804842 DOI: 10.1159/000456007] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Accepted: 01/10/2017] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND/AIMS Childhood stunting is a prevalent problem in low- and middle-income countries and is associated with long-term adverse neurodevelopment and health outcomes. In this review, we define indicators of growth, discuss key challenges in their analysis and application, and offer suggestions for indicator selection in clinical research contexts. METHODS Critical review of the literature. RESULTS Linear growth is commonly expressed as length-for-age or height-for-age z-score (HAZ) in comparison to normative growth standards. Conditional HAZ corrects for regression to the mean where growth changes relate to previous status. In longitudinal studies, growth can be expressed as ΔHAZ at 2 time points. Multilevel modeling is preferable when more measurements per individual child are available over time. Height velocity z-score reference standards are available for children under the age of 2 years. Adjusting for covariates or confounders (e.g., birth weight, gestational age, sex, parental height, maternal education, socioeconomic status) is recommended in growth analyses. CONCLUSION The most suitable indicator(s) for linear growth can be selected based on the number of available measurements per child and the child's age. By following a step-by-step algorithm, growth analyses can be precisely and accurately performed to allow for improved comparability within and between studies.
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Affiliation(s)
- Jan M. Wit
- Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands,*Jan M. Wit, MD, PhD, Department of Pediatrics, J6S, Leiden University Medical Center, PO Box 9600, NL-2300RC Leiden (The Netherlands), E-Mail
| | - John H. Himes
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Stef van Buuren
- Netherlands Organization for Applied Scientific Research TNO, Leiden, the Netherlands,Department of Methodology and Statistics, Faculty of Social and Behavioral Sciences, University of Utrecht, Utrecht, the Netherlands
| | - Donna M. Denno
- Department of Pediatrics and Global Health, University of Washington, Seattle, Washington, USA
| | - Parminder S. Suchdev
- Department of Pediatrics and Hubert Department of Global Health, Emory University, Atlanta, Georgia, USA
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17
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Morita T, Perin J, Oldja L, Biswas S, Sack RB, Ahmed S, Haque R, Bhuiyan NA, Parvin T, Bhuyian SI, Akter M, Talukder KA, Shahnaij M, Faruque AG, George CM. Mouthing of Soil Contaminated Objects is Associated with Environmental Enteropathy in Young Children. Trop Med Int Health 2017; 22:670-678. [PMID: 28319300 DOI: 10.1111/tmi.12869] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To characterise childhood mouthing behaviours and to investigate the association between object-to-mouth and food-to-mouth contacts, diarrhoea prevalence and environmental enteropathy. METHODS A prospective cohort study was conducted of 216 children ≤30 months of age in rural Bangladesh. Mouthing contacts with soil and food and objects with visible soil were assessed by 5-h structured observation. Stool was analysed for four faecal markers of intestinal inflammation: alpha-1-antitrypsin, myeloperoxidase, neopterin and calprotectin. RESULTS Overall 82% of children were observed mouthing soil, objects with visible soil, or food with visible soil during the structured observation period. Sixty two percent of children were observed mouthing objects with visible soil, 63% were observed mouthing food with visible soil, and 18% were observed mouthing soil only. Children observed mouthing objects with visible soil had significantly elevated faecal calprotectin concentrations (206.81 μg/g, 95% confidence interval [CI]: 6.27, 407.36). There was also a marginally significant association between Escherichia coli counts in soil from a child's play space and the prevalence rate of diarrhoea (diarrhoea prevalence ratio: 2.03, 95% CI 0.97, 4.25). CONCLUSION These findings provide further evidence to support the hypothesis that childhood mouthing behaviour in environments with faecal contamination can lead to environmental enteropathy in susceptible paediatric populations. Furthermore, these findings suggest that young children mouthing objects with soil, which occurred more frequently than soil directly (60% vs. 18%), was an important exposure route to faecal pathogens and a risk factor for environmental enteropathy.
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Affiliation(s)
- Tomohiko Morita
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jamie Perin
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Lauren Oldja
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Shwapon Biswas
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh.,Department of Internal Medicine, Rangpur Medical College Hospital, Rangpur, Bangladesh
| | - R Bradley Sack
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Shahnawaz Ahmed
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Rashidul Haque
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Nurul Amin Bhuiyan
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Tahmina Parvin
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | | | - Mahmuda Akter
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Kaisar A Talukder
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Mohammad Shahnaij
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Abu G Faruque
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Christine Marie George
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Normative Fecal Calprotectin Concentrations in Guatemalan Preschoolers Are High Relative to Children Reported Elsewhere. J Pediatr Gastroenterol Nutr 2017; 64:238-244. [PMID: 27101538 DOI: 10.1097/mpg.0000000000001241] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
BACKGROUND Calprotectin is a fecal marker of intraintestinal inflammation derived from activated enteric neutrophils and macrophages. It is useful as a clinical marker in inflammatory bowel diseases; furthermore, it may have a role in public health epidemiology. OBJECTIVES The aim of the study was to describe the distribution of fecal calprotectin in Guatemalan preschool children sharing a common institutional diet; to relate it collectively to pediatric distributions in other geographic settings, and individually to concomitant indicators of intestinal infection or colonization and other descriptive features of the child. METHODS Fecal samples were collected in 87 subjects, ages 2 to 7 years across 3 daycare centers sharing a common institutional menu, but from different ecological settings. Stools were examined, variously by routine light microscopy, quantitative egg counts, and a Giardia antigen test, for microbiological diagnosis, and an ELISA assay for fecal calprotectin (CalproLab). RESULTS The median fecal calprotectin value was 58 mg/kg, with a mean of 98 ± 136 mg/kg and a range from 10 to 950 mg/kg; 61% of values were above the manufacturer's cut-off for elevated concentration and 51% exceeded an age-adjusted criterion. There were no associations between sex, age, growth indicators, or fecal microbiological findings by microscopy or ELISA assays, alone or in combination. The central tendency (mean or median) and distribution were generally shifted to the right in relation to comparable reports from children across the world literature. CONCLUSIONS Although specific, low-grade intestinal infections do not define calprotectin subgroups, right-shifted fecal calprotectin status in this population may reflect a general and diffuse stress of adverse environmental sanitation.
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Song JY, Lee YM, Choi YJ, Jeong SJ. Fecal calprotectin level in healthy children aged less than 4 years in South Korea. J Clin Lab Anal 2017; 31. [PMID: 28092115 DOI: 10.1002/jcla.22113] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Accepted: 11/15/2016] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Fecal calprotectin (FC) is non-invasive inflammatory marker indicating various bowel diseases. However, the median-specific cut-off values and the standard deviations (SD) of the FC levels in each age group <4 years were not elucidated. METHODS Healthy volunteers were enrolled from four kindergartens. A questionnaire was used to confirm that the children met the inclusion criteria, and several demographics and history of bowel symptoms were collected. The FC level was measured. RESULTS A total of 234 healthy children aged between 6 months and 4 years were recruited. The median FC concentration of all participants was 245 μg/g (range 12-1033 μg/g, mean 68.5 μg/g, SD 123.12 μg/g). The children were divided into six age groups. The upper limit of 95% CI of median FC values was 135 μg/g in 7-12 months group, 65 μg/g in 13-18 months group, 55 μg/g in 19-24 months group, 40 μg/g in 25-30 months group, 21 μg/g in 31-36 months group, and 12 μg/g in 37-48 months group. A negative correlation trend was found between the age and the FC concentration. CONCLUSION This is the first study to present the FC median levels in the specific age groups <4 years in Korea. We found a FC level reduction with age, indicating a bowel maturation process and decreased intestinal permeability of the intestinal mucosa. In our study, FC levels reached the values of 50 μg/g around the age of 2 years.
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Affiliation(s)
- Joo Young Song
- Department of Pediatrics, Bundang CHA Medical Center, CHA University, Seongnam, South Korea
| | - Yoo Mi Lee
- Department of Pediatrics, Bundang CHA Medical Center, CHA University, Seongnam, South Korea
| | - You Jin Choi
- Department of Pediatrics, Bundang CHA Medical Center, CHA University, Seongnam, South Korea
| | - Su Jin Jeong
- Department of Pediatrics, Bundang CHA Medical Center, CHA University, Seongnam, South Korea
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20
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The Effect of Iron Fortification on Iron (Fe) Status and Inflammation: A Randomized Controlled Trial. PLoS One 2016; 11:e0167458. [PMID: 27923057 PMCID: PMC5140064 DOI: 10.1371/journal.pone.0167458] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Accepted: 11/11/2016] [Indexed: 12/12/2022] Open
Abstract
Background Iron deficiency (ID) is common in toddlers in developing countries. Iron fortified or meat-based complementary foods may be effective to prevent ID. Objective Our objective was to compare iron status at 18 months and growth from 6 to 18 months in rural poor toddlers fed 3 different complementary foods. Methods The study was nested within a larger trial in which 6-month-old infants were randomized to receive 50g/d meat (MG), an equi-caloric fortified cereal supplement (FG) or local cereal supplement (LG) for 1 year. Hb, sTfR, HsCRP, ferritin and AGP were measured in 410 blood samples collected by a random sampling (MG, 137; FG, 140; LG, 133); calprotectin was measured in feces. Body iron = -[log (sTfR ×1000/ferritin)-2.8229] /0.1207. ID = ferritin<12ug/L. Results The toddlers in FG had the significantly highest levels in serum ferritin and body iron (P = 0.043, 0.004), and the rates of both ID and iron deficiency anemia (IDA) were the lowest in FG (P = 0.010, 0.021). The rate of systemic inflammation in FG was 30.71%, which was the highest among three groups (P = 0.042). No intervention effects on either the rates of ID and IDA or iron stores (serum ferritin and body iron) were shown in MG. The change in length-for-age z scores (LAZ) from 6 to 18 months among three groups was significantly different (P = 0.021) and a smaller decrease of LAZ in MG and a larger decrease of LAZ in FG were observed. Conclusion Iron fortified cereal improved iron status of poor rural toddlers but was also associated with systemic inflammation which was likely to impair their growth.
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Morita T, Godfrey S, George CM. Systematic review of evidence on the effectiveness of safe child faeces disposal interventions. Trop Med Int Health 2016; 21:1403-1419. [PMID: 27546207 DOI: 10.1111/tmi.12773] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVES To review and synthesise the available evidence on the effectiveness of interventions targeting unsafe child faeces disposal in reducing this behaviour and improving child health in low- and middle-income countries. METHODS PubMed and EMBASE were systematically searched. Studies meeting the inclusion criteria were reviewed and key information on study methodologies and outcomes were extracted. RESULTS A total of 1048 articles were screened, and eight studies representing five countries were included for the review. Three were randomised controlled trials, and five were prospective cohort studies. There was wide variability across studies in the definition of 'safe disposal' of child faeces. Six studies reported the change in child faeces disposal practices associated with safe child faeces disposal interventions. However, only one study found a significant improvement in this behaviour. Two of the six studies that evaluated the health impact of delivered interventions found significant reductions in childhood diarrhoea associated with safe faeces disposal practices, and one study reported a positive effect on child growth and ascariasis. Only one study was identified that delivered a single intervention solely focused on safe child faeces disposal. Unfortunately, this study did not investigate the impact of this intervention on child health. CONCLUSIONS There are major methodological limitations in studies that assessed the impact of safe child faeces disposal interventions. The health impact of these interventions is inconclusive because the quality of the current evidence is poor. Randomised controlled trials are urgently needed to assess the impact of safe faeces disposal interventions on child health.
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Affiliation(s)
- Tomohiko Morita
- Program in Global Disease Epidemiology and Control, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Samuel Godfrey
- Water, Sanitation and Hygiene Section, UNICEF Ethiopia, Addis Ababa, Ethiopia
| | - Christine Marie George
- Program in Global Disease Epidemiology and Control, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
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George CM, Oldja L, Biswas S, Perin J, Sack RB, Ahmed S, Shahnaij M, Haque R, Parvin T, Azmi IJ, Bhuyian SI, Talukder KA, Faruque AG. Unsafe Child Feces Disposal is Associated with Environmental Enteropathy and Impaired Growth. J Pediatr 2016; 176:43-9. [PMID: 27318380 DOI: 10.1016/j.jpeds.2016.05.035] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2016] [Revised: 03/28/2016] [Accepted: 05/11/2016] [Indexed: 01/15/2023]
Abstract
OBJECTIVE To investigate the relationship between unsafe child feces disposal, environmental enteropathy, and impaired growth, we conducted a prospective cohort study of 216 young children in rural Bangladesh. STUDY DESIGN Using a prospective cohort study design in rural Bangladesh, unsafe child feces disposal, using the Joint Monitoring Program definition, was assessed using 5-hour structured observation by trained study personnel as well as caregiver reports. Anthropometric measurements were collected at baseline and at a 9-month follow-up. Stool was analyzed for fecal markers of environmental enteropathy: alpha-1-antitrypsin, myeloperoxidase, neopterin (combined to form an environmental enteropathy disease activity score), and calprotectin. FINDINGS Among 216 households with young children, 84% had an unsafe child feces disposal event during structured observation and 75% had caregiver reported events. There was no significant difference in observed unsafe child feces disposal events for households with or without an improved sanitation option (82% vs 85%, P = .72) or by child's age (P = .96). Children in households where caregivers reported unsafe child feces disposal had significantly higher environmental enteropathy scores (0.82-point difference, 95% CI 0.11-1.53), and significantly greater odds of being wasted (weight-for-height z score <-2 SDs) (9% vs 0%, P = .024). In addition, children in households with observed unsafe feces disposal had significantly reduced change in weight-for-age z-score (-0.34 [95% CI -0.68, -0.01] and weight-for-height z score (-0.52 [95% CI -0.98, -0.06]). CONCLUSION Unsafe child feces disposal was significantly associated with environmental enteropathy and impaired growth in a pediatric population in rural Bangladesh. Interventions are needed to reduce this high-risk behavior to protect the health of susceptible pediatric populations.
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Affiliation(s)
- Christine Marie George
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
| | - Lauren Oldja
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Shwapon Biswas
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) Dhaka, Bangladesh
| | - Jamie Perin
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - R Bradley Sack
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Shahnawaz Ahmed
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) Dhaka, Bangladesh
| | - Mohammad Shahnaij
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) Dhaka, Bangladesh
| | - Rashidul Haque
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) Dhaka, Bangladesh
| | - Tahmina Parvin
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) Dhaka, Bangladesh
| | - Ishrat J Azmi
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) Dhaka, Bangladesh
| | - Sazzadul Islam Bhuyian
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) Dhaka, Bangladesh
| | - Kaisar A Talukder
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) Dhaka, Bangladesh
| | - Abu G Faruque
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) Dhaka, Bangladesh
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Herrera OR, Christensen ML, Helms RA. Calprotectin: Clinical Applications in Pediatrics. J Pediatr Pharmacol Ther 2016; 21:308-321. [PMID: 27713670 DOI: 10.5863/1551-6776-21.4.308] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
As seen over the past 20 years, calprotectin has evolved as a novel, non-invasive biomarker of gastrointestinal (GI) inflammation. We present this review of calprotectin in pediatrics. This article will focus on studies using calprotectin concentrations from different body fluids to monitor inflammation in different disease states and conditions. The ultimate goal of our group is to lay down a foundation as we consider using calprotectin prospectively as a marker of intestinal inflammation that could lead to further testing and possibly a marker of preparedness for feeding. We surveyed all published studies in English of calprotectin in neonates, infants, children, and adolescents through February 2014. We will discuss calprotectin's basic properties and analysis such as characteristics, identification, presence in body fluids, and maturational development. In addition, calprotectin's use in inflammatory diseases exploring both GI and non-GI conditions will be evaluated and compared with other serum markers presently available. Finally, a summary of our findings and discussion of future work that could be undertaken in order to render calprotectin as a more useful monitoring tool to the medical research community will complete the review.
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Affiliation(s)
- Oscar R Herrera
- Department of Clinical Pharmacy, University of Tennessee Health Science Center College of Pharmacy, Memphis, Tennessee ; State of Tennessee Center of Excellence in Pediatric Pharmacokinetics and Therapeutics, Memphis, Tennessee
| | - Michael L Christensen
- Department of Clinical Pharmacy, University of Tennessee Health Science Center College of Pharmacy, Memphis, Tennessee ; State of Tennessee Center of Excellence in Pediatric Pharmacokinetics and Therapeutics, Memphis, Tennessee ; Department of Pediatrics, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Richard A Helms
- Department of Clinical Pharmacy, University of Tennessee Health Science Center College of Pharmacy, Memphis, Tennessee ; State of Tennessee Center of Excellence in Pediatric Pharmacokinetics and Therapeutics, Memphis, Tennessee ; Department of Pediatrics, University of Tennessee Health Science Center, Memphis, Tennessee
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Zhu Q, Li F, Wang J, Shen L, Sheng X. Fecal Calprotectin in Healthy Children Aged 1-4 Years. PLoS One 2016; 11:e0150725. [PMID: 26950440 PMCID: PMC4780696 DOI: 10.1371/journal.pone.0150725] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Accepted: 02/17/2016] [Indexed: 12/16/2022] Open
Abstract
Objective Calprotectin has been well emulated recently in adults as well as in children. The aim of this study was to assess fecal calprotectin concentrations in healthy children aged from 1 to 4 years. Methods Volunteers were enlisted from 3 nurseries. A brief questionnaire was used to ensure these children meet the inclusion criteria, and some clinical and sociodemographic factors were collected. Anthro software (version 3.1) was used to calculated Length-for-age Z-scores (LAZ), weight-for-age Z-scores (WAZ), and weight-for-length Z-scores (WLZ) respectively. Fecal calprotectin was detected by a commercially available ELISA. Results In total 274 children were recruited, with age ranging from 1 to 4 years old. The median FC concentration was 83.19 μg/g [range 4.58 to 702.50 μg/g, interquartile range (IQR) 14.69–419.45 μg/g] or 1.92 log10 μg/g (range 0.66 log10 to 2.85 log10 μg/g, IQR 1.17 log10-2.62 log10 μg/g). All of the children were divided into three groups, 1–2 years (12–24 months), 2–3 years (24–36 months), 3–4 years (36–48 months), with median FC concentrations 96.14 μg/g (1.98 log10 μg/g), 81.48 μg/g (1.91 log10 μg/g), 65.36 μg/g (1.82 log10 μg/g), respectively. There was similar FC level between boys and girls. FC concentrations showed a downward trend by the growing age groups. A statistic difference was found in FC concentrations among groups 1–2 years, 2–3 years and 3–4 years (P = 0.016). In inter-groups comparison, a significant difference was found between children aged 1–2 years and children aged 3–4 years (P = 0.007). A negative correlation trend was found between age and FC concentration (Spearman's rho = -0.167, P = 0.005) in all the participants. A simple correlation was performed among WLZ, WAZ, birth weight, or birth length with FC, and there was no correlation being observed. Conclusion Children aged from 1 to 4 years old have lower FC concentrations compared with healthy infants (<1years), and higher FC concentrations when comparing with children older than 4 years and adults.
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Affiliation(s)
- Qingling Zhu
- Department of Child and Adolescent Healthcare, MOE-Shanghai Key Laboratory of Children’s Environmental Health, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200092, China
| | - Feng Li
- Department of Child and Adolescent Healthcare, MOE-Shanghai Key Laboratory of Children’s Environmental Health, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200092, China
| | - Junli Wang
- Department of Child and Adolescent Healthcare, MOE-Shanghai Key Laboratory of Children’s Environmental Health, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200092, China
| | - Lixiao Shen
- Department of Child and Adolescent Healthcare, MOE-Shanghai Key Laboratory of Children’s Environmental Health, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200092, China
| | - Xiaoyang Sheng
- Department of Child and Adolescent Healthcare, MOE-Shanghai Key Laboratory of Children’s Environmental Health, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200092, China
- * E-mail:
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Lin WC, Wong JM, Tung CC, Lin CP, Chou JW, Wang HY, Shieh MJ, Chang CH, Liu HH, Wei SC. Fecal calprotectin correlated with endoscopic remission for Asian inflammatory bowel disease patients. World J Gastroenterol 2015; 21:13566-13573. [PMID: 26730169 PMCID: PMC4690187 DOI: 10.3748/wjg.v21.i48.13566] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Revised: 08/06/2015] [Accepted: 09/15/2015] [Indexed: 02/07/2023] Open
Abstract
AIM: To evaluate the correlation between fecal calprotectin (fC), C-reactive protein (CRP), and endoscopic disease score in Asian inflammatory bowel disease (IBD) patients.
METHODS: Stool samples were collected and assessed for calprotectin levels by Quantum Blue Calprotectin High Range Rapid test. Crohn’s disease endoscopic index of severity (CDEIS) and ulcerative colitis endoscopic index of severity (UCEIS) were used for endoscopic lesion scoring.
RESULTS: A total of 88 IBD patients [36 patients with Crohn’s disease (CD) and 52 with ulcerative colitis (UC)] were enrolled. For CD patients, fC correlated with CDEIS (r = 0.465, P = 0.005) and CRP (r = 0.528, P = 0.001). fC levels in UC patients correlated with UCEIS (r = 0.696, P < 0.0001) and CRP (r = 0.529, P = 0.0005). Calprotectin could predict endoscopic remission (CDEIS < 6) with 50% sensitivity and 100% specificity (AUC: 0.74) in CD patients when using 918 μg/g as the cut-off. When using 191 μg/g as the cut-off in UC patients, calprotectin could be used for predicting endoscopic remission (UCEIS < 3) with 88% sensitivity and 75% specificity (AUC: 0.87).
CONCLUSION: fC correlated with both CDEIS and UCEIS. fC could be used as a predictor of endoscopic remission for Asian IBD patients.
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George CM, Oldja L, Biswas SK, Perin J, Lee GO, Ahmed S, Haque R, Sack RB, Parvin T, Azmi IJ, Bhuyian SI, Talukder KA, Faruque AG. Fecal Markers of Environmental Enteropathy are Associated with Animal Exposure and Caregiver Hygiene in Bangladesh. Am J Trop Med Hyg 2015; 93:269-75. [PMID: 26055734 PMCID: PMC4530746 DOI: 10.4269/ajtmh.14-0694] [Citation(s) in RCA: 87] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Accepted: 04/20/2015] [Indexed: 12/18/2022] Open
Abstract
Undernutrition is estimated to be an underlying cause of over half of all deaths in young children globally. There is a growing body of literature suggesting that increased exposure to enteric pathogens is responsible for environmental enteropathy (EE), a disorder associated with impaired growth in children. To determine if household unsanitary environmental conditions were significantly associated with EE and stunting in children, we conducted a cohort of 216 children (≤ 30 months) in rural Bangladesh. Stool was analyzed for four fecal markers of EE: alpha-1-antitrypsin, myeloperoxidase, and neopterin combined to form an EE disease activity score, and calprotectin. We observed a significant association between having an animal corral in a child's sleeping room and elevated EE scores (1.0 point difference, 95% confidence interval [CI]: 0.13, 1.88) and a two times higher odds of stunting (height-for-age z-score < -2) (odds ratio [OR]: 2.53, 95% CI: 1.08, 5.43) after adjusting for potential confounders. In addition, children of caregivers with visibly soiled hands had significantly elevated fecal calprotectin (μg/g) (384.1, 95% CI: 152.37, 615.83). These findings suggest that close contact with animals and caregiver hygiene may be important risk factors for EE in young children. These findings are consistent with the hypothesis that unsanitary environmental conditions can lead to EE in susceptible pediatric populations.
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Affiliation(s)
- Christine Marie George
- Johns Hopkins University, Baltimore, Maryland; International Center for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Lauren Oldja
- Johns Hopkins University, Baltimore, Maryland; International Center for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Shwapon K Biswas
- Johns Hopkins University, Baltimore, Maryland; International Center for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Jamie Perin
- Johns Hopkins University, Baltimore, Maryland; International Center for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Gwenyth O Lee
- Johns Hopkins University, Baltimore, Maryland; International Center for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Shahnawaz Ahmed
- Johns Hopkins University, Baltimore, Maryland; International Center for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Rashidul Haque
- Johns Hopkins University, Baltimore, Maryland; International Center for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - R Bradley Sack
- Johns Hopkins University, Baltimore, Maryland; International Center for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Tahmina Parvin
- Johns Hopkins University, Baltimore, Maryland; International Center for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Ishrat J Azmi
- Johns Hopkins University, Baltimore, Maryland; International Center for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Sazzadul Islam Bhuyian
- Johns Hopkins University, Baltimore, Maryland; International Center for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Kaisar A Talukder
- Johns Hopkins University, Baltimore, Maryland; International Center for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Abu G Faruque
- Johns Hopkins University, Baltimore, Maryland; International Center for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
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George CM, Oldja L, Biswas S, Perin J, Lee GO, Kosek M, Sack RB, Ahmed S, Haque R, Parvin T, Azmi IJ, Bhuyian SI, Talukder KA, Mohammad S, Faruque AG. Geophagy is associated with environmental enteropathy and stunting in children in rural Bangladesh. Am J Trop Med Hyg 2015; 92:1117-24. [PMID: 25918214 PMCID: PMC4458812 DOI: 10.4269/ajtmh.14-0672] [Citation(s) in RCA: 106] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Accepted: 03/02/2015] [Indexed: 11/07/2022] Open
Abstract
There is a growing body of literature indicating an association between stunting and environmental enteropathy (EE), a disorder thought to be caused by repeated exposures to enteric pathogens. To investigate the relationship between exposure to enteric pathogens through geophagy, consumption of soil, EE, and stunting, we conducted a prospective cohort study of 216 children under 5 years of age in rural Bangladesh. Geophagy was assessed at baseline using 5 hour structured observation and caregiver reports. Stool was analyzed for fecal markers of intestinal inflammation: alpha-1-antitrypsin, myeloperoxidase, neopterin (all three combined to form an EE disease activity score), and calprotectin. Eighteen percent of children had observed geophagy events by structured observation and 28% had caregiver reported events in the past week. Nearly all households had Escherichia coli (97%) in soil, and 14% had diarrheagenic E. coli. Children with caregiver-reported geophagy had significantly higher EE scores (0.72 point difference, 95% confidence interval [CI]: 0.01, 1.42) and calprotectin concentrations (237.38 μg/g, 95% CI: 12.77, 462.00). Furthermore, at the 9-month follow-up the odds of being stunted (height-for-age z-score < -2) was double for children with caregiver-reported geophagy (odds ratio [OR]: 2.27, 95% CI: 1.14, 4.51). These findings suggest that geophagy in young children may be an important unrecognized risk factor for EE and stunting.
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Affiliation(s)
- Christine Marie George
- Johns Hopkins University, Baltimore, Maryland; International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Lauren Oldja
- Johns Hopkins University, Baltimore, Maryland; International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Shwapon Biswas
- Johns Hopkins University, Baltimore, Maryland; International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Jamie Perin
- Johns Hopkins University, Baltimore, Maryland; International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Gwenyth O Lee
- Johns Hopkins University, Baltimore, Maryland; International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Margaret Kosek
- Johns Hopkins University, Baltimore, Maryland; International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - R Bradley Sack
- Johns Hopkins University, Baltimore, Maryland; International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Shahnawaz Ahmed
- Johns Hopkins University, Baltimore, Maryland; International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Rashidul Haque
- Johns Hopkins University, Baltimore, Maryland; International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Tahmina Parvin
- Johns Hopkins University, Baltimore, Maryland; International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Ishrat J Azmi
- Johns Hopkins University, Baltimore, Maryland; International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Sazzadul Islam Bhuyian
- Johns Hopkins University, Baltimore, Maryland; International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Kaisar A Talukder
- Johns Hopkins University, Baltimore, Maryland; International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Shahnaij Mohammad
- Johns Hopkins University, Baltimore, Maryland; International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Abu G Faruque
- Johns Hopkins University, Baltimore, Maryland; International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
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Wernimont S, Northington R, Kullen MJ, Yao M, Bettler J. Effect of an α-lactalbumin-enriched infant formula supplemented with oligofructose on fecal microbiota, stool characteristics, and hydration status: a randomized, double-blind, controlled trial. Clin Pediatr (Phila) 2015; 54:359-70. [PMID: 25297064 PMCID: PMC4370932 DOI: 10.1177/0009922814553433] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
AIMS To evaluate the impact of oligofructose (OF)-supplemented infant formula on fecal microbiota, stool characteristics, and hydration. METHODS Ninety-five formula-fed infants were randomized to α-lactalbumin-enriched control formula (CF) or identical formula with 3.0 g/L OF (EF) for 8 weeks; 50 infants fed human milk (HM) were included. RESULTS Eighty-four infants completed the study, 70 met per-protocol criteria. Over 8 weeks, bifidobacteria increased more in EF than CF group (0.70 vs. 0.16 log10 bacterial counts/g dry feces, P = .008); EF was not significantly different from HM group (P = .32). EF group stool consistency was intermediate between CF and HM groups; at week 8, EF group had softer stools than CF (5-point scale: 1 = hard, 5 = watery; consistency score 3.46 vs. 2.82, P = .015) without significant differences in stool frequency. Physician-assessed hydration status was normal for all infants. CONCLUSIONS Infant formula with 3.0 g/L OF promoted bifidobacteria growth and softer stools without adversely affecting stool frequency or hydration.
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Li F, Ma J, Geng S, Wang J, Liu J, Zhang J, Sheng X. Fecal calprotectin concentrations in healthy children aged 1-18 months. PLoS One 2015; 10:e0119574. [PMID: 25742018 PMCID: PMC4351193 DOI: 10.1371/journal.pone.0119574] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Accepted: 01/15/2015] [Indexed: 12/13/2022] Open
Abstract
Objective Fecal calprotectin (FC) is an established biomarker of gut inflammation. The aim of this study was to evaluate FC concentrations in healthy children between 1 and 18 months of age. Methods Healthy children aged 1-18 months were enrolled in this study at the Department of Children's Health Care in Shanghai, China. Children’s stool samples were collected and analyzed, and FC concentration was determined using a commercially available enzyme-linked immunosorbent assay (ELISA). The children's weights and lengths were measured. Parents were asked to complete a brief questionnaire regarding several clinical and sociodemographic factors. Results The FC concentrations were unevenly distributed; the median FC concentration was 174.3 μg/g (range: 6.0-1097.7 μg/g) or 2.241 log10 μg/g (range: 0.775-3.041 log10 μg/g) for all 288 children. The children were divided into several age groups: 1-3 months, 3-6 months, 6-9 months, 9-12 months and 12-18 months. The median FC concentrations for these age groups were 375.2 μg/g (2.574 log10 μg/g), 217.9 μg/g (2.338 log10 μg/g), 127.7 μg/g (2.106 log10 μg/g), 96.1 μg/g (1.983 log10 μg/g) and 104.2 μg/g (2.016 log10 μg/g), respectively. A significant correlation between age and FC concentration was found (r=-0.490, p<0.001). A simple correlation analysis of weight-for-length Z-scores or weight-for-age Z-scores vs. FC concentrations showed that these variables were negatively correlated (Spearman’s rho=-0.287, p<0.001; Spearman’s rho=-0.243, p<0.001, respectively). Conclusions The FC levels of children aged 1-18 months exhibit a downward trend with increasing age and are greater than the normal levels observed in healthy adults. In healthy children aged <6 months, FC levels are high. In children aged 6-18 months, FC concentrations are relatively low but are still higher than those of children aged >4 years.
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Affiliation(s)
- Feng Li
- Department of Children and Adolescents Health Care, MOE-Shanghai Key Laboratory of Children’s Environmental Health, Xin Hua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jingqiu Ma
- Department of Children and Adolescents Health Care, MOE-Shanghai Key Laboratory of Children’s Environmental Health, Xin Hua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shanshan Geng
- Department of Children and Adolescents Health Care, MOE-Shanghai Key Laboratory of Children’s Environmental Health, Xin Hua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Junli Wang
- Department of Children and Adolescents Health Care, MOE-Shanghai Key Laboratory of Children’s Environmental Health, Xin Hua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jinrong Liu
- Department of Children and Adolescents Health Care, MOE-Shanghai Key Laboratory of Children’s Environmental Health, Xin Hua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jie Zhang
- Department of Children and Adolescents Health Care, MOE-Shanghai Key Laboratory of Children’s Environmental Health, Xin Hua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaoyang Sheng
- Department of Children and Adolescents Health Care, MOE-Shanghai Key Laboratory of Children’s Environmental Health, Xin Hua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- * E-mail:
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Krebs NF. Food Based Complementary Feeding Strategies for Breastfed Infants: What's the Evidence that it Matters? NUTRITION TODAY 2014; 49:271-277. [PMID: 26549893 PMCID: PMC4636122 DOI: 10.1097/nt.0000000000000064] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The period of complementary feeding represents a major portion of the 1000 day critical window and thus impacts a period of substantial and dynamic infant development. This review highlights and synthesizes findings of several recent studies conducted to evaluate food based strategies on outcomes related to micronutrient status, growth and neurocognitive development. Particular emphasis is placed on interventions using meat or fortified products to impact iron and zinc intakes, due to the dependence of breastfed infants on complementary food choices to meet requirements for these two critical micronutrients. Regular consumption of modest amounts of meat or fortified cereals provides adequate absorbed zinc to meet estimated physiologic requirements, whereas homeostatic adaptation to lower zinc intake from unfortified cereal/plant staples is inadequate to meet requirements. Iron fortification of cereals may be somewhat more effective than meat to improve iron status, but neither prevents iron deficiency in breastfed infants, even in westernized settings. Improvements in the quality of complementary foods have had very modest effects on linear growth in settings where stunting is prevalent. Maternal education is strongly associated with both linear growth and with child neurodevelopment. The determinants of early growth faltering are more complex and intractable than 'simple' dietary deficiencies of micronutrients. Solutions to growth faltering in young children most likely need to be multi-factorial, and almost certainly will need to start earlier than the complementary feeding period.
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Affiliation(s)
- Nancy F Krebs
- Section of Nutrition, Department of Pediatrics University of Colorado School of Medicine Aurora, CO 80045
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Li F, Ma J, Geng S, Wang J, Ren F, Sheng X. Comparison of the different kinds of feeding on the level of fecal calprotectin. Early Hum Dev 2014; 90:471-5. [PMID: 25025530 DOI: 10.1016/j.earlhumdev.2014.06.005] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Accepted: 06/14/2014] [Indexed: 12/17/2022]
Abstract
BACKGROUND Controversial results have been reported on the effect of type of feeding on the level of fecal calprotectin in infants. OBJECTIVE To assess fecal calprotectin levels in breast fed or nonbreast fed healthy infants. DESIGN A study was conducted to compare fecal calprotectin in infants who were exclusively breastfed compared to those who were not breastfed in Shanghai, China. Stool samples were collected and analyzed, and the fecal calprotectin concentration was determined using a commercially available enzyme-linked immunosorbent assay. The infant's weight and length were measured. Parents were asked to fill in a brief questionnaire, with questions about several clinical and sociodemographic factors. SUBJECTS This study included 105 healthy infants aged 0-5 months. RESULTS Stool samples were obtained from 105 healthy infants (63 boys, 42 girls) with a median age of 2.86 months (range 1-5.88). The median fecal calprotectin concentration was significantly higher in breast fed infants (377μg/g, range 35-937μg/g) than that in nonbreast fed ones (233μg/g, range 37-895μg/g) (p=0.001). A correlation was found that from 0 to 5 months, fecal calprotectin was negatively and significantly associated with age in both two kinds of feeding (breast fed: Spearman's rho -0.346, p=0.010; nonbreast fed: Spearman's rho -0.478, p<0.001). CONCLUSIONS Our findings show that the kind of feeding influences the fecal calprotectin concentration and breast fed infants have higher levels than nonbreast fed ones in the first months of life. This may represent that human milk influences the gut mucosa by immunomodulating factors.
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Affiliation(s)
- Feng Li
- Department of Children and Adolescents Health Care, MOE-Shanghai Key Laboratory of Children's Environmental Health, Xin Hua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jingqiu Ma
- Department of Children and Adolescents Health Care, MOE-Shanghai Key Laboratory of Children's Environmental Health, Xin Hua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shanshan Geng
- Department of Children and Adolescents Health Care, MOE-Shanghai Key Laboratory of Children's Environmental Health, Xin Hua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Junli Wang
- Department of Children and Adolescents Health Care, MOE-Shanghai Key Laboratory of Children's Environmental Health, Xin Hua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Fang Ren
- Department of Children and Adolescents Health Care, MOE-Shanghai Key Laboratory of Children's Environmental Health, Xin Hua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaoyang Sheng
- Department of Children and Adolescents Health Care, MOE-Shanghai Key Laboratory of Children's Environmental Health, Xin Hua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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Abstract
Linear growth failure is the most common form of undernutrition globally. With an estimated 165 million children below 5 years of age affected, stunting has been identified as a major public health priority, and there are ambitious targets to reduce the prevalence of stunting by 40% between 2010 and 2025. We view this condition as a 'stunting syndrome' in which multiple pathological changes marked by linear growth retardation in early life are associated with increased morbidity and mortality, reduced physical, neurodevelopmental and economic capacity and an elevated risk of metabolic disease into adulthood. Stunting is a cyclical process because women who were themselves stunted in childhood tend to have stunted offspring, creating an intergenerational cycle of poverty and reduced human capital that is difficult to break. In this review, the mechanisms underlying linear growth failure at different ages are described, the short-, medium- and long-term consequences of stunting are discussed, and the evidence for windows of opportunity during the life cycle to target interventions at the stunting syndrome are evaluated.
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Affiliation(s)
- Andrew J Prendergast
- Centre for Paediatrics, Blizard Institute, Queen Mary University of London, UK,Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe,Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jean H Humphrey
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe,Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Prendergast AJ, Rukobo S, Chasekwa B, Mutasa K, Ntozini R, Mbuya MNN, Jones A, Moulton LH, Stoltzfus RJ, Humphrey JH. Stunting is characterized by chronic inflammation in Zimbabwean infants. PLoS One 2014; 9:e86928. [PMID: 24558364 PMCID: PMC3928146 DOI: 10.1371/journal.pone.0086928] [Citation(s) in RCA: 178] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Accepted: 12/19/2013] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Stunting affects one-third of children in developing countries, but the causes remain unclear. We hypothesized that enteropathy leads to low-grade inflammation, which suppresses the growth hormone-IGF axis and mediates stunting. METHODS We conducted a case-control study of 202 HIV-unexposed Zimbabwean infants who were stunted (height-for-age Z-score (HAZ) <-2; cases) or non-stunted (HAZ >-0.5; controls) at 18 months. We measured biomarkers of intestinal damage (I-FABP), inflammation (CRP, AGP, IL-6) and growth hormone-IGF axis (IGF-1, IGFBP3) in infant plasma at 6 weeks and 3, 6, 12 and 18 months, and in paired maternal-infant plasma at birth. Adjusted mean differences between biomarkers were estimated using regression models. Multivariate odds ratios of stunting were estimated by logistic regression. RESULTS At birth, cases were shorter (median (IQR) HAZ -1.00 (-1.53, -0.08) vs 0.03 (-0.57, 0.62,); P<0.001) than controls and their mothers had lower levels of IGF-1 (adjusted mean difference (95%CI) -21.4 (-39.8, -3.1) ng/mL). From 6 weeks to 12 months of age, levels of CRP and AGP were consistently higher and IGF-1 and IGFBP3 lower in cases versus controls; IGF-1 correlated inversely with inflammatory markers at all time-points. I-FABP increased between 3-12 months, indicating extensive intestinal damage during infancy, which was similar in cases and controls. In multivariate analysis, higher log10 levels of CRP (aOR 3.06 (95%CI 1.34, 6.99); P = 0.008) and AGP (aOR 7.87 (95%CI 0.74, 83.74); P = 0.087) during infancy were associated with stunting. There were no associations between levels of I-FABP, IL-6, sCD14 or EndoCAb and stunting. CONCLUSIONS Stunting began in utero and was associated with low maternal IGF-1 levels at birth. Inflammatory markers were higher in cases than controls from 6 weeks of age and were associated with lower levels of IGF-1 throughout infancy. Higher levels of CRP and AGP during infancy were associated with stunting. These findings suggest that an extensive enteropathy occurs during infancy and that low-grade chronic inflammation may impair infant growth.
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Affiliation(s)
- Andrew J. Prendergast
- Centre for Paediatrics, Blizard Institute, Queen Mary University of London, London, United Kingdom
- Zvitambo Institute for Maternal Child Health Research, Harare, Zimbabwe
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Sandra Rukobo
- Zvitambo Institute for Maternal Child Health Research, Harare, Zimbabwe
| | - Bernard Chasekwa
- Zvitambo Institute for Maternal Child Health Research, Harare, Zimbabwe
| | - Kuda Mutasa
- Zvitambo Institute for Maternal Child Health Research, Harare, Zimbabwe
| | - Robert Ntozini
- Zvitambo Institute for Maternal Child Health Research, Harare, Zimbabwe
| | - Mduduzi N. N. Mbuya
- Zvitambo Institute for Maternal Child Health Research, Harare, Zimbabwe
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Andrew Jones
- University of Michigan, School of Public Health, Ann Arbor, Michigan, United States of America
| | - Lawrence H. Moulton
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Rebecca J. Stoltzfus
- Division of Nutritional Sciences, Cornell University, Ithaca, New York, United States of America
| | - Jean H. Humphrey
- Zvitambo Institute for Maternal Child Health Research, Harare, Zimbabwe
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
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