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Stoffel NU, Drakesmith H. Effects of Iron Status on Adaptive Immunity and Vaccine Efficacy: A Review. Adv Nutr 2024:100238. [PMID: 38729263 DOI: 10.1016/j.advnut.2024.100238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 05/02/2024] [Accepted: 05/06/2024] [Indexed: 05/12/2024] Open
Abstract
Vaccines can prevent infectious diseases, but their efficacy varies, and factors impacting vaccine effectiveness remain unclear. Iron deficiency is the most common nutrient deficiency, affecting >2 billion individuals. It is particularly common in areas with high-infectious disease burden and in groups that are routinely vaccinated, such as infants, pregnant women, and the elderly. Recent evidence suggests that iron deficiency and low-serum iron (hypoferremia) not only cause anemia but also may impair adaptive immunity and vaccine efficacy. A report of human immunodeficiency caused by defective iron transport underscored the necessity of iron for adaptive immune responses and spurred research in this area. Sufficient iron is essential for optimal production of plasmablasts and IgG responses by human B cells in vitro and in vivo. The increased metabolism of activated lymphocytes depends on the high-iron acquisition, and hypoferremia, especially when occurring during lymphocyte expansion, adversely affects multiple facets of adaptive immunity, and may lead to prolonged inhibition of T-cell memory. In mice, hypoferremia suppresses the adaptive immune response to influenza infection, resulting in more severe pulmonary disease. In African infants, anemia and/or iron deficiency at the time of vaccination predict decreased response to diphtheria, pertussis, and pneumococcal vaccines, and response to measles vaccine may be increased by iron supplementation. In this review, we examined the emerging evidence that iron deficiency may limit adaptive immunity and vaccine responses. We discuss the molecular mechanisms and evidence from animal and human studies, highlight important unknowns, and propose a framework of key research questions to better understand iron-vaccine interactions.
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Affiliation(s)
- Nicole U Stoffel
- Medical Research Council Translational Immune Discovery Unit, Medical Research Council Weatherall Institute of Molecular Medicine, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom.
| | - Hal Drakesmith
- Medical Research Council Translational Immune Discovery Unit, Medical Research Council Weatherall Institute of Molecular Medicine, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom
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Karamantziani T, Pouliakis A, Xanthos T, Ekmektzoglou K, Paliatsiou S, Sokou R, Iacovidou N. The Effect of Oral Iron Supplementation/Fortification on the Gut Microbiota in Infancy: A Systematic Review and Meta-Analysis. CHILDREN (BASEL, SWITZERLAND) 2024; 11:231. [PMID: 38397343 PMCID: PMC10887499 DOI: 10.3390/children11020231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 02/05/2024] [Accepted: 02/08/2024] [Indexed: 02/25/2024]
Abstract
(1) Background: Iron is an essential metal for the proper growth and neurodevelopment of infants. To prevent and treat iron deficiency, iron supplementation or fortification is often required. It has been shown, though, that it affects the synthesis of gut microbiota. (2) Methods: This paper is a systematic review and meta-analysis of the effect of oral iron supplementation/fortification on the gut microbiota in infancy. Studies in healthy neonates and infants who received per os iron with existing data on gut microbiota were included. Three databases were searched: PUBMED, Scopus, and Google Scholar. Randomized controlled trials (RCTs) were included. Quality appraisal was assessed using the ROB2Tool. (3) Results: A total of six RCTs met inclusion criteria for a systematic review, and four of them were included in the meta-analysis using both the fixed and random effects methods. Our results showed that there is very good heterogeneity in the iron group (I2 = 62%), and excellent heterogeneity in the non-iron group (I2 = 98%). According to the meta-analysis outcomes, there is a 10.3% (95% CI: -15.0--5.55%) reduction in the bifidobacteria population in the iron group and a -2.96% reduction for the non-iron group. There is a confirmed difference (p = 0.02) in the aggregated outcomes between iron and non-iron supplement, indicative that the bifidobacteria population is reduced when iron supplementation is given (total reduction 6.37%, 95%CI: 10.16-25.8%). (4) Conclusions: The abundance of bifidobacteria decreases when iron supplementation or fortification is given to infants.
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Affiliation(s)
- Theoni Karamantziani
- B’ Neonatal Intensive Care Unit and Neonatal High Dependency Unit, “Aghia Sofia” General Children’s Hospital, 11527 Athens, Greece;
| | - Abraham Pouliakis
- 2nd Department of Pathology, “Attikon” University Hospital, National and Kapodistrian University of Athens, 12464 Athens, Greece
| | - Theodoros Xanthos
- School of Health Sciences, University of West Attica, 12243 Athens, Greece;
| | | | - Styliani Paliatsiou
- 2nd Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Aretaieio Hospital, 11528 Athens, Greece;
| | - Rozeta Sokou
- Neonatal Intensive Care Unit, “Agios Panteleimon” General Hospital of Nikea, 3 D. Mantouvalou Str., Nikea, 18454 Piraeus, Greece;
| | - Nicoletta Iacovidou
- Neonatal Department, Aretaieio Hospital, National and Kapodistrian University of Athens, 11528 Athens, Greece;
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Derman RJ, Bellad RB, Bellad MB, Bradford-Rogers J, Georgieff MK, Aghai ZH, Thind S, Auerbach M, Boelig R, Leiby BE, Short V, Yogeshkumar S, Charantimath US, Somannavar MS, Mallapur AA, Pol R, Ramadurg U, Sangavi R, Peerapur BV, Banu N, Patil PS, Patil AP, Roy S, Vastrad P, Wallace D, Shah H, Goudar SS. RAPIDIRON Trial follow-up study - the RAPIDIRON-KIDS Study: protocol of a prospective observational follow-up study. Trials 2023; 24:818. [PMID: 38124098 PMCID: PMC10731903 DOI: 10.1186/s13063-023-07740-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 10/20/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Anemia is a worldwide problem with iron deficiency being the most common cause. When anemia occurs in pregnancy, it increases the risk of adverse maternal, fetal, and postnatal outcomes. It induces preterm births and low birth weight (LBW) deliveries, long-term neurodevelopmental sequelae, and an increased risk of earlier onset of postnatal iron deficiency. Anemia rates are among the highest in South Asia, and India's National Family Health Survey (NFHS-5) for 2019-2021 indicated that over half of pregnant women, and more than 65% of children, in the country are classified as anemic (Sciences IIfP, National Family Health Survey-5, 2019-21, India Fact Sheet). In 2021, the parent RAPIDIRON Trial (Derman et al., Trials 22:649, 2021) was initiated in two states in India, with the goal of assessing whether a dose of intravenous (IV) iron given to anemic women during early pregnancy results in a greater proportion of participants with normal hemoglobin concentrations in the third trimester and a lower proportion of participants with LBW deliveries compared to oral iron. As a follow-up to the RAPIDIRON Trial, the RAPIDIRON-KIDS Study will follow the offspring of previously randomized mothers to assess, neurobehavioral, hematological, and health outcomes. METHODS This prospective observational cohort study will follow a subset of participants previously randomized as part of the RAPIDIRON Trial and their newborns. Study visits occur at birth, 6 weeks, 4 months, 12 months, 24 months, and 36 months and include blood sample collection with both maternal and infant participants and specific neurobehavioral assessments conducted with the infants (depending on the study visit). The primary outcomes of interest are (1) infant iron status as indicated by both hemoglobin and ferritin (a) at birth and (b) at 4 months of age and (2) the developmental quotient (DQ) for the cognitive domain of the Bayley Scales of Infant Development Version IV (BSID-IV) at 24 months of age. DISCUSSION This RAPIDIRON-KIDS Study builds upon its parent RAPIDIRON Trial by following a subset of the previously randomized participants and their offspring through the first 3 years of life to assess neurodevelopmental and neurobehavioral (infants, children), hematological, and health outcomes. TRIAL REGISTRATION ClinicalTrials.gov NCT05504863 , Registered on 17 August 2022. Clinical Trials Registry - India CTRI/2022/05/042933 . Registered on 31 May 2022.
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Affiliation(s)
| | - Roopa B Bellad
- KLE Academy of Higher Education and Research (KAHER), Jawaharlal Nehru Medical College (JNMC), Belagavi, India
| | - Mrutyunjaya B Bellad
- KLE Academy of Higher Education and Research (KAHER), Jawaharlal Nehru Medical College (JNMC), Belagavi, India
| | | | | | | | - Simal Thind
- Thomas Jefferson University (TJU), Philadelphia, USA
| | | | - Rupsa Boelig
- Thomas Jefferson University (TJU), Philadelphia, USA
| | | | - Vanessa Short
- Thomas Jefferson University (TJU), Philadelphia, USA
| | - S Yogeshkumar
- KLE Academy of Higher Education and Research (KAHER), Jawaharlal Nehru Medical College (JNMC), Belagavi, India
| | - Umesh S Charantimath
- KLE Academy of Higher Education and Research (KAHER), Jawaharlal Nehru Medical College (JNMC), Belagavi, India
| | - Manjunath S Somannavar
- KLE Academy of Higher Education and Research (KAHER), Jawaharlal Nehru Medical College (JNMC), Belagavi, India
| | | | - Ramesh Pol
- S. Nijalingappa Medical College (SNMC), Bagalkot, India
| | | | - Radha Sangavi
- Raichur Institute of Medical Sciences (RIMS), Raichur, India
| | | | - Nasima Banu
- Raichur Institute of Medical Sciences (RIMS), Raichur, India
| | - Praveen S Patil
- Raichur Institute of Medical Sciences (RIMS), Raichur, India
| | - Amaresh P Patil
- KLE Academy of Higher Education and Research (KAHER), Jawaharlal Nehru Medical College (JNMC), Belagavi, India
| | - Subarna Roy
- Model Rural Health Research Unit (MRHRU), Sirwar, India
| | | | | | - Hemang Shah
- The Children's Investment Fund Foundation (CIFF), New Delhi, India
| | - Shivaprasad S Goudar
- KLE Academy of Higher Education and Research (KAHER), Jawaharlal Nehru Medical College (JNMC), Belagavi, India
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Semagn BE, Gebreegziabher ZA, Abebaw WA. Iron-rich food consumption and associated factors among children aged 6-23 months in Sierra Leone: multi-level logistic regression analysis. BMC Public Health 2023; 23:1793. [PMID: 37715168 PMCID: PMC10503148 DOI: 10.1186/s12889-023-16737-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 09/11/2023] [Indexed: 09/17/2023] Open
Abstract
BACKGROUND Iron deficiency is the most common micronutrient deficiency worldwide. Also, iron deficiency is a significant public health problem in low- and middle-income countries. Thus, this study aimed to assess iron-rich food consumption and associated factors among children aged 6-23 months in Sierra Leone. METHOD This study is a cross-sectional study based on data from the Sierra Leone Demographic and Health Survey dataset with a total weighted sample of 2622 children aged 6-23 months. Data cleaning, coding, and labeling were done using STATA version 14 software. A multilevel logistic regression model was employed to identify associated factors. RESULT Almost half (53.38%) of children aged between 6-23 months consumed iron-rich foods. The odds of iron rich food consumption were high among children in the age group of 12-17 months (AOR = 4.81, 95% CI: 3.67, 6.31) and 18-23 months (AOR = 9.3, 95% CI: 6.55, 13.2), and who fed minimum acceptable diet (AOR = 22.5, 95% CI: 11.65, 43.46). Moreover, a child from a mother who had work (AOR = 1.49, 95% CI: 1.08, 2.06), and with a mother who had more than four ANC visits during her pregnancy of the most recent live birth (AOR = 1.87; 95%CI: 1.36-2.55) had higher odds of iron-rich food consumption compared to their counterparts. On the other hand, children who were breastfeeding (AOR = 0.72, 95% CI: 0.53, 0.97), and mothers aged 15-19 (AOR = 0.48, 95% CI: 0.27, 0.85) decreased the odds of iron rich food consumption. CONCLUSION Consumption of iron-rich food is low among children aged 6-23 months in Sierra Leone. Iron-rich food consumption among children was significantly associated with maternal occupation, child's age, child's breastfeeding status, taking drugs for intestinal parasites, minimum acceptable diet, frequency, and timing of ANC, and region. Thus, special emphasis should be given to those children aged between 6-11 months, currently breastfeeding, children who did not get the minimum acceptable diet, and children from women who did not have work.
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Affiliation(s)
- Birhan Ewunu Semagn
- Department of Public Health, School of Public Health, Asrat Woldeyes Health Science Campus, Debre Berhan University, Debre Berhan, Ethiopia.
| | - Zenebe Abebe Gebreegziabher
- Department of Epidemiology and Biostatistics, School of Public Health, Asrat Woldeyes Health Science Campus, Debre Berhan University, Debre Berhan, Ethiopia
| | - Wondwosen Abey Abebaw
- Department of Public Health, School of Public Health, College of Health Sciences, Woldia University, Woldia, Ethiopia
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Chaudhary P, Priyadarshi M, Singh P, Chaurasia S, Chaturvedi J, Basu S. Effects of delayed cord clamping at different time intervals in late preterm and term neonates: a randomized controlled trial. Eur J Pediatr 2023; 182:3701-3711. [PMID: 37278737 PMCID: PMC10243262 DOI: 10.1007/s00431-023-05053-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 05/26/2023] [Accepted: 06/02/2023] [Indexed: 06/07/2023]
Abstract
Delayed cord clamping (DCC) at delivery has well-recognized benefits; however, current scientific guidelines lack uniformity in its definition. This parallel-group, three-arm assessor-blinded randomized controlled trial compared the effects of three different timings of DCC at 30, 60, and 120 s on venous hematocrit and serum ferritin levels in late preterm and term neonates not requiring resuscitation. Eligible newborns (n = 204) were randomized to DCC 30 (n = 65), DCC 60 (n = 70), and DCC 120 (n = 69) groups immediately after delivery. The primary outcome variable was venous hematocrit at 24 ± 2 h. Secondary outcome variables were respiratory support, axillary temperature, vital parameters, incidences of polycythemia, neonatal hyperbilirubinemia (NNH), need and duration of phototherapy, and postpartum hemorrhage (PPH). Additionally, serum ferritin levels, the incidence of iron deficiency, exclusive breastfeeding (EBF) rate, and anthropometric parameters were assessed during post-discharge follow-up at 12 ± 2 weeks. Over one-third of the included mothers were anemic. DCC 120 was associated with a significant increase in the mean hematocrit by 2%, incidence of polycythemia, and duration of phototherapy, compared to DCC30 and DCC60; though the incidence of NNH and need for phototherapy was similar. No other serious neonatal or maternal adverse events including PPH were observed. No significant difference was documented in serum ferritin, incidences of iron deficiency, and growth parameters at 3 months even in the presence of a high EBF rate. Conclusion: The standard recommendation of DCC at 30-60 s may be considered a safe and effective intervention in the busy settings of low-middle-income countries with a high prevalence of maternal anemia. Trial registration: Clinical trial registry of India (CTRI/2021/10/037070). What is Known: • The benefits of delayed cord clamping (DCC) makes it an increasingly well-accepted practice in the delivery room. • However, uncertainty continues regarding the optimal timing of clamping; this may be of concern both in the neonate and the mother. What is New: • DCC at 120 s led to higher hematocrit, polycythemia and longer duration of phototherapy, without any difference in serum ferritin, and incidence of iron deficiency. • DCC at 30-60 s may be considered a safe and effective intervention in LMICs.
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Affiliation(s)
- Pankaj Chaudhary
- Department of Neonatology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand 249203 India
| | - Mayank Priyadarshi
- Department of Neonatology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand 249203 India
| | - Poonam Singh
- Department of Neonatology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand 249203 India
| | - Suman Chaurasia
- Department of Neonatology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand 249203 India
| | - Jaya Chaturvedi
- Departments of Obstetrics & Gynecology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand India
| | - Sriparna Basu
- Department of Neonatology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand 249203 India
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Jung DK, Tan ST, Hemlock C, Mertens AN, Stewart CP, Rahman MZ, Ali S, Raqib R, Grembi JA, Karim MR, Shahriar S, Roy AK, Abdelrahman S, Shoab AK, Famida SL, Hossen MS, Mutsuddi P, Akther S, Rahman M, Unicomb L, Hester L, Granger DA, Erhardt J, Naved RT, Al Mamun MM, Parvin K, Colford JM, Fernald LC, Luby SP, Dhabhar FS, Lin A. Micronutrient status during pregnancy is associated with child immune status in rural Bangladesh. Curr Dev Nutr 2023; 7:101969. [PMID: 37560460 PMCID: PMC10407622 DOI: 10.1016/j.cdnut.2023.101969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 06/26/2023] [Accepted: 06/30/2023] [Indexed: 08/11/2023] Open
Abstract
Background Poor immune function increases children's risk of infection and mortality. Several maternal factors during pregnancy may affect infant immune function during the postnatal period. Objectives We aimed to evaluate whether maternal micronutrients, stress, estriol, and immune status during the first or second trimester of pregnancy were associated with child immune status in the first two years after birth. Methods We conducted observational analyses within the water, sanitation, and hygiene (WASH) Benefits Bangladesh randomized controlled trial. We measured biomarkers in 575 pregnant women and postnatally in their children. Maternal biomarkers measured during the first and second trimester of pregnancy included nutrition status via vitamin D (25-hydroxy-D [25(OH)D]), ferritin, soluble transferrin receptor (sTfR), and retinol-binding protein (RBP); cortisol; estriol. Immune markers were assessed in pregnant women at enrollment and their children at ages 14 and 28 mo, including C-reactive protein (CRP), alpha-1-acid glycoprotein (AGP), and 13 cytokines (including IFN-γ). We generated a standardized sum score of log-transformed cytokines. We analyzed IFN-γ individually because it is a critical immunoregulatory cytokine. All outcomes were prespecified. We used generalized additive models and reported the mean difference and 95% confidence intervals at the 25th and 75th percentiles of exposure distribution. Results At child age 14 mo, concentrations of maternal RBP were inversely associated with the cytokine sum score in children (-0.34 adjusted difference between the 25th and 75th percentile [95% confidence interval -0.61, -0.07]), and maternal vitamin A deficiency was positively associated with the cytokine sum score in children (1.02 [0.13, 1.91]). At child age of 28 mo, maternal RBP was positively associated with IFN-γ in children (0.07 [0.01, 0.14]), whereas maternal vitamin A deficiency was negatively associated with child AGP (-0.07 [-0.13, -0.02]). Maternal iron deficiency was associated with higher AGP concentrations in children at age 14 mo (0.13 [0.04, 0.23]), and maternal sTfR concentrations were positively associated with child CRP concentrations at age 28 mo (0.18 [0, 0.36]). Conclusion Maternal deficiencies in vitamin A or iron during the first 2 trimesters of pregnancy may shape the trajectory of a child's immune status.
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Affiliation(s)
- Da Kyung Jung
- Division of Epidemiology and Biostatistics, School of Public Health, University of California Berkeley, Berkeley, CA, United States
| | - Sophia T. Tan
- Division of Infectious Diseases and Geographic Medicine, Stanford University, Stanford, CA, United States
| | - Caitlin Hemlock
- Division of Epidemiology and Biostatistics, School of Public Health, University of California Berkeley, Berkeley, CA, United States
| | - Andrew N. Mertens
- Division of Epidemiology and Biostatistics, School of Public Health, University of California Berkeley, Berkeley, CA, United States
| | - Christine P. Stewart
- Institute for Global Nutrition, University of California Davis, Davis, CA, United States
| | - Md Ziaur Rahman
- Environmental Interventions Unit, Infectious Diseases Division, icddr,b, Dhaka 1212, Bangladesh
| | - Shahjahan Ali
- Environmental Interventions Unit, Infectious Diseases Division, icddr,b, Dhaka 1212, Bangladesh
| | - Rubhana Raqib
- Environmental Interventions Unit, Infectious Diseases Division, icddr,b, Dhaka 1212, Bangladesh
| | - Jessica A. Grembi
- Division of Infectious Diseases and Geographic Medicine, Stanford University, Stanford, CA, United States
| | - Mohammed Rabiul Karim
- Environmental Interventions Unit, Infectious Diseases Division, icddr,b, Dhaka 1212, Bangladesh
| | - Sunny Shahriar
- Environmental Interventions Unit, Infectious Diseases Division, icddr,b, Dhaka 1212, Bangladesh
| | - Anjan Kumar Roy
- Environmental Interventions Unit, Infectious Diseases Division, icddr,b, Dhaka 1212, Bangladesh
| | - Sarah Abdelrahman
- Division of Epidemiology and Biostatistics, School of Public Health, University of California Berkeley, Berkeley, CA, United States
| | - Abul K. Shoab
- Environmental Interventions Unit, Infectious Diseases Division, icddr,b, Dhaka 1212, Bangladesh
| | - Syeda L. Famida
- Environmental Interventions Unit, Infectious Diseases Division, icddr,b, Dhaka 1212, Bangladesh
| | - Md Saheen Hossen
- Environmental Interventions Unit, Infectious Diseases Division, icddr,b, Dhaka 1212, Bangladesh
| | - Palash Mutsuddi
- Environmental Interventions Unit, Infectious Diseases Division, icddr,b, Dhaka 1212, Bangladesh
| | - Salma Akther
- Environmental Interventions Unit, Infectious Diseases Division, icddr,b, Dhaka 1212, Bangladesh
| | - Mahbubur Rahman
- Environmental Interventions Unit, Infectious Diseases Division, icddr,b, Dhaka 1212, Bangladesh
| | - Leanne Unicomb
- Environmental Interventions Unit, Infectious Diseases Division, icddr,b, Dhaka 1212, Bangladesh
| | - Lisa Hester
- Department of Medicine, University of Maryland, Baltimore, MD USA
| | - Douglas A. Granger
- Institute for Interdisciplinary Salivary Bioscience Research, University of California Irvine, Irvine, CA, United States
| | | | | | - Md Mahfuz Al Mamun
- Health System and Population Studies Division, icddr,b, Dhaka, Bangladesh
| | - Kausar Parvin
- Health System and Population Studies Division, icddr,b, Dhaka, Bangladesh
| | - John M. Colford
- Division of Epidemiology and Biostatistics, School of Public Health, University of California Berkeley, Berkeley, CA, United States
| | - Lia C.H. Fernald
- Division of Community Health Sciences, School of Public Health, University of California, Berkeley, Berkeley, CA, United States
| | - Stephen P. Luby
- Division of Infectious Diseases and Geographic Medicine, Stanford University, Stanford, CA, United States
| | - Firdaus S. Dhabhar
- Department of Psychiatry & Behavioral Sciences, Department of Microbiology and Immunology, Sylvester Comprehensive Cancer Center, Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Audrie Lin
- Department of Microbiology and Environmental Toxicology, University of California, Santa Cruz, CA, United States
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Elhassan S, Dong F, Buckner T, Johnson RK, Seifert JA, Carry PM, Vanderlinden L, Waugh K, Rewers M, Norris JM. Investigating iron intake in risk of progression from islet autoimmunity to type 1 diabetes: The diabetes autoimmunity study in the young. Front Immunol 2023; 14:1124370. [PMID: 37056761 PMCID: PMC10086157 DOI: 10.3389/fimmu.2023.1124370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 03/15/2023] [Indexed: 03/30/2023] Open
Abstract
Background Studies of the role of iron in the risk of type 1 diabetes (T1D) have been inconsistent. Given that iron generates reactive oxygen radicals, which can lead to oxidative damage and apoptosis in the beta cells of the pancreas, we examined whether iron intake was associated with the risk of progressing to T1D in individuals with islet autoimmunity (IA), the pre-clinical phase of T1D. Methods DAISY is a prospective cohort following 2,547 children at increased risk for IA and progression to T1D. IA is defined as at least two consecutive serum samples positive for at least one autoantibody (insulin, GAD, IA-2, or ZnT8). We measured dietary intake at the time of IA seroconversion in 175 children with IA, and of these, 64 progressed to T1D. We used Cox regression to examine the association between energy-adjusted iron intake and progression to T1D, adjusting for HLA-DR3/4 genotype, race/ethnicity, age at seroconversion, presence of multiple autoantibodies at seroconversion, and multiple vitamin use. In addition, we tested whether this association was modified by vitamin C or calcium intake. Results In children with IA, high iron intake (as defined as above the 75th percentile, > 20.3 mg/day) was associated with decreased risk of progression to T1D compared to moderate iron intake (as defined by the middle 25-75th percentiles, 12.7-20.3 mg/day) (adjusted hazard ratio (HR): 0.35; 95% confidence interval (CI): 0.15, 0.79). The association between iron intake and T1D was not modified by vitamin C nor calcium intake. In a sensitivity analysis, the removal of six children who had been diagnosed with celiac disease prior to IA seroconversion did not affect this association. Conclusion Higher iron intake at the time of IA seroconversion is associated with a lower risk of progression to T1D, independent of multivitamin supplement use. Further research that includes plasma biomarkers of iron status is needed to investigate the relationship between iron and the risk of T1D.
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Affiliation(s)
- Sulafa Elhassan
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Fran Dong
- Barbara Davis Center for Diabetes, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Teresa Buckner
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
- Department of Kinesiology, Nutrition, and Dietetics, University of Northern Colorado, Greeley, CO, United States
| | - Randi K. Johnson
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
- Department of Biomedical Informatics, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Jennifer A. Seifert
- Department of Medicine, Division of Rheumatology, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Patrick M. Carry
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
- Colorado Program for Musculoskeletal Research, Department of Orthopedics, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Lauren Vanderlinden
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Kathleen Waugh
- Barbara Davis Center for Diabetes, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Marian Rewers
- Barbara Davis Center for Diabetes, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Jill M. Norris
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
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Stelle I, Venkatesan S, Edmond K, Moore SE. Acknowledging the gap: a systematic review of micronutrient supplementation in infants under six months of age. Wellcome Open Res 2023; 5:238. [PMID: 33305011 PMCID: PMC7713887 DOI: 10.12688/wellcomeopenres.16282.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2023] [Indexed: 02/22/2023] Open
Abstract
Background: Micronutrient deficiencies remain common worldwide, but the consequences to growth and development in early infancy (under six months of age) are not fully understood. We present a systematic review of micronutrient interventions in term infants under six months of age, with a specific focus on iron supplementation. Methods: We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (Ovid) and Embase (Ovid) from January 1980 through December 2019. Interventions included iron or multiple micronutrients (MMNs). Results: Of 11,109 records identified, 33 publications from 24 trials were included (19 iron and five MMN supplementation trials). All but one trial (evaluating only morbidity and mortality) evaluated the effect of supplementation on biochemical outcomes, ten reported on growth, 15 on morbidity and/or mortality and six on neuro-behavioural development. Low- and middle- income countries made up 88% (22/25) of the total trial locations. Meta-analysis was not possible due to extensive heterogeneity in both exposure and outcome measures. However, these trials indicated that infants less than six months of age benefit biochemically from early supplementation with iron, but the effect of additional nutrients or MMNs, along with the impacts on growth, morbidity and/or mortality, and neuro-behavioural outcomes remain unclear. Conclusions: Infants less than six months of age appear to benefit biochemically from micronutrient supplementation. However, well-powered randomised controlled trials are required to determine whether routine supplementation with iron or MMNs containing iron should commence before six months of life in exclusively breast-fed infants in low-resource settings.
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Affiliation(s)
- Isabella Stelle
- Department of Women and Children's Health, King's College Hospital, London, Westminster Bridge Road, London, SE1 7EH, UK,
| | - Sruthi Venkatesan
- Department of Women and Children's Health, King's College Hospital, London, Westminster Bridge Road, London, SE1 7EH, UK
| | - Karen Edmond
- Department of Women and Children's Health, King's College Hospital, London, Westminster Bridge Road, London, SE1 7EH, UK
| | - Sophie E. Moore
- Department of Women and Children's Health, King's College Hospital, London, Westminster Bridge Road, London, SE1 7EH, UK,Nutrition Unit, MRC Unit The Gambia at London School of Hygiene and Tropical Medicine, Banjul, The Gambia
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9
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Stelle I, Venkatesan S, Edmond K, Moore SE. Acknowledging the gap: a systematic review of micronutrient supplementation in infants under six months of age. Wellcome Open Res 2023; 5:238. [PMID: 33305011 PMCID: PMC7713887 DOI: 10.12688/wellcomeopenres.16282.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/24/2020] [Indexed: 11/25/2022] Open
Abstract
Background: Micronutrient deficiencies remain common worldwide, but the consequences to growth and development in early infancy (under six months of age) are not fully understood. We present a systematic review of micronutrient interventions in term infants under six months of age, with a specific focus on iron supplementation. Methods: We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (Ovid) and Embase (Ovid) from January 1980 through December 2019. Interventions included iron or multiple micronutrients (MMNs). Results: Of 11,109 records identified, 32 publications from 23 trials were included (18 iron and five MMN supplementation trials). All 23 trials evaluated the effect of supplementation on biochemical outcomes, ten reported on growth, 14 on morbidity and/or mortality and six on neuro-behavioural development. Low- and middle- income countries made up 88% (21/24) of the total trial locations. Meta-analysis was not possible due to extensive heterogeneity in both exposure and outcome measures. However, these trials indicated that infants less than six months of age benefit biochemically from early supplementation with iron, but the effect of additional nutrients or MMNs, along with the impacts on growth, morbidity and/or mortality, and neuro-behavioural outcomes remain unclear. Conclusions: Infants less than six months of age appear to benefit biochemically from micronutrient supplementation. However, well-powered randomised controlled trials are required to determine whether routine supplementation with iron or MMNs containing iron should commence before six months of life in exclusively breast-fed infants in low-resource settings.
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Affiliation(s)
- Isabella Stelle
- Department of Women and Children's Health, King's College Hospital, London, Westminster Bridge Road, London, SE1 7EH, UK,
| | - Sruthi Venkatesan
- Department of Women and Children's Health, King's College Hospital, London, Westminster Bridge Road, London, SE1 7EH, UK
| | - Karen Edmond
- Department of Women and Children's Health, King's College Hospital, London, Westminster Bridge Road, London, SE1 7EH, UK
| | - Sophie E. Moore
- Department of Women and Children's Health, King's College Hospital, London, Westminster Bridge Road, London, SE1 7EH, UK,Nutrition Unit, MRC Unit The Gambia at London School of Hygiene and Tropical Medicine, Banjul, The Gambia
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10
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de Araújo LKAR, Faria JCP, Sarni ROS. Iron deficiency anemia in infants in Sousa (PB), Brazil: an association with nutritional status. Rev Assoc Med Bras (1992) 2022; 68:1698-1704. [PMID: 36477102 PMCID: PMC9779981 DOI: 10.1590/1806-9282.20220761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Accepted: 08/23/2022] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE The aim of this study was to describe the prevalence of anemia and iron deficiency anemia (IDA) in infants and verify the association of iron deficiency with nutritional status. METHODS This cross-sectional and observational study included 104 infants aged between 7 and 9 months, assisted from August to September 2021 by the Family Health Strategy program in Sousa municipality (Paraíba, Brazil). Clinical and anthropometric data were collected, and a 24-h food recall questionnaire was applied using the DietPro software (version 5.0) in order to verify food consumption and assess iron intake. Variables associated with iron deficiency (p<0.05) were analyzed using multiple logistic regression. RESULTS Anemia and IDA were observed in 40.4% and 19.2% of infants, respectively. Only one infant was taking prophylactic supplementation (ferrous sulfate). Infants with IDA presented reduced hemoglobin (p<0.001) and ferritin (p<0.001) and increased Z-scores of body mass index-for-age (Z-BMI) (p=0.027), weight-for-height (p=0.007), and weight-for-age (p=0.032). All Z-scores were inversely correlated with ferritin (Z-BMI [rho: -0.37; p<0.001], weight-for-height [rho: -0.37; p<0.001], and weight-for-age [rho: -0.29; p=0.002]). Ferritin was also directly correlated with daily iron intake (rho: 0.22; p=0.018). Finally, multiple logistic regression showed a significant and direct association of iron deficiency with weight-for-height Z-score (odds ratio: 2.86; 95% confidence interval: 1.38-5.64; p=0.004). CONCLUSION About 60% of infants presented anemia or IDA. Iron deficiency was associated with the weight-for-height Z-score, showing the vulnerability of infants during the introduction of complementary feeding.
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Affiliation(s)
| | - João Carlos Pina Faria
- Centro Universitário Faculdade de Medicina do ABC, Departamento de Pediatria – Santo André (SP), Brasil.,Universidade Nove de Julho, Departamento de Pediatria – São Paulo (SP), Brasil.,Corresponding author:
| | - Roseli Oselka Saccardo Sarni
- Centro Universitário Faculdade de Medicina do ABC, Departamento de Pediatria – Santo André (SP), Brasil.,Universidade Federal de São Paulo, Departamento de Pediatria – São Paulo (SP), Brasil
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11
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Khan AZ, Badar S, O'Callaghan KM, Zlotkin S, Roth DE. Fecal Iron Measurement in Studies of the Human Intestinal Microbiome. Curr Dev Nutr 2022; 6:nzac143. [PMID: 36475017 PMCID: PMC9718653 DOI: 10.1093/cdn/nzac143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 09/09/2022] [Accepted: 09/09/2022] [Indexed: 04/22/2024] Open
Abstract
Iron is an essential micronutrient for humans and their intestinal microbiota. Host intestinal cells and iron-dependent bacteria compete for intraluminal iron, so the composition and functions of the gut microbiota may influence iron availability. Studies of the effects of the microbiota or probiotic interventions on host iron absorption may be particularly relevant to settings with high burdens of iron deficiency and gastrointestinal infections, since inflammation reduces iron bioavailability and unabsorbed intraluminal iron may modify the composition of the microbiota. The quantification of stool iron content may serve as an indicator of the amount of intraluminal iron to which the intestinal microbiota is exposed, which is particularly relevant for studies of the effect of iron on the intestinal microbiome, where fecal samples collected for purposes of microbiome characterization can be leveraged for stool iron analysis. However, few studies are available to guide researchers in the selection and implementation of stool iron assays, particularly because cross-comparison of available methods is limited in literature. This review aims to describe the available stool iron quantification methods and highlight their potential application in studies of iron-microbiome relationships, with a focus on pediatric research. MS-based methods offer high sensitivity and precision, but the need for expensive equipment and the high per-sample and maintenance costs may limit their widespread use. Conversely, colorimetric assays offer lower cost, ease of use, and rapid turnaround times but have thus far been optimized primarily for blood-derived matrices rather than stool. Further research efforts are needed to validate and standardize methods for stool iron assessment and to determine if the incorporation of such analyses in human microbiome studies 1) yields insights into the interactions between intestinal microbiota and iron and 2) contributes to the development of interventions that mitigate iron deficiency and promote a healthy microbiome.
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Affiliation(s)
- Afreen Z Khan
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Canada
- Centre for Global Child Health and SickKids Research Institute, The Hospital for Sick Children, Toronto, Canada
| | - Sayema Badar
- Centre for Global Child Health and SickKids Research Institute, The Hospital for Sick Children, Toronto, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Karen M O'Callaghan
- Centre for Global Child Health and SickKids Research Institute, The Hospital for Sick Children, Toronto, Canada
| | - Stanley Zlotkin
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Canada
- Centre for Global Child Health and SickKids Research Institute, The Hospital for Sick Children, Toronto, Canada
- Department of Paediatrics, The Hospital for Sick Children and University of Toronto, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Daniel E Roth
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Canada
- Centre for Global Child Health and SickKids Research Institute, The Hospital for Sick Children, Toronto, Canada
- Department of Paediatrics, The Hospital for Sick Children and University of Toronto, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
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12
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Davis JN, Williams A, Arnold CD, Rohner F, Wirth JP, Addo Y, Flores-Ayala RC, Oaks BM, Young MF, Suchdev PS, Engle-Stone R. The Relationship Between Ferritin and BMI is Mediated by Inflammation Among Women in Higher-Income Countries, But Not in Most Lower-Income Countries Nor Among Young Children: A Multi-Country Analysis. Curr Dev Nutr 2022; 6:nzac139. [PMID: 36475018 PMCID: PMC9718651 DOI: 10.1093/cdn/nzac139] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 08/26/2022] [Accepted: 08/30/2022] [Indexed: 10/03/2023] Open
Abstract
Background In the presence of inflammation, the serum or plasma ferritin concentration ("ferritin" hereafter) transiently increases, confounding its interpretation as an iron status marker. The extent to which adiposity-related inflammation may influence ferritin interpretation is uncertain. Objectives We describe relationships between weight status, inflammation, and ferritin among nonpregnant women of reproductive age (WRA; 15-49 years) and preschool-age children (PSC; 6-59 months) with normal weight to overweight or obesity (OWOB) in differing geographic settings. Methods Cross-sectional data were separately analyzed from 18 surveys (WRA) and 25 surveys (PSC) from the Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia (BRINDA) project, excluding observations with underweight, wasting, pregnancy, or malaria. Relationships were assessed between BMI (in WRA) or BMI-for-age z-score (BAZ; in PSC), inflammatory biomarkers of C-reactive protein (CRP) and/or α-1-acid glycoprotein (AGP), ferritin by linear regression, and potential mediation by CRP and/or AGP in relationships between BMI or BAZ and ferritin with structural equation modeling. Regression and mediation models accounted for complex survey designs. Results were grouped by World Bank income classifications. Results In 5 of 6 surveys among WRA from upper-middle and high-income countries, ferritin was significantly positively associated with BMI, and this relationship was partially (or fully, in the United States) mediated by CRP and/or AGP. Mediation was present in 4 of 12 surveys for WRA in low- and lower-middle income countries. Among PSC, ferritin was positively associated with CRP and/or AGP in all surveys, but there were no significant CRP- or AGP-mediated relationships between ferritin and BAZ, except a negative relationship in the Philippines. Conclusions Where having OWOB is common among WRA, measurements of inflammatory biomarkers and their uses in interpreting ferritin may improve iron status assessments. While these relationships were inconsistent among PSC, inflammation was common and should be measured to interpret iron status. Included Kenyan trial data are registered at clinicaltrials.gov as NCT01088958.
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Affiliation(s)
- Jennie N Davis
- University of California, Davis Department of Nutrition, Institute for Global Nutrition, Davis, CA, USA
| | - Anne Williams
- University of Otago, Department of Human Nutrition, Dunedin, New Zealand
| | - Charles D Arnold
- University of California, Davis Department of Nutrition, Institute for Global Nutrition, Davis, CA, USA
| | | | | | - Yaw Addo
- Division of Nutrition, Physical Activity and Obesity, Centers for Disease Control and Prevention, Chamblee, GA, USA
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Rafael C Flores-Ayala
- Division of Nutrition, Physical Activity and Obesity, Centers for Disease Control and Prevention, Chamblee, GA, USA
| | - Brietta M Oaks
- Department of Nutrition and Food Sciences, University of Rhode Island, Kingston, RI, USA
| | - Melissa F Young
- Global Health Department, Emory University, Atlanta, GA, USA
| | - Parminder S Suchdev
- Department of Pediatrics and Global Health, Emory University, Atlanta, GA, USA
- Division of Global Health Protection, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Reina Engle-Stone
- University of California, Davis Department of Nutrition, Institute for Global Nutrition, Davis, CA, USA
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13
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Omondi CJ, Ochwedo KO, Athiany H, Onyango SA, Odongo D, Otieno A, Orondo P, Ondeto BM, Lee MC, Kazura JW, Githeko AK, Yan G. Impact of Agricultural Irrigation on Anemia in Western Kenya. Am J Trop Med Hyg 2022; 107:484-491. [PMID: 35895424 PMCID: PMC9393467 DOI: 10.4269/ajtmh.21-0631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Accepted: 03/20/2022] [Indexed: 08/03/2023] Open
Abstract
Expanding agricultural irrigation efforts to enhance food security and socioeconomic development in sub-Saharan Africa may affect malaria transmission and socioeconomic variables that increase the risk of anemia in local communities. We compared the prevalence of anemia, Plasmodium falciparum infection, and indicators of socioeconomic status related to nutrition in communities in Homa Bay County, Kenya, where an agricultural irrigation scheme has been implemented, to that in nearby communities where there is no agricultural irrigation. Cross-sectional surveys conducted showed that anemia prevalence defined by WHO criteria (hemoglobin < 11 g/dL) was less in communities in the irrigated areas than in the non-irrigated areas during the wet season (38.9% and 51.5%, χ2 = 4.29, P = 0.001) and the dry season (25.2% and 34.1%, χ2 = 7.33, P = 0.007). In contrast, Plasmodium falciparum infection prevalence was greater during the wet season in irrigated areas than in non-irrigated areas (15.3% versus 7.8%, χ2 = 8.7, P = 0.003). There was, however, no difference during the dry season (infection prevalence, < 1.8%). Indicators of nutritional status pertinent to anemia pathogenesis such as weekly consumption of non-heme- and heme-containing foods and household income were greater in communities located within the irrigation scheme versus those outside the irrigation scheme (P < 0.0001). These data indicate that current agricultural irrigation schemes in malaria-endemic communities in this area have reduced the risk of anemia. Future studies should include diagnostic tests of iron deficiency, parasitic worm infections, and genetic hemoglobin disorders to inform public health interventions aimed at reducing community anemia burden.
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Affiliation(s)
- Collince J. Omondi
- Department of Biology, Faculty of Science and Technology, University of Nairobi, Kenya
- Sub-Saharan International Center of Excellence for Malaria Research, Tom Mboya University College, Homa Bay, Kenya
| | - Kevin O. Ochwedo
- Sub-Saharan International Center of Excellence for Malaria Research, Tom Mboya University College, Homa Bay, Kenya
| | - Henry Athiany
- School of Mathematics and Physical Sciences, Jomo Kenyatta University of Agriculture and Technology, Kenya
| | - Shirley A. Onyango
- Sub-Saharan International Center of Excellence for Malaria Research, Tom Mboya University College, Homa Bay, Kenya
| | - David Odongo
- Department of Biology, Faculty of Science and Technology, University of Nairobi, Kenya
| | - Antony Otieno
- Department of Biology, Faculty of Science and Technology, University of Nairobi, Kenya
| | - Pauline Orondo
- Sub-Saharan International Center of Excellence for Malaria Research, Tom Mboya University College, Homa Bay, Kenya
| | - Benyl M. Ondeto
- Sub-Saharan International Center of Excellence for Malaria Research, Tom Mboya University College, Homa Bay, Kenya
| | - Ming-Chieh Lee
- Sub-Saharan International Center of Excellence for Malaria Research, Tom Mboya University College, Homa Bay, Kenya
- Program in Public Health, University of California, Irvine, California
| | - James W. Kazura
- Center for Global Health and Diseases, Case Western Reserve University, Cleveland, Ohio
| | - Andrew K. Githeko
- Sub-Saharan International Center of Excellence for Malaria Research, Tom Mboya University College, Homa Bay, Kenya
- Climate and Human Health Research Unit, Center for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Guiyun Yan
- Program in Public Health, University of California, Irvine, California
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14
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Anaemia, iron and vitamin A status among South African school-aged children living with and without HIV. SOUTH AFRICAN JOURNAL OF CHILD HEALTH 2022. [DOI: 10.7196/sajch.2022.v16i2.1897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Background. Data on iron and vitamin A deficiency are scarce in school-aged children living with HIV (HIV+) compared with children without HIV (HIV–). Both deficiencies can contribute to anaemia.
Objective. To assess anaemia, iron and vitamin A status in a sample of HIV+ and HIV– school-aged children in South Africa.
Methods. In this comparative cross-sectional study, biomarkers for anaemia (haemoglobin), iron (plasma ferritin (PF), soluble transferrin receptor), vitamin A (retinol-binding protein (RBP)) and inflammatory status (C-reactive protein, α-1-acid glycoprotein) were measured in 8 - 13-year-old children from Cape Town living with (n=143) and without HIV (n=148). Measurements of PF and RBP were adjusted for inflammation using a regression-correction approach.
Results. HIV+ children had higher prevalences of anaemia (29% v. 14%; odds ratio (OR) = 2.6; 95% confidence interval (CI) 1.4 - 4.9; p=0.002), iron-deficient erythropoiesis (20% v. 9%; OR=2.5; 95% CI 1.2 - 5.0; p=0.013) and iron deficiency anaemia (11% v. 4%; OR=2.9; 95% CI 1.1 - 7.7; p=0.035) than HIV– children. Marginal vitamin A deficiency was noted in 52% of HIV+ and 57% of HIV– children (p=0.711). Subclinical inflammation was more prevalent in HIV+ than HIV– children (p=0.012).
Conclusion. Anaemia, iron-deficient erythropoiesis and iron deficiency anaemia were more prevalent in HIV+ than HIV– children. Prevalence of marginal vitamin A deficiency was high in both groups. Efforts to improve micronutrient status and mitigate nutritional determinants of anaemia in HIV+ children from resource-limited settings should be prioritised.
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15
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Randrianarisoa MM, Rakotondrainipiana M, Randriamparany R, Andriantsalama PV, Randrianarijaona A, Habib A, Robinson A, Raharimalala L, Hunald FA, Etienne A, Collard JM, Randrianirina F, Barouki R, Pontoizeau C, Nestoret A, Kapel N, Sansonetti P, Vonaesch P, Randremanana RV. Factors associated with anaemia among preschool- age children in underprivileged neighbourhoods in Antananarivo, Madagascar. BMC Public Health 2022; 22:1320. [PMID: 35810292 PMCID: PMC9271242 DOI: 10.1186/s12889-022-13716-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 06/07/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Anaemia occurs in children when the haemoglobin level in the blood is less than the normal (11 g/dL), the consequence is the decrease of oxygen quantity in the tissues. It is a prevalent public health problem in many low-income countries, including Madagascar, and data on risk factors are lacking. We used existing data collected within the pathophysiology of environmental enteric dysfunction (EED) in Madagascar and the Central African Republic project (AFRIBIOTA project) conducted in underprivileged neighbourhoods of Antananarivo to investigate the factors associated with anaemia in children 24 to 59 months of age. METHODS Children included in the AFRIBIOTA project in Antananarivo for whom data on haemoglobin and ferritin concentrations were available were included in the study. Logistic regression modelling was performed to identify factors associated with anaemia. RESULTS Of the 414 children included in this data analysis, 24.4% were found to suffer from anaemia. We found that older children (adjusted OR: 0.95; 95% CI: 0.93-0.98) were less likely to have anaemia. Those with iron deficiency (adjusted OR: 6.1; 95% CI: 3.4-11.1) and those with a high level of faecal calprotectin (adjusted OR: 2.5; 95% CI: 1.4-4.4) were more likely to have anaemia than controls. CONCLUSIONS To reduce anaemia in the children in this underprivileged area, more emphasis should be given to national strategies that improve children's dietary quality and micronutrient intake. Furthermore, existing measures should be broadened to include measures to reduce infectious disease burden.
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Affiliation(s)
- Mirella Malala Randrianarisoa
- Institut Pasteur de Madagascar, Unité Epidémiologie et de Recherche Clinique, BP 1274, Ambatofotsikely, 101, Antananarivo, Madagascar
| | - Maheninasy Rakotondrainipiana
- Institut Pasteur de Madagascar, Unité Epidémiologie et de Recherche Clinique, BP 1274, Ambatofotsikely, 101, Antananarivo, Madagascar
| | - Ravaka Randriamparany
- Institut Pasteur de Madagascar, Unité Epidémiologie et de Recherche Clinique, BP 1274, Ambatofotsikely, 101, Antananarivo, Madagascar
| | - Prisca Vega Andriantsalama
- Institut Pasteur de Madagascar, Unité Epidémiologie et de Recherche Clinique, BP 1274, Ambatofotsikely, 101, Antananarivo, Madagascar
| | - Anjasoa Randrianarijaona
- Institut Pasteur de Madagascar, Unité Epidémiologie et de Recherche Clinique, BP 1274, Ambatofotsikely, 101, Antananarivo, Madagascar
| | - Azimdine Habib
- Institut Pasteur de Madagascar, Unité Epidémiologie et de Recherche Clinique, BP 1274, Ambatofotsikely, 101, Antananarivo, Madagascar
| | - Annick Robinson
- Centre Hospitalier Universitaire Mère Enfant de Tsaralalana, rue Patrice Lumumba, Rue Mabizo S, 101, Antananarivo, Madagascar
| | - Lisette Raharimalala
- Centre de Santé Maternelle et Infantile de Tsaralalana, Lalana Andriantsilavo, 101, Antananarivo, Madagascar
| | - Francis Allen Hunald
- Service de Chirurgie pédiatrique, Centre Hospitalier Universitaire Joseph Ravoahangy Andrianavalona, BP 4150, Ampefiloha, 101, Antananarivo, Madagascar
| | - Aurélie Etienne
- Institut Pasteur de Madagascar, Unité Epidémiologie et de Recherche Clinique, BP 1274, Ambatofotsikely, 101, Antananarivo, Madagascar
| | - Jean-Marc Collard
- Institut Pasteur de Madagascar, Unité Epidémiologie et de Recherche Clinique, BP 1274, Ambatofotsikely, 101, Antananarivo, Madagascar.,The Center for Microbes, Development and Health, Institut Pasteur of Shanghai/Chinese Academy of Sciences, Shanghai, China
| | - Frédérique Randrianirina
- Institut Pasteur de Madagascar, Unité Epidémiologie et de Recherche Clinique, BP 1274, Ambatofotsikely, 101, Antananarivo, Madagascar
| | - Robert Barouki
- Laboratoire de Biochimie Métabolomique et Protéomique, Hôpital Universitaire Necker-Enfants Malades, Paris, France
| | - Clement Pontoizeau
- Laboratoire de Biochimie Métabolomique et Protéomique, Hôpital Universitaire Necker-Enfants Malades, Paris, France
| | - Alison Nestoret
- Service de Coprologie Fonctionnelle, Hôpital Salpétrière Paris, Paris, France
| | - Nathalie Kapel
- Service de Coprologie Fonctionnelle, Hôpital Salpétrière Paris, Paris, France
| | - Philippe Sansonetti
- Unité de Pathogénie Microbienne, Institut Pasteur, 25-28 Rue du Dr Roux, Paris, France
| | - Pascale Vonaesch
- Unité de Pathogénie Microbienne, Institut Pasteur, 25-28 Rue du Dr Roux, Paris, France.,Department of Fundamental Microbiology, University of Lausanne, Campus UNIL-Sorge, 1015, Lausanne, Switzerland
| | - Rindra Vatosoa Randremanana
- Institut Pasteur de Madagascar, Unité Epidémiologie et de Recherche Clinique, BP 1274, Ambatofotsikely, 101, Antananarivo, Madagascar.
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16
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Stelle I, Bah M, Silverio SA, Verhoef H, Comma E, Prentice AM, Moore SE, Cerami C. Iron supplementation of breastfed Gambian infants from 6 weeks to 6 months of age: protocol for a randomised controlled trial. Wellcome Open Res 2022; 7:16. [PMID: 36874582 PMCID: PMC9975413 DOI: 10.12688/wellcomeopenres.17507.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2021] [Indexed: 11/20/2022] Open
Abstract
Background: A recent analysis showed that plasma iron concentrations decline rapidly from birth in Gambian infants, irrespective of sex or birthweight, to concentrations well below normal expected values for iron-replete children older than two months of age (typically >10 μmol/L). The development and function of neural and immune cells may thus be compromised before the minimum age at which children should receive iron supplementation as per World Health Organisation recommendations. Methods: This study is a two-arm, double-blind, placebo-controlled, randomised superiority trial. Infants will be randomised to receive iron drops (7.5mg/day of iron as ferrous sulphate) or placebo daily for 98 days, to test the impact on serum iron concentrations in healthy, breastfed infants (n = 100) aged 6-10 weeks at enrolment. Participants will be visited daily and supplemented by the field team. Daily health and weekly breastfeeding questionnaires will be administered. Anthropometry, and venous blood and faecal samples will be collected at enrolment and after 98 days of supplementation with serum iron as the primary endpoint. Low birthweight (less than 2.5kg at birth) and infants born prematurely (< 37 weeks) will not be excluded. Formula-fed and infants with any illness will be excluded. An additional study exploring maternal stakeholder perspectives of the intervention will be conducted by means of maternal interviews and four focus group discussions with local stakeholders. Discussion: Most breast-fed Gambian infants have very low circulating iron levels by five months of age. This study will introduce iron supplements much earlier in infancy than has previously been attempted in a low-income setting with the primary aim of increasing serum iron concentration. Trial registration: Clincaltrials.gov ( NCT04751994); 12 th February 2021.
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Affiliation(s)
- Isabella Stelle
- Department of Women and Children's Health, King's College London, 10th Floor North Wing, St. Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK
| | - Mamadou Bah
- Nutrition and Planetary Health Theme, MRC Unit The Gambia @ the London School of Hygiene and Tropical Medicine, PO Box 273, Banjul, The Gambia
- Division of Human Nutrition and Health, Wageningen University, PO Box 17, 6700 AA Wageningen, The Netherlands
| | - Sergio A. Silverio
- Department of Women and Children's Health, King's College London, 10th Floor North Wing, St. Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK
| | - Hans Verhoef
- Division of Human Nutrition and Health, Wageningen University, PO Box 17, 6700 AA Wageningen, The Netherlands
| | - Ebrima Comma
- Nutrition and Planetary Health Theme, MRC Unit The Gambia @ the London School of Hygiene and Tropical Medicine, PO Box 273, Banjul, The Gambia
| | - Andrew M. Prentice
- Nutrition and Planetary Health Theme, MRC Unit The Gambia @ the London School of Hygiene and Tropical Medicine, PO Box 273, Banjul, The Gambia
| | - Sophie E. Moore
- Department of Women and Children's Health, King's College London, 10th Floor North Wing, St. Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK
- Nutrition and Planetary Health Theme, MRC Unit The Gambia @ the London School of Hygiene and Tropical Medicine, PO Box 273, Banjul, The Gambia
| | - Carla Cerami
- Nutrition and Planetary Health Theme, MRC Unit The Gambia @ the London School of Hygiene and Tropical Medicine, PO Box 273, Banjul, The Gambia
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17
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Goosen C, Proost S, Tito RY, Baumgartner J, Barnabas SL, Cotton MF, Zimmermann MB, Raes J, Blaauw R. The effect of oral iron supplementation on the gut microbiota, gut inflammation, and iron status in iron-depleted South African school-age children with virally suppressed HIV and without HIV. Eur J Nutr 2022; 61:2067-2078. [PMID: 34997267 DOI: 10.1007/s00394-021-02793-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Accepted: 12/20/2021] [Indexed: 02/06/2023]
Abstract
PURPOSE Both HIV and oral iron interventions may alter gut microbiota composition and increase gut inflammation. We determined the effect of oral iron supplementation on gut microbiota composition, gut inflammation, and iron status in iron-depleted South Africa school-aged children living with HIV (HIV+) but virally suppressed on antiretroviral therapy and children without HIV (HIV-ve). METHODS In this before-after intervention study with case-control comparisons, we provided 55 mg elemental iron from ferrous sulphate, once daily for 3 months, to 33 virally suppressed (< 50 HIV RNA copies/mL) HIV+ and 31 HIV-ve children. At baseline and endpoint, we assessed microbial composition of faecal samples (16S rRNA sequencing), and markers of gut inflammation (faecal calprotectin), anaemia (haemoglobin) and iron status (plasma ferritin, soluble transferrin receptor). This study was nested within a larger trial registered at clinicaltrials.gov as NCT03572010. RESULTS HIV+ (11.3y SD ± 1.8, 46% male) and HIV-ve (11.1y SD ± 1.7, 52% male) groups did not significantly differ in age or sex ratio. Following iron supplementation, improvements were observed in haemoglobin (HIV+ : 118 to 124 g/L, P = 0.003; HIV-ve: 120 to 124 g/L, P = 0.003), plasma ferritin (HIV+ : 15 to 34 µg/L, P < 0.001; HIV-ve: 18 to 37 µg/L, P < 0.001), and soluble transferrin receptor (HIV+ : 7.1 to 5.9 mg/L, P < 0.001; HIV-ve: 6.6 to 5.7 mg/L, P < 0.001), with no significant change in the relative abundance of any genera, alpha diversity of the gut microbiota (HIV+ : P = 0.37; HIV-ve: P = 0.77), or faecal calprotectin (HIV+ : P = 0.42; HIV-ve: P = 0.80). CONCLUSION Our findings suggest that oral iron supplementation can significantly improve haemoglobin and iron status without increasing pathogenic gut microbial taxa or gut inflammation in iron-depleted virally suppressed HIV+ and HIV-ve school-age children.
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Affiliation(s)
- Charlene Goosen
- Division of Human Nutrition, Department of Global Health, Stellenbosch University, Cape Town, South Africa.
| | - Sebastian Proost
- Laboratory of Molecular Bacteriology, Department of Microbiology and Immunology, Rega Institute, KU Leuven, Leuven, Belgium
- Center for Microbiology, VIB, Leuven, Belgium
| | - Raul Y Tito
- Laboratory of Molecular Bacteriology, Department of Microbiology and Immunology, Rega Institute, KU Leuven, Leuven, Belgium
- Center for Microbiology, VIB, Leuven, Belgium
| | - Jeannine Baumgartner
- Laboratory of Human Nutrition, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Shaun L Barnabas
- Family Centre for Research With Ubuntu, Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
| | - Mark F Cotton
- Family Centre for Research With Ubuntu, Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
| | - Michael B Zimmermann
- Laboratory of Human Nutrition, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Jeroen Raes
- Laboratory of Molecular Bacteriology, Department of Microbiology and Immunology, Rega Institute, KU Leuven, Leuven, Belgium.
- Center for Microbiology, VIB, Leuven, Belgium.
| | - Renée Blaauw
- Division of Human Nutrition, Department of Global Health, Stellenbosch University, Cape Town, South Africa
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18
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Nogueira-de-Almeida CA, Ued FDV, Del Ciampo LA, Martinez EZ, Ferraz IS, Contini AA, Cruz FCSD, Silva RFB, Nogueira-de-Almeida ME, Lamounier JA. Prevalence of childhood anaemia in Brazil: still a serious health problem: a systematic review and meta-analysis. Public Health Nutr 2021; 24:6450-6465. [PMID: 34212834 PMCID: PMC11148596 DOI: 10.1017/s136898002100286x] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To estimate the prevalence of anaemia in Brazilian children up to 83·9 months old. DESIGN Systematic review and meta-analysis, using databases PubMed, Scopus, SciELO, Lilacs, Google Scholar, Periódicos Capes, Arca, Biblioteca Virtual em Saúde, Microsoft Academic Search and Cochrane Library using search terms: anaemia, prevalence, child and Brazil. PROSPERO Registration number: CRD42020208818. SETTING Cross-sectional, cohort, case-control and intervention studies published between 2007 and 2020 were searched, excluding those who assessed children with an illness or chronic condition. The main outcome was anaemia prevalence. Random effects models based on the inverse variance method were used to estimate pooled prevalence measures. Sensitivity analyses removed studies with high contribution to overall heterogeneity. PARTICIPANTS From 6790 first screened, 134 eligible studies were included, totalling 46 978 children aged zero to 83·9 months analysed, with adequate regions representativeness. RESULTS Pooled prevalence of anaemia was 33 % (95 % CI 30, 35). Sensitivity analyses showed that withdrawal of studies that contributed to high heterogeneity did not influence national average prevalence. CONCLUSIONS Childhood anaemia is still a serious public health problem in Brazil, exposing 33 % of Brazilian children to the anaemia repercussions. The main limitation of the study is the estimation of national prevalence based on local surveys, but a large number of studies were included, with representation in all regions of the country, giving strength to the results. In Brazil, more public policies are needed to promote supplementation, fortification and access to healthy eating to reduce the high level of anaemia among children.
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Affiliation(s)
- Carlos Alberto Nogueira-de-Almeida
- Medical Department, Federal University of São Carlos, Brazil - DMED UFSCAR, Rod. Washington Luiz, km 235, São Carlos, SP13565-905, Brazil
| | - Fábio da Veiga Ued
- Nutrition School, University of São Paulo, Brazil - FMRP-USP, Ribeirao Preto, Brazil
| | | | | | - Ivan Savioli Ferraz
- Nutrition School, University of São Paulo, Brazil - FMRP-USP, Ribeirao Preto, Brazil
| | - Andrea Aparecida Contini
- Medical Department, Federal University of São Carlos, Brazil - DMED UFSCAR, Rod. Washington Luiz, km 235, São Carlos, SP13565-905, Brazil
| | | | | | | | - Joel Alves Lamounier
- Medical School, Federal University of Sao Joao Del Rei, Brazil - DMED UFSJ, Sao Joao Del Rei, Brazil
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19
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Wessells KR, Arnold CD, Stewart CP, Prado EL, Abbeddou S, Adu-Afarwuah S, Arnold BF, Ashorn P, Ashorn U, Becquey E, Brown KH, Byrd KA, Campbell RK, Christian P, Fernald L, Fan YM, Galasso E, Hess SY, Huybregts L, Jorgensen JM, Kiprotich M, Kortekangas E, Lartey A, Le Port A, Leroy JL, Lin A, Maleta K, Matias SL, Mbuya M, Mridha MK, Mutasa K, Naser AM, Paul RR, Okronipa H, Ouédraogo JB, Pickering AJ, Rahman M, Schulze K, Smith LE, Weber AM, Zongrone A, Dewey KG. Characteristics that modify the effect of small-quantity lipid-based nutrient supplementation on child anemia and micronutrient status: an individual participant data meta-analysis of randomized controlled trials. Am J Clin Nutr 2021; 114:68S-94S. [PMID: 34590114 PMCID: PMC8560313 DOI: 10.1093/ajcn/nqab276] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 08/04/2021] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Small-quantity lipid-based nutrient supplements (SQ-LNSs) have been shown to reduce the prevalence of child anemia and iron deficiency, but effects on other micronutrients are less well known. Identifying subgroups who benefit most from SQ-LNSs could support improved program design. OBJECTIVES We aimed to identify study-level and individual-level modifiers of the effect of SQ-LNSs on child hemoglobin (Hb), anemia, and inflammation-adjusted micronutrient status outcomes. METHODS We conducted a 2-stage meta-analysis of individual participant data from 13 randomized controlled trials of SQ-LNSs provided to children 6-24 mo of age (n = 15,946). We generated study-specific and subgroup estimates of SQ-LNSs compared with control, and pooled the estimates using fixed-effects models. We used random-effects meta-regression to examine potential study-level effect modifiers. RESULTS SQ-LNS provision decreased the prevalence of anemia (Hb < 110 g/L) by 16% (relative reduction), iron deficiency (plasma ferritin < 12 µg/L) by 56%, and iron deficiency anemia (IDA; Hb < 110 g/L and plasma ferritin <12 µg/L) by 64%. We observed positive effects of SQ-LNSs on hematological and iron status outcomes within all subgroups of the study- and individual-level effect modifiers, but effects were larger in certain subgroups. For example, effects of SQ-LNSs on anemia and iron status were greater in trials that provided SQ-LNSs for >12 mo and provided 9 (as opposed to <9) mg Fe/d, and among later-born (than among first-born) children. There was no effect of SQ-LNSs on plasma zinc or retinol, but there was a 7% increase in plasma retinol-binding protein (RBP) and a 56% reduction in vitamin A deficiency (RBP < 0.70 µmol/L), with little evidence of effect modification by individual-level characteristics. CONCLUSIONS SQ-LNSs can substantially reduce the prevalence of anemia, iron deficiency, and IDA among children across a range of individual, population, and study design characteristics. Policy-makers and program planners should consider SQ-LNSs within intervention packages to prevent anemia and iron deficiency.This trial was registered at www.crd.york.ac.uk/PROSPERO as CRD42020156663.
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Affiliation(s)
| | - Charles D Arnold
- Institute for Global Nutrition and Department of Nutrition, University of California, Davis, Davis, CA, USA
| | - Christine P Stewart
- Institute for Global Nutrition and Department of Nutrition, University of California, Davis, Davis, CA, USA
| | - Elizabeth L Prado
- Institute for Global Nutrition and Department of Nutrition, University of California, Davis, Davis, CA, USA
| | - Souheila Abbeddou
- Public Health Nutrition, Department of Public Health and Primary Care, University of Ghent, Ghent, Belgium
| | - Seth Adu-Afarwuah
- Department of Nutrition and Food Science, University of Ghana, Legon, Accra, Ghana
| | - Benjamin F Arnold
- Francis I Proctor Foundation, University of California, San Francisco, San Francisco, CA, USA
| | - Per Ashorn
- Center for Child Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland,Department of Paediatrics, Tampere University Hospital, Tampere, Finland
| | - Ulla Ashorn
- Center for Child Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Elodie Becquey
- Poverty, Health, and Nutrition Division, International Food Policy Research Institute, Washington, DC, USA
| | - Kenneth H Brown
- Institute for Global Nutrition and Department of Nutrition, University of California, Davis, Davis, CA, USA,Helen Keller International, New York, NY, USA
| | | | - Rebecca K Campbell
- Division of Epidemiology and Biostatistics, University of Illinois at Chicago School of Public Health, Chicago, IL, USA
| | - Parul Christian
- Program in Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Lia C H Fernald
- School of Public Health, University of California, Berkeley, Berkeley, CA, USA
| | - Yue-Mei Fan
- Center for Child Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | | | - Sonja Y Hess
- Institute for Global Nutrition and Department of Nutrition, University of California, Davis, Davis, CA, USA
| | - Lieven Huybregts
- Poverty, Health, and Nutrition Division, International Food Policy Research Institute, Washington, DC, USA
| | - Josh M Jorgensen
- Nutrition Program, College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, USA
| | | | - Emma Kortekangas
- Center for Child Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Anna Lartey
- Department of Nutrition and Food Science, University of Ghana, Legon, Accra, Ghana
| | | | - Jef L Leroy
- Poverty, Health, and Nutrition Division, International Food Policy Research Institute, Washington, DC, USA
| | - Audrie Lin
- School of Public Health, University of California, Berkeley, Berkeley, CA, USA
| | - Kenneth Maleta
- Department of Public Health, School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Susana L Matias
- Department of Nutritional Sciences and Toxicology, University of California, Berkeley, Berkeley, CA, USA
| | - Mduduzi N N Mbuya
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe,Global Alliance for Improved Nutrition, Washington, DC, USA
| | - Malay K Mridha
- Center for Non-communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, Dhaka, Bangladesh
| | - Kuda Mutasa
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Abu M Naser
- International Center for Diarrheal Diseases Research (icddr,b), Dhaka, Bangladesh,Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Rina R Paul
- Center for Non-communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, Dhaka, Bangladesh
| | - Harriet Okronipa
- Department of Population Medicine and Diagnostic Sciences, Cornell University, Ithaca, NY, USA
| | | | | | - Mahbubur Rahman
- International Center for Diarrheal Diseases Research (icddr,b), Dhaka, Bangladesh
| | - Kerry Schulze
- Program in Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Laura E Smith
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, The State University of New York at Buffalo, Buffalo, NY, USA
| | - Ann M Weber
- Division of Epidemiology, School of Community Health Sciences, University of Nevada, Reno, Reno, NV, USA
| | | | - Kathryn G Dewey
- Institute for Global Nutrition and Department of Nutrition, University of California, Davis, Davis, CA, USA
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20
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McGuire MK, McGuire MA. Microbiomes and Childhood Malnutrition: What Is the Evidence? ANNALS OF NUTRITION & METABOLISM 2021; 77:1-13. [PMID: 34515050 DOI: 10.1159/000519001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 08/11/2021] [Indexed: 11/19/2022]
Abstract
Both undernutrition and overnutrition continue to represent enduring global health crises, and with the growing implications of both forms of malnutrition occurring simultaneously in individuals and populations (referred to as the double burden of malnutrition), understanding their biological and environmental causes is a primary research and humanitarian necessity. There is growing evidence of a bidirectional association between variation in the gastrointestinal (GI) microbiome and risk of/resilience to malnutrition during early life. For example, studies of siblings who discordantly do or do not develop severe malnutrition show clear differences in the diversity and composition of fecal microbiomes. These differences are transiently lessened during refeeding but re-emerge thereafter. These findings have been somewhat recapitulated using animal models, but small sample sizes and limited range complicate interpretation of results and applicability to humans. Mechanisms driving these differences are currently unknown but likely involve a combination of inflammatory pathways (and perhaps antioxidant status of the host) and effects on nutrient availability, requirements, and utilization by both host and microbe. A less robust literature also suggests that variation in GI microbiome is associated with risk for obesity during childhood. The putative impact of GI microbiomes on malnutrition is likely modified by a variety of important variables such as genetics (likely driven, in part, by evolution), environmental pathogen exposure and its timing, dietary factors, and cultural/societal pattern (e.g., use of antibiotics). Given the growing double burden of malnutrition, this topic demands a focused interdisciplinary approach that expands from merely characterizing differences and longitudinal changes in fecal microbes to examining their functionality during early life. Understanding the complex composition of human milk and how its components impact establishment and maintenance of the recipient infant's GI microbiome will also undoubtedly shed important light on this topic.
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Affiliation(s)
- Michelle K McGuire
- Margaret Ritchie School of Family and Consumer Sciences, University of Idaho, Moscow, Idaho, USA
| | - Mark A McGuire
- Department of Animal, Veterinary, and Food Sciences, University of Idaho, Moscow, Idaho, USA
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21
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The critical roles of iron during the journey from fetus to adolescent: Developmental aspects of iron homeostasis. Blood Rev 2021; 50:100866. [PMID: 34284901 DOI: 10.1016/j.blre.2021.100866] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 06/28/2021] [Accepted: 07/01/2021] [Indexed: 12/12/2022]
Abstract
Iron is indispensable for human life. However, it is also potentially toxic, since it catalyzes the formation of harmful oxidative radicals in unbound form and may facilitate pathogen growth. Therefore, iron homeostasis needs to be tightly regulated. Rapid growth and development require large amounts of iron, while (especially young) children are vulnerable to infections with iron-dependent pathogens due to an immature immune system. Moreover, unbalanced iron status early in life may have effects on the nervous system, immune system and gut microbiota that persist into adulthood. In this narrative review, we assess the critical roles of iron for growth and development and elaborate how the body adapts to physiologically high iron demands during the journey from fetus to adolescent. As a first step towards the development of clinical guidelines for the management of iron disorders in children, we summarize the unmet needs regarding the developmental aspects of iron homeostasis.
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22
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Hill DL, Carr EJ, Rutishauser T, Moncunill G, Campo JJ, Innocentin S, Mpina M, Nhabomba A, Tumbo A, Jairoce C, Moll HA, van Zelm MC, Dobaño C, Daubenberger C, Linterman MA. Immune system development varies according to age, location, and anemia in African children. Sci Transl Med 2021; 12:12/529/eaaw9522. [PMID: 32024802 DOI: 10.1126/scitranslmed.aaw9522] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 07/19/2019] [Accepted: 01/13/2020] [Indexed: 12/14/2022]
Abstract
Children from low- and middle-income countries, where there is a high incidence of infectious disease, have the greatest need for the protection afforded by vaccination, but vaccines often show reduced efficacy in these populations. An improved understanding of how age, infection, nutrition, and genetics influence immune ontogeny and function is key to informing vaccine design for this at-risk population. We sought to identify factors that shape immune development in children under 5 years of age from Tanzania and Mozambique by detailed immunophenotyping of longitudinal blood samples collected during the RTS,S malaria vaccine phase 3 trial. In these cohorts, the composition of the immune system is dynamically transformed during the first years of life, and this was further influenced by geographical location, with some immune cell types showing an altered rate of development in Tanzanian children compared to Dutch children enrolled in the Generation R population-based cohort study. High-titer antibody responses to the RTS,S/AS01E vaccine were associated with an activated immune profile at the time of vaccination, including an increased frequency of antibody-secreting plasmablasts and follicular helper T cells. Anemic children had lower frequencies of recent thymic emigrant T cells, isotype-switched memory B cells, and plasmablasts; modulating iron bioavailability in vitro could recapitulate the B cell defects observed in anemic children. Our findings demonstrate that the composition of the immune system in children varies according to age, geographical location, and anemia status.
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Affiliation(s)
- Danika L Hill
- Lymphocyte Signalling and Development, Babraham Institute, Cambridge CB22 3AT, UK. .,Department of Immunology and Pathology, Central Clinical School, Monash University and Alfred Hospital, Melbourne, Victoria 3004, Australia
| | - Edward J Carr
- Lymphocyte Signalling and Development, Babraham Institute, Cambridge CB22 3AT, UK.,Department of Medicine, University of Cambridge, Cambridge CB2 0QQ, UK
| | - Tobias Rutishauser
- Swiss Tropical and Public Health Institute, Basel 4051, Switzerland.,University of Basel, Basel 4001, Switzerland
| | - Gemma Moncunill
- ISGlobal, Barcelona Centre for International Health Research, Hospital Clínic-Universitat de Barcelona, Catalonia 08036, Spain
| | - Joseph J Campo
- ISGlobal, Barcelona Centre for International Health Research, Hospital Clínic-Universitat de Barcelona, Catalonia 08036, Spain
| | - Silvia Innocentin
- Lymphocyte Signalling and Development, Babraham Institute, Cambridge CB22 3AT, UK
| | - Maxmillian Mpina
- Swiss Tropical and Public Health Institute, Basel 4051, Switzerland.,University of Basel, Basel 4001, Switzerland.,Ifakara Health Institute, Bagamoyo, Tanzania
| | - Augusto Nhabomba
- Centro de Investigação em Saúde de Manhiça, Maputo, CP 1929, Mozambique
| | - Anneth Tumbo
- Swiss Tropical and Public Health Institute, Basel 4051, Switzerland.,University of Basel, Basel 4001, Switzerland.,Ifakara Health Institute, Bagamoyo, Tanzania
| | - Chenjerai Jairoce
- Centro de Investigação em Saúde de Manhiça, Maputo, CP 1929, Mozambique
| | - Henriëtte A Moll
- Department of Pediatrics, Sophia Children's Hospital, Erasmus MC, University Medical Center, Rotterdam 3015 GD, Netherlands
| | - Menno C van Zelm
- Department of Immunology and Pathology, Central Clinical School, Monash University and Alfred Hospital, Melbourne, Victoria 3004, Australia
| | - Carlota Dobaño
- ISGlobal, Barcelona Centre for International Health Research, Hospital Clínic-Universitat de Barcelona, Catalonia 08036, Spain.,Centro de Investigação em Saúde de Manhiça, Maputo, CP 1929, Mozambique
| | - Claudia Daubenberger
- Swiss Tropical and Public Health Institute, Basel 4051, Switzerland. .,University of Basel, Basel 4001, Switzerland
| | - Michelle A Linterman
- Lymphocyte Signalling and Development, Babraham Institute, Cambridge CB22 3AT, UK.
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23
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Ribeiro M, Fonseca L, Anjos JS, Capo-Chichi JCC, Borges NA, Burrowes J, Mafra D. Oral iron supplementation in patients with chronic kidney disease: Can it be harmful to the gut microbiota? Nutr Clin Pract 2021; 37:81-93. [PMID: 33979013 DOI: 10.1002/ncp.10662] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Patients with chronic kidney disease (CKD) have several pathophysiological alterations, including anemia, one of the first changes in CKD patients. More recently, researchers have observed that the intestinal microbiota alterations are also another complication in these patients. The most common treatment for anemia is oral (mainly ferrous sulfate) or intravenous iron supplementation. Despite being a necessary treatment, recent studies have reported that supplementation with oral iron may increase its availability in the intestine, leading to disturbance in the gut microbiota and also to oxidative stress in the enterocytes, which may change the permeability and the microbiota profile. Although it is a therapy routinely used in patients with CKD, supplementation with oral iron on the gut microbiota has been rarely studied in these patients. Thus, this review will discuss the relationship between iron and the gut microbiota and the possible effects of oral iron supplementation on gut microbiota in patients with CKD.
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Affiliation(s)
- Marcia Ribeiro
- Graduate Program in Nutrition Sciences, Fluminense Federal University (UFF), Niterói, Rio de Janeiro, Brazil.,Unidade de Pesquisa Clinica (UPC)-University Hospital Antonio Pedro, Niterói, Rio de Janeiro, Brazil
| | - Larissa Fonseca
- Unidade de Pesquisa Clinica (UPC)-University Hospital Antonio Pedro, Niterói, Rio de Janeiro, Brazil.,Graduate Program in Medical Sciences, Fluminense Federal University (UFF), Niterói, Rio de Janeiro, Brazil
| | - Juliana S Anjos
- Unidade de Pesquisa Clinica (UPC)-University Hospital Antonio Pedro, Niterói, Rio de Janeiro, Brazil.,Graduate Program in Cardiovascular Sciences, Fluminense Federal University (UFF), Niterói, Rio de Janeiro, Brazil
| | - Jean C C Capo-Chichi
- Graduate Program in Medical Sciences, Fluminense Federal University (UFF), Niterói, Rio de Janeiro, Brazil
| | - Natália A Borges
- Institute of Nutrition, Rio de Janeiro State University (UERJ), Rio de Janeiro, RJ, Brazil
| | | | - Denise Mafra
- Graduate Program in Nutrition Sciences, Fluminense Federal University (UFF), Niterói, Rio de Janeiro, Brazil.,Unidade de Pesquisa Clinica (UPC)-University Hospital Antonio Pedro, Niterói, Rio de Janeiro, Brazil.,Graduate Program in Cardiovascular Sciences, Fluminense Federal University (UFF), Niterói, Rio de Janeiro, Brazil.,Graduate Program in Medical Sciences, Fluminense Federal University (UFF), Niterói, Rio de Janeiro, Brazil
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24
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Goosen C, Baumgartner J, Mikulic N, Barnabas SL, Cotton MF, Zimmermann MB, Blaauw R. Examining Associations of HIV and Iron Status with Nutritional and Inflammatory Status, Anemia, and Dietary Intake in South African Schoolchildren. Nutrients 2021; 13:nu13030962. [PMID: 33809705 PMCID: PMC8002246 DOI: 10.3390/nu13030962] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 03/12/2021] [Accepted: 03/13/2021] [Indexed: 12/29/2022] Open
Abstract
The etiology of multifactorial morbidities such as undernutrition and anemia in children living with the human immunodeficiency virus (HIV) (HIV+) on antiretroviral therapy (ART) is poorly understood. Our objective was to examine associations of HIV and iron status with nutritional and inflammatory status, anemia, and dietary intake in school-aged South African children. Using a two-way factorial case-control design, we compared four groups of 8 to 13-year-old South African schoolchildren: (1) HIV+ and low iron stores (inflammation-unadjusted serum ferritin ≤ 40 µg/L), n = 43; (2) HIV+ and iron sufficient non-anemic (inflammation-unadjusted serum ferritin > 40 µg/L, hemoglobin ≥ 115 g/L), n = 41; (3) children without HIV (HIV-ve) and low iron stores, n = 45; and (4) HIV-ve and iron sufficient non-anemic, n = 45. We assessed height, weight, plasma ferritin (PF), soluble transferrin receptor (sTfR), plasma retinol-binding protein, plasma zinc, C-reactive protein (CRP), α-1-acid glycoprotein (AGP), hemoglobin, mean corpuscular volume, and selected nutrient intakes. Both HIV and low iron stores were associated with lower height-for-age Z-scores (HAZ, p < 0.001 and p = 0.02, respectively), while both HIV and sufficient iron stores were associated with significantly higher CRP and AGP concentrations. HIV+ children with low iron stores had significantly lower HAZ, significantly higher sTfR concentrations, and significantly higher prevalence of subclinical inflammation (CRP 0.05 to 4.99 mg/L) (54%) than both HIV-ve groups. HIV was associated with 2.5-fold higher odds of iron deficient erythropoiesis (sTfR > 8.3 mg/L) (95% CI: 1.03–5.8, p = 0.04), 2.7-fold higher odds of subclinical inflammation (95% CI: 1.4–5.3, p = 0.004), and 12-fold higher odds of macrocytosis (95% CI: 6–27, p < 0.001). Compared to HIV-ve counterparts, HIV+ children reported significantly lower daily intake of animal protein, muscle protein, heme iron, calcium, riboflavin, and vitamin B12, and significantly higher proportions of HIV+ children did not meet vitamin A and fiber requirements. Compared to iron sufficient non-anemic counterparts, children with low iron stores reported significantly higher daily intake of plant protein, lower daily intake of vitamin A, and lower proportions of inadequate fiber intake. Along with best treatment practices for HIV, optimizing dietary intake in HIV+ children could improve nutritional status and anemia in this vulnerable population. This study was registered at clinicaltrials.gov as NCT03572010.
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Affiliation(s)
- Charlene Goosen
- Division of Human Nutrition, Department of Global Health, Stellenbosch University, Cape Town 7505, South Africa;
- Correspondence:
| | - Jeannine Baumgartner
- Laboratory of Human Nutrition, Institute of Food, Nutrition and Health, Department of Health Sciences and Technology, ETH Zurich, 8092 Zurich, Switzerland; (J.B.); (N.M.); (M.B.Z.)
| | - Nadja Mikulic
- Laboratory of Human Nutrition, Institute of Food, Nutrition and Health, Department of Health Sciences and Technology, ETH Zurich, 8092 Zurich, Switzerland; (J.B.); (N.M.); (M.B.Z.)
| | - Shaun L. Barnabas
- Family Centre for Research with Ubuntu, Department of Pediatrics and Child Health, Stellenbosch University, Cape Town 7505, South Africa; (S.L.B.); (M.F.C.)
| | - Mark F. Cotton
- Family Centre for Research with Ubuntu, Department of Pediatrics and Child Health, Stellenbosch University, Cape Town 7505, South Africa; (S.L.B.); (M.F.C.)
| | - Michael B. Zimmermann
- Laboratory of Human Nutrition, Institute of Food, Nutrition and Health, Department of Health Sciences and Technology, ETH Zurich, 8092 Zurich, Switzerland; (J.B.); (N.M.); (M.B.Z.)
| | - Renée Blaauw
- Division of Human Nutrition, Department of Global Health, Stellenbosch University, Cape Town 7505, South Africa;
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Vlasova RM, Wang Q, Willette A, Styner MA, Lubach GR, Kling PJ, Georgieff MK, Rao RB, Coe CL. Infantile Iron Deficiency Affects Brain Development in Monkeys Even After Treatment of Anemia. Front Hum Neurosci 2021; 15:624107. [PMID: 33716694 PMCID: PMC7947927 DOI: 10.3389/fnhum.2021.624107] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 01/25/2021] [Indexed: 12/26/2022] Open
Abstract
A high percent of oxidative energy metabolism is needed to support brain growth during infancy. Unhealthy diets and limited nutrition, as well as other environmental insults, can compromise these essential developmental processes. In particular, iron deficiency anemia (IDA) has been found to undermine both normal brain growth and neurobehavioral development. Even moderate ID may affect neural maturation because when iron is limited, it is prioritized first to red blood cells over the brain. A primate model was used to investigate the neural effects of a transient ID and if deficits would persist after iron treatment. The large size and postnatal growth of the monkey brain makes the findings relevant to the metabolic and iron needs of human infants, and initiating treatment upon diagnosis of anemia reflects clinical practice. Specifically, this analysis determined whether brain maturation would still be compromised at 1 year of age if an anemic infant was treated promptly once diagnosed. The hematology and iron status of 41 infant rhesus monkeys was screened at 2-month intervals. Fifteen became ID; 12 met clinical criteria for anemia and were administered iron dextran and B vitamins for 1-2 months. MRI scans were acquired at 1 year. The volumetric and diffusion tensor imaging (DTI) measures from the ID infants were compared with monkeys who remained continuously iron sufficient (IS). A prior history of ID was associated with smaller total brain volumes, driven primarily by significantly less total gray matter (GM) and smaller GM volumes in several cortical regions. At the macrostructual level, the effect on white matter volumes (WM) was not as overt. However, DTI analyses of WM microstructure indicated two later-maturating anterior tracts were negatively affected. The findings reaffirm the importance of iron for normal brain development. Given that brain differences were still evident even after iron treatment and following recovery of iron-dependent hematological indices, the results highlight the importance of early detection and preemptive supplementation to limit the neural consequences of ID.
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Affiliation(s)
- Roza M. Vlasova
- Department of Psychiatry, The University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Qian Wang
- Department of Food Science and Human Nutrition, Iowa State University, Ames, IA, United States
| | - Auriel Willette
- Department of Food Science and Human Nutrition, Iowa State University, Ames, IA, United States
| | - Martin A. Styner
- Department of Psychiatry, The University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Gabriele R. Lubach
- Harlow Center for Biological Psychology, University of Wisconsin-Madison, Madison, WI, United States
| | - Pamela J. Kling
- Department of Pediatrics, University of Wisconsin-Madison, Madison, WI, United States
| | - Michael K. Georgieff
- Department of Pediatrics, University of Minnesota, Minneapolis, MN, United States
| | - Raghavendra B. Rao
- Department of Pediatrics, University of Minnesota, Minneapolis, MN, United States
| | - Christopher L. Coe
- Harlow Center for Biological Psychology, University of Wisconsin-Madison, Madison, WI, United States
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Tchum SK, Arthur FK, Adu B, Sakyi SA, Abubakar LA, Atibilla D, Amenga-Etego S, Oppong FB, Dzabeng F, Amoani B, Gyan T, Arhin E, Poku-Asante K. Impact of iron fortification on anaemia and iron deficiency among pre-school children living in Rural Ghana. PLoS One 2021; 16:e0246362. [PMID: 33571267 PMCID: PMC7877575 DOI: 10.1371/journal.pone.0246362] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Accepted: 01/18/2021] [Indexed: 02/06/2023] Open
Abstract
Anaemia in young sub-Saharan African children may be due to the double burden of malaria and iron deficiency. Primary analysis of a double-blind, cluster randomized trial of iron containing micronutrient powder supplementation in Ghanaian children aged 6 to 35 months found no difference in malaria risk between intervention and placebo groups. Here, we performed a secondary analysis of the trial data to assess the impact of long-term prophylactic iron fortificant on the risk of iron deficiency and anaemia in trial subjects. This population-based randomized-cluster trial involved 1958 children aged between 6 to 35 months, identified at home and able to eat semi-solid foods. The intervention group (n = 967) received a daily dose containing 12.5 mg elemental iron (as ferrous fumarate), vitamin A (400 μg), ascorbic acid (30 mg) and zinc (5 mg). The placebo group (n = 991) received a similar micronutrient powder but without iron. Micronutrient powder was provided daily to both groups for 5 months. At baseline and endline, health assessment questionnaires were administered and blood samples collected for analysis. The two groups had similar baseline anthropometry, anaemia, iron status, demographic characteristics, and dietary intakes (p > 0.05). Of the 1904 (97.2%) children who remained at the end of the intervention, the intervention group had significantly higher haemoglobin (p = 0.0001) and serum ferritin (p = 0.0002) levels than the placebo group. Soluble transferrin receptor levels were more saturated among children from the iron group compared to non-iron group (p = 0.012). Anaemia status in the iron group improved compared to the placebo group (p = 0.03). Continued long-term routine use of micronutrient powder containing prophylactic iron reduced anaemia, iron deficiency and iron deficiency anaemia among pre-school children living in rural Ghana's malaria endemic area.
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Affiliation(s)
- Samuel Kofi Tchum
- Department of Biochemistry and Biotechnology, College of Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- Kintampo Health Research Centre, Ghana Health Service, Kintampo-North, Ghana
- * E-mail:
| | - Fareed Kow Arthur
- Department of Biochemistry and Biotechnology, College of Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Bright Adu
- Department of Immunology, College of Health Sciences, Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Accra, Ghana
| | - Samuel Asamoah Sakyi
- Department of Molecular Medicine, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | | | - Dorcas Atibilla
- Kintampo Health Research Centre, Ghana Health Service, Kintampo-North, Ghana
| | - Seeba Amenga-Etego
- Kintampo Health Research Centre, Ghana Health Service, Kintampo-North, Ghana
| | - Felix Boakye Oppong
- Kintampo Health Research Centre, Ghana Health Service, Kintampo-North, Ghana
| | - Francis Dzabeng
- Kintampo Health Research Centre, Ghana Health Service, Kintampo-North, Ghana
| | - Benjamin Amoani
- Department of Biomedical Sciences, School of Allied Health Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Thomas Gyan
- Kintampo Health Research Centre, Ghana Health Service, Kintampo-North, Ghana
| | - Emmanuel Arhin
- Faculty of Earth and Environmental Sciences, Department of Earth Science, C K. Tedam University of Technology and Applied Sciences, Navrongo, Ghana
| | - Kwaku Poku-Asante
- Kintampo Health Research Centre, Ghana Health Service, Kintampo-North, Ghana
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Preston AE, Drakesmith H, Frost JN. Adaptive immunity and vaccination - iron in the spotlight. IMMUNOTHERAPY ADVANCES 2021; 1:ltab007. [PMID: 35919735 PMCID: PMC9327113 DOI: 10.1093/immadv/ltab007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 04/21/2021] [Accepted: 05/12/2021] [Indexed: 01/03/2023] Open
Abstract
Vaccination programmes are critically important to suppress the burden of infectious diseases, saving countless lives globally, as emphasised by the current COVID-19 pandemic. Effective adaptive immune responses are complex processes subject to multiple influences. Recent genetic, pre-clinical, and clinical studies have converged to show that availability of iron is a key factor regulating the development of T and B cell responses to infection and immunisation. Lymphocytes obtain iron from circulating transferrin. The amount of iron bound to transferrin is dependent on dietary iron availability and is decreased during inflammation via upregulation of the iron-regulatory hormone, hepcidin. As iron deficiency and chronic inflammatory states are both globally prevalent health problems, the potential impact of low iron availability on immune responses is significant. We describe the evidence supporting the importance of iron in immunity, highlight important unknowns, and discuss how therapeutic interventions to modulate iron availability might be implementable in the context of vaccination and infectious disease.
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Affiliation(s)
- Alexandra E Preston
- MRC Human Immunology Unit, MRC Weatherall Institute of Molecular Medicine, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - Hal Drakesmith
- MRC Human Immunology Unit, MRC Weatherall Institute of Molecular Medicine, University of Oxford, John Radcliffe Hospital, Oxford, UK
- Haematology Theme, Oxford Biomedical Research Centre, Oxford, UK
| | - Joe N Frost
- MRC Human Immunology Unit, MRC Weatherall Institute of Molecular Medicine, University of Oxford, John Radcliffe Hospital, Oxford, UK
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28
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Nairz M, Weiss G. Iron in infection and immunity. Mol Aspects Med 2020; 75:100864. [PMID: 32461004 DOI: 10.1016/j.mam.2020.100864] [Citation(s) in RCA: 145] [Impact Index Per Article: 36.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Revised: 04/25/2020] [Accepted: 05/05/2020] [Indexed: 12/12/2022]
Abstract
Iron is an essential micronutrient for virtually all living cells. In infectious diseases, both invading pathogens and mammalian cells including those of the immune system require iron to sustain their function, metabolism and proliferation. On the one hand, microbial iron uptake is linked to the virulence of most human pathogens. On the other hand, the sequestration of iron from bacteria and other microorganisms is an efficient strategy of host defense in line with the principles of 'nutritional immunity'. In an acute infection, host-driven iron withdrawal inhibits the growth of pathogens. Chronic immune activation due to persistent infection, autoimmune disease or malignancy however, sequesters iron not only from infectious agents, autoreactive lymphocytes and neoplastic cells but also from erythroid progenitors. This is one of the key mechanisms which collectively result in the anemia of chronic inflammation. In this review, we highlight the most important interconnections between iron metabolism and immunity, focusing on host defense against relevant infections and on the clinical consequences of anemia of inflammation.
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Affiliation(s)
- Manfred Nairz
- Department of Internal Medicine II, Infectious Diseases, Immunology, Rheumatology, Pneumology, Medical University of Innsbruck, Austria
| | - Günter Weiss
- Department of Internal Medicine II, Infectious Diseases, Immunology, Rheumatology, Pneumology, Medical University of Innsbruck, Austria; Christian Doppler Laboratory for Iron Metabolism and Anemia Research, Medical University of Innsbruck, Austria.
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29
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Iron Deficiency Anemia in Children Residing in High and Low-Income Countries: Risk Factors, Prevention, Diagnosis and Therapy. Mediterr J Hematol Infect Dis 2020; 12:e2020041. [PMID: 32670519 PMCID: PMC7340216 DOI: 10.4084/mjhid.2020.041] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 06/12/2020] [Indexed: 12/22/2022] Open
Abstract
Iron deficiency and iron-deficiency anemia (IDA) affects approximately two billion people worldwide, and most of them reside in low- and middle-income countries. In these nations, additional causes of anemia include parasitic infections like malaria, other nutritional deficiencies, chronic diseases, hemoglobinopathies, and lead poisoning. Maternal anemia in resource-poor nations is associated with low birth weight, increased perinatal mortality, and decreased work productivity. Maintaining a normal iron balance in these settings is challenging, as iron-rich foods with good bioavailability are of animal origin and either expensive and/or available in short supply. Apart from infrequent consumption of meat, inadequate vitamin C intake, and diets rich in inhibitors of iron absorption are additional important risk factors for IDA in low-income countries. In-home iron fortification of complementary foods with micronutrient powders has been shown to effectively reduce the risk of iron deficiency and IDA in infants and young children in developing countries but is associated with unfavorable changes in gut flora and induction of intestinal inflammation that may lead to diarrhea and hospitalization. In developed countries, iron deficiency is the only frequent micronutrient deficiency. In the industrialized world, IDA is more common in infants beyond the sixth month of life, in adolescent females with heavy menstrual bleeding, in women of childbearing age and older people. Other special at-risk populations for IDA in developed countries are regular blood donors, endurance athletes, and vegetarians. Several medicinal ferrous or ferric oral iron products exist, and their use is not associated with harmful effects on the overall incidence of infectious illnesses in sideropenic and/or anemic subjects. However, further research is needed to clarify the risks and benefits of supplemental iron for children exposed to parasitic infections in low-income countries, and for children genetically predisposed to iron overload.
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30
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Iron as Therapeutic Target in Human Diseases. Pharmaceuticals (Basel) 2019; 12:ph12040178. [PMID: 31817314 PMCID: PMC6958491 DOI: 10.3390/ph12040178] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 11/28/2019] [Indexed: 12/14/2022] Open
Abstract
Iron is essential for almost all organisms, being involved in oxygen transport, DNA synthesis, and respiration; however, it is also potentially toxic via the formation of free radicals [...].
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31
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Ferreira A, Neves P, Gozzelino R. Multilevel Impacts of Iron in the Brain: The Cross Talk between Neurophysiological Mechanisms, Cognition, and Social Behavior. Pharmaceuticals (Basel) 2019; 12:ph12030126. [PMID: 31470556 PMCID: PMC6789770 DOI: 10.3390/ph12030126] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 08/26/2019] [Accepted: 08/27/2019] [Indexed: 12/12/2022] Open
Abstract
Iron is a critical element for most organisms, which plays a fundamental role in the great majority of physiological processes. So much so, that disruption of iron homeostasis has severe multi-organ impacts with the brain being particularly sensitive to such modifications. More specifically, disruption of iron homeostasis in the brain can affect neurophysiological mechanisms, cognition, and social behavior, which eventually contributes to the development of a diverse set of neuro-pathologies. This article starts by exploring the mechanisms of iron action in the brain and follows with a discussion on cognitive and behavioral implications of iron deficiency and overload and how these are framed by the social context. Subsequently, we scrutinize the implications of the disruption of iron homeostasis for the onset and progression of psychosocial disorders. Lastly, we discuss the links between biological, psychological, and social dimensions and outline potential avenues of research. The study of these interactions could ultimately contribute to a broader understanding of how individuals think and act under physiological and pathophysiological conditions.
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Affiliation(s)
- Ana Ferreira
- Centro Interdisciplinar de Ciências Sociais (CICS.NOVA), Faculdade de Ciências Sociais e Humanas da Universidade NOVA de Lisboa (NOVA FCSH), 1069-061 Lisbon, Portugal
| | - Pedro Neves
- School of Business and Economics, NOVA University of Lisbon, 2775-405 Lisbon, Portugal
| | - Raffaella Gozzelino
- Chronic Diseases Research Center (CEDOC)/NOVA Medical School, Universidade NOVA de Lisboa, 1180-052, 1150-082 Lisbon, Portugal.
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